Coats CJ, et al. - In patients with symptomatic nonobstructive hypertrophic cardiomyopathy, researchers determined if oral therapy with trimetazidine, a direct inhibitor of fatty acid β-oxidation, can improve exercise capacity. Investigators included 51 drug-refractory symptomatic (New York Heart Association class ≥2) patients (24 to 74 years) with a maximum left ventricular outflow tract gradient 50 mm Hg or lower and a peak oxygen consumption during exercise of 80% or less, predicted value for age and sex. Trimetazidine therapy did not improve exercise capacity, with patients in the trimetazidine group walking 38.4 miles less than patients in the placebo group at 3 months, following adjustment for their baseline walking distance measurements. Overall, they concluded that trimetazidine therapy does not improve exercise capacity in symptomatic patients with nonobstructive hypertrophic cardiomyopathy in this randomized clinical trial. There is still limited pharmacological therapy for this disease.