Atlas of HEART FAILURE: Cardiac Function and Dysfunction

314 Pages·2004·46.225 MB·English

by  Arnold M. Katz (auth.), Wilson S. Colucci MD (eds.)

Atlas of
HEART FAILURE
Cardiac Function and Dysfunction
Fourth Edition
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
Boston, Massachusetts
Series Editor
Eugene Braunwald, M.D.
Distinguished Hersey Professor of Medicine
Harvard Medical School
Chairman, TIMI Study Group
Brigham and Women's Hospital
Boston, Massachusetts
eM
Springer Science+Business Media, LLC
CURRENT.
MEDICINE
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Editoral Assistant .................................... .A nnmarie D'Ortona
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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 978-1-4757-4560-3 ISBN 978-1-4757-4558-0 (eBook)
DOI 10.1007/978-1-4757-4558-0
1. Heart failure--Atlases. I. Colucci, Wilson 5., 1949-
[DNLM: 1. Heart Failure, Congestive--Atlases. 2. Heart--physiology--Atlases. 3.
Heart--physiology--Atlases. WG 17 A88162 2004]
RC685.C53A852004
616.1 '29'0222--dc22
2004049419
ISBN 978-1-4757-4560-3
Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the
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or compound at present under clinical investigation.
© 2005 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
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iv
PREFACE
Heart failure is a common clinical syndrome that has antagonists, and l3-adrenergic blockers has been shown to
enormous impact on the prognosis and lifestyle of patients. improve clinical status and reduce mortality. Furthermore,
In the United States, more than 5 million people have heart it appears that the early treatment of patients with left vent
failure and more than 400,000 new cases are diagnosed each ricular dysfunction can slow or prevent the progression of
year. This diagnosis is associated with a 5-year mortality rate disease and the development of heart failure. Several new
of approximately 50%, and the morbidity of the syndrome factors, including inflammatory cytokines, endothelin, and
has a major effect on the quality of life and productivity of oxidative stress have been identified that have the potential
afflicted patients. to mediate the development of myocardial failure and have
In recent years, impressive strides have been made toward led to promising new therapeutic approaches.
understanding the pathophysiology of heart failure at all Now in its 4th edition, the Atlas of Heart Failure provides a
levels, from molecular changes to the integrated circulatory comprehensive up-to-date overview of normal cardiac
system. It is now apparent that many forms of primary function, the mechanisms of dysfunction in heart failure,
cardiomyopathy, such as hypertrophic cardiomyopathy and and the therapeutic approaches that are available to manage
some forms of dilated cardiomyopathy, are genetic in origin, the syndrome. The first two chapters provide a state-of-art
and rapid progress is being made in identifying specific review of the mechanisms that regulate normal myocardial
molecular defects that cause a variety of inherited heart function, beginning with molecular and cellular events in the
muscle diseases. Likewise, it is now clear that profound cardiomyocyte and progressing to the level of tissue-organ
secondary changes occur in previously normal myocardium mechanics and systemic circulatory regulation. Chapters 3
in response to abnormal mechanical stresses and neuro to 6 present the pathophysiology of heart failure by
humoral stimuli that result from common cardiovascular addressing the etiology of the syndrome, the molecular and
conditions such as myocardial infarction, valvular heart cellular basis of myocardial failure, the structural and
disease, and systemic hypertension. Collectively referred functional effects of myocardial remodeling, and the critical
to as "remodeling/' these secondary changes in myocytes, roles of the circulatory system and neurohumoral mech
fibroblasts, and other constituents of the myocardium result anisms in the pathophysiology of heart failure. Chapters 7
in myocyte hypertrophy and apoptosis, alterations in the to 14 are devoted to the clinical management of patients
interstitial matrix, chamber enlargement, and abnormalities with heart failure. These chapters provide a timely survey
of systolic and diastolic pump function. These structural and of the evidence base for the use of diuretics, digitalis, and
functional changes determine the timing and extent of the inhibitors of the renin-angiotensin system, including aldo
myocardial dysfunction and thereby playa central role in sterone antagonists and l3-blockers. Also presented are
defining the time course and severity of the clinical syndrome. descriptions of new therapeutic approaches such as the use
Advances in understanding the pathophysiology of heart of stem cells, cardiac transplantation, and new mechanical
failure have been paralleled by an impressive expansion in devices. Finally, two syndrome-specific chapters address the
modalities available for treatment. Only a few years ago, a approach to patients with unstable heart failure or diastolic
monograph dealing with this syndrome would have focused dysfunction, respectively.
on therapies directed at the short-term improvement of As understanding of heart failure advances, new appro
hemodynamic function. Although short-term hemodynamic aches to the prevention and treatment of the syndrome will
stabilization continues to be an important goal of the in emerge. Conversely, it is likely that lessons learned from
hospital management of patients with heart failure, it is prevention and treatment trials will continue to foster
increasingly apparent that hemodynamic improvement is insight into the mechanisms that determine this syndrome.
only one aspect of successful long-term therapy. There is The complexity of this intersection of basic and clinical
now evidence that therapy of heart failure with neuro information presents a challenge to both the clinician and
hormonal antagonists that inhibit the renin-angiotensin the investigator but ultimately promises that additional
aldosterone system or the sympathetic nervous system is exciting progress will occur in both arenas. I believe that this
superior to treatment with agents that cause direct edition of the Atlas of Heart Failure will serve clinicians,
vasodilation of cause an increase in myocardial contractility. investigators, and teachers who are interested in heart
Specifically, therapy with converting enzyme inhibitors, failure by synthesizing and presenting information that is
angiotensin-receptor antagonists, aldosterone receptor relevant to all.
Wilson S. Colucci, MD
v
CONTRIBUTORS
Carl S. Apstein, MD Michael M. Givertz, MD David A. Orsinelli, MD
Professor Assistant Professor Associate Professor of Clinical Medicine
Department of Medicine and Physiology Department of Medicine Department of Internal Medicine;
Boston University School of Medicine; Harvard Medical School; The Ohio State University
Attending Cardiologist Co-Director, Cardiomyopathy and Heart Director, Echocardiography Lab
Boston Medical Center Failure Program Ohio State University Hospitals
Boston, Massachusetts Brigham and Women's Hospital Columbus, Ohio
Boston, Massachusetts
Wilson S. Colucci, MD Marc A. Pfeffer, MD, PhD
Professor of Medicine and Physiology Joshua M. Hare, MD Brigham and Women's Hospital
Boston University School of Medicine; Associate Professor Boston, Massachusetts
Chief Department of Medicine
Cardiovascular Medicine Division of Cardiology; Alljll Nohria, MD
Boston University Medical Center Director, Heart Failure and Cardiac Instructor
Boston, Massachusetts Transplantation Department of Medicine
Johns Hopkins University School of Harvard Medical School;
Mark A. Creager, MD Medicine Associate Physician
Professor Baltimore, Maryland Brigham and Women's Hospital
Department of Medicine Boston, Massachusetts
Harvard Medical School; Arnold M. Katz, MD
Director, Vascular Center Visiting Professor Douglas B. Sawyer, MD, PhD
Brigham and Women's Hospital Department of Medicine and Physiology Associate Professor
Boston, Massachusetts Dartmouth Medical School Department of Medicine
Hanover, New Hampshire; Boston University School of Medicine
Jay N. Cohn, MD Professor of Medicine Emeritus Boston, Massachusetts
Professor of Medicine University of Connecticut School of
Cardiovascular Division Medicine Scott D. Solomon, MD
University of Minnesota Farmington, Connecticut Associate Professor
Minneapolis, Minnesota Department of Medicine
Todd M. Koelling, MD
Harvard Medical School;
Robert J. Cody, MD, MBA Assistant Professor Director, Noninvasive Cardiology
Professor Department of Internal Medicine Brigham and Women's Hospital
Department of Internal Medicine University of Michigan Health System Boston, Massachusetts
University of Michigan Health System Ann Arbor, Michigan
Ann Arbor, Michigan Mark R. Starling, MD
Carl V Leier, MD
Professor
Jorge A. Cusco, MD Overstreet Professor of Medicine and Department of Internal Medicine
Teaching Physician Pharmacology University of Michigan Medical School;
Orlando Regional Medical Center Division of Cardiology Associate Chief, Division of Cardiology
Orlando, Florida The Ohio State University College of University of Michigan Health System
Medicine and Public Health Ann Arbor, Michigan
Daniel A. Duprez, MD, PhD Columbus, Ohio
Professor of Medicine James B. Young, MD, FACC
Cardiovascular Division; Donna M. Mancini, MD Medical Director
Director of Research Associate Professor Kaufman Center for Heart Failure;
Rasmussen Center for Cardiovascular Department of Medicine Head, Section of Heart Failure and Cardiac
Disease Prevention Columbia University; Transplant Medicine
University of Minnesota; Medical Director of Cardiac Transplant The Cleveland Clinic Foundation
Minneapolis, Minnesota Columbia-Presbyterian Medical Center Cleveland, Ohio
New York, New York
D. Bradley S. Dyke, MD
Clinical Assistant Professor
Department of Internal Medicine
University of Michigan Health System
Ann Arbor, Michigan
vi
CONTENTS
CHAPTER 1
Molecular and Cellular Basis of Contraction and Relaxation
Arnold M. Katz
Structure ..............................................................................................2
Contraction and Relaxation ..............................................................................5
Cellular Regulation ....................................................................................1 3
CHAPTER 2
Physiology of Myocardial Contraction
Mark R. Starling
Mechanics of Cardiac Contraction .......................................................................1 6
Determinants of Contraction in the Intact Heart ..........................................................2 0
Preload ...............................................................................................2 2
Contractility ..........................................................................................2 5
Afterload .............................................................................................2 6
Myocardial Energetics .................................................................................2 8
Neural Control of Contractility .........................................................................3 0
CHAPTER 3
The Etiologic Basis of Congestive Heart Failure
Joshua M. Hare
Etiology and Epidemiology ............................................................................. 34
Heart Failure Associated with Coronary Disease .......................................................... 35
Heart Failure Associated with Valvular Lesions ........................................................... 37
Idiopathic Dilated Cardiomyopathy ..................................................................... 39
Inflammatory Diseases of the Myocardium ............................................................... 40
Secondary Causes of Cardiomyopathy .... ............................................................... 47
Infiltrative/Restrictive Cardiomyopathies ................................................................ 55
Hypertrophic Cardiomyopathy ......................................................................... 57
Right Ventricular Cardiomyopathy ...................................................................... 58
CHAPTER 4
Molecular and Cellular Events in Myocardial Hypertrophy and Failure
Douglas B. Sawyer and Wilson S. Colucci
Ventricular Remodeling ................................................................................6 2
Molecular and Cellular Phenotypes .....................................................................6 3
Calcium Handling and Contractile Protein Expression .....................................................6 6
Cell Death ............................................................................................6 9
Cell Replacement ......................................................................................7 2
Extracellular Matrix ....................................................................................7 4
[3-Adrenergic Pathway .................................................................................7 5
Renin-angiotensin System, Endothelin, and Inflammatory Cytokines .......................................7 7
Oxidative Stress .......................................................................................7 9
vii
CHAPTER 5
Cardiac Remodeling and Its Prevention
Scott D. Solomon and Marc A. Pfeffer
Cardiac Growth and Remodeling .......................................................................8 4
Early Remodeling After Myocardial Infarction and Infarct Expansion .......................................8 6
Remodeling and Prognosis .............................................................................8 8
Progressive Enlargement After Myocardial Infarction .....................................................8 9
Modification of Remodeling After MyocardialInfarction ..................................................9 2
CHAPTER 6
Neurohumoral, Renal, and Vascular Adjustments in Heart Failure
Anju Nohria, Jorge A. Cusco, and Mark A. Creager
Mechanisms in Heart Failure ..........................................................................1 02
Sympathetic Nervous System ..........................................................................1 02
The Renin-angiotensin-aldosterone System .............................................................1 07
The Arginine-vasopressin System ......................................................................1 12
Natriuretic Peptides ..................................................................................1 15
Local Mechanisms ....................................................................................1 19
Regional Blood Flow ..................................................................................1 25
CHAPTER 7
Assessment of Heart Failure
James B. Young
Overview ............................................................................................1 28
Assessing the Patient .................................................................................1 30
Diagnostic Tests ......................................................................................1 39
Designing a Therapeutic Plan ..........................................................................1 42
CHAPTER 8
Prognostic Indicators and Assessment of Therapeutic Responses
Daniel A. Duprez and Jay N. Cohn
Mortality in Patients with Heart Failure .................................................................1 46
Use of Prognostic Factors ..............................................................................1 51
Assessment of Therapeutic Responses ..................................................................1 56
CHAPTER 9
Unstable Heart Failure
Carl V. Leier and David A. Orsinelli
Acute Heart Failure ...................................................................................1 62
Decompensated Chronic Heart Failure ..................................................................1 72
CHAPTER 10
Diuretics and Digitalis
D. Bradley S. Dyke and Robert J. Cody
Diuretics ............................................................................................1 82
Digoxin .............................................................................................1 87
Chapter 11
Inhibition of the Renin-Angiotensin-Aldosterone System
Todd M. Koelling, D. Bradley S. Dyke, and Robert J. Cody
Angiotensin-converting Enzyme Inhibitors .............................................................1 96
Aldosterone Receptor Blockade ........................................................................2 05
Angiotensin Receptor Blockers ........................................................................2 06
viii
CHAPTER 12
l3-blockers
Michael M. Givertz and Wilson S. Colucci
Role of Sympathetic Activation ........................................................................2 14
Mechanistic Studies ..................................................................................2 15
Randomized Controlled Trials .........................................................................2 17
Race and b-Blockers ..................................................................................2 22
Differential Effects of f3-blockers .......................................................................2 23
Strategies to Increase f3-blocker Use ....................................................................2 27
CHAPTER 13
New Approaches to the Treatment of Heart Failure
Michael M. Givertz and Wilson S. Colucci
Neurohormonal Antagonists ...........................................................................2 30
Inotropic Agents .....................................................................................2 33
Cardiac Resynchronization Therapy ....................................................................2 35
Novel Biologic Therapies for Myocardial Recovery ......................................................2 38
Treatment of Comorbidities: Anemia, Sleep Apnea, and Pulmonary Hypertension ..........................2 43
CHAPTER 14
Cardiac Transplantation
Donna M. Mancini
Posttransplantation Survival ...........................................................................2 50
Candidate Selection ..................................................................................2 50
Donor Selection Criteria ..............................................................................2 53
Surgical Techniques ..................................................................................2 54
Allograft Rejection ...................................................................................2 56
Quality of Life After Transplantation ...................................................................2 60
Accelerated Transplantation, Atherosclerosis, and Retransplantation .......................................2 61
Mechanical-assist Devices .............................................................................2 62
CHAPTER 15
Diastolic Dysfunction: Pathophysiology, Clinical Features, and Treatment
Carl S. Apstein
Normal Diastolic Function ............................................................................2 72
Pathophysiology of LV Diastolic Dysfunction ...........................................................2 79
Diastolic Dysfunction with Ischemia, Hypertrophy, and Other Causes .....................................2 84
Aging and Diastolic Dysfunction ......................................................................2 90
Clinical Features, Prognosis, and Treatment .............................................................2 95
Index .......................................................................................3 03
Color plates ................•.................•••............................................3 07
ix
MOLECULAR AND CELLULAR
BASIS OF CONTRACTION
AND RELAXATION
Arnold M. Katz
h f th ir uJ ti n
rm liti in th
Un and maJadapti