Cargando…

Allopurinol and global left myocardial function in heart failure patients

BACKGROUND AND AIM: Increased xanthine oxidase (XO) activity may contribute to heart failure pathophysiology. This study evaluated whether a XO inhibitor, allopurinol produces clinical and functional benefits in patients with New York Heart Association functional class III to IV heart failure due to...

Descripción completa

Detalles Bibliográficos
Autores principales: Nasr, Gamela, Maurice, Cherine
Formato: Texto
Lenguaje:English
Publicado: Medknow Publications 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3023896/
https://www.ncbi.nlm.nih.gov/pubmed/21264183
http://dx.doi.org/10.4103/0975-3583.74262
_version_ 1782196724049117184
author Nasr, Gamela
Maurice, Cherine
author_facet Nasr, Gamela
Maurice, Cherine
author_sort Nasr, Gamela
collection PubMed
description BACKGROUND AND AIM: Increased xanthine oxidase (XO) activity may contribute to heart failure pathophysiology. This study evaluated whether a XO inhibitor, allopurinol produces clinical and functional benefits in patients with New York Heart Association functional class III to IV heart failure due to systolic dysfunction receiving optimal medical therapy as estimated by global left myocardial function. PATIENTS AND METHODS: Fifty-nine patients with a diagnosis of chronic heart failure due to coronary heart disease or idiopathic dilated cardiomyopathy and 20 healthy controls who attended the outpatient clinic of cardiology were subjected to full echocardiographic study including left ventricular diastolic and systolic function, and the combined index of myocardial performance [Tei index: isovolumetric relaxation time (IRT) + isovolumetric contraction time (ICT)/ejection time (ET)]. Patients were randomized to allopurinol (300 mg/day) or placebo. Improvement at 36 weeks was assessed using a composite end point comprising global left cardiac function as well as heart failure morbidity and mortality. RESULTS: The percentage of patients characterized as improved, unchanged, or worsened did not differ between those receiving allopurinol or placebo. Allopurinol reduced serum uric acid (SUA) by 1.5 mg/dL (P = 0.001). In a subgroup analysis, patients with elevated SUA (more than 7mg/ dL) responded favorably to allopurinol whereas those with SUA less than 7mg/dL exhibited a trend toward no change. In addition, SUA reduction to allopurinol correlated with favorable clinical and functional response. Within the entire allopurinol patient cohort, those characterized as either improved or unchanged had significantly greater reductions in SUA compared with patients who did not change (P = 0.0007). In placebo patients, lower baseline SUA, but not change in SUA, correlated with improved clinical outcome. CONCLUSIONS: Allopurinol did not produce significant clinical and functional improvement in unselected patients with moderate-to-severe heart failure. However, it is suggested that it is useful in patients with elevated SUA in a manner according to degree of SUA reduction. SUA may serve as a valuable biomarker to target heart failure therapy.
format Text
id pubmed-3023896
institution National Center for Biotechnology Information
language English
publishDate 2010
publisher Medknow Publications
record_format MEDLINE/PubMed
spelling pubmed-30238962011-01-24 Allopurinol and global left myocardial function in heart failure patients Nasr, Gamela Maurice, Cherine J Cardiovasc Dis Res Original Paper BACKGROUND AND AIM: Increased xanthine oxidase (XO) activity may contribute to heart failure pathophysiology. This study evaluated whether a XO inhibitor, allopurinol produces clinical and functional benefits in patients with New York Heart Association functional class III to IV heart failure due to systolic dysfunction receiving optimal medical therapy as estimated by global left myocardial function. PATIENTS AND METHODS: Fifty-nine patients with a diagnosis of chronic heart failure due to coronary heart disease or idiopathic dilated cardiomyopathy and 20 healthy controls who attended the outpatient clinic of cardiology were subjected to full echocardiographic study including left ventricular diastolic and systolic function, and the combined index of myocardial performance [Tei index: isovolumetric relaxation time (IRT) + isovolumetric contraction time (ICT)/ejection time (ET)]. Patients were randomized to allopurinol (300 mg/day) or placebo. Improvement at 36 weeks was assessed using a composite end point comprising global left cardiac function as well as heart failure morbidity and mortality. RESULTS: The percentage of patients characterized as improved, unchanged, or worsened did not differ between those receiving allopurinol or placebo. Allopurinol reduced serum uric acid (SUA) by 1.5 mg/dL (P = 0.001). In a subgroup analysis, patients with elevated SUA (more than 7mg/ dL) responded favorably to allopurinol whereas those with SUA less than 7mg/dL exhibited a trend toward no change. In addition, SUA reduction to allopurinol correlated with favorable clinical and functional response. Within the entire allopurinol patient cohort, those characterized as either improved or unchanged had significantly greater reductions in SUA compared with patients who did not change (P = 0.0007). In placebo patients, lower baseline SUA, but not change in SUA, correlated with improved clinical outcome. CONCLUSIONS: Allopurinol did not produce significant clinical and functional improvement in unselected patients with moderate-to-severe heart failure. However, it is suggested that it is useful in patients with elevated SUA in a manner according to degree of SUA reduction. SUA may serve as a valuable biomarker to target heart failure therapy. Medknow Publications 2010 /pmc/articles/PMC3023896/ /pubmed/21264183 http://dx.doi.org/10.4103/0975-3583.74262 Text en © Journal of Cardiovascular Disease Research http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Paper
Nasr, Gamela
Maurice, Cherine
Allopurinol and global left myocardial function in heart failure patients
title Allopurinol and global left myocardial function in heart failure patients
title_full Allopurinol and global left myocardial function in heart failure patients
title_fullStr Allopurinol and global left myocardial function in heart failure patients
title_full_unstemmed Allopurinol and global left myocardial function in heart failure patients
title_short Allopurinol and global left myocardial function in heart failure patients
title_sort allopurinol and global left myocardial function in heart failure patients
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3023896/
https://www.ncbi.nlm.nih.gov/pubmed/21264183
http://dx.doi.org/10.4103/0975-3583.74262
work_keys_str_mv AT nasrgamela allopurinolandgloballeftmyocardialfunctioninheartfailurepatients
AT mauricecherine allopurinolandgloballeftmyocardialfunctioninheartfailurepatients