New molecular insights into heart failure and cardiomyopathy: potential strategies and therapies
In the most severely affected patients the mortality for congestive heart failure exceeds that of many cancers. While therapies are largely aimed at attenuating neurohumoral responses recent molecular insights reveal other potential targets for therapy.
To summarise some of the recent developments in the management of heart failure and provide the clinician who treats heart failure with new insights into emerging approaches.
A literature review was conducted of the recent literature together with personal research data.
Large randomised trials will provide a more comprehensive understanding of the interaction of β-blockers and other heart failure therapies with gene polymorphisms. Cytokines are important in the progression of heart failure, yet therapy aimed at blocking cytokine effects has not been successful. More selective use of anti-cytokine therapy may have beneficial effects. Gene therapy to improve heart failure has not yet reached clinical trials. The molecular genetics of hypertrophic and dilated cardiomyopathy is rapidly improving our understanding so that genetic diagnostics and counselling may soon be performed for patients and families.
The emergence of a molecular based understanding of heart failure will hopefully improve therapy of this common condition.
KeywordsHeart Failure Angiotensin Converting Enzyme Dilate Cardiomyopathy Hypertrophic Cardiomyopathy Negative Inotropic Effect
Unable to display preview. Download preview PDF.
- 4.Yusuf S, Nicklas JM, Timmis G et al. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions.N Engl J Med 1992; 327: 685–91.Google Scholar
- 28.MacGowan GA, Kormos RL, McNamara DM et al. Predicting short term outcome in severely ill heart failure patients: Implications regarding listing for urgent cardiac transplantation and patient selection for temporary ventricular assist device support.J Card Fail 1998; 4 (3): 169–75.CrossRefPubMedGoogle Scholar
- 34.Mohler KM, Murray KM, Mann DL, Francis DL. Use of targeted anticytokine treatments in heart failure.Circulation 2000; 102: 65.Google Scholar
- 37.McNamara DM, Starling R, Dec GW et al. Plasma cytokines in acute cardiomyopathy: Evolution over time, correlation with functional studies, and potential role in recovery.Circulation 2000; 102: 11–415 (abstract).Google Scholar
- 42.del Monte F, Harding SE, Schmidt U et al. Restoration of contractile function in isolated cardiomyocytes from failing human hearts by gene transfer of SERCA2a.Circulation 1999; 100: 2308–11.Google Scholar
- 69.MacGowan GA, Du C, Cowan DB et al. Ischaemic dysfunction in transgenic mice expressing troponin I lacking protein kinase C phosphorylation sites.Am J Physiol (Heart Circ Physiol) 2001; 280: H835–43.Google Scholar
- 77.McDonald K, Ledwidge M, Cahill J et al. Elimination of early rehospitalisation in a randomised, controlled trial of multidisciplinary care in a high risk, elderly heart failure population: the potential contributions of specialist care, clinical stability and optimal angiotensin-converting enzyme inhibitor dose at discharge.Eur J Heart Fail. 2001; 3: 209–15.CrossRefPubMedGoogle Scholar