title: Amiodarone hepatotoxicity in the context of the metabolic syndrome and right-sided heart failure.
abstract: 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.
authors.affiliation: Washington Hospital Center, Washington, DC USA.
authors.forename: Wissam
authors.initials: W
authors.lastname: Mattar
authors.forename: Beth
authors.initials: B
authors.lastname: Juliar
authors.forename: Irmina
authors.initials: I
authors.lastname: Gradus-Pizlo
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Kwo
mesh_terms: 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
chemical_list: D000889:Anti-Arrhythmia Agents; D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000638:Amiodarone