Abstract: Objective To investigate the clinical efficacy of ginkgo leaf tablets combined with trimetazidine in the treatment of elderly patients with chronic heart failure(CHF)and its impact on the mRNA expression of transforming growth factor-β1(TGF-β1)/Smad3 signaling pathway molecules in peripheral blood mononuclear cells(PBMCs). Methods Ninety-six elderly patients with CHF were selected from January 2021 to October 2023 and randomly assigned to a combination group, a trimetazidine group, and a ginkgo leaf tablet group, with 32 patients in each group. The clinical efficacy, cardiac function indicators(including cardiac index, left ventricular ejection fraction, left ventri-cular end-systolic diameter, and left ventricular end-diastolic diameter), levels of heart failure-related biomarkers(amino-terminal pro-B-type natriuretic peptide, soluble stromal derived factor 2, angiotensin II), and mRNA relative expression levels of key molecules in the TGF-β1/Smad3 pathway(TGF-β1, Smad2, Smad3, Smad7)in PBMCs were compared among the three groups, and the occurrence of adverse reactions was recorded. Results The cardiac index and left ventricular ejection fraction in the combination group were higher than those in the trimetazidine group and ginkgo leaf tablet group, and the trimetazidine group had higher values than the ginkgo leaf tablet group, with statistically significant differences(P<0.05). The left ventricular end-systolic diameter and left ventricular end-diastolic diameter in the combination group were lower than those in the trimetazidine group and ginkgo leaf tablet group, and the trimetazidine group had lower values than the ginkgo leaf tablet group, with statistically significant differences(P<0.05). The levels of amino-terminal pro-brain natriuretic peptide, soluble stromal derived factor 2, and angiotensin II in the combination group were lower than those in the trimetazidine group and ginkgo leaf tablet group, and the trimetazidine group had lower values than the ginkgo leaf tablet group, with statistically significant differences(P<0.05). The relative mRNA expression levels of TGF-β1, Smad2, and Smad3 in PBMCs from the combination group were lower than those in the trimetazidine group and ginkgo leaf tablet group; the relative mRNA expression level of Smad7 was higher than that in the trimetazidine group and ginkgo leaf tablet group, with statistically significant differences(P<0.05). There was no statistically significant difference in the incidence of adverse reactions among the three groups(P>0.05). Conclusions The combination of Ginkgo leaf tablets and trimetazidine can significantly improve cardiac function and alleviate myocardial damage in elderly patients with CHF. The mechanism is related to the inhibition of the TGF-β1/Smad3 signaling pathway, providing a new strategy for the integrated traditional Chinese and Western medicine treatment of CHF.

Key words: Elderly chronic heart failure, Ginkgo leaf tablets, Trimetazidine, Transforming growth factor-β1, Left ventricular ejection fraction, N-terminal pro-brain natriuretic peptide