The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy

Sliwa, Karen; Skudicky, Daniel; Candy, Geoffrey P.; Bergemann, Annette; Hopley, Mark; Sareli, Pinhas

doi:10.1016/s1388-9842(02)00008-9

Cited by 153 publications

(98 citation statements)

References 15 publications

(18 reference statements)

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“…Baseline CRP, IL-6, TNF-a, and higher NYHA FC were the only predictors of mortality. These results contribute to inflammation which may contribute to the pathogenesis of PPCM and its complications [7,8,22]. Graph 2 Baseline plasma inflammatory markers of deceased patients versus survivors.…”

Section: Discussionmentioning

confidence: 99%

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Inflammatory Markers-Serum Level of C-Reactive Protein, Tumor Necrotic Factor-α, and Interleukin-6 as Predictors of Outcome for Peripartum Cardiomyopathy

Sarojini

Shanker

Anitha

2013

J Obstet Gynecol India

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Aim/Objective Peripartum cardiomyopathy (PPCM) is a disorder of unknown etiology in which symptoms of heart failure occur between the last month of pregnancy and 5 months post-partum. These findings prompted us to carry out a more detailed study aimed at correlating plasma levels of C-reactive protein TNF-a and IL-6 as prognostic value for major clinical in-hospital events and 6-month follow-up in patients with PPCM. Materials and Methods After ethical clearance, in the present prospective case-control study, a total of 86 subjects were enrolled [patients (n = 46) and controls (n = 40)]. After checking for the inclusion and exclusion criteria, informed consent was obtained and patients were enrolled. The details of history of pre-eclampsia and mode of delivery were obtained from the patients. The history of onset of symptoms and signs was recorded at the first presentation and at 6 months. Clinical assessment, echocardiography, and blood analysis were done at baseline and after 6 months of standard therapy. All patients received treatment with diuretics and the ACE inhibitor (ramipril), Carvedilol if not contraindicated, and inotropic support inj-Dobutamine. Inflammatory markers (C-reactive protein, TNF-a, and IL-6) were measured at baseline and at 6 months. Data were analyzed using the SAS version 9.1 statistical program. Results The characteristics of the study population at first presentation to the cardiac clinic are similar (compared with controls): 0.91 % of the study patients were diagnosed as PPCM patients for the first time and 49 % patients presented within one month after delivery. C-reactive protein (22 vs 08 mg/dl, p \ 0.05), TNF-a (9.6 vs 3.2 pg/dl, p \ 001), and IL-6 (73.19 ± 34.4 vs 31.52 ± 8.83 pg/dl, p \ 0.005) were significantly abnormal, and these patients showed significantly higher LV dimensions, LV EDD (61.6 ± 7.1 vs 46 ± 9 mm p \ 0.004) LV ESD (53.1 ± 7 vs 32 ± 8, p \ 0.005), and significantly lower echocardiographic left ventricular ejection fraction (LVEF) (25.9 ± 8.2 vs 55 ± 12 p \ 0.001) and correlate well with NYHA FC and death. LVEF improved from 25.9 ± 8.2 to 42.9 ? 13.6 % at 6 months (p \ 0.0001). Patients who completed 6 months of standard care showed a significant reduction of heart rate, LV dimensions, and NYHA FC (p \ 0.001). However, normalization of LVEF ([50 %) was only observed in 11 (35 %) patients. Seven patients died within 6 months of diagnoses and eight patients were lost to follow-up. Conclusions Plasma markers of inflammation were significantly elevated in PPCM patients and correlated with increased LV dimensions and lower EF at presentation. Baseline CRP, IL-6, TNF-a, and higher NYHA FC were the only predictors of mortality. These results contribute to inflammation which may contribute to the pathogenesis of PPCM and its complications and predictors of mortality.

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Section: Discussionmentioning

confidence: 99%

“…Elevations of troponin T (TnT) appear to have prognostic significance in this group. The TnT level C0.04 ng/ml at presentation predicts persistence of systolic dysfunction with a sensitivity of 55 % and specificity of 91 % [8]. Inflammatory cytokines (TNF-a and IL-6) are elevated in women with PPCM compared to pregnancy controls [9,10].…”

Section: Introductionmentioning

confidence: 99%

Inflammatory Markers-Serum Level of C-Reactive Protein, Tumor Necrotic Factor-α, and Interleukin-6 as Predictors of Outcome for Peripartum Cardiomyopathy

Sarojini

Shanker

Anitha

2013

J Obstet Gynecol India

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“…This includes pentoxifylline, a drug reducing the production of TNF-alpha and preventing apoptosis, which despite the positive results of one study has not spread more widely 24 . The previously mentioned drug bromocriptine, a prolactin inhibitor used for years to suppress lactation, is currently often discussed.…”

Section: Discussionmentioning

confidence: 99%

The variable clinical course of peripartum cardiomyopathy

Krejčí¹,

Hude²,

Špinarová³

et al. 2014

BIOMED PAP

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“…31 However, this agent has not shown any benefit in randomised controlled trials in terms of resolution of symptoms and improvements in ventricular function. 32 A more recent, non-randomised prospective study has suggested a potential benefit for anti-tumour necrosis factor α therapy with pentoxyfylline 33 although trends have not yet been corroborated in more established studies.…”

Section: Current Researchmentioning

confidence: 99%