Document Detail

The neuroendocrine and sympathetic nervous system in congestive heart failure.
MedLine Citation:
PMID:  9651735     Owner:  NLM     Status:  MEDLINE    
A review of recent randomized clinical trials has shown that neurohormonal activation starts early in the natural history of left ventricular dysfunction and levels of the circulating hormones increase in proportion to the severity of heart failure. Most studies suggest that high levels of neurohormones predict a poor prognosis. Among the several neurohormones, the sympathetic system is the one which is activated earlier, it increases in proportion to the severity of the disease and has a negative prognostic implication. These concepts have been also proven in untreated patients. Augmented sympathetic activity in the syndrome of heart failure is initially beneficial, appears to be adaptive and helps support blood pressure and cardiac output. Prolonged and excessive sympathetic activation has deleterious effects with adverse consequences at both cardiac and vascular levels which aggravates the clinical status of the syndrome and negatively affects its prognosis. Evidence is accumulating that, contrary to popular belief, beta-blockers may be beneficial in heart failure by inhibiting sympathetic activation. In addition to neuroendocrine activation, another class of biologically active molecules, termed cytokines, are excessively secreted by cells in heart failure. Important among these cytokines are tumour necrosis factor-alpha and interleukin-6. They appear to exert deleterious effects on the heart and circulation which may be also involved in the progression of heart failure.
R Ferrari; C Ceconi; S Curello; O Visioli
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  European heart journal     Volume:  19 Suppl F     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1998-09-29     Completed Date:  1998-09-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  F45-51     Citation Subset:  IM    
Cardiovascular Research Center, S. Maugeri Foundation, Gussago, Brescia, Italy.
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MeSH Terms
Adrenergic beta-Antagonists / adverse effects,  therapeutic use
Cytokines / physiology
Heart Failure / drug therapy,  physiopathology*
Hemodynamics / drug effects,  physiology
Neurosecretory Systems / drug effects,  physiopathology*
Neurotransmitter Agents / physiology
Norepinephrine / physiology
Sympathetic Nervous System / drug effects,  physiopathology*
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Cytokines; 0/Neurotransmitter Agents; 51-41-2/Norepinephrine

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