Diet drug-related cardiac valve disease: the Mayo Clinic echocardiographic laboratory experience.
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.


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 fenfluramine 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.


CONCLUSIONS
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.
Teramae
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Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Connolly
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Grogan
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Miller
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D001022:Aortic Valve Insufficiency / Q000139:chemically induced; D001067:Appetite Depressants / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005277:Fenfluramine / Q000008:administration & dosage / Q000009:adverse effects*; D006349:Heart Valve Diseases / Q000139:chemically induced* / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D008297:Male; D008910:Minnesota; D010645:Phentermine / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D014463:Ultrasonography
D001067:Appetite Depressants; D005277:Fenfluramine; D010645:Phentermine; D017367:Selective Serotonin Reuptake Inhibitors