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Effect of Trimetazidine on functional status and left ventricular function in non-valvular heart failure patients – Results of Ajmer Heart Failure Registry
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Heart failure / Indian Heart Journal 69S (2017) S85–S89
Fig. 1. Pedigree of one family with familial restrictive cardiomyopathy.
of the same mutation, among which two members had a similar restrictive filling pattern and biatrial dilation on echocardiography (Fig. 1). Conclusions: It may be postulated that the RCM phenotype might be due failure of the mutant cTnI to associate with the thin filament. The reduced troponin I content may lead to altered interactions of cTnI with the actin-tropomyosin complex that result in severe diastolic dysfunction within this family. Exploration of RCM causing mutations provides an excellent framework on which new therapeutic strategies can be developed to target the effects of the disease. Conflicts of interest The authors have none to declare. https://doi.org/10.1016/j.ihj.2017.09.107
Results: A total of 100 patient records were reviewed, and only 78 patients were included in the study. Patients who were treated and transferred from another hospital were excluded from the study. Sixteen patients were readmitted within 30 days of the index hospitalization, whereas 103 patients were readmitted after 30 days or not at all. On readmission, majority of the patients readmitted within 30 days were not on a target dose of an ACE-I/ARB (75%), and none were on a target dose of a -blocker, and their baseline left ventricular ejection fraction (LVEF), HR and BP were compared. Nearly 25% of the patients were not following their medications strictly as advised by physician. On readmission, 78% of the patients had high HR (>80/min) at the time of discharge, and almost 68% had a high SBP of more than 140 mmHg. Conclusions: Based on the observations form the present study, multiple recommendations can be made to further improve the quality of care and reduce HF readmissions in clinical practice. Starting from proper clinical assessment along with checking the vital parameters like HR and SBP, RR at the time of discharge and proper management of the coexisting conditions will definitely help in reducing the number of hospitalizations. Those who were not on or on inadequate dose of diuretics and/or ACE-I/ARB and/or ß-blocker, had higher incidences of heart failures and high readmission rates. Discussion: There are several limitations to the present study, including its retrospective design and small sample size. To understand the results better, large prospective studies with statistical analysis capturing all-cause readmissions are necessary to further evaluate various patient characteristics that may be contributing to HF. Conflicts of interest The author has none to declare.
ABS280 Can we minimize the re-admissions of the heart failure patients, if we properly address the various factors that have a close association with the overall outcome? Janardhana Rao Babburi Aster Medical Center and Aster Hospital, India E-mail address: [email protected]. Background: Despite strictly following the guideline-driven pharmacological therapies and careful transitional care, the rates of preventable hospital readmission of heart failure (HF) patients and associated costs remain unacceptably high. According to several data available from various hospitals, nearly 25% of patients are still symptomatic at the time of discharge. Objective: The aim of this study is to identify different factors affecting the re-admissions of HF patients to the hospital due to congestive heart failure. Methods: A retrospective electronic chart review was completed on 100 patients with HF who were admitted into our medical center between 2010 and 2012. The data collected included age, sex, prior diagnosis of HF, date of diagnosis, hospitalization for HF within 30 days of the index HF admission, comorbid conditions, vitals like systolic blood pressure (SBP), heart rate (HR), RR, weight, along with electrolytes, renal function test (RFT), hematocrit, and glucose levels. Various classes of medications were reviewed at the time of admission to determine whether the patient was prescribed an ACE-I/ARB, ß-blocker, diuretic, nitrates, aldosterone antagonist, digoxin etc.
https://doi.org/10.1016/j.ihj.2017.09.108
ABS302 Effect of Trimetazidine on functional status and left ventricular function in non-valvular heart failure patients – Results of Ajmer Heart Failure Registry Rajendra K. Gokhroo, Shashi Kant Pandey ∗ , Ramsagar, Kailash Chandra J.L.N Medical College Ajmer, Rajasthan, India E-mail address: [email protected] (S.K. Pandey). Background: Shifting the energy substrate preference away from fatty-acid metabolism and toward glucose metabolism by trimetazidine, a ketoacyl-coenzyme A thiolase inhibitor, is an effective adjunctive treatment in patients with heart failure. Objectives: To study the role of Trimetazidine on patients of heart failure in terms of its effect as a metabolic modulator and to see whether the long-term addition of Trimetazidine to conventional heart failure treatment could improve functional class, left ventricular ejection fraction (LVEF) and myocardial performance index (MPI). Methods: A total of 389 patients with non-valvular heart failure were randomly allocated in to three groups. First group (131patients) had conventional treatment (CT) plus 120 mg Trimetazidine divided in two doses, second group (129 patients) had 60 mg Trimetazidine once daily plus CT and third group (129
Heart failure / Indian Heart Journal 69S (2017) S85–S89
patients) only received CT. Follow-up was done at 6 months with two-dimensional echocardiography. Results: On treatment with Trimetazidine 60 mg once daily and 120 mg twice daily in addition to CT for 6 months, compared to baseline, mean EF improved from 34 ± 7 to 41 ± 6 (p < 0.001) and 37 ± 9 to 43 ± 8 (p = 0.02), mean left ventricle internal dimension in systole (LVIDs) decreased from 47 ± 11 to 42 ± 7 mm (p = 0.016) and 49 ± 11 to 41 ± 7 mm (p = 0001), mean MPI improved from 0.60 ± 0.11 to 0.49 ± 0.12 (p < 0.001) and 0.57 ± 0.10 to 0.49 ± 0.90 (p < 0.001) and mean NYHA class improved from 2.28 ± 0.23 to 1.90 ± 0.16 (p < 0.0001) and 2.25 ± 0.13 to 1.85 ± 0.13 (p < 0.0001), respectively. Left ventricle internal dimension in diastole, end diastolic volume and end systolic volume did not change significantly.
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Only CT group did not show any significant improvement in any of the indices. Double dose Trimetazidine did not have any added advantage. Conclusion: Long-term Trimetazidine improves functional class, left ventricular function and MPI in patients with heart failure in comparison to standard heart failure therapy alone and more so on longer duration of treatment. Conflicts of interest The authors have none to declare. https://doi.org/10.1016/j.ihj.2017.09.109
Heart failure / Indian Heart Journal 69S (2017) S85–S89
Fig. 1. Pedigree of one family with familial restrictive cardiomyopathy.
of the same mutation, among which two members had a similar restrictive filling pattern and biatrial dilation on echocardiography (Fig. 1). Conclusions: It may be postulated that the RCM phenotype might be due failure of the mutant cTnI to associate with the thin filament. The reduced troponin I content may lead to altered interactions of cTnI with the actin-tropomyosin complex that result in severe diastolic dysfunction within this family. Exploration of RCM causing mutations provides an excellent framework on which new therapeutic strategies can be developed to target the effects of the disease. Conflicts of interest The authors have none to declare. https://doi.org/10.1016/j.ihj.2017.09.107
Results: A total of 100 patient records were reviewed, and only 78 patients were included in the study. Patients who were treated and transferred from another hospital were excluded from the study. Sixteen patients were readmitted within 30 days of the index hospitalization, whereas 103 patients were readmitted after 30 days or not at all. On readmission, majority of the patients readmitted within 30 days were not on a target dose of an ACE-I/ARB (75%), and none were on a target dose of a -blocker, and their baseline left ventricular ejection fraction (LVEF), HR and BP were compared. Nearly 25% of the patients were not following their medications strictly as advised by physician. On readmission, 78% of the patients had high HR (>80/min) at the time of discharge, and almost 68% had a high SBP of more than 140 mmHg. Conclusions: Based on the observations form the present study, multiple recommendations can be made to further improve the quality of care and reduce HF readmissions in clinical practice. Starting from proper clinical assessment along with checking the vital parameters like HR and SBP, RR at the time of discharge and proper management of the coexisting conditions will definitely help in reducing the number of hospitalizations. Those who were not on or on inadequate dose of diuretics and/or ACE-I/ARB and/or ß-blocker, had higher incidences of heart failures and high readmission rates. Discussion: There are several limitations to the present study, including its retrospective design and small sample size. To understand the results better, large prospective studies with statistical analysis capturing all-cause readmissions are necessary to further evaluate various patient characteristics that may be contributing to HF. Conflicts of interest The author has none to declare.
ABS280 Can we minimize the re-admissions of the heart failure patients, if we properly address the various factors that have a close association with the overall outcome? Janardhana Rao Babburi Aster Medical Center and Aster Hospital, India E-mail address: [email protected]. Background: Despite strictly following the guideline-driven pharmacological therapies and careful transitional care, the rates of preventable hospital readmission of heart failure (HF) patients and associated costs remain unacceptably high. According to several data available from various hospitals, nearly 25% of patients are still symptomatic at the time of discharge. Objective: The aim of this study is to identify different factors affecting the re-admissions of HF patients to the hospital due to congestive heart failure. Methods: A retrospective electronic chart review was completed on 100 patients with HF who were admitted into our medical center between 2010 and 2012. The data collected included age, sex, prior diagnosis of HF, date of diagnosis, hospitalization for HF within 30 days of the index HF admission, comorbid conditions, vitals like systolic blood pressure (SBP), heart rate (HR), RR, weight, along with electrolytes, renal function test (RFT), hematocrit, and glucose levels. Various classes of medications were reviewed at the time of admission to determine whether the patient was prescribed an ACE-I/ARB, ß-blocker, diuretic, nitrates, aldosterone antagonist, digoxin etc.
https://doi.org/10.1016/j.ihj.2017.09.108
ABS302 Effect of Trimetazidine on functional status and left ventricular function in non-valvular heart failure patients – Results of Ajmer Heart Failure Registry Rajendra K. Gokhroo, Shashi Kant Pandey ∗ , Ramsagar, Kailash Chandra J.L.N Medical College Ajmer, Rajasthan, India E-mail address: [email protected] (S.K. Pandey). Background: Shifting the energy substrate preference away from fatty-acid metabolism and toward glucose metabolism by trimetazidine, a ketoacyl-coenzyme A thiolase inhibitor, is an effective adjunctive treatment in patients with heart failure. Objectives: To study the role of Trimetazidine on patients of heart failure in terms of its effect as a metabolic modulator and to see whether the long-term addition of Trimetazidine to conventional heart failure treatment could improve functional class, left ventricular ejection fraction (LVEF) and myocardial performance index (MPI). Methods: A total of 389 patients with non-valvular heart failure were randomly allocated in to three groups. First group (131patients) had conventional treatment (CT) plus 120 mg Trimetazidine divided in two doses, second group (129 patients) had 60 mg Trimetazidine once daily plus CT and third group (129
Heart failure / Indian Heart Journal 69S (2017) S85–S89
patients) only received CT. Follow-up was done at 6 months with two-dimensional echocardiography. Results: On treatment with Trimetazidine 60 mg once daily and 120 mg twice daily in addition to CT for 6 months, compared to baseline, mean EF improved from 34 ± 7 to 41 ± 6 (p < 0.001) and 37 ± 9 to 43 ± 8 (p = 0.02), mean left ventricle internal dimension in systole (LVIDs) decreased from 47 ± 11 to 42 ± 7 mm (p = 0.016) and 49 ± 11 to 41 ± 7 mm (p = 0001), mean MPI improved from 0.60 ± 0.11 to 0.49 ± 0.12 (p < 0.001) and 0.57 ± 0.10 to 0.49 ± 0.90 (p < 0.001) and mean NYHA class improved from 2.28 ± 0.23 to 1.90 ± 0.16 (p < 0.0001) and 2.25 ± 0.13 to 1.85 ± 0.13 (p < 0.0001), respectively. Left ventricle internal dimension in diastole, end diastolic volume and end systolic volume did not change significantly.
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Only CT group did not show any significant improvement in any of the indices. Double dose Trimetazidine did not have any added advantage. Conclusion: Long-term Trimetazidine improves functional class, left ventricular function and MPI in patients with heart failure in comparison to standard heart failure therapy alone and more so on longer duration of treatment. Conflicts of interest The authors have none to declare. https://doi.org/10.1016/j.ihj.2017.09.109