Document Detail

Can drug effects on mortality in heart failure be predicted by any surrogate measure?
MedLine Citation:
PMID:  9447312     Owner:  NLM     Status:  MEDLINE    
Clearly at present, the one perfect surrogate marker for mortality remains elusive. Chronic heart failure is a complex syndrome: as such it may perhaps be too simplistic to expect any single parameter to be universally predictive of drug effects on mortality, especially when each drug works by different mechanisms. Nevertheless, neurohormonal antagonists, such as ACE inhibitors and beta-blockers, seem to benefit both mortality and all surrogate markers of mortality. Equally, inotropic drugs and Class I antiarrhythmics appear to worsen both mortality and many surrogates. This is encouraging. However, significant discrepancies exist, particularly for digoxin, ibopamine and hydralazine-nitrates, although it is only with the latter two that diametrically opposite effects occurred, whereby favourable surrogate effects turned into unfavourable mortality effects (or vice versa). It appears appropriate to have guarded optimism about the potential use of these surrogates to predict drug effects in chronic heart failure. Given our current understanding, none of the parameters discussed above is perfect when used alone. Perhaps a battery of surrogates would be more appropriate rather than there being any single surrogate. The most promising surrogates are heart rate variability, QT dispersion and plasma neurohormones, the first two for sudden death and the last one for death from progressive disease.
K M Yee; A D Struthers
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  European heart journal     Volume:  18     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  1997 Dec 
Date Detail:
Created Date:  1998-03-18     Completed Date:  1998-03-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  1860-4     Citation Subset:  IM    
Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee, UK.
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MeSH Terms
Amiodarone / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Anti-Arrhythmia Agents / therapeutic use
Biological Markers
Calcium Channel Blockers / therapeutic use
Deoxyepinephrine / analogs & derivatives,  therapeutic use
Dopamine Agonists / therapeutic use
Heart Failure / drug therapy,  mortality*
Hydralazine / therapeutic use
Isosorbide Dinitrate / therapeutic use
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Anti-Arrhythmia Agents; 0/Biological Markers; 0/Calcium Channel Blockers; 0/Dopamine Agonists; 1951-25-3/Amiodarone; 501-15-5/Deoxyepinephrine; 66195-31-1/ibopamine; 86-54-4/Hydralazine; 87-33-2/Isosorbide Dinitrate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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