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[The best of cardiac failure in 2002]
1Département de cardiologie, CHU Nancy-Brabois, allée du Morvan, 54500 Vandoeuvre-les-Nancy.
Insights
Cardiac failure prevalence tripled from 1989-1999, with obesity as a risk factor. Advances include new acute heart failure drugs and confirmed benefits of cardiac resynchronization and defibrillators.
Area of Science:
- Cardiology
- Heart Failure Research
- Clinical Medicine
Context:
- Cardiac failure incidence remained stable from 1989 to 1999, yet its prevalence increased threefold.
- Obesity is identified as a significant risk factor for developing cardiac failure.
- Genetic mutations in muscle cell proteins can lead to dilated cardiomyopathy.
Purpose:
- To review the current understanding and recent advancements in cardiac failure management.
- To highlight the diagnostic and prognostic significance of Brain Natriuretic Peptide.
- To evaluate emerging therapeutic strategies and devices for heart failure.
Summary:
- Brain Natriuretic Peptide shows confirmed utility in acute dyspnea, diastolic dysfunction, and predicting prognosis.
- Omapatrilat trials yielded disappointing results, showing no added efficacy over ACE-inhibitors but increased side effects.
- New drugs like levosimendan and nesiritide show promise for acute heart failure.
- Cardiac resynchronization therapy's short- and long-term benefits are established.
- Implantable cardioverting defibrillators reduce mortality in patients with prior myocardial infarction and severe left ventricular dysfunction.
- The Jarvik 2000 artificial heart offers hope for heart transplant candidates.
Impact:
- Provides an overview of the evolving landscape of cardiac failure research and treatment.
- Informs clinicians about the latest evidence regarding diagnostic markers and therapeutic interventions.
- Highlights areas for future research in cardiac failure genetics, pharmacology, and device therapy.
Abstract:
From 1989 to 1999, the incidence of cardiac failure appears stable but its prevalence has increased up to three folds. Obesity increases the risk of development of cardiac failure. In genetics, mutations in some proteins of muscular cells may lead to the occurrence of dilated cardiomyopathy. The interest of Brain Natriuretic Peptid was confirmed in case of acute dyspnea or diastolic dysfunction as well as its prognostic role in the functional capacity and the occurrence of sudden death. In the therapeutic field, a great disappointment came from the results of studies on omapatrilat. Despite its advantageous hemodynamic effects, this drug is not more efficacious than any ACE-inhibitor, but with much more side effects. New drugs (levosimendan, nesiritide) appear interesting in the acute heart failure. The short-term as well as long-term effects of cardiac resynchronization are confirmed. Implantable cardioverting defibrillators decrease the mortality of patients with a past history of myocardial infarction with severe left ventricle dysfunction. The artificial heart Jarvik 2000 appears to be hopeful for patients on waiting lists for heart transplantation.