(Circulation. 2001;103:1083.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Beneficial Effects of Pentoxifylline in Patients With Idiopathic Dilated Cardiomyopathy Treated With Angiotensin-Converting Enzyme Inhibitors and Carvedilol
Results of a Randomized Study
From the Department of Cardiology, Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
Correspondence to Daniel Skudicky, MD, Department of Cardiology, Baragwanath Hospital, PO Bertsham 2013, Johannesburg, South Africa. E-mail dskudi{at}icon.co.za
Background—We
previously reported beneficial effects of pentoxifylline, a
xanthine-derived agent known to inhibit the production of tumor
necrosis factor-
, in patients with idiopathic dilated cardiomyopathy
treated with diuretics, digoxin, and ACE inhibitors. Since then, 3
large clinical trials showed important clinical benefits of
ß-blockers in this population. Therefore, we designed the present
study to establish whether in patients with heart failure already
receiving treatment with ACE inhibitors and ß-blockers, the addition
of pentoxifylline would have an additive beneficial
effect.
Methods and Results—In a single-center, prospective, double-blind, randomized, placebo-controlled study, 39 patients with idiopathic dilated cardiomyopathy were randomized to pentoxifylline 400 mg TID (n=20) or placebo (n=19) if they had a left ventricular ejection fraction <40% after 3 months of therapy with digoxin, ACE inhibitors, and carvedilol. Primary end points were New York Heart Association functional class, exercise tolerance, and left ventricular function. Patients were followed up for 6 months. Five patients died (3 in the placebo group). Patients treated with pentoxifylline had a significant improvement in functional class compared with the placebo group (P=0.01), with an increment in exercise time from 9.5±5 to 12.3±6 minutes (P=0.1). Left ventricular ejection fraction improved from 24±9% to 31±13%, P=0.03, in the treatment group.
Conclusions—In patients with idiopathic dilated cardiomyopathy, the addition of pentoxifylline to treatment with digoxin, ACE inhibitors, and carvedilol is associated with a significant improvement in symptoms and left ventricular function.
Key Words: cardiomyopathy • heart failure • apoptosis
This article has been cited by other articles:
 |
|
 |
|
  S. M. Shaw, M. K.H. Shah, S. G. Williams, and J. E. Fildes Immunological mechanisms of pentoxifylline in chronic heart failure Eur J Heart Fail, February 1, 2009; 11(2): 113 - 118. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Liu, Z. Jia, L. Dong, R. Wang, and G. Qiu A Randomized Pilot Study of Atractylenolide I on Gastric Cancer Cachexia Patients Evid. Based Complement. Altern. Med., September 1, 2008; 5(3): 337 - 344. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Guggilam, M. Haque, E. K. Kerut, E. McIlwain, P. Lucchesi, I. Seghal, and J. Francis TNF-{alpha} blockade decreases oxidative stress in the paraventricular nucleus and attenuates sympathoexcitation in heart failure rats Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H599 - H609. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Sliwa, A. Damasceno, and B. M. Mayosi Epidemiology and Etiology of Cardiomyopathy in Africa Circulation, December 6, 2005; 112(23): 3577 - 3583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Zhang, Y.-J. Xu, H. K. Saini, B. Turan, P. P. Liu, and N. S. Dhalla Pentoxifylline attenuates cardiac dysfunction and reduces TNF-{alpha} level in ischemic-reperfused heart Am J Physiol Heart Circ Physiol, August 1, 2005; 289(2): H832 - H839. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. F. Navarro, C. Mora, M. Muros, and J. Garcia Additive Antiproteinuric Effect of Pentoxifylline in Patients with Type 2 Diabetes under Angiotensin II Receptor Blockade: A Short-Term, Randomized, Controlled Trial J. Am. Soc. Nephrol., July 1, 2005; 16(7): 2119 - 2126. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M E Onwuamaegbu, M Henein, and A J Coats Cachexia in malaria and heart failure: therapeutic considerations in clinical practice Postgrad. Med. J., November 1, 2004; 80(949): 642 - 649. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Sliwa, A. Woodiwiss, E. Libhaber, F. Zhanje, C. Libhaber, R. Motara, and R. Essop C-reactive protein predicts response to pentoxifylline in patients with idiopathic dilated cardiomyopathy Eur J Heart Fail, October 1, 2004; 6(6): 731 - 734. [Full Text] [PDF]
|
|
|
|
|
|
J. Francis, Y. Chu, A. K. Johnson, R. M. Weiss, and R. B. Felder Acute myocardial infarction induces hypothalamic cytokine synthesis Am J Physiol Heart Circ Physiol, June 1, 2004; 286(6): H2264 - H2271. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Bahrmann, U. M. Hengst, B. M. Richartz, and H. R. Figulla Pentoxifylline in ischemic, hypertensive and idiopathic-dilated cardiomyopathy: effects on left-ventricular function, inflammatory cytokines and symptoms Eur J Heart Fail, March 1, 2004; 6(2): 195 - 201. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Sliwa, A. Woodiwiss, V. N. Kone, G. Candy, D. Badenhorst, G. Norton, C. Zambakides, F. Peters, and R. Essop Therapy of Ischemic Cardiomyopathy With the Immunomodulating Agent Pentoxifylline: Results of a Randomized Study Circulation, February 17, 2004; 109(6): 750 - 755. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. B. Felder, J. Francis, Z.-H. Zhang, S.-G. Wei, R. M. Weiss, and A. K. Johnson Heart failure and the brain: new perspectives Am J Physiol Regulatory Integrative Comp Physiol, February 1, 2003; 284(2): R259 - R276. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P A Henriksen and D E Newby Therapeutic inhibition of tumour necrosis factor {alpha} in patients with heart failure: cooling an inflamed heart Heart, January 1, 2003; 89(1): 14 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J J V McMurray Heart failure in 10 years time: focus on pharmacological treatment Heart, October 1, 2002; 88(90002): ii40 - 46. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Afanasyeva and N. R. Rose Cardiomyopathy Is Linked to Complement Activation Am. J. Pathol., August 1, 2002; 161(2): 351 - 357. [Full Text] [PDF]
|
|
|
|
|
|
K. Sliwa, D. Skudicky, G. Candy, A. Bergemann, M. Hopley, and P. Sareli The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy Eur J Heart Fail, June 1, 2002; 4(3): 305 - 309. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. McMurray and M. A. Pfeffer New Therapeutic Options in Congestive Heart Failure: Part II Circulation, May 7, 2002; 105(18): 2223 - 2228. [Full Text] [PDF]
|
|