Document Detail


Strategies to attenuate pathological remodeling in heart failure.
MedLine Citation:
PMID:  19318933     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: The incidence of heart failure is increasing due to an aging population and improved management of diseases that are precursors to ventricular dysfunction. The success of therapeutic advances has created a challenge for the next generation of investigational heart failure treatments because the mortality rate has decreased to such a degree that larger trials will be needed to demonstrate mortality advantage. Prior work has linked favorable changes in ventricular geometry to improved survival, suggesting that remodeling may be a suitable surrogate endpoint. RECENT FINDINGS: In addition to the established benefits of neurohormonal blockade, new mechanical and electrical therapies are proving beneficial in heart failure. Passive cardiac support devices and cardiac resynchronization therapy have been recently demonstrated to induce reverse remodeling of the left ventricle and may improve outcomes, including quality of life, functional status, and mortality. SUMMARY: Ventricular remodeling is strongly correlated with improvement in other heart failure outcomes. Early phase trials of novel therapeutics should carefully examine remodeling to obtain an efficacy signal. Larger clinical investigations should include remodeling metrics as endpoints and consider their use in a composite primary endpoint to reduce trial size.
Authors:
Zubin Eapen; Joseph G Rogers
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in cardiology     Volume:  24     ISSN:  1531-7080     ISO Abbreviation:  Curr. Opin. Cardiol.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-22     Completed Date:  2009-07-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8608087     Medline TA:  Curr Opin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  223-9     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Department of Medicine, Duke University, Durham 27710, North Carolina, USA.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / pharmacology,  therapeutic use*
Aldosterone Antagonists / pharmacology,  therapeutic use
Angiotensin II Type 1 Receptor Blockers / pharmacology,  therapeutic use*
Angiotensin-Converting Enzyme Inhibitors / pharmacology,  therapeutic use*
Cardiac Pacing, Artificial
Heart Failure / drug therapy*,  surgery
Humans
Mitral Valve Insufficiency / complications,  surgery
Myocardial Revascularization
Ventricular Dysfunction, Left / etiology
Ventricular Remodeling / drug effects*
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Aldosterone Antagonists; 0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors

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


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