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[The effects of pharmacological treatment in asymptomatic left ventricular dysfunction]
S Caponnetto1, U Martini, C Brunelli
1Dipartimento di Medicina Interna, Università degli Studi, Genova.
Insights
Early intervention in heart failure is crucial. Angiotensin-converting enzyme inhibitors show promise in improving prognosis by targeting early myocardial dysfunction and reducing cardiac events.
Area of Science:
- Cardiology
- Pathophysiology
- Pharmacology
Context:
- Overt heart failure management has a poor prognosis due to disease advancement.
- Symptom relief and short-term hemodynamic improvements are unreliable prognostic markers.
- Myocardial dysfunction initiates early, preceding significant cardiac remodeling.
Purpose:
- To explore interventions targeting early myocardial dysfunction.
- To evaluate the prognostic impact of medical therapies in early heart failure.
- To highlight the role of angiotensin-converting enzyme inhibitors.
Summary:
- Myocardial dysfunction begins early in cardiac disease progression, involving cellular and interstitial remodeling.
- Experimental studies provide insights into interventions for early myocardial dysfunction.
- Angiotensin-converting enzyme inhibitors demonstrate potential in retarding ventricular dilation and improving oxygen consumption.
Impact:
- Medical therapy has advanced in treating early myocardial dysfunction.
- Angiotensin-converting enzyme inhibitors are emerging as a cornerstone therapy.
- Evidence suggests these inhibitors lower cardiac event rates in heart failure patients.
Abstract:
It is clearly settled that the management of overt heart failure offers poor prognostic impact due to the advanced setting of the disease. Relief of symptoms, objective benefits, as testified by short-term hemodynamic improvements, are as a matter of fact not reliable prognostic markers. Myocardial dysfunction starts early in the natural history of many cardiac diseases, and runs through the steps of progressive wall remodeling, witnessed by quantitative and qualitative changes in cells, interstitium and connective tissue. Experimental studies offered keys to interventions modulated to oppose the pathophysiological changes present in early myocardial dysfunction. At present, medical therapy has made great strides in testing early myocardial dysfunction. Angiotensin-converting enzyme inhibitors, which retard ventricular dilatation and thus may lower myocardial oxygen consumption requirements seem to offer a unique prognostic profile. Preliminary pilot studies on them and some of many large-scale multicentre trials still in progress reached evidence that this class of drugs is by this time a cornerstone of medical therapy, useful to lower cardiac events-rate in patients with heart failure.