Document Detail


Effects of neurohormonal antagonism on symptoms and quality-of-life in heart failure.
MedLine Citation:
PMID:  9519349     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Increased mortality and reduced functional capacity are the two main characteristics of chronic heart failure. Activation of the renin-angiotensin and sympathetic systems has a primary role in the progressive worsening of heart failure and increased mortality of patients. In addition, both systems may be important in the pathogenesis of exercise intolerance, although there is only a weak relationship between neurohormonal activation and exercise capacity. While neurohormonal antagonists, such as angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, consistently improve the prognosis of patients with heart failure, their effects on exercise tolerance have often been less significant. This problem has been emphasized by the introduction of beta-blockers for the therapy of heart failure. Beta blockade results in a significant improvement in left ventricular function during rest and exercise. However, the reduction in chronotropic response to exercise as well as the metabolic changes caused by these agents in skeletal muscle may result in an apparent lack of change in maximal functional capacity. This effect is particularly important with the new third generation non-selective beta-blockers. The pronounced anti-adrenergic activity of these compounds accounts for their greater negative chronotropic effect and relates to the lack of improvement in peak oxygen consumption (VO2). Submaximal exercise testing can be used to assess changes induced by these agents. However, even the six-minute walk test may act as an almost maximal test in patients with advanced heart failure: moreover, the measurement of submaximal exercise duration may be sensitive enough to detect changes in single-centre trials, but not in multicentre trials. To date, direct assessment of symptoms by both patient and physician is still the most sensitive tool to monitor changes in functional status with non-selective beta-blockers. Thus, an accurate method of measuring patients' symptoms, in addition to the clinical examination, is still necessary when neurohormonal antagonists are used in patients with chronic heart failure.
Authors:
M Metra; S Nodari; A D'Aloia; A Madureri; F Rosselli; L Bontempi; R Zanini; L Dei Cas
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  European heart journal     Volume:  19 Suppl B     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-04-30     Completed Date:  1998-04-30     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  B25-35     Citation Subset:  IM    
Affiliation:
Cattedra di Cardiologia, Università di Brescia, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Cardiac Output, Low / drug therapy*,  physiopathology*
Humans
Neurotransmitter Agents / antagonists & inhibitors*
Physical Exertion
Quality of Life*
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Neurotransmitter Agents

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