Effects of trimetazidine on cardiac function in patients undergoing pulmonary stereotactic body radiotherapy evaluated by speckle-tracking echocardiography: A randomized, double-blind study

Radiation-induced heart damage (RIHD) has become an important factor affecting the long-term prognosis of cancer patients, and there are still no effective prevention or treatment measures. The purpose of this study was to evaluate the prevention and treatment effect of trimetazidine (TMZ) on early subclinical cardiac damage. We conducted a prospective, single-centre, randomized controlled study in the Department of Radiation Oncology of Peking University Third Hospital from May 2021 to April 2022. Patients who planned to receive pulmonary stereotactic body radiotherapy (SBRT) were randomly divided into a TMZ group and a control group. The TMZ group was treated with TMZ 2 weeks before SBRT (20 mg/time, 3 times a day, for 12 weeks). The control group received SBRT 2 weeks after admission. The primary outcomes were myocardial strain indices. Safety was analysed in all treated patients. We enrolled 73 patients, of whom 36 were assigned to the TMZ group and 37 to the control group. One patient in each of the two groups was lost to follow-up. The main outcome index, global longitudinal strain (GLS), was better in the TMZ group than the control group (-11.8 ± 3.7% vs. -10.1 ± 3.4%, P=0.042). There was no significant difference between the two groups in any secondary outcome indicators, including cardiac injury markers, cardiac structure, left ventricular ejection fraction and diastolic function indices. No drug-related adverse reactions occurred. In patients who plan to undergo pulmonary SBRT, TMZ can improve the myocardial strain parameter GLS after pulmonary SBRT, suggesting that TMZ has preventive and therapeutic effects on RIHD. Trial registration: ClinicalTrials.gov: NCT04939857 (25/06/2021).