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Kalp Yetersizliğinin Farmakolojik Tedavisinde Güncel Yaklaşımlar: Nöroendokrin ve İmmün Yanıtın Baskılanması

Novel Approaches in Pharmacological Therapy of Heart Failure: Supression of Neuroendocrihe and Immune Response

Journal Name:

  • Uludağ Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2002

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
Heart failure is a clinical syndrome in which the heart muscle is insufficient to supply the metabolic demands of the tissues due to its impaired neurohormonal state as well as functions. Today, by taking the physiopathology into consideration, the main aim of the therapy is to terminate chain reaction causing and exacerbating the heart failure. In working towards the aim stated above, it was shown in many large-scaled trails that the angiotensin-converting enzyme inhibitors and beta blockers, which are utilized as the first step in therapy, reduce mortality and morbidity rates. Angiotensin receptor blockers, endothelin receptor antagonists, neutral endopeptidase inhibitors, natriuretic peptides and immune suppressing agents showed beneficial effects in pilot trials, however their necessity is not clear. In this review, evidence based treatment of congestive heart failure and new approaches for the inhibition of neuroendocrine and immune responses were evaluated.
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Abstract (Original Language): 
Kalp yetersizliği (KY) kalp kasının fonksiyonlarının ve nörohormonal düzenin bozulmasına bağlı olarak dokuların metabolik ihtiyaçlarını karşılamakta yetersiz kaldığı bir klinik sendromdur. Bugün tedavide esas amaç, fizyopatolojiye dayanarak kalp yetersizliğine neden olan ve kötüleştiren olaylar zincirini durdurmaktır. Birinci basamak tedavide kullanılmakta olan anjiyotensin dönüştürücü enzim inhibitörleri, beta blokerlerin bu amaca hizmet ederek mortalite ve morbiditeyi ciddi anlamda azalttığı çok sayıda büyük çalışma ile gösterilmiş olup, anjiyotensin II tip 1 reseptör blokerleri, endotelin blokajı, nötral endopeptidazların inhibisyonu, natriüretik peptidler ve immün yanıtı baskılayan ajanların kullanımı henüz netlik kazanmamasına rağmen pilot çalışmalarla faydalı etkileri gösterilmiştir. Bu derlemede KY’nin kanıta dayalı tedavisi ile birlikte nöroendokrin ve immün yanıtın baskılanmasına yönelik yeni yaklaşımlar gözden geçirilmiştir.
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  • Turkish

REFERENCES

References: 

1. Kannel WB: Need and prospects for prevention of cardiac failure.
Eur J Clin Pharmacol 1996; 49: 53-59.
2. Mehra MR, Lavie CJ, Ventura HO: Diastolic dsyfunction. What
role does it play in heart failure? Internal Med 1995; 11: 12-24.
3. Jilma B, Krejey K, Dirnberger E, et al: Effects of angiotensin II
infusion at pressor and subpressor does on endothelin-1 plasma
level in healty men. Life Sci 1997; 60: 1859-1866.
4. Cody RJ: The integrated effects of angiotensin II. Am J Cardiol
1997; 79: 9-11.
5. Izzo JL, Moser M: Clinical impact of renin-angiotensin system
blockade: angiotensin converting enzyme inhibitors vs. angiotensin receptor antagonists. J Clin Hypertens 2002; 4: 11-19.
6. Jaramillo LP, Casas JP: Endothelial dysfunction, angiotensinconverting enzyme inhibitors and calcium antagonists. J Hum
Hypertens 2002; 16: 34-37.
7. Sheth T, Parker T, Block A, et al: The IMPRESS Investigators.
Comparison of the effects of omapatrilat and lisinopril on circulating neurohormones and cytokines in patients with chronic heart
failure. Am J Cardiol 2002; 90: 496-500.
8. Guidi E, Minetti EE, Cozzi MG: Acute and long-term effects of
ACE inhibition on renal haemodynamics in glomerular and interstitial nephropathies. J Renin Angiotensin Aldosterone Syst 2002;
3: 40-45.
9. Swedberg K, Kjekshus J, Snapinn S, et al: Long-term survival in
severe heart failure in patients treated with enalapril. Ten year follow-up of CONSENSUS I. Eur Heart J 1999; 20:136-139.
10. The SOLVD Investigators: Effect of enalapril on survival in
ptients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991; 325: 293-302
11. Chon JN, Johnson G, Ziesche S, et al: A comparison of enalapril
with hydralazine- isosorbite dinitrate in the treatment of chronic
congestive heart failure. N Engl J Med 1991; 325: 303-310.
12. The Acute Infarction Efficacy (AIRE) Study Investigators: Effect
of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet
1993; 342: 812-828.
13. Carlsen J, TRACE Study Group: Result of the trandolapril cardiac
evaluation study. Am J of Hypert 1995; 8: 3A
14. Yusuf S, Nicklas JM, Timmis G, et al: Effect of enalapril on
mortality and the development of heart failure in asymptomatic
patients with reduced left ventricular ejection fractions. N Engl J
Med 1992; 325: 293-302..
15. Sutton JM, Pfeffer MA, Moye L, et al: Cardiovascular death and
left ventricular remodeling two years after myocardial infarction:
baseline predictors and impact of long-term use of captopril: information from the Survival and Ventricular Enlargement
(SAVE) trial. Circulation 1997; 96: 3294-32999.
16. Brown NJ, Vaughan ED: Angiotensin-converting enzym inhibitors. Circulation 1998; 97: 1411-1420.
17. Hunt SA, Baker DW, Chin MH, et al: ACC/AHA Guidelines for
the Evaluation and Management of Chronic Heart Failure in the
Adult. J Am Coll Cardiol 2001; 38: 2101-2113.
18. Parker M, Poole-Wilson PA, Amstrong PW, et al: Comparative
effects of high doses of the angiotensin-converting enzyme inhibitor, Lisinopril, on morbidity and mortality in chronic heart failure:
ATLAS study group. Circulation 1999; 100: 2312-2318.
19. Pitt B, Segal R, Martinez FA, et al: Randomised trial of losartan
versus captopril in patients over 65 with heart failure: Evaluation
of Losartan in Elderly Study, ELITE. Lancet 1997; 349: 747-752.
20. Pitt B, Poole- Wilson PA, Segal R, et al: Effect of losartan compared with captopril on mortality in patients with symptomatic
heart failure: randomised trial the Losartan Heart Failure Survival
Study ELİTE II. Lancet 2000; 355: 1582-1587.
21. McKelvie RS, Yusuf S, Pericak D, et al: Compasion of candesartan, enalapril, and their combination in congestive heart failure.
Randomised evalution of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD Pilot Study Investigators. Circulation 1999; 100: 1056-1064.
22. Latini R, Masson S, Anand I, et al:Effects of valsartan on
circulating brain natriuretic peptide and norepinephrine in
symptomatic chronic heart failure: The Valsartan Heart Failure
Trial (Val-HeFT). Circulation 2002; 106: 2454-2458.
23. Dickstein K, Kjekshus J; OPTIMAAL Steering Committee for the
OPTIMAAL Study Group: Effects of losartan and captopril on
mortality and morbidity in high-risk patients after acute
myocardial infarction: the OPTIMAAL randomised trial.Lancet
2002; 360: 752-760.
24. Pfeffer MA, McMurray J, Leizorovicz A, et al: Valsartan in acute
myocardial infarction trial VALIANT: rationale and design. Am
Heart J 2000; 140: 727-750.
25. Kozan Ö, Keskin V: Kalp yetmezliğinde diüretik tedavi. T
Cardiol Seminars 2001; 2: 16-22.
26. Pitt B, Zannad F, Remme WJ: The effect of spironolactone on
morbidity in patients with severe heart failure. Randomized
Aldactone Evauation Study Investigators. N Engl J Med 1999;
341: 709-717.
27. Cohn MJ, Levine B, Olivari MT, et al:Plasma norepinephrine as a
guide to prognosis in patient with chronic congestive heart failure.
N Engl J Med 1984; 311: 819-823
28. Aksöyek S: Kalp yetersizliği tedavisinde beta blokerler. T Klin J
Cardiol 2000; 13: 47-57
29. Bristow MR: Beta adrenerjik receptor blockade in chronic heart
failure. Circulation 2000; 101: 558-569.
30. Colucci WS, Packer M, Bristow MR, et al:For the US heart
failure study group. Carvedilol inhibits clinical progression in
patiants with mild symptoms of heart failure. Circulation 1996;
94: 2800-2806.
31. Eicharn EJ, Heejeh CM, Barnett JH, et al: Effect of metoprolol on
myocardial function and energetic in patient with nonischemic
dilated cardiomyopathy. A randomized double blind placebo
controlled study. J Am Coll Cardiol 1994; 24: 1310-1320.
32. The international steering commitee on behalf of the MERIT-HF
study group: Effect of metoprolol CR/XL chronic heart failure:
Metoprolol CR/XL randomized intervention trial in congestive
heart failure. Lancet 1999;353: 2001-2007.
33. CIBIS-II investigators and commitees: The cardiac insuffiency
bisoprolol study II (CIBIS II). A randomized trial. Lancet 1999;
353: 9-13.
34. Packer M, Coats AJS, Fowler MB, et al: Effect of carvedilol on
survival in severe chronic heart failure. N Engl J Med 2001; 344:
1851-1858.
35. BEST investigators: A trial of the beta blocker bucindolol in
patients with advanced chronic heart failure. N Engl J Med 2001;
344:1659-1667. A. Aydın, ark.
120
36. Kiowski W, Linder L, Stoschitzky K, et al: Diminished vascular
response to inhibition of endothelium derived nitric oxide and
enhanced vasoconstrition to exogenously administered
endothelin-1 in clinically healty smokers. Circulation 1994; 90:
27-34.
37. Giverts MM, Colucci WS: News targets for heart failure
therapy:Endothelin, inflamatory cytokines and oxidative stress.
Lancet. 1998; 352 (supp 1): 5134-5138.
38. O’Connor CM, Gattis WA, Kirkwood FA, et al: Tezosentan in
patients with acute heart failure and acute coronary syndromes:
Design of the Randomized Intravenous Tezosentan Study (RITZ-
4). Am Heart J 2002; 144: 583-588.
39. Cody RJ, Haas GJ, Binkley PF, Capers Q, Kelly R: Plasma
endothelin correlates with the extent of pulmonary hypertension
in patients with chronic congestive heart failure. Circulation
1992; 85: 504-509.
40. Loffler BM, Breu V, Clozel M: Effect of different endothelin
receptor antagonists and of the non-peptide antagonist Ro 46-
2005 on endothelin levels in rat plasma. FEBS lett 1993; 533:
108-110.
41. Öngen Z: Kalp yetersizliğinde yeni farmakolojik tedavi yaklaşımları. T Cardiol Seminars 2001; 2: 54-62.
42. Mylona P, Cleland JGF: Update of REACH-1 and MERITHFclincal trials in heart failure. Eur J Heart Failure 1999; 1: 197-
200.
43. Dupuis J, Rouleau JL, Cernacek P, et al: Reduced pulmonary
clearance of endothelin-1 contributes to the increase of circulating
levels in heart failure secondary to myocardial infarction.
Circulation 1998; 98: 1684-1687.
44. Spieker LE, Mitrovic V, Noll G, et al:Acute hemoynamic and
neurohumoral effect of selective ET A receptor blockade in
patients with congestive heart failure. J Am Coll Cardiol 2000;
35: 1745-1752.
45. Louis A, Cleland JGF, Crabbe S, et al: Clinical trials update:
CAPRICORN, COPERNICUS, MIRACLE, STAF, RITZ-2,
RECOVER AND RENAISSANCE and cachaexia and cholesterol
in heart failure. Highlights of scientific sessions of the American
College of Cardiology, 2001. Eur J Heart Failure 2001; 3: 381-
387.
46. Trippodo NC, Fox M, Natarajan V, et al: Combined inhibition of
neutral endopeptidase and angiotensin converting enzym in
cardiomyopathic hamsters with compansated heart failure. J
Pharmachol Exp Ther 1993; 267: 108-117.
47. Rouleau JL, Pfeffer MA, Stewart DJ, et al: Comparison of
vasopeptidase inhibitor, omapatrilat and lisinopril on exercise
tolerance and morbidity in patient with heart failure: IMPRESS
randomized trial. Lancet 2000; 356: 615-620.
48. Rouleau JL,Pfeffer MA, Stewart DJ, et al: Effect of omapatrilat
and lisinopril on renal function in patients with heart failure.
Circulation 2000; 102 (supp II): 533.
49. Coats AJS: Omapatrilat- the story of Overture and Octave.
International J of Cardiol 2002; 86: 1-4.
50. Chen HH, Burnett JC Jr: Natriuretic peptides in heart failure:
Diagnostic and therapeutic potentials. Proc Assoc Am Physicians
1999; 11: 406-416.
51. Colucci WS, Elkayam U, Horton D, et al: Intravenous nesiritide a
natriuretic peptide, in the
52. Treatment decompanseted heart failure. N Engl J Med. 2000;
343:246-53.
53. Mills RM, LeJemtel TH, Horton PD, et al: Sustained
hemodynamic effect of an infusion of nesiritide (human b- type
natriuretic peptide) in heart failure: A randomized, double blind,
placebo controlled clinical trial. J Am Coll Cardiol 1999; 34: 155-
162.
54. Chen HH, Lainchbury JG, Harty GJ, et al: Maximizing natriuretic
peptide system in experimental heart failure: Subcutaneus brain
natriuretic peptide and acute vasopeptidase inhibition. Circulation
2002; 105: 999-1003.
55. Gullestat L, Aass H, Fjeld JG, et al: Immunomodulating therapy
with intravenous immunoglobulin in patients with chronic heart
failure. Circulation 2001; 103: 220-225.
56. Aukrust P, Froland SS, Liabakk NK, et al: Release of cytokines
soluble cytokine receptors and interleukin-1 receptor antagonist
after intravenous immunoglobulin administration in vivo. Blood
1994; 84: 2136-2143.
57. Bozkurt B, Kribbs SB, Clubb FJ Jr, et al: Pathophysiologically
relevant consentration of tumor necrosis factor-α promote
progressive dysfunction and remodeling in rats. Circulation 1998;
97: 1382-1391.
58. Skudicky D, Bergeman A, Sliwa K, et al: Beneficial effect of
pentoxifylline in patients with dilated cardiomyopathy treated
with angiotensin converting enzym inhibitors and carvedilol.
Circulation 2001;103:1083-1088.

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