Effect of partial fatty acid oxidation inhibition with trimetazidine on mortality and morbidity in heart failure: Results from an international multicentre retrospective cohort study

Gabriele Fragasso, Giuseppe Rosano, Sang Hong Baek, Hamayak Sisakian, Pericle Di Napoli, Luca Alberti, Giliola Calori, seokmin kang, Laura Sahakyan, Armen Sanosyan, Cristiana Vitale, Giuseppe Marazzi, Alberto Margonato, Romualdo Belardinelli

Research output: Contribution to journalArticle

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Abstract

Objectives: The aim of this cohort study was to retrospectively evaluate, in patients with chronic heart failure (CHF), the long term effect of trimetazidine (TMZ) on morbidity and mortality. Background: Previous small studies in patients with CHF have shown that TMZ can improve left ventricular function, exercise capacity and NYHA class compared to placebo. However, no data on the effects of TMZ on survival in patients with CHF have ever been produced. Methods: In this international multicentre retrospective cohort study data from 669 patients were analyzed. 362 patients were on TMZ due to symptom persistence despite up-titration of optimal CHF therapy, while the remaining patients continued conventional CHF therapy alone. Propensity score analysis was performed in order to minimize selection bias between the two groups. Results: Kaplan-Meier analysis for global mortality showed 11.3% improved global survival (p = 0.015) and 8.5% improved survival for cardiovascular (CVD) death (p = 0.050) in the TMZ group. Cox regression analysis for global mortality showed a significant risk reduction for TMZ treated patients with a hazard ratio (HR) = 0.189 (confidence interval - CI 95%: 0.017-0.454; p = 0.0002). TMZ also showed a good risk reduction profile for CVD death causes (HR = 0.072, CI 95%: 0.019-0.268, p = 0.0001). The rate of hospitalization for cardiovascular causes was reduced by 10.4% at 5 years (p < 0.0005) with increased hospitalization-free survival of 7.8 months. Conclusion: TMZ is effective in reducing mortality and event-free survival in patients with CHF. The addition of TMZ on top of optimal medical therapy improves long term survival in CHF patients.

Original languageEnglish
Pages (from-to)320-325
Number of pages6
JournalInternational Journal of Cardiology
Volume163
Issue number3
DOIs
Publication statusPublished - 2013 Mar 10

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Trimetazidine
Cohort Studies
Fatty Acids
Heart Failure
Retrospective Studies
Morbidity
Mortality
Survival
Risk Reduction Behavior
Hospitalization
Inhibition (Psychology)
Propensity Score
Selection Bias
Kaplan-Meier Estimate
Left Ventricular Function
Disease-Free Survival
Cause of Death
Therapeutics
Placebos
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Fragasso, Gabriele ; Rosano, Giuseppe ; Baek, Sang Hong ; Sisakian, Hamayak ; Di Napoli, Pericle ; Alberti, Luca ; Calori, Giliola ; kang, seokmin ; Sahakyan, Laura ; Sanosyan, Armen ; Vitale, Cristiana ; Marazzi, Giuseppe ; Margonato, Alberto ; Belardinelli, Romualdo. / Effect of partial fatty acid oxidation inhibition with trimetazidine on mortality and morbidity in heart failure : Results from an international multicentre retrospective cohort study. In: International Journal of Cardiology. 2013 ; Vol. 163, No. 3. pp. 320-325.
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title = "Effect of partial fatty acid oxidation inhibition with trimetazidine on mortality and morbidity in heart failure: Results from an international multicentre retrospective cohort study",
abstract = "Objectives: The aim of this cohort study was to retrospectively evaluate, in patients with chronic heart failure (CHF), the long term effect of trimetazidine (TMZ) on morbidity and mortality. Background: Previous small studies in patients with CHF have shown that TMZ can improve left ventricular function, exercise capacity and NYHA class compared to placebo. However, no data on the effects of TMZ on survival in patients with CHF have ever been produced. Methods: In this international multicentre retrospective cohort study data from 669 patients were analyzed. 362 patients were on TMZ due to symptom persistence despite up-titration of optimal CHF therapy, while the remaining patients continued conventional CHF therapy alone. Propensity score analysis was performed in order to minimize selection bias between the two groups. Results: Kaplan-Meier analysis for global mortality showed 11.3{\%} improved global survival (p = 0.015) and 8.5{\%} improved survival for cardiovascular (CVD) death (p = 0.050) in the TMZ group. Cox regression analysis for global mortality showed a significant risk reduction for TMZ treated patients with a hazard ratio (HR) = 0.189 (confidence interval - CI 95{\%}: 0.017-0.454; p = 0.0002). TMZ also showed a good risk reduction profile for CVD death causes (HR = 0.072, CI 95{\%}: 0.019-0.268, p = 0.0001). The rate of hospitalization for cardiovascular causes was reduced by 10.4{\%} at 5 years (p < 0.0005) with increased hospitalization-free survival of 7.8 months. Conclusion: TMZ is effective in reducing mortality and event-free survival in patients with CHF. The addition of TMZ on top of optimal medical therapy improves long term survival in CHF patients.",
author = "Gabriele Fragasso and Giuseppe Rosano and Baek, {Sang Hong} and Hamayak Sisakian and {Di Napoli}, Pericle and Luca Alberti and Giliola Calori and seokmin kang and Laura Sahakyan and Armen Sanosyan and Cristiana Vitale and Giuseppe Marazzi and Alberto Margonato and Romualdo Belardinelli",
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Fragasso, G, Rosano, G, Baek, SH, Sisakian, H, Di Napoli, P, Alberti, L, Calori, G, kang, S, Sahakyan, L, Sanosyan, A, Vitale, C, Marazzi, G, Margonato, A & Belardinelli, R 2013, 'Effect of partial fatty acid oxidation inhibition with trimetazidine on mortality and morbidity in heart failure: Results from an international multicentre retrospective cohort study', International Journal of Cardiology, vol. 163, no. 3, pp. 320-325. https://doi.org/10.1016/j.ijcard.2012.09.123

Effect of partial fatty acid oxidation inhibition with trimetazidine on mortality and morbidity in heart failure : Results from an international multicentre retrospective cohort study. / Fragasso, Gabriele; Rosano, Giuseppe; Baek, Sang Hong; Sisakian, Hamayak; Di Napoli, Pericle; Alberti, Luca; Calori, Giliola; kang, seokmin; Sahakyan, Laura; Sanosyan, Armen; Vitale, Cristiana; Marazzi, Giuseppe; Margonato, Alberto; Belardinelli, Romualdo.

In: International Journal of Cardiology, Vol. 163, No. 3, 10.03.2013, p. 320-325.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of partial fatty acid oxidation inhibition with trimetazidine on mortality and morbidity in heart failure

T2 - Results from an international multicentre retrospective cohort study

AU - Fragasso, Gabriele

AU - Rosano, Giuseppe

AU - Baek, Sang Hong

AU - Sisakian, Hamayak

AU - Di Napoli, Pericle

AU - Alberti, Luca

AU - Calori, Giliola

AU - kang, seokmin

AU - Sahakyan, Laura

AU - Sanosyan, Armen

AU - Vitale, Cristiana

AU - Marazzi, Giuseppe

AU - Margonato, Alberto

AU - Belardinelli, Romualdo

PY - 2013/3/10

Y1 - 2013/3/10

N2 - Objectives: The aim of this cohort study was to retrospectively evaluate, in patients with chronic heart failure (CHF), the long term effect of trimetazidine (TMZ) on morbidity and mortality. Background: Previous small studies in patients with CHF have shown that TMZ can improve left ventricular function, exercise capacity and NYHA class compared to placebo. However, no data on the effects of TMZ on survival in patients with CHF have ever been produced. Methods: In this international multicentre retrospective cohort study data from 669 patients were analyzed. 362 patients were on TMZ due to symptom persistence despite up-titration of optimal CHF therapy, while the remaining patients continued conventional CHF therapy alone. Propensity score analysis was performed in order to minimize selection bias between the two groups. Results: Kaplan-Meier analysis for global mortality showed 11.3% improved global survival (p = 0.015) and 8.5% improved survival for cardiovascular (CVD) death (p = 0.050) in the TMZ group. Cox regression analysis for global mortality showed a significant risk reduction for TMZ treated patients with a hazard ratio (HR) = 0.189 (confidence interval - CI 95%: 0.017-0.454; p = 0.0002). TMZ also showed a good risk reduction profile for CVD death causes (HR = 0.072, CI 95%: 0.019-0.268, p = 0.0001). The rate of hospitalization for cardiovascular causes was reduced by 10.4% at 5 years (p < 0.0005) with increased hospitalization-free survival of 7.8 months. Conclusion: TMZ is effective in reducing mortality and event-free survival in patients with CHF. The addition of TMZ on top of optimal medical therapy improves long term survival in CHF patients.

AB - Objectives: The aim of this cohort study was to retrospectively evaluate, in patients with chronic heart failure (CHF), the long term effect of trimetazidine (TMZ) on morbidity and mortality. Background: Previous small studies in patients with CHF have shown that TMZ can improve left ventricular function, exercise capacity and NYHA class compared to placebo. However, no data on the effects of TMZ on survival in patients with CHF have ever been produced. Methods: In this international multicentre retrospective cohort study data from 669 patients were analyzed. 362 patients were on TMZ due to symptom persistence despite up-titration of optimal CHF therapy, while the remaining patients continued conventional CHF therapy alone. Propensity score analysis was performed in order to minimize selection bias between the two groups. Results: Kaplan-Meier analysis for global mortality showed 11.3% improved global survival (p = 0.015) and 8.5% improved survival for cardiovascular (CVD) death (p = 0.050) in the TMZ group. Cox regression analysis for global mortality showed a significant risk reduction for TMZ treated patients with a hazard ratio (HR) = 0.189 (confidence interval - CI 95%: 0.017-0.454; p = 0.0002). TMZ also showed a good risk reduction profile for CVD death causes (HR = 0.072, CI 95%: 0.019-0.268, p = 0.0001). The rate of hospitalization for cardiovascular causes was reduced by 10.4% at 5 years (p < 0.0005) with increased hospitalization-free survival of 7.8 months. Conclusion: TMZ is effective in reducing mortality and event-free survival in patients with CHF. The addition of TMZ on top of optimal medical therapy improves long term survival in CHF patients.

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