Here’s another review:
Concern over whether new or worsening left ventricular (
) dysfunction is a contributing factor to TZD-induced peripheral edema and heart failure has led to several studies. To date, however, none have demonstrated a detrimental effect of TZDs on myocardial structure or function. Several echocardiographic studies have failed to reveal any adverse effect on LV LVmass index, LVejection fraction, or end diastolic volume. LV
…Acute decompensated heart failure is an indication to discontinue the TZD, while peripheral edema is not. As per the AHA/ADA consensus recommendations, other potential reasons for peripheral edema should be sought, such as venous insufficiency, other edema producing drugs, and hypoalbuminemia.22 Increased edema may require decreasing the dose of the TZD, slower dose accelerations, and the use of diuretics.
…Due to a paucity of TZD studies in patients with NYHA class III and IV heart failure, their use continues to be relatively contraindicated in this patient population, and has a Food and Drug Administration mandated “black box” warning in patients with NYHA class I and II heart failure.