Exercise Tolerance as a Guide to Therapeutic Efficacy for Heart Failure

Cohn, Jay N.

doi:10.1161/01.cir.100.22.2208

Cited by 3 publications

(1 citation statement)

References 16 publications

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“…However, in a larger data base of men in whom gas exchange was monitored during exercise, the Veterans Administration Cooperative Study. (V-HeFT) demonstrated that peak oxygen consumption (VO,) is an independent predictor of prognosis in heart failure (6).…”

Section: Dr Charulata Londhementioning

confidence: 99%

Prognostic Factors in Heart Failure: Poverty Amidst a Wealth of Variables

Gade,

Nandwani,

Bharat Pawar

et al. 2023

PIJR

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Although life expectancy is a concept that everyone understands and attempts to prolong life are widely appreciated, the traditional physician-patient relation usually is based on short-term goals such as an improvement in quality of life, rather than on the more nebulous attempt to delay death. Nonetheless. Early death occurs with such alarming frequency in patients with chronic heart failure that a reduction in its incidence has emerged as an important goal in the management of these patients

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Section: Dr Charulata Londhementioning

confidence: 99%

Prognostic Factors in Heart Failure: Poverty Amidst a Wealth of Variables

Gade,

Nandwani,

Bharat Pawar

et al. 2023

PIJR

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Do ACE inhibitors or angiotensin II antagonists reduce total mortality and arrhythmic mortality? A critical review of controlled clinical trials

Naccarella

Naccarelli

Maranga

et al. 2002

Current Opinion in Cardiology

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ACE-inhibitors (ACE-I) represent effective drugs more and more widely used in acute myocardial infarction (AMI) patients, in post AMI patients and mainly, today, in CHF patients.A complete review of the scientific literature and of all the randomized controlled clinical trials (RCTs), where ACE-I have been tested directly or in association with other drugs, have been performed. ACE-I effects on total mortality (TM) and arrhythmic mortality (AM) and other composite clinical endpoints have been evaluated. It is well known that frequent ventricular arrhythmias (VA) and a high incidence of sudden death (SD) can be documented in CHF patients; nevertheless a direct relationship between VA, TM, and AM has not been clearly demonstrated; neither beneficial effects, on the same endpoints, of the treatment and suppression of ambient VA in CHF. Conversely, sometimes clear negative effects on both TM and AM have been observed. According to individual studies and two recent complete and large metanalysis, ACE-I were unable to reduce AM, but they reduced TM. Furthermore, they can affect and modify many, if not all, of the triggering factors of VA and SD in this context. Differently from ACE-I, betablockers (BB) have been clearly associated with a reduction in TM and AM, in the same context. Thus, at present time, ACE-I, with or without BB, should be considered the standard therapy in all patients with CHF, if not contraindicated. Angiotensin II antagonists (AII-a) probably represent a comparably effective treatment, in all CHF patients and mainly in those patients, suffering from side effects or showing intolerance to ACE-I, but we are still lacking definitive data from RCTs. In many RCTs, conducted with traditional antiarrhythmic drug therapy (ADT), these drugs have been widely used, contributing probably, in a consistent way, to some of the positive results of these studies. All primary and some secondary implantable defibrillators (ICD) RCTs, in the prevention of SD, have included these drugs as the standard treatment of the underlying cardiac disease, with or without CHF. The same therapeutical strategy is regularly applied in all biventricular pacing (BP) RCTs, with or without the ICD. These trials are supposed to assess the reduction in TM and AM, preventing deterioration or progression of CHF and improving the quality of the patients' s life.Finally, according to these clinical evidences, in the last part of the review, we stress the need for a more widespread implementation of ACE-I and AII-a in treating CHF patients.

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