Meldonium improves aerobic capability and quality of life in HFpEF patients

Abstract Introduction Meldonium ameliorates cardiac function by reducing intracellular L-carnitine levels, thereby shifting cardiomyocyte energy metabolism toward glucose consumption. Recently, interest has emerged regarding its potential performance-enhancing effects. However, the role of meldonium in patients with heart failure with preserved left ventricular ejection fraction (HFpEF) remains unclear. Purpose The aim of our study was to evaluate the effects of meldonium on functional capacity and quality of life in patients with HFpEF. Methods Patients with HFpEF receiving OMT were enrolled in the prospective study. Before and 3 months after add-on meldonium therapy 500mg b.i.d. all patients underwent quality of life assesment using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12), cardiopulmonary exercise testing (CPET) and 6-minute walk test. Data statistical analysis was conducted using SPSS, with a predefined significance level of 0.05. Results In total 15 patients were enrolled. The median age was 64 years. Echocardiographic characteristics were as follows: median left atrial volume index 41 mL/m² (38.5–50), left ventricular ejection fraction 60 % (55–60), and right ventricular systolic pressure 35 mmHg (30–40). Analysis of CPET results demonstrated anaerobic threshold of 90 W [80–142.5] vs 115 W [86–165], p = 0.03, respiratory exchange ratio 1.01 [0.96–1.04] vs 1.11 [0.99–1.25], p = 0.02, and O₂ pulse 11.3 [9.35–15.0] vs 11.65 [5.9–16.6], p = 0.03 before and after the meldonium treatment, respectively. An improvement in KCCQ-12 score was observed after 3 months of meldonium use (71.87 [60.1–91.6] vs 80.2 [71.8–87.7], p = 0.01), including the physical limitation score (83.3 [66.6–91.6] vs 91.6 [83.3–100], p = 0.02), symptom frequency score (75.0 [70.8–91.6] vs 85.4 [82.3–96.9], p = 0.01), quality of life score (37.5 [25–62.5] vs 62.5 [46.9–75], p= 0.01), and social limitation score (58.3 [50.0–91.6] vs 87.5 [64.6–93.8], p = 0.02). Conclusion In HFpEF patients 3 months of meldonium therapy showed improvement of functional capacity and quality of life.