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Effects of pentoxifylline in patients with chronic Chagas cardiomyopathy: A randomized, double-blind, controlled
Káryta Suely Macêdo Martins1, Denise Mayumi Tanaka1, Camila Godoy Fabricio1
1Medical School of Ribeirao Preto - University of São Paulo, Sao Paulo, Brazil.
Insights
Pentoxifylline (PTX) may modulate inflammation in Chronic Chagas cardiomyopathy (CCC). While PTX did not improve heart function or perfusion, it significantly enhanced patients' quality of life.
Area of Science:
- Cardiology
- Immunology
- Pharmacology
Background:
- Chronic Chagas cardiomyopathy (CCC) is a significant cause of heart failure and sudden death in Latin America.
- CCC is characterized by persistent myocarditis and cytokine production.
- Pentoxifylline (PTX) is investigated for its potential immunomodulatory effects in CCC.
Purpose of the Study:
- To evaluate the efficacy of pentoxifylline (PTX) in treating Chronic Chagas cardiomyopathy (CCC).
- To assess PTX's impact on inflammatory markers, cardiac function, myocardial perfusion, and quality of life in CCC patients.
Main Methods:
- A randomized controlled trial involving 38 CCC patients assigned to PTX or placebo for 6 months.
- Measurements included cytokine levels (TNF-α, IL-10), 2D echocardiography, myocardial perfusion scintigraphy, and quality of life assessment.
- Data were analyzed at baseline and post-treatment.
Main Results:
- PTX showed a trend towards reduced TNF-α and increased IL-10, but without statistical significance.
- No significant improvements were observed in echocardiographic variables or myocardial perfusion.
- A significant improvement in functional capacity was reported in the PTX group's quality of life assessment.
Conclusions:
- Pentoxifylline (PTX) may have a role in modulating the inflammatory profile of Chronic Chagas cardiomyopathy (CCC) patients.
- PTX did not demonstrate significant benefits in improving ventricular dysfunction or reducing myocardial perfusion defects.
- PTX treatment led to a notable enhancement in the quality of life for CCC patients.
Background:
Chronic Chagas cardiomyopathy (CCC) is a major public health issue in endemic areas of Latin America, representing one of the leading causes of heart failure and sudden death. The hallmark histopathological lesion of CCC is low-intensity, persistent myocarditis associated with cytokine production. Long-term use of pentoxifylline (PTX) may serve as an effective pharmacological intervention for immunomodulation, reducing inflammation and, consequently, diminishing myocardial perfusion abnormalities and thus preserving left ventricular systolic function.
Methods:
We investigated 38 patients with CCC, randomly assigned to PTX (n = 19), 400 mg 3 times a day for 6 months, or placebo (PLC) (n = 19). At baseline and post-treatment, patients underwent cytokine measurements, quality of life assessment, 2D echocardiography, and myocardial perfusion scintigraphy. After treatment, TNF-α levels in the PTX group decreased from 10.14 ± 5.5 to 8.32 ± 3.6 and from 9.12 ± 4.4 to 10.32 ± 8.5 in the PLC group (p = 0.06). Additionally, IL-10 levels increased from 2.74 ± 0.7 to 5.61 ± 8.6 in the PTX group, while in the placebo group, they decreased from 6.96 ± 11.8 to 5.50 ± 8.3 (p = 0.09); neither of these findings reached statistical significance. Also, no significant changes were observed in the echocardiographic variables after treatment. LVEF showed a modest change from 46.2% ± 7.9 to 47.4% ± 7.0 in the PTX group and from 48.2% ± 6.6 to 48.0% ± 6.9 in the PLC group (p = 0.37). No significant positive effects on myocardial perfusion were noted. However, the quality-of-life assessment documented a significant improvement of functional capacity in the PTX group.
Conclusions:
The results of this study suggest a potential positive effect of PTX in modulating the inflammatory profile of CCC patients. However, use of pentoxifylline in these patients did not attenuate the degree of ventricular dysfunction or reduce myocardial perfusion defects.
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