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

Abstract

Objectives: Fragmented QRS (fQRS) is an indicator of nonhomogeneous ventricular activity caused bymyocardial ischemia and fibrosis. The anti-ischemic agent trimetazidine (TMZ) added to pharmacologicaltreatment appears to have positive effects on cardiac parameters of patients with ischemic heart failure. Weaimed 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 forour study were recruited for the study. A 12-lead electrocardiogram with standard chest and limb leads wasused to evaluate the presence of fQRS. Further patients were divided into groups according to adjunctive TMZtreatment and fQRS presence. Confounding factors were adjusted by propensity score matching andmultivariate logistic regression analysis.Results: One hundred ninety-seven (40.3%) patients had fQRS on their ECGs and 235 (48.1%) patients wereon adjunctive treatment with trimetazidine. Compared to patients without fQRS, patients with fQRS had lowerleft ventricular ejection fraction (LVEF), higher NYHA classes and more frequent mineralocorticoid receptorantagonist and diuretic usage (p < 0.05). Add-on treatment with TMZ was independently associated with fQRSpresence (OR, 0.45; (95% CI, 0.29-0.70); p < 0.0001).Conclusion: According to conventional therapy, adjunctive treatment with TMZ among ischemic heart failurepatients can be associated with fQRS in 12-lead ECG independent of LVEF.