Effect of trimetazidine on heart rate variability in elderly patients with acute coronary syndrome

Comprehensive viewpoints on heart rate variability at high altitude

OBJECTIVES

Hypoxia is a physiological state characterized by reduced oxygen levels in organs and tissues. It is a common clinicopathological process and a major cause of health problems in highland areas.  Heart rate variability (HRV) is a measure of the balance in autonomic innervation to the heart. It provides valuable information on the regulation of the cardiovascular system by neurohumoral factors, and changes in HRV reflect the complex interactions between multiple systems. In this review, we provide a comprehensive overview of the relationship between high-altitude hypoxia and HRV. We summarize the different mechanisms of diseases caused by hypoxia and explore the changes in HRV across various systems. Additionally, we discuss relevant pharmaceutical interventions. Overall, this review aims to provide research ideas and assistance for in-depth studies on HRV. By understanding the intricate relationship between high-altitude hypoxia and HRV, we can gain insights into the underlying mechanisms and potential therapeutic approaches to mitigate the effects of hypoxia on cardiovascular and other systems.

METHODS

The relevant literature was collected systematically from scientific database, including PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Baidu Scholar, as well as other literature sources, such as classic books of hypoxia.

RESULTS

There is a close relationship between heart rate variability and high-altitude hypoxia. Heart rate variability is an indicator that evaluates the impact of hypoxia on the cardiovascular system and other related systems. By improving the observation of HRV, we can estimate the progress of cardiovascular diseases and predict the impact on other systems related to cardiovascular health. At the same time, changes in heart rate variability can be used to observe the efficacy of preventive drugs for altitude related diseases.

CONCLUSIONS

HRV can be used to assess autonomic nervous function under various systemic conditions, and can be used to predict and monitor diseases caused by hypoxia at high altitude. Investigating the correlation between high altitude hypoxia and heart rate variability can help make HRV more rapid, accurate, and effective for the diagnosis of plateau-related diseases.

Effectiveness of Trimetazidine in Patients with Chronic Heart Failure Stratified by the Expression of Soluble Suppression of Tumorigenicity-2 (sST2): A Prospective Cohort Study

INTRODUCTION

Trimetazidine has been reported to have potential benefits in patients with chronic heart failure (CHF). Soluble suppression of tumorigenicity-2 (sST2) was shown to worsen CHF and, hence, has a diagnostic value in heart failure. The aim of the present study was to evaluate the effectiveness of trimetazidine in patients expressing high and low levels of sST2 compared with their matched placebo.

METHODS

In this prospective cohort study, 170 patients were enrolled. Patients expressing more than 35 ng/mL sST2 (S+) were split into a trimetazidine group (group A) and placebo group (group B). Likewise, patients expressing 35 ng/mL or less of sST2 (S-) were divided into a trimetazidine (group C) and placebo group (group D). Patients in both the trimetazidine groups were administered 20-mg twice-a-day doses of trimetazidine. Trimetazidine effectiveness was determined in terms of changes in cardiac function, motor function, and mental status at 1, 3, 6, and 12 months from baseline among the four groups.

RESULTS

A total of 158 patients were included for final data analysis (group A, n = 50; group B, n = 57; group C, n = 27; group D, n = 24). On comparing different outcomes between the four groups and across the time points, significant difference was observed between the groups in ejection fraction (EF; P < 0.001), cardiac index (CI; P < 0.001), New York Heart Association score (P < 0.001), 6-min walk test (P < 0.001), Veterans Specific Activity Questionnaire (VSAQ; P < 0.001), Minnesota Living with Heart Failure Questionnaire (MLHFQ; P < 0.001), hospital anxiety and depression scores (P < 0.001), and Copenhagen Burnout Inventory (P < 0.001). Significant difference in systolic blood pressure (P < 0.001), heart rate (P < 0.001), EF (P < 0.001), CI (P < 0.001), VSAQ (P = 0.017), and MLHFQ (P < 0.001) was observed.

CONCLUSION

Trimetazidine demonstrated an overall improvement in cardiac function, motor function, quality of life (QoL), and mental status in both S+ and S- patients. Among patients administered trimetazidine, significant changes in maximum outcomes were observed among those expressing higher levels of sST2 compared with placebo.

Mitochondrial Dysfunction in Atrial Fibrillation-Mechanisms and Pharmacological Interventions

Despite the enormous progress in the treatment of atrial fibrillation, mainly with the use of invasive techniques, many questions remain unanswered regarding the pathomechanism of the arrhythmia and its prevention methods. The development of atrial fibrillation requires functional changes in the myocardium that result from disturbed ionic fluxes and altered electrophysiology of the cardiomyocyte. Electrical instability and electrical remodeling underlying the arrhythmia may result from a cellular energy deficit and oxidative stress, which are caused by mitochondrial dysfunction. The significance of mitochondrial dysfunction in the pathogenesis of atrial fibrillation remains not fully elucidated; however, it is emphasized by the reduction of atrial fibrillation burden after therapeutic interventions improving the mitochondrial welfare. This review summarizes the mechanisms of mitochondrial dysfunction related to atrial fibrillation and current pharmacological treatment options targeting mitochondria to prevent or improve the outcome of atrial fibrillation.

Comparison of efficacy between trimetazidine and cilostazol in the treatment of arteriosclerosis obliterans in lower extremity

This study compared the efficacy and long-term survival rate of trimetazidine and cilostazol in the treatment of lower extremity arteriosclerosis obliterans (ASO). A retrospectively analysis on the medical records of 206 patients with ASO who were admitted to The Central Hospital of Wuhan from January 2011 to May 2013 was performed, including 94 patients treated with trimetazidine (group A) and 112 patients treated with cilostazol (group B). On the basis of the same basic treatment, both groups were applied with these two drugs after two courses of treatments. Then the efficacy of clinical treatment, dorsal artery blood flow, anterior femoral artery, posterior tibial artery blood flow, brachial artery index, toe-brachial index, painless walking distance, maximum walking distance, adverse reactions, 5-year survival rates were compared. The total effective rate of clinical efficacy in group B was higher than group A (P<0.05). After the first course of treatment, the above indicators increased in both groups (P<0.05). After the end of the second course of treatment, the above-mentioned index values in both groups were significantly increased (P<0.05). The improvement of the above indicators in group B were better than the trimetazidine group in both the first and second treatment courses (P<0.05). In group A, there were 15 cases of patients with lethargy and hypodynamia and 9 cases of dizziness and headache. There were significant differences between the 7th and 3rd cases of patients when compared to group B (P<0.05). The 5-year survival rate of group A was lower than group B (P<0.05). The clinical efficacy of cliostazol in the treatment of ASO had a good effect, and there was only a few adverse reactions and the long-term survival rate was high. It is worthy of being promoted in clinical practice.

The Effects of Trimetazidine on QT-interval Prolongation and Cardiac Hypertrophy in Diabetic Rats

Background

Trimetazidine (TMZ) is an anti-ischemic drug. In spite of its protective effects on cardiovascular system, there is no scientific study on the usefulness of TMZ treatment for prolonged QT interval and cardiac hypertrophy induced by diabetes.

Objectives

To evaluate the effects of TMZ on QT interval prolongation and cardiac hypertrophy in the diabetic rats.

Methods

Twenty-four male Sprague-Dawley rats (200-250 g) were randomly assigned into three groups (n = 8) by simple random sampling method. Control (C), diabetic (D), and diabetic administrated with TMZ at 10 mg/kg (T10). TMZ was administrated for 8 weeks. The echocardiogram was recorded before isolating the hearts and transfer to a Langendorff apparatus. Hemodynamic parameters, QT and corrected QT interval (QTc) intervals, heart rate and antioxidant enzymes were measured. The hypertrophy index was calculated. The results were evaluated by one-way ANOVA and paired t-test using SPSS (version 16) and p < 0.05 was regarded as significant.

Results

The diabetic rats significantly indicated increased hypertrophy, QT and QTc intervals and decreased Left ventricular systolic pressure (LVSP), Left ventricular developed pressure (LVDP), rate pressure product (RPP), Max dp/dt, and min dp/dt (±dp/dt max), heart rate, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase in the heart. Treatment with TMZ in the diabetic animals was significantly improved these parameters in comparison to the untreated diabetic group.

Conclusions

TMZ improves QTc interval prolongation and cardiac hypertrophy in diabetes.