Trimetazidine May Protect the Myocardium during Cardiac Surgery

  • Ihsan Iskesen
  • Adnan Taner Kurdal
  • Mazhar Eserdag
  • Mustafa Cerrahoglu
  • Bekir Hayrettin Sirin

Abstract

Background: Trimetazidine is an anti-ischemic agent with cardioprotective effects. The purpose of this double-blind, controlled, prospective randomized study was to investigate the possible effects of the preoperative use of trimetazidine on the biochemical markers of myocardial injury during open heart surgery and to determine if it has any myocardial protective effects.

Methods: Thirty patients undergoing coronary artery bypass grafting surgery, received either trimetazidine (study group, n = 15) or not (control group, n = 15). Pretreatment began 2 weeks before the operation with trimetazidine (60 mg/day orally), and the control group received no medication. We measured the levels of serum creatine kinase (CK), CK isoenzyme MB (CK-MB), myoglobin, and troponin T in venous blood samples obtained before and after the operation to evaluate the effect of this drug against myocardial damage. We also took serial blood samples from the radial artery and the coronary sinus before the institution of cardiopulmonary bypass (CPB) and at 2 and 15 minutes after the removal of the cross-clamp to measure lactate levels and calculate the lactate extraction of the myocardium.

Results: Postoperative levels of myoglobin, troponin T, CK, and CK-MB were significantly lower in the trimetazidine group than in the control group (P < .05). There was also a significant difference in the values for the lactate extraction calculation between the groups at minute 2 after the removal of the cross-clamp (P < .05).

Conclusion: We conclude that pretreatment with trimetazidine has some beneficial effects in protecting the myocardium and decreasing myocardial injury during the cardioplegic arrest period in open heart surgery without affecting postoperative hemodynamics.

References

Banach M, Rysz J, Goch A, Mikhailidis DP, Rosano GM 2008. The role of trimetazidine after acute myocardial infarction. Curr Vasc Pharmacol 6:282-91.\nBarsotti A, Di Napoli P 2004. Trimetazidine and cardioprotection during ischemia-reperfusion. Ital Heart J 5:29-36.\nBelardinelli R, Lacalaprice F, Faccenda E, Volpe L 2008. Trimetazidine potentiates the effects of exercise training in patients with ischemic cardiomyopathy referred for cardiac rehabilitation. Eur J Cardiovasc Prev Rehabil 15:533-40.\nIskesen I, Saribulbul O, Cerrahoglu M, Var A, Nazli Y, Sirin H 2006. Trimetazidine reduces oxidative stress in cardiac surgery. Circ J 70:1169-73.\nKara AF, Demiryürek S, Celik A, Tarakcio?lu M, Demiryülu M, Demiryürek AT 2004. Effects of trimetazidine on myocardial preconditioning in anesthetized rats. Eur J Pharmacol 503:135-45.\nKara AF, Demiryürek S, Celik A, Tarakcio?lu M, Demiryürek AT 2006. Effects of chronic trimetazidine treatment on myocardial preconditioning in anesthetized rats. Fundam Clin Pharmacol 20:449-59.\nLabrou A, Giannoglou G, Zioutas D, Fragaris N, Katsaris G, Louridas G 2007. Trimetazidine administration minimizes myocardial damage and improves left ventricular function after percutaneous coronary intervention. Am J Cardiovasc Drugs 7:143-50.\nLopaschuk GD, Barr R, Thomas PD, Dyck JR 2003. Beneficial effects of trimetazidine in ex vivo working ischemic hearts are due to a stimulation of glucose oxidation secondary to inhibition of long-chain 3-ketoacyl coenzyme A thiolase. Circ Res 93:33-7.\nPenttila K, Koukkunen H, Halinen M, et al. 2002. Myoglobin, creatine kinase MB isoforms and creatine kinase MB mass in early diagnosis of myocardial infarction in patients with acute chest pain. Clin Biochem 35:647-53.\nSellier P, Broustet JP 2003. Assessment of anti-ischemic and antianginal effect at trough plasma concentration and safety of trimetazidine MR 35 mg in patients with stable angina pectoris: a multicenter, double-blind, placebo-controlled study. Am J Cardiovasc Drugs 3:361-9.\nSilveira Filho LM, Petrtucci O Jr, Carmo MR, et al. 2008. Trimetazidine as cardioplegia addictive without pre-treatment does not improve myocardial protection: study in a swine working heart model. Rev Bras Cir Cardiovasc 23:224-34.\nSingh D, Chopra K 2004. Effect of trimetazidine on renal ischemia/reperfusion injury in rats. Pharmacol Res 50:623-9.\nStanley WC, Marzilli M 2003. Metabolic therapy in the treatment of ischaemic heart disease: the pharmacology of trimetazidine. Fundam Clin Pharmacol 17:133-45.\n
Published
2009-06-22
Section
Articles