Objective: Trimetazidine (TZM) has been shown to have anti-ischemia properties by optimizing ischemic myocardium metabolism. We evaluated the effect of TZM on myocardial metabolism with Positron Emission Computed Tomography (PET-CT) in patients with ischemic cardiomyopathy.
Methods: TZM (60 mg/d, n = 15) or placebo (n = 15) was randomly applied to ischemic cardiomyopathy patients on top of conventional therapy for 12 months. Color Doppler Flow Imaging (CDFI), (18)F-FDP PET-CT imaging and (99m)Tc-MIBI gated single photon emission computerized tomography (SPECT) imaging were performed at study begin and after 12 months. LVEF with CDFI, summed rest scores (SRS) with SPECT and standard uptake value (SUV) with PET-CT of the segments which were perfusion-metabolism matched and decreased were determined respectively.
Results: After 12 months, LVEF of the therapy group was increased from (37.9 +/- 5.0)% to (42.3 +/- 10.4)% (P < 0.05), while the control group increased from (37.9 +/- 4.6)% to (40.1 +/- 5.5)% (P > 0.05); SRSs of the matched segments of the therapy and the control were reduced from 3.9 +/- 1.0 to 2.4 +/- 2.3 (P < 0.01) and 4.0 +/- 0.7 to 2.8 +/- 1.8 (P < 0.05) respectively, while LVEF and SRSs were similar at study begin and after 12 months between these two groups. SUV of myocardial segments classified as myocardial perfusion-metabolism matched was increased from 5.3 +/- 1.5 to 9.8 +/- 4.7 in the therapy group (P < 0.05) and from 5.4 +/- 1.2 to 6.0 +/- 2.3 (P > 0.05) in the placebo group, SUV was significantly higher in the therapy group than that in placebo group after 12 months (P < 0.05).
Conclusion: SPECT and (18)F-FDG imaging combination could be used to detect the surviving myocardium and chronic trimetazidine treatment could increase the glucose metabolism of ischemic cardiomyocytes in patients with ischemic cardiomyopathy.