Beneficial effects of pentoxifylline in patients with idiopathic dilated cardiomyopathy treated with angiotensin-converting enzyme inhibitors and carvedilol - Results of a randomized study

Background-We previously reported beneficial effects of pentoxifylline, a x anthine-derived agent known to inhibit the production of tumor necrosis fac tor-alpha, in patients with idiopathic dilated cardiomyopathy treated with diuretics, digoxin, and ACE inhibitors, Since then, 3 large clinical trials showed important clinical benefits of P-blockers in this population. There fore, we designed the present study to establish whether in patients with h eart failure already receiving treatment with ACE inhibitors and beta -bloc kers, the addition of pentoxifylline would have an additive beneficial effe ct. Methods and Results-In a single-center, prospective, double-blind, randomiz ed, placebo-controled study, 39 patients with idiopathic dilated cardiomyop athy were randomized to pentoxifylline 400 mg TLD (n=20) or placebo (n=19) if they had a left ventricular ejection fraction <40% after 3 months of the rapy with digoxin, ACE inhibitors, and carvedilol. Primary end points were New York Heart Association functional class, exercise tolerance, and left v entricular function, Patients were followed up for 6 months. Five patients died (3 in the placebo group). Patients treated with pentoxifylline had a s ignificant improvement in functional class compared with the placebo group (P=0.01), with an increment in exercise rime from 9.5+/-5 to 12.3+/-6 minut es (P=0.1). Left ventricular ejection fraction improved from 24+/-9% to 31/-13%, P=0.03, in the treatment group. Conclusions-In patients with idiopathic dilated cardiomyopathy, the additio n of pentoxifylline to treatment with digoxin, ACE inhibitors, and carvedil ol is associated with a significant improvement in symptoms and left ventri cular function.