Key result
A 65-year-old diabetic male developed congestive heart failure and pulmonary edema with preserved left ventricular ejection fraction within 1 year of starting pioglitazone therapy.
Case Report (n=1)
No
Pioglitazone can induce congestive heart failure and pulmonary edema even in patients with preserved left ventricular ejection fraction.
Pioglitazone may precipitate HF with preserved EF; this case report leaves open causality and generalizability.
Pioglitazone-induced heart failure is known in patients with underlying heart disease, but is not well documented in patients with normal left ventricular function. Pioglitazone has been very popular as it is an insulin sensitizer and insulin resistance is prevalent among Indians. Fluid retention exacerbates pre-existing heart failure or precipitates heart failure in a patient with underlying left ventricular dysfunction. However, pathogenesis of heart failure in a patient with normal left ventricular function is not known. Probably it is due to dose-related effect on pulmonary endothelial permeability, rather than alterations in left ventricular mass or ejection fraction. We report a patient who developed congestive heart failure and pulmonary edema with normal left ventricular function within 1 year of starting pioglitazone therapy. We have to be careful in monitoring all possible side effects during followup when patients are on pioglitazone therapy.
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Jearath et al. (2016) conducted a case report in Type 2 diabetes mellitus (n=1). Pioglitazone was evaluated on Congestive heart failure and pulmonary edema. A 65-year-old diabetic male developed congestive heart failure and pulmonary edema with preserved left ventricular ejection fraction within 1 year of starting pioglitazone therapy.
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