domingo, abril 10, 2011
Valvopatia induzida por drogas
Valvular heart disease associated with benfluorex therapy
Eur J Echocardiogr (2011) 12 (4): 265-271.
Methods and results Forty patients suffering from unexplained restrictive valvular disease with a previous exposition to benfluorex, a fenfluramine derivative, were identified from eight French university hospitals. Patients were mostly women (87.5%) with a mean age of 57 ± 9 years and high body mass index of 30 ± 7 kg/m²; 37.5% of them presented with severe heart failure symptoms (NYHA class III and IV). Benfluorex mean daily dose was 415 ± 131 mg with total therapy duration of 72 ± 53 months. Resulting cumulative dose was 910 ± 675 g. Common echocardiographic findings were leaflets and sub-valvular apparatus thickening and retraction. Aortic and mitral valve regurgitations resulting from leaflets loss of coaptation were the most frequent findings (87.5 and 82.5%) and were severe in 29 patients (72.5%). Multiple valve involvements were present in 31 cases (77.5%). Pulmonary arterial hypertension was identified in 20 cases (50%). Histopathological examination demonstrated abundant extra cellular matrix encasing the leaflets without modification of valve architecture. Fifteen patients (37.5%) underwent valvular surgery.
Conclusion Benfluorex-related valvulopathy shares numerous characteristics with other drug-induced valvular disease. Clinical consequences may be serious with severe heart failure symptoms that may lead to surgical treatment.
É curiosa essa associação de anorexígenos com valvopatias. Demonstrada ha mais de 10 anos, provoca uma degeneração da valva. Qual mecanismo está envolvido? Parece que o anorexígeno interfere com a matrix extracelular. Acredito que o tratamento farmacológico da obesidade e a degeneração valvar apontam um caminho comum, que envolveria IMC baixo, Marfan e matrix extracelular. Em nosso trabalho publicado na mesma revista, mostramos o IMC baixo relacionado ao Prolapso da valva mitral e IMC abaixo da média.