THE EFFECTIVENESS OF TRIMETAZIDINE THERAPY FOR CHRONIC HEART FAILURE INDUCED BY ANTHRACYCLINE

Highlights

• Chronic heart failure is a serious complication in the treatment of tumor diseases due to the cardiotoxic effect of anticancer drugs, especially anthracyclines. The addition of trimetazidine to combination therapy of left ventricular dysfunction induced by anthracyclines, carvedilol and enalapril increases the effectiveness of secondary prevention of chronic heart failure.

Absract

Aim. To study the effectiveness of trimetazidine as part of treatment regimens for chronic heart failure (CHF) induced by cardiotoxicity of chemotherapy.

Methods. The study included 114 women (48,0 [46,0; 52,0] years) with CHF that developed 12 months after the end of chemotherapy for breast cancer using anthracycline drugs. All patients received therapy with carvedilol and enalapril. Control points for assessing the effectiveness of therapy are 12 and 24 months of observation. Criteria for an unfavorable course of CHF: an increase in the functional class of CHF by 1 or more during the observation period; hospitalization for HF 1 or more times during the observation period; progressive deterioration of structural and functional changes of the left ventricle during the study period.

Results. After 12 months of treatment for CHF with combination therapy of carvedilol and enalapril, trimetazidine was added to therapy in 47 patients. After 12 months of treatment with trimetazidine, the dynamics of the course of CHF were assessed. Before the appointment of trimetazidine during treatment with a combination of carvedilol and enalapril, patients experienced progression of structural and functional changes in the myocardium (decrease in left ventricular ejection fraction, increase in the size of the left atrium, end-systolic and end-diastolic size of the left ventricle), progression of CHF according to the 6-minute walk. After adding trimetazidine to the previous treatment, after 12 months of combination therapy, a significant increase in left ventricular ejection fraction (p = 0,004), a decrease in the size of the left atrium (p = 0,001), end-systolic (p = 0,045) and end-diastolic (p = 0,022) left ventricular dimensions. Also, during the therapy, the level of the N-terminal pro-B-type brain natriuretic peptide significantly decreased (p = 0,005), and the distance during the 6-minute walk test increased (p = 0,009): from 387 (335; 445) meters from 387 (335; 445) meters to 432 (408; 476) meters.

Conclusions. In cases of ineffective treatment of CHF induced by cardiotoxicity of chemotherapy, carvedilol and enalapril, the addition of trimetazidine to treatment is associated with a significant regression of clinical (6-minute walk test), laboratory (N-terminal pro-B-type brain natriuretic peptide) and echocardiographic signs of heart failure.

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