[Clinical aspects of the use of trimetazidine in the prevention and treatment of myocardial diseases]. / Kliniczne aspekty zastosowania trimetazydyny w prewencji i terapii chorób miesnia sercowego.

Trimetazidine, next to ranolazine and L-carnitine, belongs to cardioprotective drugs and as their main agent is used in experimental and clinical trials to evaluate its effect on modulation of cardiomyocytes metabolism. The blockade of fatty acid oxidation in ischemic myocardium and increase in the glucose utilization are the main mechanisms of trimetazidine action, which eventually lead to the reduction in intracellular acidosis. Recent studies concerning cardioprotective treatment encourage to continue the research on effectiveness, possible side effects, and clinical outcome which arise from "metabolic shift" toward the improvement of glucose metabolism. It has been demonstrated that trimetazidine not only ameliorate the quality of life by increasing physical tolerance, but also inhibits cardiac remodeling associated with long-standing diabetes or ischemia. Futhermore, trimetazidine exhibits antiarrhythmic properties and reduces myocardial damage associated with oxidative stress and inflammation after invasive procedures. In the light of these findings, trimetazidine seems to be an attractive therapeutic option andlor complementary therapy for treated conservatively patients with heart disease and with high risk of postreperfusal damage after cardiac invasive procedures. Moreover, particularly large benefits from introducing the metabolic treatment obtain patients with diabetes. The literature concerning trimetazidine function and treatment is broad. Therefore, the aim of this article is to summarize recent multicenter clinical trials on metabolic cardioprotection, showing its effectiveness or neutrality to the myocardial damaging factors.