Comparison of efficacy of revascularization and drug therapy including trimetazidine for achievement of recovery of hibernating myocardium

Aim. To compare efficacy of combined drug therapy including trimetazidine w ith that of myocardial revascularization for restoration of function of hib ernating myocardium in patients with ischemic heart disease. Material and m ethods. Dobutamine stress echocardiography was used for identification of h ibernating myocardium in 65 patients with left ventricular dysfunction due to angiographically proven multivessel coronary artery disease. Thirty pati ents received standard antianginal therapy followed by combination of stand ard drugs with trimetazidine (60 mg/day) (group 1), 33 patients were subjec ted to revascularization procedure (group 2). Results. At baseline investig ation hibernating myocardium was detected in 79.6 and 85.2% of initially as ynergic segments, index of segmental wall motion abnormalities was equal to 1.74+/-0.06 and 1.82+/-0.05 in groups 1 and 2, respectively. In group 1 st andard therapy was associated with recovery of 12.5% of previously hibernat ing segments and insignificant lowering of wall motion abnormalities index to 1.67+/-0.06. Addition of trimetazidine resulted in recovery of 66.3% hib ernating segments and lowering of the wall motion abnormalities index down to 1.37+/-0.06 (p<0.001). After myocardial revascularization recovery of co ntractile function occurred in 88.2% of hibernating segments and index of w all motion abnormalities decreased to 1.23+/-0.05 (p<0.001). Conclusion. Co mbination therapy with standard antianginal drugs and trimetazidine allowed to restore contractility of the hibernating myocardium. Efficacy of combin ation drug therapy was comparable with that of myocardial revascularization .