Efficacy of adjunctive treatment with trimetazidine for fragmented QRS among patients with ischemic heart failure: a propensity score match analysis

Year 2019, Volume: 5 Issue: 2, 291 - 298, 04.03.2019

Selçuk Kanat , Barış Şensoy

https://doi.org/10.18621/eurj.397369

Abstract

Objectives: Fragmented QRS (fQRS) is an indicator of nonhomogeneous ventricular
activity caused by myocardial ischemia and fibrosis. The anti-ischemic agent
trimetazidine (TMZ) added to pharmacological treatment appears to have positive
effects on cardiac parameters of patients with ischemic heart failure. We aimed
to investigate the relationship of fQRS with adjunctive TMZ therapy in ischemic
HF patients.

Methods: Four hundred eighty-nine consecutive ambulatory ischemic patients with heart
failure eligible for our study were recruited for the study. A 12-lead
electrocardiogram with standard chest and limb leads was used to evaluate the
presence of fQRS. Further patients were divided into groups according to
adjunctive TMZ treatment and fQRS presence. Confounding factors were adjusted
by propensity score matching and multivariate logistic regression analysis.

Results: One hundred ninety-seven (40.3%) patients had fQRS on their ECGs and 235
(48.1%) patients were on adjunctive treatment with trimetazidine. Compared to
patients without fQRS, patients with fQRS had lower left ventricular ejection
fraction (LVEF), higher NYHA classes and more frequent mineralocorticoid
receptor antagonist and diuretic usage (p < 0.05). Add-on treatment
with TMZ was independently associated with fQRS presence (OR, 0.45; (95% CI,
0.29-0.70); p < 0.0001).

Conclusion: According to conventional therapy, adjunctive treatment with TMZ among
ischemic heart failure patients can be associated with fQRS in 12-lead ECG
independent of LVEF.

Keywords

Adjunctive treatment, fragmented QRS, ischemic heart failure, myocardial fibrosis, trimetazidine

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