Cheng Alice Y Y, Fantus I George
Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada.
Ann Pharmacother. 2004 May;38(5):817-20. doi: 10.1345/aph.1D400. Epub 2004 Mar 23.
To report 2 cases of thiazolidinedione (TZD)-associated congestive heart failure (CHF). As of March 13, 2004, one of the cases may represent the first description of TZD-associated cardiomyopathy in humans. case summaries: A 57-year-old obese white man with type 2 diabetes was treated with pioglitazone 30 mg/day and insulin. He had no prior history of CHF and had an excellent exercise tolerance. Over the first 4 weeks of pioglitazone therapy, the patient experienced significant weight gain and subsequently developed CHF and pulmonary edema. A 50-year-old obese white man with type 2 diabetes presented with cardiogenic shock. Rosiglitazone 4 mg once daily had been initiated 6 weeks prior to presentation. He had no prior history of cardiac disease, and investigations did not reveal a cause for the cardiogenic shock. Rosiglitazone therapy was discontinued on admission. He improved and was discharged 21 days later.
TZDs are oral agents used for the treatment of type 2 diabetes. TZD-associated CHF and pulmonary edema have been reported in patients with a prior history of CHF. These 2 cases highlight that this adverse event can occur even in the absence of any preexisting history of clinical heart failure or cardiac disease. The second case may represent the first description of TZD-associated cardiomyopathy in humans. In both cases, an objective causality assessment using the Naranjo probability scale revealed that the adverse drug reaction between cardiomyopathy and rosiglitazone in this patient was probable.
TZD should be considered as a cause in the differential diagnosis of CHF and pulmonary edema in patients without a prior history of clinical CHF or cardiac disease. Healthcare professionals should be aware of the possible association between TZDs and cardiomyopathy.
报告2例噻唑烷二酮类药物（TZD）相关的充血性心力衰竭（CHF）病例。截至2004年3月13日，其中1例可能是人类首例TZD相关心肌病的描述。病例摘要：1例57岁肥胖白人2型糖尿病男性患者，接受每日30mg吡格列酮及胰岛素治疗。他既往无CHF病史，运动耐量良好。在吡格列酮治疗的前4周，患者体重显著增加，随后发生CHF和肺水肿。1例50岁肥胖白人2型糖尿病男性患者出现心源性休克。在出现症状前6周开始每日服用4mg罗格列酮。他既往无心脏病史，检查未发现心源性休克的病因。入院时停用罗格列酮治疗。他病情好转，21天后出院。
TZD是用于治疗2型糖尿病的口服药物。既往有CHF病史的患者中曾报告过TZD相关的CHF和肺水肿。这2例病例突出表明，即使在没有任何临床心力衰竭或心脏病既往史的情况下，也可能发生这种不良事件。第2例病例可能是人类首例TZD相关心肌病的描述。在这2例病例中，使用Naranjo概率量表进行的客观因果关系评估显示，该患者心肌病与罗格列酮之间的药物不良反应很可能存在。
在无临床CHF或心脏病既往史的患者中，CHF和肺水肿的鉴别诊断应考虑TZD为病因之一。医疗保健专业人员应意识到TZD与心肌病之间可能存在的关联。
