Pentoxyphylline: possibilities to reduce manifestations of chronic heart failure with preserved left ventricular ejection fraction in elderly
Keywords:chronic heart failure with preserved left ventricular ejection fraction, pentoxifylline, diastolic dysfunction, quality of life, aged
The aim: to study the effect of add-on pentoxifylline therapy on the structural and functional indicators of the heart state, endothelial function, quality of life and physical abilities in patients with chronic heart failure with preserved left ventricular ejection fraction.
Materials and methods. The indicators of the structural and functional state of the heart, endothelial function, quality of life and physical abilities of patients older than 60 years, who were followed-up in the Department of Cardiology of the State Institution “D. F. Chebotarev Institute of Gerontology of the NAMS of Ukraine”, based on 67 case histories, 37 of them were prescribed pentoxifylline as add-on therapy to the standard therapeutic regimen. Statistical data were calculated using modern application packages, in particular SPSS v.22, Statistica 7.0, MedCalc statical software v.22.214.171.124. The significance level was assessed using paired and unpaired Student's t-test with Bonferroni corrections, and the correlation and two-way analysis of variance were performed.
Results. A significant additional effect of pentoxifylline treatment on the indicators of maximum blood flow in the forearm microvessels in response to the reactive hyperemia test, which characterizes the ability of the microvessel endothelium to synthesize relaxation factors, was detected. Patients who additionally received pentoxifylline showed significantly better indicators of left ventricular myocardial relaxation and reduction of hypertrophy than those on the standard therapy. There was a significant increase in walking distance in the third year of treatment in the patients who additionally received pentoxifylline. There was no difference in the impact on the quality of life of the patients.
Conclusions. The addition of pentoxifylline to the standard therapy in patients with chronic heart failure with preserved left ventricular ejection fraction significantly reduces myocardial hypertrophy, improves diastolic relaxation, increases volumetric blood flow velocity in microvessels mediating reactive hyperemia, which may contribute to further stabilizing the clinical course of the disease and increasing 6-minute walking distance. The presented data are an additional evidence of pathogenetically reasonable therapy with pentoxifylline in patients with chronic heart failure with preserved left ventricular ejection fraction, which allows us to consider this drug as potentially promising for the routine treatment of such patients.
Voronkov, L. G. (2017). Korrektsiya disfunktsii endoteliya kak klyuchevoe zveno v kardiovaskulyarnoi i tserebrovaskulyarnoi farmakoterapii: aktual'nost' novykh podkhodov [Treatment of endothelial dysfunction as a key link in a cardiovascular and cerebrovascular pharmacotherapy: the urgency of new approaches]. Kardiologiya: ot nauki k praktike, (3), 33-47. [in Russian].
Voronkov, L. G. (2012). Patsiient iz KhSN v Ukraini: analiz usiiei populiatsii patsiientiv, obstezhenykh u ramkakh pershoho natsionalnoho zrizovoho doslidzhennia UNIVERS [A patient with CHF in Ukraine: an analysis of all population of patients examined in the first national cross-sectional study UNIVERS]. Sertseva nedostatnist, (1), 8-12. [in Ukrainian].
Gavryushina, S. V., & Ageyev, F. T. (2018). Serdechnaya nedostatochnost' s sokhranennoi fraktsiei vybrosa levogo zheludochka: epidemiologiya, «portret» bol'nogo, klinika, diagnostika [Heart failure with preserved left ventricular ejection fraction: epidemiology, patient «portrait», clinic and diagnostics]. Kardiologiya, 58(4S), 55-64. https://doi.org/10.18087/cardio.2467 [in Russian].
Yena, L. M., & Yarosh, V. A. (2016). Endotelialna dysfunktsiia i yii vzaiemozv’iazok iz morfofunktsionalnym stanom sertsia ta arterii u patsiientiv z hipertonichnoiu khvoroboiu, uskladnenoiu khronichnoiu sertsevoiu nedostatnistiu zi zberezhenoiu fraktsiieiu vykydu livoho shlunochka [Endothelial dysfunction and its relationship with morphofunctional characteristics of arteries and heart in hypertensive patients with complicated chronic heart failure with preserved left ventricular ejection fraction]. Sertse i sudyny, (3), 71-76. [in Ukrainian].
Korkushko, O. V., Zharinova, V. Yu., Bodretskaya, L. А., Igrunova, K. N., Yakovlev, B. P., Samots, I. А., & Mazaev, Yu. А. (2013). Vliyanie pentoksifillina na pokazateli gemovaskulyarnogo gomeostaza, tsentral'noi gemodinamiki, uroven' markerov vospaleniya i vyrazhennost' apoptoza u patsientov pozhilogo vozrasta s IBS [Effects of pentoxifylline on hemovascular homeostasis, central hemodynamic, level of inflammation markers and apoptosis in elderly patients with IHD]. Krovoobih ta hemostaz, (3-4), 22-27. [in Russian].
Syvolap, V. V., & Kurilets, L. O. (2014). Osoblyvosti diastolichnoi funktsii livoho shlunochka u khvorykh na nehospitalnu pnevmoniiu [Features of the left ventricle diastolic function in patients with community acquired pneumonia]. Zaporozhye medical journal, (2), 32-35. https://doi.org/10.14739/2310-1210.2014.2.25322 [in Ukrainian].
Pieske, B., Tschöpe, C., de Boer, R. A., Fraser, A. G., Anker, S. D., Donal, E., Edelmann, F., Fu, M., Guazzi, M., Lam, C., Lancellotti, P., Melenovsky, V., Morris, D. A., Nagel, E., Pieske-Kraigher, E., Ponikowski, P., Solomon, S. D., Vasan, R. S., Rutten, F. H., Voors, A. A., … Filippatos, G. (2019). How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). European Heart Journal, 40(40), 3297-3317. https://doi.org/10.1093/eurheartj/ehz641
Chun, S., Tu, J. V., Wijeysundera, H. C., Austin, P. C., Wang, X., Levy, D., & Lee, D. S. (2012). Lifetime Analysis of Hospitalizations and Survival of Patients Newly Admitted With Heart Failure. Circulation: Heart Failure, 5(4), 414-421. https://doi.org/10.1161/CIRCHEARTFAILURE.111.964791
Franssen, C., Chen, S., Unger, A., Korkmaz, H. I., De Keulenaer, G. W., Tschöpe, C., Leite-Moreira, A. F., Musters, R., Niessen, H. W., Linke, W. A., Paulus, W. J., & Hamdani, N. (2016). Myocardial Microvascular Inflammatory Endothelial Activation in Heart Failure With Preserved Ejection Fraction. JACC: Heart failure, 4(4), 312-324. https://doi.org/10.1016/j.jchf.2015.10.007
Lam, C. S., Donal, E., Kraigher-Krainer, E., & Vasan, R. S. (2011). Epidemiology and clinical course of heart failure with preserved ejection fraction. European Journal of Heart Failure, 13(1), 18-28. https://doi.org/10.1093/eurjhf/hfq121
Levine, B., Kalman, J., Mayer, L., Fillit, H. M., & Packer, M. (1990). Elevated Circulating Levels of Tumor Necrosis Factor in Severe Chronic Heart Failure. The New England Journal of Medicine, 323(4), 236-241. https://doi.org/10.1056/NEJM199007263230405
Paulus, W. J., & Tschöpe, C. (2013). A Novel Paradigm for Heart Failure With Preserved Ejection Fraction: Comorbidities Drive Myocardial Dysfunction and Remodeling Through Coronary Microvascular Endothelial Inflammation. Journal of the American College of Cardiology, 62(4), 263-271. https://doi.org/10.1016/j.jacc.2013.02.092
Shah, R. V., Desai, A. S., & Givertz, M. M. (2010). The Effect of Renin-Angiotensin System Inhibitors on Mortality and Heart Failure Hospitalization in Patients With Heart Failure and Preserved Ejection Fraction: A Systematic Review and Meta-Analysis. Journal of Cardiac Failure, 16(3), 260-267. https://doi.org/10.1016/j.cardfail.2009.11.007
Ul Haq, M. A., Wong, C., & Hare, D. L. (2015). Heart failure with preserved ejection fraction: an insight into its prevalence, predictors, and implications of early detection. Reviews in Cardiovascular Medicine, 16(1), 20-27. https://doi.org/10.3909/ricm0725
McCarty, M. F., O'Keefe, J. H., & DiNicolantonio, J. J. (2016). Pentoxifylline for vascular health: a brief review of the literature. Open Heart, 3(1), Article e000365. https://doi.org/10.1136/openhrt-2015-000365
Belenkov, Yu. N., Mareev, V. Yu., Ageev, F. T., Fomin, I. V., Badin, Yu. V., Polyakov, D. S., Danielyan, M. O., Artem'eva, E. G., Malenkova, V. Yu., Poroshina, E. A., Tarlovskaya, E. I., Smirnova, E. A., Yakushin, S. S., & Shcherbinina, E. V. (2011). Istinnaya rasprostranennost' KhSN v Evropeiskoi chasti Rossiiskoi Federatsii (issledovanie EPOKhA, gospital'nyi etap) [Veritable prevalence of CHF in the European part of Russian Federation (EPOCHA trial, hospital stage)]. Zhurnal Serdechnaya Nedostatochnost', (2), 63-68. [in Russian].
How to Cite
LicenseAuthors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)