Jiang Weidong Gao Xiang Zhang Fengli Tang Yanfen Tao Zhiqiang Department of Cardiology, Nantong Hospital of Traditional Chinese Medicine, Jiangsu Province, China (Nantong 226001, Jiangsu) Abstract Objective To investigate the effects of trimetazidine hydrochloride on cardiac function and serum free fatty acids (FFA) in patients with chronic heart failure (CHF). Methods One hundred and twenty patients with CHF were randomly divided into a treatment group (60 patients) and a control group (60 patients). In the treatment group, trimetazidine hydrochloride (20 mg orally, 3 times/d) was added to conventional treatment (diuretics, ACEI or ARB, digitalis, β-blockers), and the left ventricular ejection fraction (LVEF), left ventricular short-axis shortening rate (FS ), 6-min walk distance (6 MWT), and serum free fatty acid (FFA) changes before and three months after treatment. Results At the end of the treatment course, LVEF and FS increased, 6 min walking distance increased significantly and serum FFA concentration decreased in the treatment and control groups compared with those before treatment (P<0.05); compared with the control group, LVEF and FS increased more significantly and serum FFA concentration decreased in the treatment group (P<0.05). Conclusion Trimetazidine hydrochloride can improve cardiac function in CHF patients, which may be related to the reduction of FFA levels. JIANG Wei-Dong, Department of Cardiovascular Medicine, Nantong Hospital of Traditional Chinese Medicine Keywords: Chronic heart failure; Serum free fatty acids; Left ventricular ejection fraction; Left ventricular short-axis shortening rate; Trimetazidine The Effect of Trimetazidine on Cardiac Function and Free Fatty Acids in Patients with Chronic Heart Failure JIANG Wei-dong, GAO xiang, ZHANG Feng-li, TANG Yan-fen, TAO Zhi-qiang Department of Cardiology, Nantong Municipal Hospital of Traditionnal Chinese Medicine, Nantong 226001, Jiangsu China [Abstract] Objective To investigate the effects of f trimetazidine on cardiac function Methods The stochastic comparison compares 120 cases with chronic heart failure (treatment group, control group contained 60 each) with the effects of f trimetazidine on cardiac function and free fatty acids in patients with chronic heart failure. The stochastic comparison compares 120 cases with chronic heart failure (treatment group, control group contained 60 each), the treatment group adds the trimetazidine in the conventional treatment foundation.To observe the change of To observe the change of left ventricular ejection fraction (LVEF), fraction shortening (FS), 6-minute walk test (6MWT) and free fatty acids (FFA) before and after of three Results compared with those before treatment, the levels of left ventricular ejection, fraction, fraction shortening and free fatty acids (FFA) before and after of three months in the treatment of patients with chronic heart failure. fraction, fraction shortening and 6-minute walk test significantly increased while free fatty acids significantly reduced (P<0.05). Compared with control group, the levels of left ventricular ejection fraction and fraction shortening significantly increased while free fatty acids The levels of left ventricular ejection fraction and fraction shortening significantly increased while free fatty acids significantly reduced (P<0.05). Conclusion Trimetazidine can improve the cardiac function of CHF patients, which may be related to a decrease in the serum level of FFA. [Key Words] Chronic heart failure; Free fatty acids; Left ventricular ejection fraction; Fraction shortening; Trimetazidine Fundamental project: Nantong Talent Work Special Fund (S8008) Chronic heart failure ( CHF is a complex group of clinical symptoms that is the ultimate outcome of various cardiovascular diseases, and the disease is highly prevalent and is the only cardiovascular disease whose incidence continues to increase to date. Although significant progress has been made in the treatment of heart failure, the efficacy is unsatisfactory, mainly because of the complex pathogenesis of heart failure, the alteration of myocardial energy metabolism in CHF, which is closely related to serum free fatty acids (FFA), and the inhibition of FFA oxidation has been suggested as a new direction in the treatment of CHF patients [1]. In this study, we investigated the effects of trimetazidine hydrochloride on cardiac function and changes in serum FFA in patients with chronic heart failure, and explored the possible mechanisms of the effects of trimetazidine hydrochloride on cardiac function in patients with chronic heart failure. 1 Data and methods 1. 1 General data: From December 2008 to December 2010, there were 120 inpatients and outpatients in our department, including 56 males and 64 females, aged 48-78 years, average (61±11) years, including 48 cases of coronary heart disease, 38 cases of hypertensive heart disease, 22 cases of dilated cardiomyopathy, and 12 cases of rheumatic heart disease. All patients were given electrocardiogram, X-ray chest radiograph, echocardiogram, routine blood and urine and biochemical examination, left ventricular ejection fraction (LVEF) <50%, short-axis shortening (FS) <30%, and New York Heart Association (NYHA) cardiac function class II-IV by echocardiography. A randomized, open, controlled study was taken, and 60 cases each were divided into treatment and control groups. There was no statistically significant difference between the two groups in terms of age, gender and cardiac function classification. Exclusion criteria: recent myocardial infarction or performing CABG/PTCA, cardiogenic shock, severe ventricular arrhythmias, complete AV block, unrepaired valvular disease, uncontrolled hypertension, trimetazidine allergy, and chronic liver and kidney disease. 1. 2 METHODS: All patients were treated with standard chronic heart failure medications including angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists, β-blockers, diuretics (hydrochlorothiazide or furosemide), spironolactone, and some patients took digoxin intermittently. for 3 times/d for three months. 1.2. 1 Routine examination: routine blood, urine, liver function, kidney function, blood glucose, lipids, electrolytes and electrocardiogram were examined in the selected patients. 1. 2. 2 Heart rate and 6-min walking distance measurement: Patients were measured at the time of enrollment and at the end of the treatment course for 6-min walking distance. 1. 2. 3 Measurement of LVEF and FS: The LVEF and FS were measured at the time of enrollment and at the end of the course of treatment, respectively, using a color Doppler 2D ultrasound imaging device (HP5500). 1.2. 4 Serum FFA measurement: FFA was measured by colorimetric method, and the FFA kit was provided by RANDOX, UK. 1. 3 Statistical methods:The data were processed using the SPSS 11. 0 statistical package. The measurement data were expressed as mean ± standard deviation ( ±s), and the difference between the same group before and after treatment was compared by paired t-test, and the difference between two groups was compared by independent sample t-test, and P<0.05 was considered statistically significant. 2 Results 2. 1 In the treatment group, 59 patients completed the follow-up, and 1 patient died suddenly. In the control group, 58 patients completed the follow-up, 1 patient died of cerebral infarction and 1 patient died suddenly. No adverse effects were found in the two groups, and there were no significant changes in blood and urine analysis and biochemical examination indexes. 2. 2 Changes in LVEF and FS, six-minute walking distance (6MT): compared with before treatment, LVEF and FS increased, and six-minute walking distance increased, and the difference was statistically significant (P<0.05) Table 1 Changes in LVEF, FS, and six-minute walking distance in two groups before and after treatment Group LVEF (%) FS (%) Six-minute walking distance (m) Before treatment After treatment After treatment Pre-treatment Post-treatment Pre-treatment Post-treatment Treatment group 0.40±0.02 0.48±0.03* 0.22±0.04 0.25±0.04* 325±106 560±122* Control group 0.41±0.03 0.46±0.03*△ 0.21±0.05 0.24±0.03*△ 330±112*△ 540±109*△ Compared with treatment Comparison with pre-treatment: * P<0.05; comparison with control group △ P<0.05 2. 3 Changes in serum FFA: The results of serum free fatty acid determination before and after treatment in the two groups (see Table 2) were analyzed by ANOVA, and compared with pre-treatment after 3 months of treatment, the differences within the treatment and control groups were significant (P<0.05); compared between the two groups, there was no significant difference before treatment (P>0.05), and the difference after treatment The difference between the two groups was not significant before treatment (P>0.05), but after treatment (P<0.05). Table 2 Comparison of FFAS between the two groups before and after treatment Pre-treatment (mmol/L) Post-treatment (mmol/L) Treatment group (n=59) 0.54±0.05 0.35±0.06* Control group (n=58) 0.56±0.04 0.47±0.04*△