The role of trimetazidine in heart failure

Shifting the energy substrate preference away from free fatty acids (FFA) and toward glucose metabolism by FFA oxidation inhibitors, such as trimetazidine, may be an effective adjunctive treatment in terms of myocardial metabolism and left ventricular function improvement. These effects seem operative in heart failure syndromes regardless of their aetiopathogenetic cause and not confined to those of ischaemic origin. Additionally, abnormalities of glucose homeostasis are consistently present in patients with heart failure, definitely contributing to the progression of the primary disease. Apart from a meticulous metabolic control of frank diabetes, special attention should also be paid to insulin resistance, a condition that is generally under-diagnosed as a distinct clinical entity. The observed combined beneficial effects of trimetazidine on left ventricular function and glucose metabolism represent an additional advantage of this drug. In this paper, the recent literature on the beneficial therapeutic effects of trimetazidine on left ventricular dysfunction and glucose metabolism is reviewed and discussed.