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Year 2014, Volume: 31 Issue: 1, 19 - 23, 05.06.2014

Abstract

References

  • Bahrmann, P., Hengst, U.M., Richartz, B.M., Figulla, H.R., 2004. Pentoxifylline in ischemic, hypertensive and idiopathic-dilated cardiomyopathy: Effects on left-ventricular function, inflammatory cytokines and symptoms. Eur. J. Heart Fail. 6. 195-201. doi: 10.1016/j.ejheart.2003.09.005. Chacko, K.A., 1995. AHA Medical/Scientific Statement: 1994 revisions to classification of functional capacity and objective assessment of patients with diseases of the heart. Circulation. 92, 2003-2005.
  • Chung, E.S., Packer, M., Lo, K.H., Fasanmade, A.A., Willerson, J.T., 2003. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: Results of the anti-TNF Therapy against congestive heart failure (ATTACH) trial. Circulation. 107, 3133-3140. doi: 10.1161/ 01.CIR.0000077913.60364. D
  • Del Carlo, C.H., O’Connor, C.M., 1999. Cardiac troponins in congestive heart failure. Am. Heart J. 138, 646-653. http://dx.doi.org/10.1016/ S0002-8703(99)70178-X.
  • Durdu, S., Akar, R., Çavolli, R., Eren, N.T., Çorapçıoğlu, T., Uçanok, K., Özyurda, Ü., 2003. İleri dönem kalp yetmezliğinde alternatif arayışlar. AJC. 3, 252-260.
  • Edwars, M.J., Abney, D.L., Miller, F.N., 1991. Pentoxifylline inhibits interleukin-2-induced leukocyte-endothelial adherence and reduce systemic toxicity. Surgery. 110, 199-204.
  • Levine, B., Kalman, J., Mayer, L., Fillit, H.M., Packer, M., 1990. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N. Engl. J. Med. 323, 236-241. doi: 10.1056/NEJM199007263230405.
  • Mann, D.L., McMurray, J.J., Packer, M., Swedberg, K., Borer, J.S., Colucci, W.S., Djian, J., Drexler, H., Feldman, A., Kober, L., Krum, H., Liu, P., Nieminen, M., Tavazzi, L., Veldhuisen, D.J, Waldenstrom, A., Warren, M., Westheim, A., Zannad, F., Fleming, T., 2004. Targeted anticytokine therapy in patients with chronic heart failure: Results of the randomized etanercept worldwide evaluation (RENEWAL). Circulation. 109, 1594-1602. doi: 10.1161/ 01.CIR.0000124490.27666.B2.
  • Narula, J., Arbustini, E., Chandrashekhar, Y., Schwaiger, M., 2001. Apoptosis and the systolic dysfunction in congestive heart failure. Cardiol. Clin. 19, 113-126. doi:10.1016/S0733-8651(05)70198-3.
  • O’Connell, J.B., Bristow, M.R., 1994. Economic impact of heart failure in the United States. Time for a different approach. J. Heart Lung Transplant. 13, 107-112.
  • Sahn, D.J., DeMaria, A., Kisslo, J., Weyman, A., 1978. Recommendations regarding quantitation in M-mode echocardiography: Results of a survey of echocardiographic measurements. Circulation. 58, 1072-1083. doi: 10.1161/ 01.CIR.58.6.1072.
  • Schandene, L., Vandenbussche, P., Crusiaux, A., Alègre, M.L., Abramowicz, D., Dupont, E., Content, J., Goldman, M., 1992. Differential effects of pentoxifylline on the production of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) by monocytes and T cells. Immunology. 76, 30-34. study we planned a long term follow up to observe late period effects of pentoxifylline. Only patients with sinus rhythm were reviewed in the previous studies but we enrolled three patients with atrial fibrillation in pentoxifylline group and six patients in control group. Additionally a more extensive assessment including diastolic parameters and pulmonary artery pressure was performed not to overlook any significant variance. An other feature of this study that it lets us to make interpre tation about frequency of hospi talization, which was not evaluated in the previous studies.
  • Beside these, our study has some limitations. The number of patients evaluated in the study is insufficient. Furthermore, levels of TNF-alpha and other cytokines that are asserted to be influenced by pentoxifylline could be investigated. In this study, we hypothesized that inhibition of TNF-alpha may provide improvement in heart failure because TNF-alpha levels are elevated in these patients. Because TNF-alpha contributes to progression of heart failure by accelerating apoptosis. Significance of TNF-alpha in pathophysiology of heart failure is not well defined. Moreover, in the recent studies, although pentoxifylline treatment improved symptoms and ejection fraction, a notable reduction was not seen in the serum levels of TNF-alpha. Therefore it can be speculated that potential effects reported in the previous studies can act via different mechanisms. Consequently, no additional benefit was observed in clinical and echocardiographic parameters with addition of pentoxifylline to standart treatment protocol in patients with heart failure. Despite existence of studies resulted positively, the potantial role of pentoxifylline in heart failure therapy is still controversial. As a result, more extensive clinical researches with larger study populations are needed.

Long-term effects of pentoxifylline in heart failure therapy

Year 2014, Volume: 31 Issue: 1, 19 - 23, 05.06.2014

Abstract

The aim of the present study is to investigate the effects of pentoxifylline on left ventricular
ejection fractions (EF) and volumes, New York Heart Association (NYHA) functional
class, left ventricular diastolic parameters and hospitalization for heart failure in patients
with ischemic or non-ischemic cardiomyopathy. A total of 60 patients were randomised
to either peroral 1200 mg/day pentoxifylline or control group. All patients were on optimal
heart failure therapy and their EF was <40% by transthoracic echocardiography. The
patients were followed up for 12 months. Twenty-one patients (70%) in pentoxifylline
group and 20 (66.7%) in control group completed the study. Baseline and 12 months’
end-diastolic volume, end-systolic volume, EF and NYHA class were as follows in pentoxifylline
group; 160.5±51.3 mL vs 156.6±43.1 mL, 109.1±40 mL vs 106.1±33.4 mL,
32.4±5.7% vs 33.2±5.2%, 2.4±0.5 vs 2.2±0.5, p=0.5411, 0.5257, 0.4099 and 0.1037; respectively.
There were also no difference in baseline and follow-up diastolic parameters.
Mean hospitalization numbers for heart failure were similar between groups (1.26±0.71
vs 1.60±1.04, p=0.1717). Contrary to previous reports, no beneficial effect of pentoxifylline
was observed on clinical or echocardiographic parameters.

References

  • Bahrmann, P., Hengst, U.M., Richartz, B.M., Figulla, H.R., 2004. Pentoxifylline in ischemic, hypertensive and idiopathic-dilated cardiomyopathy: Effects on left-ventricular function, inflammatory cytokines and symptoms. Eur. J. Heart Fail. 6. 195-201. doi: 10.1016/j.ejheart.2003.09.005. Chacko, K.A., 1995. AHA Medical/Scientific Statement: 1994 revisions to classification of functional capacity and objective assessment of patients with diseases of the heart. Circulation. 92, 2003-2005.
  • Chung, E.S., Packer, M., Lo, K.H., Fasanmade, A.A., Willerson, J.T., 2003. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: Results of the anti-TNF Therapy against congestive heart failure (ATTACH) trial. Circulation. 107, 3133-3140. doi: 10.1161/ 01.CIR.0000077913.60364. D
  • Del Carlo, C.H., O’Connor, C.M., 1999. Cardiac troponins in congestive heart failure. Am. Heart J. 138, 646-653. http://dx.doi.org/10.1016/ S0002-8703(99)70178-X.
  • Durdu, S., Akar, R., Çavolli, R., Eren, N.T., Çorapçıoğlu, T., Uçanok, K., Özyurda, Ü., 2003. İleri dönem kalp yetmezliğinde alternatif arayışlar. AJC. 3, 252-260.
  • Edwars, M.J., Abney, D.L., Miller, F.N., 1991. Pentoxifylline inhibits interleukin-2-induced leukocyte-endothelial adherence and reduce systemic toxicity. Surgery. 110, 199-204.
  • Levine, B., Kalman, J., Mayer, L., Fillit, H.M., Packer, M., 1990. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N. Engl. J. Med. 323, 236-241. doi: 10.1056/NEJM199007263230405.
  • Mann, D.L., McMurray, J.J., Packer, M., Swedberg, K., Borer, J.S., Colucci, W.S., Djian, J., Drexler, H., Feldman, A., Kober, L., Krum, H., Liu, P., Nieminen, M., Tavazzi, L., Veldhuisen, D.J, Waldenstrom, A., Warren, M., Westheim, A., Zannad, F., Fleming, T., 2004. Targeted anticytokine therapy in patients with chronic heart failure: Results of the randomized etanercept worldwide evaluation (RENEWAL). Circulation. 109, 1594-1602. doi: 10.1161/ 01.CIR.0000124490.27666.B2.
  • Narula, J., Arbustini, E., Chandrashekhar, Y., Schwaiger, M., 2001. Apoptosis and the systolic dysfunction in congestive heart failure. Cardiol. Clin. 19, 113-126. doi:10.1016/S0733-8651(05)70198-3.
  • O’Connell, J.B., Bristow, M.R., 1994. Economic impact of heart failure in the United States. Time for a different approach. J. Heart Lung Transplant. 13, 107-112.
  • Sahn, D.J., DeMaria, A., Kisslo, J., Weyman, A., 1978. Recommendations regarding quantitation in M-mode echocardiography: Results of a survey of echocardiographic measurements. Circulation. 58, 1072-1083. doi: 10.1161/ 01.CIR.58.6.1072.
  • Schandene, L., Vandenbussche, P., Crusiaux, A., Alègre, M.L., Abramowicz, D., Dupont, E., Content, J., Goldman, M., 1992. Differential effects of pentoxifylline on the production of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) by monocytes and T cells. Immunology. 76, 30-34. study we planned a long term follow up to observe late period effects of pentoxifylline. Only patients with sinus rhythm were reviewed in the previous studies but we enrolled three patients with atrial fibrillation in pentoxifylline group and six patients in control group. Additionally a more extensive assessment including diastolic parameters and pulmonary artery pressure was performed not to overlook any significant variance. An other feature of this study that it lets us to make interpre tation about frequency of hospi talization, which was not evaluated in the previous studies.
  • Beside these, our study has some limitations. The number of patients evaluated in the study is insufficient. Furthermore, levels of TNF-alpha and other cytokines that are asserted to be influenced by pentoxifylline could be investigated. In this study, we hypothesized that inhibition of TNF-alpha may provide improvement in heart failure because TNF-alpha levels are elevated in these patients. Because TNF-alpha contributes to progression of heart failure by accelerating apoptosis. Significance of TNF-alpha in pathophysiology of heart failure is not well defined. Moreover, in the recent studies, although pentoxifylline treatment improved symptoms and ejection fraction, a notable reduction was not seen in the serum levels of TNF-alpha. Therefore it can be speculated that potential effects reported in the previous studies can act via different mechanisms. Consequently, no additional benefit was observed in clinical and echocardiographic parameters with addition of pentoxifylline to standart treatment protocol in patients with heart failure. Despite existence of studies resulted positively, the potantial role of pentoxifylline in heart failure therapy is still controversial. As a result, more extensive clinical researches with larger study populations are needed.
There are 12 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Basic Medical Sciences
Authors

Ahmet Karagöz

Özgül Uçar

Ayşe Yüksel This is me

Sinan Aydoğdu

Publication Date June 5, 2014
Submission Date July 27, 2012
Published in Issue Year 2014 Volume: 31 Issue: 1

Cite

APA Karagöz, A., Uçar, Ö., Yüksel, A., Aydoğdu, S. (2014). Long-term effects of pentoxifylline in heart failure therapy. Journal of Experimental and Clinical Medicine, 31(1), 19-23.
AMA Karagöz A, Uçar Ö, Yüksel A, Aydoğdu S. Long-term effects of pentoxifylline in heart failure therapy. J. Exp. Clin. Med. June 2014;31(1):19-23.
Chicago Karagöz, Ahmet, Özgül Uçar, Ayşe Yüksel, and Sinan Aydoğdu. “Long-Term Effects of Pentoxifylline in Heart Failure Therapy”. Journal of Experimental and Clinical Medicine 31, no. 1 (June 2014): 19-23.
EndNote Karagöz A, Uçar Ö, Yüksel A, Aydoğdu S (June 1, 2014) Long-term effects of pentoxifylline in heart failure therapy. Journal of Experimental and Clinical Medicine 31 1 19–23.
IEEE A. Karagöz, Ö. Uçar, A. Yüksel, and S. Aydoğdu, “Long-term effects of pentoxifylline in heart failure therapy”, J. Exp. Clin. Med., vol. 31, no. 1, pp. 19–23, 2014.
ISNAD Karagöz, Ahmet et al. “Long-Term Effects of Pentoxifylline in Heart Failure Therapy”. Journal of Experimental and Clinical Medicine 31/1 (June 2014), 19-23.
JAMA Karagöz A, Uçar Ö, Yüksel A, Aydoğdu S. Long-term effects of pentoxifylline in heart failure therapy. J. Exp. Clin. Med. 2014;31:19–23.
MLA Karagöz, Ahmet et al. “Long-Term Effects of Pentoxifylline in Heart Failure Therapy”. Journal of Experimental and Clinical Medicine, vol. 31, no. 1, 2014, pp. 19-23.
Vancouver Karagöz A, Uçar Ö, Yüksel A, Aydoğdu S. Long-term effects of pentoxifylline in heart failure therapy. J. Exp. Clin. Med. 2014;31(1):19-23.