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 xanthine-derived agent known to inhibit the production of tumor necrosis factor-␣, in patients with idiopathic dilated cardiomyopathy treated with diuretics, digoxin, and ACE inhibitors. Since then, 3 large clinical trials showed important clinical benefits of ␤-blockers in this population. Therefore, we designed the present study to establish whether in patients with heart failure already receiving treatment with ACE
... bitors and ␤-blockers, the addition of pentoxifylline would have an additive beneficial effect. Methods and Results-In a single-center, prospective, double-blind, randomized, placebo-controlled study, 39 patients with idiopathic dilated cardiomyopathy were randomized to pentoxifylline 400 mg TID (nϭ20) or placebo (nϭ19) if they had a left ventricular ejection fraction Ͻ40% after 3 months of therapy with digoxin, ACE inhibitors, and carvedilol. Primary end points were New York Heart Association functional class, exercise tolerance, and left ventricular function. Patients were followed up for 6 months. Five patients died (3 in the placebo group). Patients treated with pentoxifylline had a significant improvement in functional class compared with the placebo group (Pϭ0.01), with an increment in exercise time from 9.5Ϯ5 to 12.3Ϯ6 minutes (Pϭ0.1). Left ventricular ejection fraction improved from 24Ϯ9% to 31Ϯ13%, Pϭ0.03, in the treatment group. Conclusions-In patients with idiopathic dilated cardiomyopathy, the addition of pentoxifylline to treatment with digoxin, ACE inhibitors, and carvedilol is associated with a significant improvement in symptoms and left ventricular function.