Via practica 1/2009

Metabolic treatment with trimetazidine

Besides hemodynamic treatment is metabolic treatment a new trend in improving of conservative management especially in patients with myocardial ischemia. Metabolic therapy is aimed at improving of energy production. Typical agent in metabolic therapy is trimetazidine (TMZ), a selective inhibitor of activity of the key enzyme in beta-oxidation of fatty acids – 3-ketoacylcoenzyme A thiolase (3-KAT). The inhibition of 3-KAT induces change in preference of the energetic substrate with partial inhibition of fatty acids beta-oxidation and increase of glucose oxidation. The shift is connected to the lower consumption of oxygen. The paper deals briefly and from the practical therapeutic view with TMZ treatment of stable angina pectoris, myocardial revascularization, heart failure, in patients with diabetes mellitus, in elderly patients with the emphasis laid on some recently published outcomes in regard to TMZ preventive effect on nephropathy induced by contrast media and to the first mortality therapeutic effects in patient with ischaemic dilatation cardio myopathy with lowered function of the left heart ventricular. TMZ MR (Preductal MR) definitely belongs with its anti-ischaemic, anti-anginous, cardioprotective effects to the therapeutic armamentarium used not only by specialists, but also by general practitioners.

Keywords: metabolic treatment, trimetazidine