Long-term effects of pentoxifylline in heart failure therapy

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.

Keywords

• Echocardiography
• Heart failure
• Pentoxifylline
• Therapy

References

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12. 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.