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Prediction of individual response to heart failure therapy.

Content Provider	Semantic Scholar
Author	Bax, Jeroen J. Delgado, Victoria
Copyright Year	2012
Abstract	This editorial refers to ‘Effects of myocardial fibrosis and ventricular dyssynchrony on response to therapy in new-presentation idiopathic dilated cardiomyopathy: insights from cardiovascular magnetic resonance and echocardiography’, by D.P. Leong et al. , doi:10.1093/eurheartj/ehr391 Heart failure is associated with an adverse prognosis, and aggressive therapy is needed. In most patients, medical therapy is the cornerstone of treatment. Although the response to medical therapy is good in heart failure patients, benefit varies significantly among individual patients. This has been particularly demonstrated for beta-blocker therapy. Packer and colleagues evaluated >2000 heart failure patients, who were randomized to placebo or carvedilol.1 The authors reported a 35% decrease in the risk of death with carvedilol as compared with placebo; moreover, a 24% decrease in the combined risk of death or hospitalization was observed. Other studies demonstrated that beta-blocker therapy in heart failure patients was associated with an improvement in left ventricular ejection fraction (LVEF),2,3 although a substantial percentage of individual patients did not exhibit a significant improvement in LVEF (defined as an increase >5%).2 Data from the Carvedilol Hibernation Reversible Ischemia Trial: Marker of Success (CHRISTMAS) trial showed that the magnitude of improvement in LVEF after carvedilol therapy was related to the extent of viable tissue (on single photon emission computed tomography) in the left ventricle.4 Similarly, Bello et al. evaluated 45 heart failure patients who received beta-blocker therapy, with contrast-enhanced cardiovascular magnetic resonance (CMR) to assess the extent of scar tissue in the left ventricle.5 The authors demonstrated that significant improvement in LVEF (defined as >5%) after 6 months of beta-blocker therapy was not observed in 43% of the patients. Moreover, the extent of scar tissue on CMR was inversely related to the likelihood of improvement in LVEF. Another study in 43 heart failure patients demonstrated that …
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PubMed reference number	22108836v1
Alternate Webpage(s)	https://doi.org/10.1093/eurheartj/ehr416
DOI	10.1093/eurheartj/ehr416
Journal	European heart journal
Volume Number	33
Issue Number	5
Language	English
Access Restriction	Open
Subject Keyword	Adrenergic beta-Antagonists Artificial cardiac pacemaker Cardiac Resynchronization Therapy Cardiomyopathies Cardiomyopathy, Dilated Cardiovascular Diseases Cessation of life Cicatrix Depressive disorder Dobutamine Echocardiography Ejection fraction (procedure) Heart Diseases Heart Ventricle Heart failure Heart valve disease Hospitalization Ischemic cardiomyopathy Left ventricular ejection fraction Left ventricular structure Mitral Valve Insufficiency Myocytes, Cardiac Patients Photons Regurgitation Tomography, Emission-Computed Tomography, Emission-Computed, Single-Photon X-Ray Computed Tomography beta Thalassemia carvedilol
Content Type	Text
Resource Type	Article

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