Left ventricle and arteries: structure, function, hormones, and disease.
The observation in the 1970s that the performance of the dysfunctional left ventricle was under the influence of aortic impedance led us to exploration of the role of the renin-angiotensin system and other hormonal systems in the progression of heart failure. The apparent efficacy of vasodilator drugs led to the first randomized, controlled trial in heart failure that demonstrated that all impedance-lowering drugs did not exert the same long-term benefit. Differences on the structural remodeling process in the myocardium and arterial vasculature were shown to account for the differential long-term response. We now recognize that the remodeling process in the left ventricle may be inhibited by nitrates, converting enzyme inhibitors, and beta-blockers, and this growth process leads to adverse outcomes. The impedance load on the left ventricle is influenced by vascular remodeling that also may be inhibited by drugs such as converting enzyme inhibitors. Thus, progression of cardiovascular disease is largely a consequence of structural changes that are hormonally mediated and may be inhibited by drug therapy.
Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, USA. cohnx001@tc.umn.edu
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Cohn
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001127:Arginine Vasopressin / Q000097:blood; D004338:Drug Combinations; D004837:Epinephrine / Q000097:blood; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D006830:Hydralazine / Q000627:therapeutic use; D007548:Isosorbide Dinitrate / Q000627:therapeutic use; D009599:Nitroprusside / Q000627:therapeutic use; D011224:Prazosin / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology*; D013318:Stroke Volume; D016019:Survival Analysis; D013997:Time Factors; D014665:Vasodilator Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000209:etiology; D020257:Ventricular Remodeling / Q000187:drug effects
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004338:Drug Combinations; D014665:Vasodilator Agents; D001127:Arginine Vasopressin; D009599:Nitroprusside; D006830:Hydralazine; D012083:Renin; D007548:Isosorbide Dinitrate; D011224:Prazosin; D004837:Epinephrine