Coats CJ, et al. - In this randomized, placebo-controlled, double-blind clinical trial (from May 31, 2012, to September 8, 2014), researchers studied how exercise capacity in 51 drug-refractory patients with symptomatic nonobstructive hypertrophic cardiomyopathy (New York Heart Association class ≥2) was altered by oral trimetazidine dihydrochloride therapy (a direct inhibitor of fatty acid β-oxidation). Study participants (aged 24 to 74 years) had a maximum left ventricular outflow tract gradient 50 mm Hg or lower. These patients had a peak oxygen consumption during exercise of 80% or less predicted value for age and sex. For 3 months, 27 patients were treated with trimetazidine, 20 mg, 3 times daily and 24 patients received placebo, via a random assignment. No improvement in exercise capacity was evident following trimetazidine therapy in symptomatic patients with nonobstructive hypertrophic cardiomyopathy.