[Paradoxes of the treatment of cardiac insufficiency].
The explosion of new techniques and concepts arising from progress in molecular and cellular biology transformed our way of thinking about cardiac failure of mechanical origin in 1990. Cardiac failure indicates the limitations and imperfections of biological adaptation to a change in conditions of cardiac loading. Understanding this process of adaptation, understanding why cardiac hypertrophy of hypertensive origin remains compensated for such a long time, is and should be the basis of treatment. Inotropic therapy is paradoxically, fundamentally deleterious for the myocardial fibres, although, when considering the heart as a whole, reduction in chamber size is beneficial. Vasodilators and diuretics are not an alternative but a complement. Careful analysis of recently published clinical trials invalidates a dogmatic attitude in the debate of inotropic versus vasodilator therapy. Future developments should be based on a rational approach. The treatment of a disease of adaptation would seem to lie in the wide and virgin field of gene therapy or therapies modifying genetic expression or "drug design" based on the know structure of the hypertrophied myocyte.
Swynghedauw
B
B
U127-INSERM, Hôpital Lariboisière, Paris.
D000222:Adaptation, Physiological; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005544:Forecasting; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans
D002316:Cardiotonic Agents
Les paradoxes du traitement de l'insuffisance cardiaque.