Abstract

THE POSSIBLE BENEFICIAL EFFECT OF ALLOPURINOL, XANTHINE OXIDASE INHIBITOR, IN PATIENTS WITH SYSTOLIC HEART FAILURE

Ali M. Abbas Al-Ateya*, Dr. Ibrahim A. Majeed and Dr. Qais.A.AL-jazarri

Abstract

Objective: Evaluated the beneficial effects of Allopurinol on left ventricular remodeling and function in patients with chronic heart failure and documented LV systolic dysfunction(LVEF ≤ 50%) on optimal drug therapy for HF. Background : Reactive oxygen species are important mediators of myocardial remodeling, myocyte hypertrophy, and myocardial fibrosis; xanthine oxidase produces ROS such as superoxide and increase oxidative stress and cardiac remodeling; so, xanthine oxidase inhibitor; Allopurinol reduces ventricular remodeling and improve left ventricular function. Also by blocking xanthine oxidase allopurinol might prevent oxygen losing and thereby increase the supply of molecular oxygen in the ischemic tissue.These due to xanthine oxidase is known to use molecular oxygen to produce oxidative stress. Methods: Only 60 patients included. All patients diagnosed as having chronic heart failure and documented LV systolic dysfunction (LVEF ≤ 50%). Patients divided as follows: Group one includes 20 patients with normal serum uric acid receiving the study drug Allopurinol (300mg twice daily) along with standard medication as assessed by their treating physicians. Group two: includes 20 patients with high serum uric acid receiving the study drug Allopurinol (300mg twice daily) along with standard medication as assessed by their treating physicians. Group three (control): includes 20 patients with normal serum uric acid receiving the standard medication as assessed by their treating physicians. The duration of treatment was two months. The Patients assessed for the following parameters at the baseline, one month and two months after treatment: Oxidized low density lipoprotein (oxLDL), total oxidant status(TAS), N-Terminal proBrain Natriuretic peptide (NTproBNP), high-sensitivity C-reactive protein(hs-CRP) ,left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV) and left ventricular endsystolic volume(LVESV). Results: Group one and group two showed a significant lowering of uric acid, oxLDL, hs- CRP, and NTproBNP.Only group two showed a significant increasing of TAS. Group one and group two showed a significant increasing in left ventricular ejection fraction (LVEF). Group one and group two showed a significant lowering of left ventricular end systolic volume (LVESV) and left ventricular end diastolic volume (LVEDV). Conclusions: allopurinol in high doses produce many positive effects on remodeling and function of the left ventricule in patients with chronic heart failure and normal or high uric acid level.

Keywords: Allopurinol; chronic heart failure; oxidative stress; uric acid level.