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Heart failure therapy at the turn of the century
1Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Heart and Vascular Medicine, Detroit, Michigan, USA. sgoldstl@hfhs.org
Insights
Heart failure treatments have advanced significantly, improving survival. While Angiotensin Converting Enzyme Inhibitors (ACEI) and Beta Adrenergic Blocking agents aid remodeling and survival, enhancing left ventricular function remains a key future research goal.
Area of Science:
- Cardiology
- Pharmacology
- Medical Science
Background:
- Heart failure treatment has evolved over 50 years, significantly impacting morbidity and mortality.
- Historical treatments include digitalis and loop diuretics.
- Recent advancements focus on pharmacologic interventions to improve patient outcomes.
Purpose of the Study:
- To review major changes in heart failure treatment over the last fifty years.
- To highlight the impact of vasodilators, ACEI, and Beta Adrenergic Blocking agents.
- To identify future research directions for improving left ventricular function in heart failure.
Main Methods:
- Review of historical data and major randomized clinical trials.
- Analysis of the effects of digitalis, loop diuretics, vasodilators, ACEI, and Beta Adrenergic Blocking agents.
- Discussion of current therapeutic strategies and their impact on heart failure.
Main Results:
- Significant reductions in heart failure morbidity and mortality have been achieved.
- Angiotensin Converting Enzyme Inhibitors (ACEI) demonstrate benefits in left ventricular remodeling.
- Beta Adrenergic Blocking agents provide incremental improvements in mortality and morbidity when added to ACEI therapy.
Conclusions:
- Current therapies have improved heart failure patient outlook but have limited effect on left ventricular function.
- Future research should focus on enhancing cardiomyocyte contractile properties.
- Cellular transplantation is proposed as a strategy to increase functional contractile units.
Abstract:
Major changes in the treatment of heart failure have occurred in the last fifty years that have had a dramatic effect on its morbidity and mortality. Over two hundred years have passed since the demonstration of the benefit of digitalis in heart failure to the development of potent loop diuretics. The observation that vasodilators could improve both cardiac function and mortality led to the investigation of the Angiotensin Converting Enzyme Inhibitors (ACEI). Although these agents had significant vasodilator properties, their major benefit appears to be related to their ability to effect remodeling of the failing left ventricle. The most recent randomized clinical trials demonstrate that Beta Adrenergic Blocking agents can provide an incremental effect on both mortality and morbidity when added to therapy with ACEI. Although these agents have improved the outlook for the heart failure patient, they have had very little effect on the improvement of left ventricular function. Future research must be directed at methods to deal with this issue by either changing the contractile properties of the cardiomyocyte by pharmacologic or electrical therapy or by transplanting functional cells that can increase the number of functioning contractile units.