© 2003 European Society of Cardiology
Pentoxifylline in ischemic, hypertensive and idiopathic-dilated cardiomyopathy: effects on left-ventricular function, inflammatory cytokines and symptoms
Clinic of Internal Medicine I Friedrich-Schiller-University, Erlanger Allee 101, 07740 Jena, Germany
* Corresponding author. Tel.: +49-3641-939138; fax: +49-3641-939363. E-mail address: philipp.bahrmann{at}med.uni-jena.de
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Abstract |
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Introduction: Tumor necrosis factor (TNF)-
and interleukin-6 (IL-6) are significantly elevated in patients with congestive heart failure (CHF). Pentoxifylline, a xanthin-derived agent, is known to inhibit the production of TNF- and IL-6. Recent studies have shown that pentoxifylline produces an increase in ejection fraction, a decrease in left-ventricular chamber size and an improvement in clinical status in patients with idiopathic-dilated cardiomyopathy. Therefore, we studied the effects of pentoxifylline in ischemic, hypertensive and idiopathic-dilated cardiomyopathy.
Methods: Primary endpoint was left-ventricular ejection fraction (LVEF) assessed by contrast 2D echocardiography. Secondary endpoints were concentrations of TNF-, IL-6, brain natriuretic peptide, maximal oxygen uptake (VO2 max) assessed by cardiopulmonary exercise testing and Minnesota Living with Heart Failure Questionnaire score or New York Heart Association scale.
Results: Forty-seven patients (31.9% ischemic, 21.3% hypertensive, 10.6% ischemic and hypertensive, 36.2% idiopathic-dilated cardiomyopathy) were randomly assigned to pentoxifylline 600 mg BID (n=23) or placebo (n=24) if they had a compensated CHF with a LVEF less than or equal to 40% and had taken their standard treatment consisting of angiotensin-converting enzyme inhibitors, diuretics and β-blockers for at least 3 months. Baseline demographic and clinical characteristics of each group were similar. Forty-one patients completed the study protocol and were analysed for primary and secondary endpoints. After 6 months of treatment, LVEF was unchanged in the pentoxifylline group compared with placebo (29±7 to 33±10% vs. 27±9 to 34±9%, respectively, P=NS). Also the secondary endpoints did not significantly change during follow-up.
Conclusion: Additional treatment with pentoxifylline is neutral with regard to left-ventricular function, inflammatory cytokines and symptoms in patients with ischemic, hypertensive and idiopathic-dilated cardiomyopathy.
Key Words: Cardiomyopathy • Heart failure treatment • Ejection fraction • Cytokines • Pentoxifylline
Received November 1, 2002; Revised May 16, 2003; Accepted September 15, 2003
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