RANDOMIZED INVESTIGATION OF EFFECTS OF PENTOXIFYLLINE ON LEFT-VENTRICULAR PERFORMANCE IN IDIOPATHIC DILATED CARDIOMYOPATHY

Background There is accumulating evidence that inflammatory cytokines have an important role in the pathogenesis of heart failure, Plasma co ncentrations of tumour necrosis factor a (TNF-alpha) are high in heart failure and have been correlated with the severity of symptoms. Pento xifylline suppresses the production of TNF-alpha. This study aimed to assess the effects of pentoxifylline on left-ventricular function and functional class in patients with idiopathic dilated cardiomyopathy. M ethods We undertook a single-centre, prospective, double-blind, random ised, placebo-controlled trial, in which 28 patients with idiopathic d ilated cardiomyopathy were assigned pentoxifylline 400 mg three times daily or matching placebo. Clinical, echocardiographic, and radionucli de assessments were done at baseline and after 6 months of treatment, Primary endpoints were New York Heart Association (NYHA) functional cl ass and left-ventricular function. Findings Baseline characteristics w ere similar in the two groups. Four patients died during the study per iod, all in the placebo group. After 6 months of treatment, the propor tion of patients in NYHA functional class I or II was higher in the pe ntoxifylline group than in the placebo group (14/14 vs 10/14; p=0.01), and ejection fraction was higher in the pentoxifylline group than in the placebo group (mean 38.7% [SD 15.0] vs 26.8% [11.0], p=0.04). At 6 months, TNF-alpha plasma concentrations were significantly lower in t he pentoxifylline-treated group than in the placebo group (2.1 [1.0] v s 6.5 [5.0] pg/mL, p=0.001). Interpretation Our results suggest that p entoxifylline improves symptoms and left-ventricular systolic function in patients with idiopathic dilated cardiomyopathy. These results mus t be confirmed in larger-scale trials.