Impact of Trimetazidine on Echocardiographic Indices and Clinical Outcomes in Ischemic Cardiomyopathy: An Updated Meta-Analysis of Clinical Trials.

Abstract

Ischemic cardiomyopathy (ICM) is a major cause of chronic heart failure with impaired left ventricular (LV) function. Trimetazidine, a metabolic modulator that shifts energy utilization from fatty acid oxidation to glucose oxidation, may improve cardiac function in ischemic myocardium. This meta-analysis aimed to evaluate trimetazidine's effect in patients with ICM compared to standard therapy alone. A systematic search was conducted across PubMed, ProQuest, SAGE, EBSCO Host, Wiley, Science Direct, and SpringerLink databases until November 2024. Clinical trials assessing trimetazidine versus standard therapy in ICM were included. Data were analyzed using a random-effects model to calculate mean differences (MD) and relative risk (RR), with heterogeneity evaluated using the I2 statistic. Ten studies met the inclusion criteria. Trimetazidine significantly improved left ventricular ejection fraction (MD 6.35%, 95% CI: 4.63-8.07; p<0.05), reduced LV end-systolic diameter (MD -4.51 mm, p<0.05), LV end-diastolic diameter (MD -3.13 mm, p<0.05), and LV end-systolic volume (MD -14.20 ml, p<0.05). Exercise capacity improved markedly with a mean increase of 83.64 meters in the 6-minute walking test (p<0.05). NYHA class also improved (MD -0.80, p<0.05). However, no significant differences were found in anginal episodes or nitrate consumption. Trimetazidine as an adjunct to standard therapy improves cardiac function and exercise capacity in ischemic cardiomyopathy patients. It may be considered in patients with persistent symptoms or exercise intolerance despite optimal medical therapy. Further large-scale trials are warranted to assess long-term outcomes such as mortality and hospitalization.