The implantable cardioverter defibrillator.
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Arrhythmias, Cardiac↗
Biomedical subjects
S D'Isa
Publications and source records attributed to S D'Isa.
[Beta-blockers in CHF: kidney's consequences].
In the 1980s congestive heart failure (CHF) was exclusively interpreted in hemodynamic terms. In accordance with this pathophysiologic hypothesis, cardiovascular drugs, mainly positive inotropics and/or vasodilators were used but not with significant results. From the mid 1980s, attention started focusing on the neurohumoral asset, strongly activated in patients suffering from CHF, and that it was itself the cause of CHF and responsible for the poor prognosis in these patients; therefore, to become the therapeutic target and to represent the rationale for using angiotensin-converting enzyme inhibitors (ACE-I), beta-blockers and angiotensin II receptor blockers (ARBs). Evidence has been provided that these drugs can reduce morbidity and mortality. However, this evidence derives only from studies on the general population. In uremic patients, there are no dedicated controlled trials, assuming that the effect can be extended to these patients, but this is not necessarily true. The evidence based on retrospective analysis is a better survival in patients using ACE-I, but there are no prospective trials on mortality and morbidity available. Even less evidence is available on ARBs, in spite of their favorable pharmacokinetic characteristics. Uremia has been suggested as state of excess sympathetic activation; therefore, the benefit derived from beta-blockers should be even greater in uremic than in non-renal patients. Therapy with beta-blockers significantly reduces morbidity and mortality in the general population. These results are also specifically demonstrated in dialysis patients. Finally, only specifically designed trials will be able to answer the questions that cardiologists and nephrologists ask themselves in their daily practice.
Adrenergic beta-Antagonists↗
[Chronic heart failure treatment in uremic patients with beta-blockers].
The interpretation of congestive heart failure (CHF) in '80 was exclusively in haemodynamic terms. In accordance with such a pathophysiologic hypothesis, cardiovascular drugs, mainly positive inotropics and/or vasodilators were experimented with not significative results. From the second half of the 80's the attention starts focusing on the neurohumoral asset, strongly activated in patients suffering from CHF and that was it selves cause of worsening of CHF and responsible for the poor prognosis of these patients, so as to become therapeutic targets and to represent the rationale for using ace-inhibitors (ACE-I), betablockers and angiotensin II receptor blockers (ARBs). Evidence has been provided that these drugs can reduce morbidity and mortality. However, this evidence derives only from studies on general population. In uraemic patients there are no controlled trials dedicated and the nephrological guidelines recommends the use of ACE-I on the hypothesis that they may have similar efficacy than non uremic patients. Among all the medications used to treat CHF in the general population, only betablockers has been shown to be effective in a randomized trial in the dialysis population. Carvedilol was found to improve left ventricular function and decrease hospitalization, cardiovascular deaths and total mortality, remarking that pathophysiology, rationale for using and results may be similar in uremic and non uremic patients suffering from CHF.
Adrenergic beta-Antagonists↗