Atlas of HEART FAILURE. Cardiac Function and Dysfunction Fourth Edition

Transcription

1 Atlas of HEART FAILURE Cardiac Function and Dysfunction Fourth Edition

2 Atlas of HEART FAILURE Cardiac Function and Dysfunction Fourth Edition Editor Wilson S. Colucci, MD Professor of Medicine Boston University School of Medicine; Chief, Cardiovascular Medicine Boston University Medical Center Series Editor Eugene Braunwald, M.D. Distinguished Hersey Professor of Medicine Harvard Medical School Chairman, TIMI Study Group em CURRENT. MEDICINE Springer Science+Business Media, LLC

3 CURRENT MEDICINE LLC 400 Market Street, Suite 700 Philadelphia, PA Developmental Editor... Elise M. Paxson Editoral Assistant.... Annmarie D'Ortona Cover Design... Wendy Vetter Design and Layout... William C. Whitman, Jr. and Christine Keller-Quirk Illustrators.... Marie Dean Matthew Holmes, Maureen Looney, John McCullough Deborah Lynam Assistant Production Manager.... Margaret La Mare Indexing... Holly Lukens Library of Congress Cataloging-in-Publication Data Atlas of Heart Failure: cardiac function and dysfunction / editor, Wilson S. Colucci. -- 4th ed. p.; cm. Includes bibliographical references and index. ISBN DOI / ISBN (ebook) 1. Heart failure--atlases. I. Colucci, Wilson 5., [DNLM: 1. Heart Failure, Congestive--Atlases. 2. Heart--physiology--Atlases. 3. Heart--physiology--Atlases. WG 17 A ] RC685.C53A '29'0222--dc ISBN Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the author can be held responsible for errors or for any consequences arising from the use of the information contained therein. Any product mentioned in this publication should be used in accordance with the prescribing information prepared by the manufacturers. No claims or endorsements are made for any drug or compound at present under clinical investigation by Springer Science+Business Media New York Originally published by Current Medicine LLC in 2005 Softcover reprint of the hardcover 4th edition 2005 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means electronic, mechanical, photocopying, recording, or otherwise, without prior written consent of the publisher iv

4 PREFACE Heart failure is a common clinical syndrome that has enormous impact on the prognosis and lifestyle of patients. In the United States, more than 5 million people have heart failure and more than 400,000 new cases are diagnosed each year. This diagnosis is associated with a 5-year mortality rate of approximately 50%, and the morbidity of the syndrome has a major effect on the quality of life and productivity of afflicted patients. In recent years, impressive strides have been made toward understanding the pathophysiology of heart failure at all levels, from molecular changes to the integrated circulatory system. It is now apparent that many forms of primary cardiomyopathy, such as hypertrophic cardiomyopathy and some forms of dilated cardiomyopathy, are genetic in origin, and rapid progress is being made in identifying specific molecular defects that cause a variety of inherited heart muscle diseases. Likewise, it is now clear that profound secondary changes occur in previously normal myocardium in response to abnormal mechanical stresses and neurohumoral stimuli that result from common cardiovascular conditions such as myocardial infarction, valvular heart disease, and systemic hypertension. Collectively referred to as "remodeling/' these secondary changes in myocytes, fibroblasts, and other constituents of the myocardium result in myocyte hypertrophy and apoptosis, alterations in the interstitial matrix, chamber enlargement, and abnormalities of systolic and diastolic pump function. These structural and functional changes determine the timing and extent of the myocardial dysfunction and thereby playa central role in defining the time course and severity of the clinical syndrome. Advances in understanding the pathophysiology of heart failure have been paralleled by an impressive expansion in modalities available for treatment. Only a few years ago, a monograph dealing with this syndrome would have focused on therapies directed at the short-term improvement of hemodynamic function. Although short-term hemodynamic stabilization continues to be an important goal of the inhospital management of patients with heart failure, it is increasingly apparent that hemodynamic improvement is only one aspect of successful long-term therapy. There is now evidence that therapy of heart failure with neurohormonal antagonists that inhibit the renin-angiotensinaldosterone system or the sympathetic nervous system is superior to treatment with agents that cause direct vasodilation of cause an increase in myocardial contractility. Specifically, therapy with converting enzyme inhibitors, angiotensin-receptor antagonists, aldosterone receptor antagonists, and l3-adrenergic blockers has been shown to improve clinical status and reduce mortality. Furthermore, it appears that the early treatment of patients with left ventricular dysfunction can slow or prevent the progression of disease and the development of heart failure. Several new factors, including inflammatory cytokines, endothelin, and oxidative stress have been identified that have the potential to mediate the development of myocardial failure and have led to promising new therapeutic approaches. Now in its 4th edition, the Atlas of Heart Failure provides a comprehensive up-to-date overview of normal cardiac function, the mechanisms of dysfunction in heart failure, and the therapeutic approaches that are available to manage the syndrome. The first two chapters provide a state-of-art review of the mechanisms that regulate normal myocardial function, beginning with molecular and cellular events in the cardiomyocyte and progressing to the level of tissue-organ mechanics and systemic circulatory regulation. Chapters 3 to 6 present the pathophysiology of heart failure by addressing the etiology of the syndrome, the molecular and cellular basis of myocardial failure, the structural and functional effects of myocardial remodeling, and the critical roles of the circulatory system and neurohumoral mechanisms in the pathophysiology of heart failure. Chapters 7 to 14 are devoted to the clinical management of patients with heart failure. These chapters provide a timely survey of the evidence base for the use of diuretics, digitalis, and inhibitors of the renin-angiotensin system, including aldosterone antagonists and l3-blockers. Also presented are descriptions of new therapeutic approaches such as the use of stem cells, cardiac transplantation, and new mechanical devices. Finally, two syndrome-specific chapters address the approach to patients with unstable heart failure or diastolic dysfunction, respectively. As understanding of heart failure advances, new approaches to the prevention and treatment of the syndrome will emerge. Conversely, it is likely that lessons learned from prevention and treatment trials will continue to foster insight into the mechanisms that determine this syndrome. The complexity of this intersection of basic and clinical information presents a challenge to both the clinician and the investigator but ultimately promises that additional exciting progress will occur in both arenas. I believe that this edition of the Atlas of Heart Failure will serve clinicians, investigators, and teachers who are interested in heart failure by synthesizing and presenting information that is relevant to all. Wilson S. Colucci, MD v

5 CONTRIBUTORS Carl S. Apstein, MD Professor and Physiology Boston University School of Medicine; Attending Cardiologist Boston Medical Center Wilson S. Colucci, MD Professor of Medicine and Physiology Boston University School of Medicine; Chief Cardiovascular Medicine Boston University Medical Center Mark A. Creager, MD Professor Harvard Medical School; Director, Vascular Center Jay N. Cohn, MD Professor of Medicine Cardiovascular Division University of Minnesota Minneapolis, Minnesota Robert J. Cody, MD, MBA Professor Department of Internal Medicine University of Michigan Health System Ann Arbor, Michigan Jorge A. Cusco, MD Teaching Physician Orlando Regional Medical Center Orlando, Florida Daniel A. Duprez, MD, PhD Professor of Medicine Cardiovascular Division; Director of Research Rasmussen Center for Cardiovascular Disease Prevention University of Minnesota; Minneapolis, Minnesota D. Bradley S. Dyke, MD Clinical Assistant Professor Department of Internal Medicine University of Michigan Health System Ann Arbor, Michigan Michael M. Givertz, MD Assistant Professor Harvard Medical School; Co-Director, Cardiomyopathy and Heart Failure Program Joshua M. Hare, MD Associate Professor Division of Cardiology; Director, Heart Failure and Cardiac Transplantation Johns Hopkins University School of Medicine Baltimore, Maryland Arnold M. Katz, MD Visiting Professor and Physiology Dartmouth Medical School Hanover, New Hampshire; Professor of Medicine Emeritus University of Connecticut School of Medicine Farmington, Connecticut Todd M. Koelling, MD Assistant Professor Department of Internal Medicine University of Michigan Health System Ann Arbor, Michigan Carl V Leier, MD Overstreet Professor of Medicine and Pharmacology Division of Cardiology The Ohio State University College of Medicine and Public Health Columbus, Ohio Donna M. Mancini, MD Associate Professor Columbia University; Medical Director of Cardiac Transplant Columbia-Presbyterian Medical Center New York, New York David A. Orsinelli, MD Associate Professor of Clinical Medicine Department of Internal Medicine; The Ohio State University Director, Echocardiography Lab Ohio State University Hospitals Columbus, Ohio Marc A. Pfeffer, MD, PhD Alljll Nohria, MD Instructor Harvard Medical School; Associate Physician Douglas B. Sawyer, MD, PhD Associate Professor Boston University School of Medicine Scott D. Solomon, MD Associate Professor Harvard Medical School; Director, Noninvasive Cardiology Mark R. Starling, MD Professor Department of Internal Medicine University of Michigan Medical School; Associate Chief, Division of Cardiology University of Michigan Health System Ann Arbor, Michigan James B. You ng, MD, FACC Medical Director Kaufman Center for Heart Failure; Head, Section of Heart Failure and Cardiac Transplant Medicine The Cleveland Clinic Foundation Cleveland, Ohio vi

6 CONTENTS CHAPTER 1 Molecular and Cellular Basis of Contraction and Relaxation Arnold M. Katz Structure Contraction and Relaxation... 5 Cellular Regulation CHAPTER 2 Physiology of Myocardial Contraction Mark R. Starling Mechanics of Cardiac Contraction Determinants of Contraction in the Intact Heart Preload Contractility Afterload Myocardial Energetics Neural Control of Contractility CHAPTER 3 The Etiologic Basis of Congestive Heart Failure Joshua M. Hare Etiology and Epidemiology Heart Failure Associated with Coronary Disease Heart Failure Associated with Valvular Lesions Idiopathic Dilated Cardiomyopathy Inflammatory Diseases of the Myocardium Secondary Causes of Cardiomyopathy Infiltrative/Restrictive Cardiomyopathies Hypertrophic Cardiomyopathy Right Ventricular Cardiomyopathy CHAPTER 4 Molecular and Cellular Events in Myocardial Hypertrophy and Failure Douglas B. Sawyer and Wilson S. Colucci Ventricular Remodeling Molecular and Cellular Phenotypes Calcium Handling and Contractile Protein Expression Cell Death Cell Replacement Extracellular Matrix [3-Adrenergic Pathway Renin-angiotensin System, Endothelin, and Inflammatory Cytokines Oxidative Stress vii

7 CHAPTER 5 Cardiac Remodeling and Its Prevention Scott D. Solomon and Marc A. Pfeffer Cardiac Growth and Remodeling Early Remodeling After Myocardial Infarction and Infarct Expansion Remodeling and Prognosis Progressive Enlargement After Myocardial Infarction Modification of Remodeling After MyocardialInfarction CHAPTER 6 Neurohumoral, Renal, and Vascular Adjustments in Heart Failure Anju Nohria, Jorge A. Cusco, and Mark A. Creager Mechanisms in Heart Failure Sympathetic Nervous System The Renin-angiotensin-aldosterone System The Arginine-vasopressin System Natriuretic Peptides Local Mechanisms Regional Blood Flow CHAPTER 7 Assessment of Heart Failure James B. Young Overview Assessing the Patient Diagnostic Tests Designing a Therapeutic Plan CHAPTER 8 Prognostic Indicators and Assessment of Therapeutic Responses Daniel A. Duprez and Jay N. Cohn Mortality in Patients with Heart Failure Use of Prognostic Factors Assessment of Therapeutic Responses CHAPTER 9 Unstable Heart Failure Carl V. Leier and David A. Orsinelli Acute Heart Failure Decompensated Chronic Heart Failure CHAPTER 10 Diuretics and Digitalis D. Bradley S. Dyke and Robert J. Cody Diuretics Digoxin Chapter 11 Inhibition of the Renin-Angiotensin-Aldosterone System Todd M. Koelling, D. Bradley S. Dyke, and Robert J. Cody Angiotensin-converting Enzyme Inhibitors Aldosterone Receptor Blockade Angiotensin Receptor Blockers viii

8 CHAPTER 12 l3-blockers Michael M. Givertz and Wilson S. Colucci Role of Sympathetic Activation Mechanistic Studies Randomized Controlled Trials Race and b-blockers Differential Effects of f3-blockers Strategies to Increase f3-blocker Use CHAPTER 13 New Approaches to the Treatment of Heart Failure Michael M. Givertz and Wilson S. Colucci Neurohormonal Antagonists Inotropic Agents Cardiac Resynchronization Therapy Novel Biologic Therapies for Myocardial Recovery Treatment of Comorbidities: Anemia, Sleep Apnea, and Pulmonary Hypertension CHAPTER 14 Cardiac Transplantation Donna M. Mancini Posttransplantation Survival Candidate Selection Donor Selection Criteria Surgical Techniques Allograft Rejection Quality of Life After Transplantation Accelerated Transplantation, Atherosclerosis, and Retransplantation Mechanical-assist Devices CHAPTER 15 Diastolic Dysfunction: Pathophysiology, Clinical Features, and Treatment Carl S. Apstein Normal Diastolic Function Pathophysiology of LV Diastolic Dysfunction Diastolic Dysfunction with Ischemia, Hypertrophy, and Other Causes Aging and Diastolic Dysfunction Clinical Features, Prognosis, and Treatment Index Color plates ix