Detection of Amiodarone-Induced Pulmonary Toxicity in Supine and Prone Positions-High-Resolution Computed Tomography Study-

Abstract

miodarone is a unique anti-arrhythmic drug originally developed for angina. 1 Because of its clinically proven effectiveness, amidodarone is now used to control atrial and ventricular arrhythmias. [2][3][4] Unfortunately, many adverse effects are related to the use of this agent, especially pulmonary toxicity, so called amiodarone-induced pulmonary toxicity (APT). 5,6 The condition of APT is extremely serious and difficult to diagnose, with an incidence of up to 13%. Patients with APT may have an associated mortality rate of 10% to 23%. 5 The toxic effects of amiodarone seem to be related to dose and duration of therapy. However, a meta-analysis of studies using lowdose amiodarone revealed that the risk of experiencing pulmonary adverse effects was increased by twofold (1.9% vs 0.7%) compared with placebo treatment. 7 APT can be difficult to diagnose clinically, but early recognition of APT is important because discontinuation of amiodarone could prevent its progression. In clinical practice, despite all radiological tests such as chest X-ray or computed tomography (CT), the diagnosis of APT is often reached by a therapeutic test: corticotherapy, given after the discontinuation of amiodarone.Since the first report describing the patterns of CT findings in cases of APT 15 years ago, several studies on CT findings have been carried out. [8][9][10][11][12][13] Kulhman et al have established the value of CT using standard techniques that provide a means of identifying patients with significant pulmonary accumulation of amiodarone. 13 High-resolution computed tomography (HRCT) is well established for noninvasive evaluation of the thin structural details of the normal and pathological pulmonary parenchyma. 14 Recently, HRCT findings of reversible APT 15 and symptomatic patients with APT 16 were reported.The technique of HRCT is usually performed in a supine position. Atelectasis is commonly seen in the dependent lung in both healthy and diseased subjects on ordinal HRCT in supine positions, resulting in a 'dependent density' or 'subpleural line'. However, there have been several reports claiming that HRCT in prone positions can be a useful modality to exclude the effect of gravity in patients with asbestosis. 17 Volpe et al reported the usefulness of HRCT in prone positions when chest radiographs show normal findings, possibly abnormal findings, or minimal abnormalities indicative of diffuse lung disease. 18 Therefore, an additional HRCT in prone positions may add important information by countering the effects of gravity on pulmonary vascularity. However, there is no study to evaluate APT by HRCT using a combination of supine and prone positions. The aim of the current study was to describe the effectiveness and feasibility of HRCT in patients in supine and prone positions to detect APT. Serum KL-6 could be a useful maker of APT. Background The aim of the present study was to describe the effectiveness and feasibility of high-resolution computed tomography (HRCT) in patients in supine and prone positions to detect am...

Cryptogenic organizing pneumonia due to amiodarone: long-term follow-up after corticosteroid treatment

“…As a conclusion, patients undergoing an antiarrythmic therapy with amiodarone featuring the characteristic clin- ical and radiological fi ndings for COP might be treated with corticoids empirically, even without achieving a BAL or invasive lung biopsy before [7,12,16,25,26].…”

“…In computed tomography (CT) the infi ltrates will be confi rmed with mostly bilateral areas of consolidation and ground-glass opacities [1,2,7,12,16,[24][25][26], which are usually in the periphery, sometimes shaped in the form of triangles (with the base facing the pleura and the tip pointing towards the mediastinum). Further diagnostic means can include BAL and lung biopsy.…”

Japanese Randomized Trial for Investigation of a Combined Therapy of Amiodarone and Implantable Cardioverter Defibrillator in Patients With Ventricular Tachycardia and Fibrillation

“…The side-effects of amiodarone will be assessed by symptoms, chest X-ray, DLco, and KL-6 level every 3 months, 22 and the QOL will be evaluated before randomization and at 12 and 24 months after the initiation of the treatment.…”

Mechanisms of Amiodarone and Desethylamiodarone Cytotoxicity in Nontransformed Human Peripheral Lung Epithelial Cells

“…However, longterm treatment with AM is associated with several adverse effects, the one of greatest concern being AM-induced pulmonary toxicity (AIPT), because it can progress to potentially life-threatening pulmonary fibrosis. Recent studies have reported that the incidence of AIPT occurs in 5 to 13% of patients treated with AM in a dose-and duration-dependent manner (Oyama et al, 2005). The prognosis of a patient with AIPT is poor, with a 10 to 23% mortality rate (Vrobel et al, 1989;Oyama et al, 2005).…”

“…Recent studies have reported that the incidence of AIPT occurs in 5 to 13% of patients treated with AM in a dose-and duration-dependent manner (Oyama et al, 2005). The prognosis of a patient with AIPT is poor, with a 10 to 23% mortality rate (Vrobel et al, 1989;Oyama et al, 2005).…”