Clinical Trials Update: CAPRICORN, COPERNICUS, MIRACLE, STAF, RITZ-2, RECOVER and RENAISSANCE and cachexia and cholesterol in heart failure. Highlights of the Scientific Sessions of the American College of Cardiology, 2001.
This is a synopsis of presentations made at the American College of Cardiology (ACC) in 2001 summarising recent research developments relating to heart failure. Clinical studies of particular interest to physicians with an interest in heart failure and its prevention are reviewed. The COPERNICUS trial lends further support to the use of the beta-blocker, carvedilol, in severe heart failure and the CAPRICORN trial to its use in patients with post-infarction left ventricular systolic dysfunction. The MIRACLE study reinforces the evidence from three smaller trials that cardiac resynchronisation therapy is an effective treatment for the relief of symptoms in patients with severe heart failure and cardiac dyssynchrony. The STAF trial casts further doubt on the wisdom of cardioversion as a routine strategy for the management of chronic atrial fibrillation. The RITZ-2 trial suggests that an intravenous, non-selective endothelin antagonist is effective in improving haemodynamics and symptoms and possibly in reducing morbidity in severe heart failure. Observational studies in heart failure suggest that a moderate excess of body fat and elevated blood cholesterol may be desirable in patients with heart failure, challenging the current non-evidenced-based vogue for cholesterol lowering therapy in heart failure. The RENAISSANCE and RECOVER outcome studies of etanercept, a tumour necrosis factor (TNF) receptor analogue that blocks the effect of TNF, were stopped because of lack of evidence of benefit shortly after the ACC.
Louis
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Academic Unit of Cardiology, University of Hull, School of Medicine, Castle Hill Hospital, HU 16 5JQ, Kingston Upon Hull, UK.
Cleland
J G
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Crabbe
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Ford
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Thackray
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Houghton
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Clark
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D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D002100:Cachexia / Q000150:complications* / Q000188:drug therapy*; D002227:Carbazoles / Q000627:therapeutic use*; D002264:Carboxylic Acids / Q000627:therapeutic use; D000077261:Carvedilol; D002784:Cholesterol / Q000097:blood*; D016207:Cytokines / Q000037:antagonists & inhibitors; D016232:Endothelins / Q000037:antagonists & inhibitors; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D007189:Indans / Q000627:therapeutic use; D007275:Injections, Intravenous; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D011412:Propanolamines / Q000627:therapeutic use*; D011725:Pyridines / Q000008:administration & dosage; D013777:Tetrazoles / Q000008:administration & dosage; D014481:United States; D014665:Vasodilator Agents / Q000008:administration & dosage
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D002264:Carboxylic Acids; D016207:Cytokines; D016232:Endothelins; D007189:Indans; D011412:Propanolamines; D011725:Pyridines; D013777:Tetrazoles; D014665:Vasodilator Agents; D000077261:Carvedilol; C120582:tezosentan; D002784:Cholesterol; C098288:enrasentan