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Titolo:
Heart rate as a therapeutic target in heart failure
Autore:
Kjekshus, J; Gullestad, L;
Indirizzi:
Univ Oslo, Cardiol Sect, Dept Med, Rikshosp, N-0027 Oslo, Norway Univ Oslo Oslo Norway N-0027 ct, Dept Med, Rikshosp, N-0027 Oslo, Norway
Titolo Testata:
EUROPEAN HEART JOURNAL SUPPLEMENTS
fascicolo: H, volume: 1, anno: 1999,
pagine: H64 - H69
SICI:
1520-765X(199906)1:H<H64:HRAATT>2.0.ZU;2-3
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACUTE MYOCARDIAL-INFARCTION; FREE FATTY-ACIDS; CARDIOVASCULAR MORTALITY; NOREPINEPHRINE LEVELS; ISCHEMIC MYOCARDIUM; OXYGEN-CONSUMPTION; RATE-VARIABILITY; TIMOLOL; FLOW; SIZE;
Keywords:
sympathetic activity; congestive heart failure; beta-receptor blockade; beta-blocker; myocardial infarction;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
49
Recensione:
Indirizzi per estratti:
Indirizzo: Kjekshus, J Univorway, Cardiol Sect, Dept Med, Rikshosp, Pilestredet 32, N-0027 Oslo, N Univ Oslo Pilestredet 32 Oslo Norway N-0027 2, N-0027 Oslo, N
Citazione:
J. Kjekshus e L. Gullestad, "Heart rate as a therapeutic target in heart failure", EUR H J SUP, 1(H), 1999, pp. H64-H69

Abstract

Resting heart rate has prognostic importance regarding late cardiovascularmortality and morbidity. Hypertension and heart failure are often associated with increased resting heart rate. The resting heart rate is an index ofdominant sympathetic nervous activity which may increase coronary vasoconstriction, enhance myocardial oxygen consumption, reduce diastolic perfusiontime, increase endothelial shear stress and platelet aggregation, release growth factors and increase plaque instability. Reduction of heart rate by beta-receptor blockade has been shown to delay and limit enzyme release during acute myocardial infarction. Reduction in heart rate by at least 15 beats. min(-1) during. infarct evolution has been associated with a reduction in infarct size of between 25 and 30%. However. it is suggested that a reduction in heart rate of less than 8 beats.min(-1) has no effect. In large controlled clinical trials beta-blockade has reduced mortality by 15% during acute myocardial infarction. The benefit is larger among patients with leftventricular dysfunction, enlarged hearts, symptomatic heart failure and elevated heart rates. The effect is improved if treatment is started early during infarct evolution, (less than 4 h after onset of symptoms): however, none of the trials have specifically tested early intervention during infarct evolution. Comparison between placebo and drug intervention in patients with signs ofheart failure suggests a relationship between the reduction of resting heart rate and the percentage reduction of mortality obtained in each trial. beta-blocker treatment has the largest potential to reduce heart rate. Confounding properties of a beta-blocker, such as intrinsic sympatomimeticactivity or prolongation of the QT interval, may reduce its overall efficacy. These results suggest that the beneficial effect of beta-blockers in heartfailure is related to the blocking of the sympathetic activity, as reflected in a quantitative reduction in heart rate and increase in diastolic time.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/12/20 alle ore 16:36:32