Effects of Allopurinol on Coronary Microvascular and Left Ventricular Function in Patients With Idiopathic Dilated Cardiomyopathy

被引:54
作者
Erdogan, Dogan [1 ]
Tayyar, Senol [1 ]
Uysal, Bayram Ali [1 ]
Icli, Atilla [1 ]
Karabacak, Mustafa [1 ]
Ozaydin, Mehmet [1 ]
Dogan, Abdullah [1 ]
机构
[1] Suleyman Demirel Univ, Dept Cardiol, Fac Med, TR-32200 Isparta, Turkey
关键词
CHRONIC HEART-FAILURE; XANTHINE-OXIDASE INHIBITORS; SERUM URIC-ACID; FLOW RESERVE; BLOOD-FLOW; DOPPLER-ECHOCARDIOGRAPHY; OXIDATIVE STRESS; DYSFUNCTION; OXIDOREDUCTASE; DETERMINANTS;
D O I
10.1016/j.cjca.2012.04.005
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Uric acid (UA) is an independent marker of mortality and associated with increased oxidative stress in patients with congestive heart failure (CHF). The present study aimed to investigate the effect of allopurinol on left ventricular (LV) function and coronary microvascular integrity in patients with idiopathic dilated cardiomyopathy (IDC). Methods: Thirty-nine consecutive IDC patients were divided into 2 groups: elevated (>7 mg/dL for men and >6.5 mg/dL for women; n = 24) and normal (n = 15) UA. Allopurinol 300 mg per day was given to the elevated UA group. Patients with elevated UA were assessed after a 3-month treatment period. Echocardiography assessing coronary flow reserve (CFR) and systolic and diastolic LV functions were studied. Results: LV ejection fraction was significantly lower in elevated UA group: mean (interquartile range), 32.3% (26.0-36.5%) vs 37.3% (35.5-39.1%) (P < 0.01). Also, CFR and LV diastolic and combined function parameters were more prominently impaired in the elevated UA group. After allopurinol treatment, UA was significantly decreased (7.2 mg/dL [6.8-7.8] to 4.4 mg/dL [3.9-5.8]; P < 0.001) and CFR was markedly improved (1.87 [1.63-2.00] to 2.20 [1.87-2.49]; P < 0.001). The therapeutic effect of allopurinol on the reduction of UA from baseline was directly related to the improvement of CFR (r = 0.49; P = 0.01). Mitral A and E/E' were reduced, while S', E', E/A, and E'/A' were increased significantly. Conclusions: The present study showed that 3-month treatment with allopurinol was significantly associated with reduced UA levels, and improvement of CFR and LV functions in patients with IDC and hyperuricemia.
引用
收藏
页码:721 / 727
页数:7
相关论文
共 33 条
[11]   The role of urate and xanthine oxidase inhibitors in cardiovascular disease [J].
George, Jacob ;
Struthers, Allan D. .
CARDIOVASCULAR THERAPEUTICS, 2008, 26 (01) :59-64
[12]   Elevated serum uric acid levels impair coronary microvascular function in patients with idiopathic dilated cardiomyopathy [J].
Gullu, Hakan ;
Erdogan, Dogan ;
Caliskan, Mustafa ;
Tok, Derya ;
Kulaksizoglu, Sevsen ;
Yildirir, Aylin ;
Muderrisoglu, HaIdun .
EUROPEAN JOURNAL OF HEART FAILURE, 2007, 9 (05) :466-468
[13]   VASODILATORY CAPACITY OF CORONARY RESISTANCE VESSELS IN DILATED CARDIOMYOPATHY [J].
INOUE, T ;
SAKAI, Y ;
MOROOKA, S ;
HAYASHI, T ;
TAKAYANAGI, K ;
YAMAGUCHI, H ;
KAKOI, H ;
TAKABATAKE, Y .
AMERICAN HEART JOURNAL, 1994, 127 (02) :376-381
[14]   CORONARY FLOW RESERVE IN PATIENTS WITH DILATED CARDIOMYOPATHY [J].
INOUE, T ;
SAKAI, Y ;
MOROOKA, S ;
HAYASHI, T ;
TAKAYANAGI, K ;
YAMANAKA, T ;
KAKOI, H ;
TAKABATAKE, Y .
AMERICAN HEART JOURNAL, 1993, 125 (01) :93-98
[15]   Vascular oxidative stress and endothelial dysfunction in patients with chronic heart failure - Role of xanthine-oxidase and extracellular superoxide dismutase [J].
Landmesser, U ;
Spiekermann, S ;
Dikalov, S ;
Tatge, H ;
Wilke, R ;
Kohler, C ;
Harrison, DG ;
Hornig, B ;
Drexler, H .
CIRCULATION, 2002, 106 (24) :3073-3078
[16]   Uric acid in chronic heart failure: A marker of chronic inflammation [J].
Leyva, F ;
Anker, SD ;
Godsland, IF ;
Teixeira, M ;
Hellewell, PG ;
Kox, WJ ;
Poole-Wilson, PA ;
Coats, AJS .
EUROPEAN HEART JOURNAL, 1998, 19 (12) :1814-1822
[17]  
Leyva F, 1997, EUR HEART J, V18, P858
[18]   The 2011 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: Focus on Sleep Apnea, Renal Dysfunction, Mechanical Circulatory Support, and Palliative Care [J].
McKelvie, Robert S. ;
Moe, Gordon W. ;
Cheung, Anson ;
Costigan, Jeannine ;
Ducharme, Anique ;
Estrella-Holder, Estrellita ;
Ezekowitz, Justin A. ;
Floras, John ;
Giannetti, Nadia ;
Grzeslo, Adam ;
Harkness, Karen ;
Heckman, George A. ;
Howlett, Jonathan G. ;
Kouz, Simon ;
Leblanc, Kori ;
Mann, Elizabeth ;
O'Meara, Eileen ;
Rajda, Miroslav ;
Rao, Vivek ;
Simon, Jessica ;
Swiggum, Elizabeth ;
Zieroth, Shelley ;
Arnold, J. Malcolm O. ;
Ashton, Tom ;
D'Astous, Michel ;
Dorian, Paul ;
Haddad, Haissam ;
Isaac, Debra L. ;
Leblanc, Marie-Helene ;
Liu, Peter ;
Sussex, Bruce ;
Ross, Heather J. .
CANADIAN JOURNAL OF CARDIOLOGY, 2011, 27 (03) :319-338
[19]   Xanthine oxidoreductase inhibition causes reverse remodeling in rats with dilated cardiomyopathy [J].
Minhas, KM ;
Saraiva, RM ;
Schuleri, KH ;
Lehrke, S ;
Zheng, MZ ;
Saliaris, AP ;
Berry, CE ;
Vandegaer, KM ;
Li, DC ;
Hare, JM .
CIRCULATION RESEARCH, 2006, 98 (02) :271-279
[20]   Prognostic role of myocardial blood flow impairment in idiopathic left ventricular dysfunction [J].
Neglia, D ;
Michelassi, C ;
Trivieri, MG ;
Sambuceti, G ;
Giorgetti, A ;
Pratali, L ;
Gallopin, M ;
Salvadori, P ;
Sorace, O ;
Carpeggiani, C ;
Poddighe, R ;
L'Abbate, A ;
Parodi, O .
CIRCULATION, 2002, 105 (02) :186-193