Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
MEDICAL ADVANCES IN THE TREATMENT OF CONGESTIVE-HEART-FAILURE
Autore:
ARMSTRONG PW; MOE GW;
Indirizzi:
UNIV ALBERTA,DEPT MED,2F130 WALTER C MACKENZIE HLTH SCI CTR EDMONTON T6G 2R7 AB CANADA UNIV TORONTO,ST MICHAELS HOSP,DEPT MED,DIV CARDIOL TORONTO ON CANADA
Titolo Testata:
Circulation
fascicolo: 6, volume: 88, anno: 1993,
pagine: 2941 - 2952
SICI:
0009-7322(1993)88:6<2941:MAITTO>2.0.ZU;2-M
Fonte:
ISI
Lingua:
ENG
Soggetto:
IDIOPATHIC DILATED CARDIOMYOPATHY; CONVERTING ENZYME-INHIBITORS; LEFT-VENTRICULAR DYSFUNCTION; ACUTE MYOCARDIAL-INFARCTION; ATRIAL-NATRIURETIC-FACTOR; CHRONIC CARDIAC-FAILURE; DOUBLE-BLIND; ISOSORBIDE DINITRATE; EXERCISE TOLERANCE; MULTICENTER TRIAL;
Keywords:
HEART FAILURE, CONGESTIVE; DIURETICS; VASODILATION; INOTROPIC AGENTS;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
129
Recensione:
Indirizzi per estratti:
Citazione:
P.W. Armstrong e G.W. Moe, "MEDICAL ADVANCES IN THE TREATMENT OF CONGESTIVE-HEART-FAILURE", Circulation, 88(6), 1993, pp. 2941-2952

Abstract

The increased incidence and prevalence of congestive heart failure place a high priority on novel treatment strategies. Left ventricular ejection fraction remains the single most valuable measurement providingboth diagnostic and prognostic insights. The most systematic approachto heart failure involves an objective assessment of functional disability, to include exercise tests such as a 6-minute walk under standardized conditions. Left ventricular dysfunction incites a host of neurohumoral compensations that are of fundamental importance in the heart failure syndrome expression. Both vasoconstrictor and vasodilator neurohormones are stimulated and provide new therapeutic opportunities. The therapeutic approach to heart failure begins with a strong emphasis on prevention, patient education, and self-participation in therapy with respect to both its monitoring and adjustment. Diuretics remain a mainstay of therapy but, in the face of severe heart failure, may become ineffectual, requiring constant infusion of loop-active diuretics, combination diuretics, or diuretics in association with concomitant low-dose dopamine infusion. Vasodilator therapy has been an important advance: combination hydralazine and nitrate therapy was initially shown to be efficacious in improving survival, and more recently, angiotensin-converting enzyme (ACE) inhibitors, in the form of enalapril, have shown incremental benefit on survival over this combination. Interestingly, there is now evidence from both SOLVD and SAVE to demonstrate an unexpected and, as yet, unexplained reduction in the frequency of bothunstable angina and myocardial infarction. Although, on balance, the weight of evidence concerning the long-term efficacy of inotropic agents has been disappointing, especially as it relates to their unfavorable effects on survival, recent information on vesnarinone, an agent with a complex and diversified mechanism of action, suggests that with appropriate doses, improved symptoms and survival are possible. A substantial amount of new information from randomized placebo-controlled trials attests to the symptomatic relief, hemodynamic improvement, and gain in exercise performance achieved by digoxin. A long-term survival study is ongoing to assess its effects on mortality. beta-Blockers, especially metoprolol, appear beneficial in some patients with heart failure, possibly related to their reduction in sympathetic nervous activity and restoration of beta-receptor population, with resultant improved contractile performance, enhanced myocardial relaxation, and overall increase in cardiac efficiency. Based on available evidence, the best contemporary approach to treatment involves the use of ACE inhibitors coupled with diuretic therapy, either continuous or intermittent, torelieve central or peripheral congestion. The addition of digoxin or a hydralazine nitrate combination is a logical next step, with commencement of low-dose beta-blocker a reasonable option. The residual mortality in the treatment groups of large-scale, contemporary, randomized clinical trials of novel therapy suggests substantial continuing need for the development of novel treatment strategies.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/07/20 alle ore 22:56:06