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KMID : 1033820000010010009
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Journal of Artificial Heart Research
2000 Volume.1 No. 1 p.9 ~ p.18
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Medical treatment of end stage heart failure: A new combinational approach based on pathophysiology
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Pak Hui-Nam
Kim Young-Hoon
Ro Young-Moo
Shim Wan-Joo
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Abstract
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The prevalence of heart failure (HF) has increased due to improvement of treatment modalities of cardiac disease and prolonged life span of general population, but the mortality of HF does not decrease. For this reason, it has been attempted to develope the treatments based on the pathophysiology of HF. The pathophysiologic models include hemodynamic model, neurohormonal model and myocardial remodeling model. The hemodynamic model resulted in therapies with diuretics, inotropes and vasodilators to minimize cardiac load by modulating blood pressure, vascular resistance and circulating volume. These therapies improve HF symptoms, however, they cannot delay the progression of HF. The neurohormonal model states that the sympathetic activation or diverse hormones secondarily increased by circulatory failure deteriorate myocardial functions. It has been known that certain drugs intercepting these neurohormones, such as, beta-blocker, ACE inhibitor and spironolactone, mitigate the progression and decrease the mortality of HF. Recently, some researchers try to restore failing hearts by stopping myocardial remodeling which is the independent factor of HF progression. Myocardial remodeling gives the depression of myocardial function, the decrease of myocyte number and fibrosis of interstitial matrix and the change of left ventricular geometry. Beta-blocker and left ventricular assist device (LVAD) have been known not only to suppress the remodeling but also to induce the reverse remodeling and improve the condition of HF. Gene therapies has also attempted which improve functions of myocytes and suppress interstitial fibrosis. It is expected that the future studies for the treatment of HF will be focused on the anti-remodeling and the recovery of heart muscle by gene therapy.
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KEYWORD
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heart failure, reverse remodeling, beta-blocker, ventricular assist device
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