EFFECTS OF TRIMETAZIDINE ON HEART-RATE-VARIABILITY AND LEFT-VENTRICULAR SYSTOLIC PERFORMANCE IN PATIENTS WITH CORONARY-ARTERY DISEASE AFTERPERCUTANEOUS TRANSLUMINAL ANGIOPLASTY

Fifty-one patients (mean age 51.6 +/- 7.1 years) with angiographically proven coronary artery disease (CAD) entered the study. In 26 patient s (Group I), trimetazidine treatment started twenty-four hours after p ercutaneous transluminal coronary angioplasty (PTCA). Another 25 patie nts (Group II) without trimetazidine treatment were kept as controls. The groups were comparable by age, gender, risk factors of CAD, corona ry anatomy, left ventricular performance, and heart rate variability i ndices at baseline state. Power spectral analysis of heart rate variab ility and two-dimensional and Doppler echocardiographic examinations w ere performed before PTCA, and twenty-four hours, ten days, thirty day s, and three months after PTCA. A statistically significant improvemen t of left ventricular systolic performance (P<0.001), augmentation of the parasympathetic band of heart rate variability (P<0.001), and decl ine of P1/P2 ratio (P<0.01) were evident in patients treated with trim etazidine, while no apparent changes were observed in controls. The in tergroup analysis also showed marked difference between groups as reco rded on the day 30 and month 3 of observation (P<0.001). During follow -up period recurrences of angina pectoris and ischemia were registered in Group II, while no evidence of ischemia was discerned in Group I p atients. In conclusion, trimetazidine modulates the autonomic control of heart rate, ie, reduces sympathetic overactivity and augments vagal influences, improves left ventricular contractility, and diminishes t he clinical manifestations of ischemia in patients with CAD after PTCA .