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Case shows reversible mitral regurgitation with pioglitazone
12 May 2008
MedWire News: Researchers report the case of a man who developed reversible mitral regurgitation during 6 months' treatment with pioglitazone.
They say it highlights the importance of carefully monitoring patients receiving treatment with thiazolidinediones.
Magnus Dencker (Lund University, Malmö, Sweden) and colleagues report in the journal Cardiovascular Diabetology the case of a 60-year-old man with Type 2 diabetes with proliferative retinopathy and microalbuminuria.
The patient had no history or clinical signs of cardiovascular disease on entering an ongoing study, in which he received add-on treatment (on top of metformin and glimepiride) with pioglitazone for 6 months, at a dose of 30 mg/day for the first 16 weeks, which was thereafter increased to 45 mg/day.
At 26 weeks, the patient's plasma hemoglobin A1c had decreased from >10% at baseline to 7.4% in parallel with a decrease in hemoglobin from 113 g/l to 100 g/l, a 3-kg increase in weight, and an increase in plasma brain natriuretic peptide (BNP) from 5 to 22 pmol/l. These changes indicated the development of fluid retention.
Echocardiography measurements revealed trivial mitral regurgitation at baseline and newly developed moderate mitral regurgitation with a predominantly central jet at 6 months.
Ejection fraction and left ventricular (LV) and atrial dimensions had also increased from baseline at 6 months, with a slight increase in estimate of LV filling pressure.
All echocardiography changes and indicators of fluid retention returned to baseline values 6 months after the discontinuation of pioglitazone therapy.
"It is noteworthy that 6 months' treatment with pioglitazone could induce significant valve dysfunction, which was reversible," the authors write.
They suggest that the development of mitral regurgitation could be due to the fluid retention causing LV dilatation, which in turn leads to mitral annular dilatation, altered papillary muscle orientation, and inadequate mitral leaflet coaptation.
