Trimetazidine (TMZ, 1-[2,3,4-trimethoxy-benzyl] piperazine, 2 HCl), which was introduced as an antianginal drug 20 years ago, exerts its properties at the cellular level, without haemodynamic effects in clinical conditions [1±3]. Bricaud et al. [4] demonstrated the bene®cial effect of a long-term TMZ treatment in ischemic cardiopathy without associated adverse effects. In vitro, the bene®cial properties of the molecule were reported in isolated perfused heart models, which con®rmed that the mechanism of the bene®cial effect was not associated to any haemodynamic component [5,6]. Using a similar model, Lavanchy et al. [7] showed that during a global normothermic ischemia, TMZ prevented acidosis and inorganic phosphate accumulation and increased the recovery of adenosine triphosphate (ATP) at reperfusion. Similar results were obtained on cardiomyocyte cultures Keywords angina,