Diet drug related cardiac valve disease

The Mayo clinic echocardiographic laboratory experience

C. Y. Teramae, H. M. Connolly, Martha Grogan, Fletcher A Jr. Miller

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objective: To describe the prevalence of diet drug-related valvular disease among our referral population and the association of valvular disease with duration of exposure to fenfluramine and phentermine in combination and to dexfenfluramine alone. Patients and Methods: In this retrospective review of clinical and echocardiographic data, charts of patients referred for treatment of toxic effects of diet drugs were reviewed, and telephone interviews were conducted. Results: Between June and December 1997, 191 patients (164 women, 27 men; mean age, 47 years) were referred for possible diet drug-related valvular disease. Twenty-eight (28%) of the 99 asymptomatic patients and 40 (43%) of the 92 symptomatic patients had abnormal echocardiographic findings. Valvular lesions among the 68 patients with abnormal echocardiographic findings included mild (or greater) aortic regurgitation in 55 patients (81%), moderate (or greater) mitral regurgitation in 12 (18%), and moderate (or greater) tricuspid regurgitation in 7 (10%). The Food and Drug AdministratiOn case definition of diet drug- related valvulopathy was noted in 31% of this referral population. Of patients with valvulopathy, mean duration of therapy with fenfiuramine and phentermine in combination and dexfenfluramine alone was 9 months and 5 months, respectively. Duration of therapy was not associated with presence or absence of disease. Five patients had surgical intervention for severe valvulopathy: 3 had mitral valve repair, 1 had mitral valve replacement, and 1 had aortic valve replacement. Pulmonary hypertension (≥40 mm Hg) was found in 24 patients (13%), and 17 (71%) had pulmonary hypertension in association with valvulopathy. Conclusion: This study demonstrated a 31% (60/191) prevalence of valvulopathy in patients with a history of diet drug exposure who were referred for echocardiographic evaluation. The most common finding was mild aortic regurgitation. Twenty-eight percent of asymptomatic patients had abnormal echocardiographic findings. This study emphasizes the spectrum of diet drug-related cardiac disease and the potential for valvulopathy in asymptomatic patients.

Original languageEnglish (US)
Pages (from-to)456-461
Number of pages6
JournalMayo Clinic Proceedings
Volume75
Issue number5
StatePublished - 2000

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Heart Valves
Heart Diseases
Diet
Pharmaceutical Preparations
Phentermine
Dexfenfluramine
Aortic Valve Insufficiency
Mitral Valve
Pulmonary Hypertension
Referral and Consultation
Fenfluramine
Tricuspid Valve Insufficiency
Poisons
Mitral Valve Insufficiency
United States Food and Drug Administration
Aortic Valve
Population
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Diet drug related cardiac valve disease : The Mayo clinic echocardiographic laboratory experience. / Teramae, C. Y.; Connolly, H. M.; Grogan, Martha; Miller, Fletcher A Jr.

In: Mayo Clinic Proceedings, Vol. 75, No. 5, 2000, p. 456-461.

Research output: Contribution to journalArticle

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abstract = "Objective: To describe the prevalence of diet drug-related valvular disease among our referral population and the association of valvular disease with duration of exposure to fenfluramine and phentermine in combination and to dexfenfluramine alone. Patients and Methods: In this retrospective review of clinical and echocardiographic data, charts of patients referred for treatment of toxic effects of diet drugs were reviewed, and telephone interviews were conducted. Results: Between June and December 1997, 191 patients (164 women, 27 men; mean age, 47 years) were referred for possible diet drug-related valvular disease. Twenty-eight (28{\%}) of the 99 asymptomatic patients and 40 (43{\%}) of the 92 symptomatic patients had abnormal echocardiographic findings. Valvular lesions among the 68 patients with abnormal echocardiographic findings included mild (or greater) aortic regurgitation in 55 patients (81{\%}), moderate (or greater) mitral regurgitation in 12 (18{\%}), and moderate (or greater) tricuspid regurgitation in 7 (10{\%}). The Food and Drug AdministratiOn case definition of diet drug- related valvulopathy was noted in 31{\%} of this referral population. Of patients with valvulopathy, mean duration of therapy with fenfiuramine and phentermine in combination and dexfenfluramine alone was 9 months and 5 months, respectively. Duration of therapy was not associated with presence or absence of disease. Five patients had surgical intervention for severe valvulopathy: 3 had mitral valve repair, 1 had mitral valve replacement, and 1 had aortic valve replacement. Pulmonary hypertension (≥40 mm Hg) was found in 24 patients (13{\%}), and 17 (71{\%}) had pulmonary hypertension in association with valvulopathy. Conclusion: This study demonstrated a 31{\%} (60/191) prevalence of valvulopathy in patients with a history of diet drug exposure who were referred for echocardiographic evaluation. The most common finding was mild aortic regurgitation. Twenty-eight percent of asymptomatic patients had abnormal echocardiographic findings. This study emphasizes the spectrum of diet drug-related cardiac disease and the potential for valvulopathy in asymptomatic patients.",
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