Amiodarone hepatotoxicity in the context of the metabolic syndrome and right-sided heart failure.
BACKGROUND
Amiodarone is associated with varying degrees of hepatotoxicity.


OBJECTIVE
to study the association between the presence of the metabolic syndrome or right-sided heart failure and the prevalence of amiodarone induced liver disease.


METHODS
Retrospective chart review of patients who received amiodarone for > or =60 days at a university affiliated community hospital. We collected information about clinical progression and liver chemistries on 409 included patients. Subgroup analysis was based on the presence or absence of right-sided heart failure and the metabolic syndrome.


RESULTS
The 409 patients (58% male, 55% Caucasian) had a mean age of 62 years, mean follow up of 37.6 months and mean cumulative amiodarone dose of 295+/-404 grams. No subjects developed clinical hepatitis, cirrhosis or death related to amiodarone. Eight patients developed amiodarone hepatotoxicity, 5 required discontinuation and 3 required dose reduction of the medication with resolution of the transaminitis in all. No differences in liver chemistries at follow up between patients with or without the metabolic syndrome and with or without right cardiac dysfunction were noted.


CONCLUSIONS
Administration of amiodarone was associated with a low incidence of hepatotoxicity without relationship to cumulative dose. The presence of the metabolic syndrome or right-sided heart failure does not increase the incidence of amiodarone hepatotoxicity.
Mattar
Wissam
W
Washington Hospital Center, Washington, DC USA.
Juliar
Beth
B
Gradus-Pizlo
Irmina
I
Kwo
Paul Y
PY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D004796:Clinical Enzyme Tests; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
D000889:Anti-Arrhythmia Agents; D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000638:Amiodarone