Forest plots for all-cause mortality and hospitalization for cardiac causes.

<p>(<b>A</b>) All-cause mortality; (<b>B</b>) hospitalization for cardiac causes. CI = confidence intervals; M-H = Mantel-Haenszel; TMZ = trimetazidine.</p

Flow diagram of eligible studies included in the meta-analysis.

<p>Flow diagram of eligible studies included in the meta-analysis.</p

Study characteristics.

<p>BNP = brain natriuretic peptide; CRP = C-reactive protein; HF = heart failure; IDCM = idiopathic dilated cardiomyopathy; LVEF = left ventricular ejection fraction; NYHA = New York Heart Association; QOL = quality of life; REE = resting energy expenditure; SPECT = single photon emission CT; TMZ = trimetazidine.</p

Patient characteristics.

<p>LVEF = left ventricular ejection fraction; NYHA = New York Heart Association; TMZ = trimetazidine.</p

Forest plots for NYHA classification and exercise duration.

<p>(<b>A</b>) NYHA classification; (<b>B</b>) exercise duration. CI = confidence intervals; IV = inverse variance; TMZ = trimetazidine.</p

Is Treatment with Trimetazidine Beneficial in Patients with Chronic Heart Failure?

<div><p>Background</p><p>Whether additional benefit can be achieved with the use of trimetazidine (TMZ) in patients with chronic heart failure (CHF) remains controversial. We therefore performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of TMZ treatment in CHF patients.</p><p>Methods</p><p>We searched PubMed, EMBASE, and Cochrane databases through October 2013 and included 19 RCTs involving 994 CHF patients who underwent TMZ or placebo treatment. Risk ratio (RR) and weighted mean differences (WMD) were calculated using fixed or random effects models.</p><p>Results</p><p>TMZ therapy was associated with considerable improvement in left ventricular ejection fraction (WMD: 7.29%, 95% CI: 6.49 to 8.09, p<0.01) and New York Heart Association classification (WMD: −0.55, 95% CI: −0.81 to −0.28, p<0.01). Moreover, treatment with TMZ also resulted in significant decrease in left ventricular end-systolic volume (WMD: −17.09 ml, 95% CI: −20.15 to −14.04, p<0.01), left ventricular end-diastolic volume (WMD: −11.24 ml, 95% CI: −14.06 to −8.42, p<0.01), hospitalization for cardiac causes (RR: 0.43, 95% CI: 0.21 to 0.91, p = 0.03), B-type natriuretic peptide (BNP; WMD: −157.08 pg/ml, 95% CI: −176.55 to −137.62, p<0.01) and C-reactive protein (CRP; WMD: −1.86 mg/l, 95% CI: −2.81 to −0.90, p<0.01). However, there were no significant differences in exercise duration and all-cause mortality between patients treated with TMZ and placebo.</p><p>Conclusions</p><p>TMZ treatment in CHF patients may improve clinical symptoms and cardiac function, reduce hospitalization for cardiac causes, and decrease serum levels of BNP and CRP.</p></div

Sensitivity analysis of NYHA classification.

<p>NYHA = New York Heart Association; WMD = weighted mean difference; CI = confidence interval.</p

Quality assessment of included studies.

<p>Y = yes; N = no.</p

Forest plots for left ventricular function.

<p>(<b>A</b>) Left ventricular ejection fraction; (<b>B</b>) left ventricular end-systolic volume; (<b>C</b>) left ventricular end-diastolic volume. CI = confidence intervals; IV = inverse variance; TMZ = trimetazidine.</p

Forest plots for serum markers.

<p>(<b>A</b>) B-type natriuretic peptide; (<b>B</b>) C-reactive protein. CI = confidence intervals; IV = inverse variance; TMZ = trimetazidine.</p