The usefulness of chronic heart failure treatments in chronic cardiac graft failure.
Following cardiac transplantation, registry data has demonstrated a gradual improvement in survival over the last several decades, which is testament to continual improvement in aftercare strategy. However, a significant number of patients will eventually develop a new syndrome of chronic heart failure, owing to the multitude of physiological processes that occur after transplantation. This condition, referred to as chronic graft failure (CGF) should be regarded as a unique illness rather than one that is simply analogous with chronic heart failure. In particular, the unique pathophysiological (and pharmacological) environment in the setting of CGF presents a challenging situation to the transplant physician. There is uncertainty over which treatments to offer given a paucity of clinical trial data to support the use of standard heart failure treatments in CGF. In this review, we discuss which chronic heart failure treatments could be considered in the setting of CGF based on their mechanisms of action, benefits within the native heart failure setting, and the relevant issues within the posttransplant environment.
Najam
Osman
O
North West Regional Heart Centre and Transplant Unit, University of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK.
Yonan
Nizar
N
Williams
Simon G
SG
Shaw
Steven M
SM
D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D006085:Graft Survival / Q000187:drug effects*; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006339:Heart Rate / Q000187:drug effects; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D009200:Myocardial Contraction / Q000187:drug effects; D009204:Myocardial Revascularization; D018579:Patient Selection; D012084:Renin-Angiotensin System / Q000187:drug effects; D012086:Reoperation; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects; D014882:Water-Electrolyte Balance / Q000187:drug effects
D002317:Cardiovascular Agents