The Effect of Cilostazol on Right Heart Function and Pulmonary Pressure

Abstract

SUMMARYIntroduction: Cilostazol is a PDE3 inhibitor and used to treat peripheral arterial disease. There are few reports on the influence of cilostazol on heart. Aims: The aim of this study was to assess this effect on right ventricular function and pulmonary artery pressure. Methods: Forty patients with normal left and right ventricular ejection fraction and mild or moderate pulmonary artery hypertension were enrolled in the study. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), tissue Doppler imaging (TDI), and two-dimensional speckle-tracking echocardiography (2D-STE) before and after oral administration of cilostazol. Also pulmonary artery pressure assessed before and after administration of cilostazol. Results: After cilostazol administration, there were significant increases in the TAPSE (1.9 AE 0.3 cm vs. 2.2 AE 0.3 cm, P < 0.001). Peak longitudinal strain (À18.7 AE 4.5% vs. À21.3 AE 3.7%, P = 0.001), isovolumetric acceleration (IVA) (176.6 AE 62.7 cm/sec 2 vs. 200.6 AE 61.9 cm/

Update on Cilostazol: A Critical Review of Its Antithrombotic and Cardiovascular Actions and Its Clinical Applications

“…According to a study of 56 patients with acute MI (27 receiving a conventional antiplatelet regimen with cilostazol and 29 without cilostazol) who were managed with coronary stenting, and had serial echocardiographic studies within 24 hours and at 6 months, cilostazol had no harmful effect on left ventricular (LV) remodeling or LV function after acute MI 84 . An echocardiography study showed that cilostazol ameliorated right ventricular systolic function and lowered pulmonary artery pressure in 40 patients with normal left and right ventricular ejection fraction and mild or moderate pulmonary hypertension 85 …”

“…84 An echocardiography study showed that cilostazol ameliorated right ventricular systolic function and lowered pulmonary artery pressure in 40 patients with normal left and right ventricular ejection fraction and mild or moderate pulmonary hypertension. 85 Cilostazol has a favorable positive chronotropic action in patients with bradyarrhythmias, particularly slow atrial fibrillation and sinus node dysfunction. 86 In a small study of 13 patients with chronic atrial fibrillation associated with bradycardia (minimal heart rate <40/min and/or pauses, ie, episodes with an RR interval >2.5 sec), cilostazol improved the slow ventricular rate and maintained heart-rate variability.…”

Roles of A-Kinase Anchoring Proteins and Phosphodiesterases in the Cardiovascular System

“…In addition, it is also approved for the treatment of intermittent claudication-induced symptoms [ 170 , 171 , 172 ]. Cilostazol appears to be a promising therapeutic agent for secondary prevention of stroke and was shown to improve right ventricular systolic function as well as to decrease pulmonary artery pressure [ 167 , 173 ]. PDE3 inhibitors inhibit neointima formation in a rat balloon double-injury model displaying neither cytotoxicity nor effects on VSMC migration, and thus are considered targets in preventing acute re-occlusion after angioplasties, e.g., percutaneous transluminal coronary angioplasty (PTCA) [ 174 ].…”

New Developments in the Pharmacological Treatment of Hypertension: Dead-End or a Glimmer at the Horizon?

“…A PDE3 inhibitor, cilostazol, is used to improve walking distance in patients with intermittent claudication. Cilostazol also attenuated pulmonary hypertension in rats [ 33 ] and improved right ventricle function and reduced pulmonary artery pressure in patients with right heart failure or moderate pulmonary arterial hypertension [ 34 ]. Due to its selectivity, cilostazol does not exert an influence on systemic blood pressure [ 35 ] and is not investigated for the treatment of hypertension.…”