Myocardial metabolic support in patients with coronary disease treated by percutaneous interventions
Debreceni Egyetem, Kardiológiai Intézet, Debrecen, Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház, Jósa András Oktatókórház, Invazív Kardiológiai Laboratórium, Nyíregyháza
The “omnivorous” myocardium can utilize free fatty acids and glucose simultaneously in variable ratios according to substrate availability. During glucose oxidation one molecule O2 consumption produces 5.2 ATPs while fatty acid oxidation generate only 4.6 ATP/O2. Involving other mechanisms also, the cardiac efficiency can increase by 33% during glucose oxidation compared to the fatty acid consumption.
Experimental positron emission tomography studies showed that trimetazidine (TMZ) shifts the myocardial metabolism from the fatty acid oxidation to glucose oxidation being more efficient source of energy. In clinical investigations the TMZ proved to be a prominent agent in the metabolic treatment of coronary heart disease. The results of relatively large scale studies demonstrated the cytoprotective effect of TMZ in patients treated by percutaneous coronary interventions (PCI). The direct beneficial metabolic effect on cellular level can prevent the myocardium from the potential ischemic and reperfusion injury during the PCI.
According to a recent study the TMZ reduces the pathological intimal hyperplasia after drug eluting stent implantation through its beneficial metabolic effect on the vascular cells. If these preliminary results will confirmed in large scale randomized trials then the TMZ can play even more role among the therapeutic actors of the coronary heart disease.