Management of Microvascular Angina: Trimetazidine Improves Clinical Symptoms and Reduces Microvascular Dysfunction

60 patients with microvascular angina (MVA) were randomized into 2 groups: the “TMZ” received standard antianginal therapy and TMZ 35 mg bid for 3 months (M3), the control group (CG) received only the standard therapy. Treadmill test (TT), myocardial blood flow (MBF) with cold pressor testing (CPT) assessed by positron emission tomography , reactive hyperemia index (RHI) by peripheral arterial tonometry, assessments of quality of life (QOL) by Seattle Angina Questionnaire (SAQ), measurement of circulating endothelial cells (CECs), serum endothelin-1 level (ET-1) and total antioxidant status (TOS) were carried out at M0 and after M3 of treatment. Both groups were similar at baseline. At M3, 26.7% of TMZ patients and 83.3% of CG patients (P<0.05) had a positive TT. TMZ treatment was associated with improvements in all SAQ scores. At the M3 40% of TMZ patients were angina-free, 33.3% had class I angina and 26.7% had class II angina (P<0.05), without changes in the CG. Response of MBF to CPT significantly improved in the TMZ group compared with baseline and with the CG at M3. TMZ group M0 vs M3 LAD MBFa 86.2±29.7 vs 129.5±41.0 Р<0.001; LCX MBFa 93.3±30.5 vs 131.7±32.7 Р<0.001; RCA MBFa 91.3±30.4 vs 135.9±41.1 Р0.05; LCX MBFa 98.6±33 vs 97.9±30 Р>0.05; RCA MBFa 94.7±34.4 vs 105.2±49.6 Р>0.05). MBF value is mean ± SD, mL/100g/min; P-value between groups at M3 5 vs 9±5 cells/3x10⁵ Le; Р<0.001), the TOS increased (261.13±47.21 vs 323.14±115.99 μmol/L; Р<0.001).Conclusion: In patients with MVA adding TMZ to the standard treatment improves symptoms and reduces microvascular dysfunction