Ryan D H, Bray G A, Helmcke F, Sander G, Volaufova J, Greenway F, Subramaniam P, Glancy D L
Pennington Biomedical Research Center, Baton Rouge, LA 70808-4124, USA.
Obes Res. 1999 Jul;7(4):313-22. doi: 10.1002/j.1550-8528.1999.tb00414.x.
The prevalence of cardiac valvular regurgitation demonstrated by echocardiography in patients who took appetite-suppressant medication for weight loss has been assessed at 5%-30%. We studied 86 patients who had echocardiograms before treatment with appetite suppressants to determine the incidence of new cases and to evaluate the clinical implication of the echocardiographic findings.
We studied 69 men [Mean+/-Standard Deviation (S) age 49+/-8] and 17 women (mean+/-S age 50+/-7) who had 233 echocardiograms before, during, and after a weight-loss program that used predominantly fenfluramine (or dexfenfluramine) with mazindol (or phentermine). Mean drug exposure was 17 months. Blinded echocardiographic readings were performed to identify and grade aortic regurgitation (AR) or mitral regurgitation (MR).
Seven of 86 patients (8%) had pre-existing regurgitation with five (6%) meeting our case definition. Thirteen (16.5%) of initially normal patients developed valvular regurgitation and were new cases. Of the new cases, 12 were grade I/IV AR and one was both grade II/III MR and II/IV AR. All 13 patients were asymptomatic, and only two aortic insufficiency murmurs could be auscultated. There was significantly greater risk for developing valvulopathy for those who took medications longer than 6 months (p = 0.03), and no new cases were observed in patients exposed for less than 8 months. No increased risk associated with age, presence of hypertension, or exposure to fenfluramine-phentermine combination was demonstrated. Although there was a higher incidence of new regurgitation in women (31% vs. 13% for men), this was not statistically significant (p = 0.093).
Some patients who had normal echocardiograms at baseline developed cardiac valvular regurgitation after exposure to fenfluramine or dexfenfluramine with mazindol or phentermine. The development of valvulopathy was significantly correlated with duration of exposure. The clinical implications of echocardiographically demonstrated regurgitation are uncertain, since there were only two audible murmurs and no other clinically relevant signs or symptoms among the patients.
通过超声心动图检查发现，服用食欲抑制药物进行减肥的患者中，心脏瓣膜反流的患病率为5% - 30%。我们研究了86例在接受食欲抑制剂治疗前进行超声心动图检查的患者，以确定新发病例的发生率，并评估超声心动图检查结果的临床意义。
我们研究了69名男性（平均±标准差年龄49±8岁）和17名女性（平均±标准差年龄50±7岁），他们在一个主要使用芬氟拉明（或右芬氟拉明）与马吲哚（或苯丁胺）的减肥计划之前、期间和之后进行了233次超声心动图检查。平均药物暴露时间为17个月。进行了盲法超声心动图读数，以识别和分级主动脉反流（AR）或二尖瓣反流（MR）。
86例患者中有7例（8%）存在既往反流，其中5例（6%）符合我们的病例定义。13例（16.5%）最初正常的患者出现了瓣膜反流，为新发病例。在新发病例中，12例为I/IV级AR，1例为II/III级MR和II/IV级AR。所有13例患者均无症状，仅可闻及2例主动脉瓣关闭不全杂音。服用药物超过6个月的患者发生瓣膜病的风险显著更高（p = 0.03），暴露时间少于8个月的患者未观察到新发病例。未发现与年龄、高血压的存在或芬氟拉明 - 苯丁胺联合用药相关的风险增加。尽管女性新反流的发生率较高（31%对男性的13%），但差异无统计学意义（p = 0.093）。
一些基线超声心动图正常的患者在接触芬氟拉明或右芬氟拉明与马吲哚或苯丁胺后出现了心脏瓣膜反流。瓣膜病的发生与暴露时间显著相关。超声心动图显示的反流的临床意义尚不确定，因为患者中仅可闻及2例杂音，且无其他临床相关体征或症状。
