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The ever expanding spectrum of ischemic left ventricular dysfunction
1Medical Research Council Ischaemic Heart Disease Research Unit, University of Cape Town Medical School, South Africa.
Insights
Calcium antagonists show promise for treating specific forms of ischemic left ventricular (LV) dysfunction, particularly stunning and postinfarct diastolic dysfunction. Further evaluation in reperfusion and postinfarct syndromes is warranted.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Ischemic left ventricular (LV) dysfunction encompasses diverse conditions like acute LV failure, myocardial infarction, and cardiomyopathy.
- Emerging entities include postinfarct diastolic dysfunction, stunning, hibernation, and preconditioning, which can coexist.
- Pathophysiological differences complicate generalized therapeutic approaches.
Purpose of the Study:
- To explore the potential benefits of calcium antagonists in various forms of ischemic LV dysfunction.
- To assess the efficacy of calcium antagonists in specific entities like stunning and postinfarct diastolic dysfunction.
Main Methods:
- Review of experimental and clinical evidence regarding calcium antagonist use in ischemic LV dysfunction.
- Analysis of pathophysiological states contributing to LV dysfunction.
Main Results:
- Experimental data suggests calcium antagonists may benefit myocardial stunning.
- Clinical evidence indicates benefits for postinfarct ischemic LV diastolic dysfunction.
Conclusions:
- Calcium antagonists demonstrate potential for specific ischemic LV dysfunction syndromes.
- Further investigation in reperfusion and postinfarct dysfunctional syndromes is recommended.
Abstract:
Ischemic left ventricular (LV) dysfunction includes a number of discrete entities, such as acute LV failure in angina, acute myocardial infarction, and ischemic cardiomyopathy. Recently, new entities have arisen to expand the spectrum of ischemic LV function. These include postinfarct diastolic dysfunction, stunning, hibernation, and preconditioning. The tantalizing possibility exists that several of these states can coexist. There are widely differing underlying pathophysiologic states. Hence it is not easy to be dogmatic about whether a given group of therapeutic agents, such as the calcium antagonists, may be beneficial in ischemic LV dysfunction. Nonetheless, there is experimental evidence that calcium antagonists may benefit the specific entity of stunning and clinical evidence that they benefit postinfarct ischemic LV diastolic dysfunction. These agents, as a group, should be evaluated in reperfusion and postinfarct dysfunctional syndromes.