[Beta blockers in therapy of chronic heart failure].


BACKGROUND:Once contraindicated, beta-blockers have become an established, evidence-based, recommended treatment concept in chronic heart failure during the last years. PATHOPHYSIOLOGY:The increased activation of the adrenergic system in heart failure syndrome, which leads to transmission of several adverse biological signals to myocytes through adrenergic receptors, provides the rationale for the use of beta-blockers in patients with chronic heart failure. Long-term treatment with different types of beta-blockers addictive to an ACE-inhibitor and diuretics results in normalization of left ventricular shape, an improvement of left ventricular function, and a reduction of hospitalization rate for heart failure. Hemodynamic and clinical improvement is independent of etiology and severity of left ventricular dysfunction. THERAPEUTICAL RECOMMENDATIONS ACCORDINGS TO STUDIES: Adequately powered clinical trials (CIBIS II, MERIT-HF, COPERNICUS) testing different types of beta-blockers (bisoprolol, metoprolol, carvedilol) clearly demonstrated that total mortality and the incidence of sudden cardiac death were significantly reduced in heart failure patients by each of these agents. On the basis of all available evidence, all patients with chronic, stable heart failure (NYHA class II-IV) and with impaired left ventricular function (LVEF < 45%) should receive one of the three above mentioned beta-blockers. Protective effects of beta-blockers in heart failure comprise decrease in heart rate, a decrease of energy consumption, antifibrillatory effects, protection against adrenergic overactivation, and hence, inhibition of myocardial cell necrosis. Moreover, several beta-blockers induce an up-regulation of beta-receptors leading to an improvement of contractility during long-term treatment. It should be mentioned that even a low dosage of beta-blockers exert negative inotropic effects and may lead to a deterioration of hemodynamics and heart failure symptoms in patients with heart failure. The patients treated should be informed that the success of the "paradoxical intervention" will be obvious until 2-3 months after initiation of additional beta-blocker therapy. Beta-blocker treatment for heart failure should be started in stable patients with a very low initial dosage and then up-titrated to the maximal tolerated dosage and should be continued indefinitely. Mortality reduction by beta-blockade in heart failure is no class effect. So far, beneficial effects could only be demonstrated for lipophilic agents. Whether the non-selective beta-blocker carvedilol with additional properties has advantages over the beta-1-selective metoprolol is currently investigated in the COMET (Carvedilol or Metoprolol European Trial) study. Despite the impressive effects in terms of morbidity and mortality reduction, the transfer of these benefits to the clinical practice setting is difficult, with international data showing only 10% of patients with heart failure being treated.






Hoffman J,Grimm W,Maisch B





Has Abstract


2002-03-01 00:00:00














  • [Catheter interventions for congenital heart disease].

    abstract::Interventional catheterization for congenital heart disease has rapidly developed over the last 2 decades. The role of interventions has evolved from replacing surgery altogether in some cases to complementing surgery in others. The most commonly used approaches to common cardiac lesions such as persistent arterial du...


    pub_type: 杂志文章,评审


    authors: Krasemann T

    更新日期:2008-12-01 00:00:00

  • Stress echocardiography: an overview.

    abstract::Stress echocardiography has come a long way in the past ten to twelve years since it first began. There have been many procedural and technical advances. The results being obtained by those laboratories with active programs are very gratifying. Stress echocardiography is proving to be particularly valuable in women an...


    pub_type: 杂志文章,评审


    authors: Feigenbaum H

    更新日期:1991-10-01 00:00:00

  • [Overweight and obesity in childhood and adolescence. Is prevention possible?].

    abstract::The prevalence of overweight and obesity in children and adolescents is increasing. In Germany, 10-20% of children and youth are overweight and obese. Childhood obesity is associated with cardiovascular and other comorbidities. 25% suffer from arterial hypertension and/or hypercholesterolemia, 1% from diabetes mellitu...


    pub_type: 杂志文章


    authors: Graf C,Dordel S,Tokarski W,Predel HG

    更新日期:2006-09-01 00:00:00

  • [Atrial myxoma in the patients of a general and internal medicine outpatient clinic].

    abstract::In a medical out-patient clinic, over a period of several years, atrial myxoma was diagnosed in four patients with ages ranging between 32 and 69 years. With the exception of one patient referred for assessment of ventricular premature beats, presentation was not primarily attributable to cardiac causes. In all patien...


    pub_type: 杂志文章


    authors: Keller H,Bodem R

    更新日期:1983-12-01 00:00:00

  • [Anxiety and depression in cardiology patients: how to diagnose, how to treat?].

    abstract:IMPORTANCE:Anxiety and depression are frequent problems in patients with heart diseases. Prevalences vary between 15 and 50%, depending on diagnostic criteria as well as on sociodemographic and medical patient characteristics. During the last 10-15 years, a large number of studies have shown that anxiety and depression...


    pub_type: 杂志文章,评审


    authors: Herrmann-Lingen C

    更新日期:2001-08-01 00:00:00

  • [Effectiveness of various combination therapies in patients with coronary heart disease].

    abstract::There is only a limited number of studies available comparing the effectiveness of various combinations of anti-ischemic and antianginal substances in the same patients with coronary artery disease and stable angina pectoris and even these are restricted to either only a few drugs or a single point in time for testing...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Lehmann G,Reiniger G,Wolf H,Beyerle A,Rudolph W

    更新日期:1990-12-01 00:00:00

  • Surgical septation of univentricular heart with outlet chamber.

    abstract::From April 1973 through March 1978, 34 patients with univentricular heart and outlet chamber underwent repair by septation of the ventricle. Three had normally related great arteries in which the pulmonary artery arose from the outlet chamber. Six patients had an anterior aorta arising from an anterior or right-sided ...


    pub_type: 杂志文章


    authors: Danielson GK,McGoon DC,Maloney JD,Ritter DG

    更新日期:1979-04-01 00:00:00

  • [Arrhythmogenic right ventricular cardiomyopathy].

    abstract::Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a primary myocardial disorder that is characterized by localized or diffuse atrophy of predominantly right ventricular myocardium with subsequent replacement by fatty and fibrous tissue. Arrhythmias of right ventricular origin are the main clinical manifestatio...


    pub_type: 杂志文章,评审


    authors: Haverkamp W,Rolf S,Osterziel KJ,Dietz R,Peters S

    更新日期:2005-09-01 00:00:00

  • [Coronary artery bypass surgery for the treatment of acute coronary syndromes].

    abstract::According to the current guidelines coronary revascularization in acute coronary syndromes (ACS) is primarily performed by percutaneous coronary interventions (PCI). However, in several scenarios like complex coronary pathologies, unsuccessful PCI, complicated PCI or cardiogenic shock, surgical coronary revascularizat...


    pub_type: 杂志文章,评审


    authors: Rastan AJ,Thiele H,Schuler G,Mohr FW

    更新日期:2010-03-01 00:00:00

  • [Surgical atrial fibrillation ablation therapy and postoperative monitoring].

    abstract::Atrial fibrillation represents the most common atrial arrhythmia seen in clinical practice. The surgical treatment of atrial fibrillation is recommended in symptomatic patients as well as in asymptomatic patients at low postoperative risk. As a "stand alone" procedure, surgical ablation therapy is indicated after fail...


    pub_type: 杂志文章


    authors: Hanke T,Sievers HH

    更新日期:2011-12-01 00:00:00

  • [Reconstruction methods for 3D imaging and quantification of intracoronary ultrasound cross-sectional images using biplanar fluoroscopy. Initial experiences in vitro and in vivo].

    abstract::In this investigation, we studied the feasibility of 3D-reconstruction from 2D cross-sectional intracoronary ultrasound images. A computer-aided, automated 3D-reconstruction was used to generate cylindrical and sagittal format of vessels in vitro (n = 9) and in vivo (n = 48). Ultrasound 2D-images were acquired with a ...


    pub_type: 杂志文章


    authors: Ge J,Koch L,Roth T,Görge G,Kearney P,Haude M,Baumgart D,von Birgelen C,Brennecke R,Meyer J

    更新日期:1995-08-01 00:00:00

  • [Perforation and rupture of coronary arteries].

    abstract::Spontaneous rupture of coronary arteries as well as coronary perforation during percutaneous interventions are rare but potentially life-threatening incidents often resulting in emergency surgery. Frequency of acute perforation due to therapeutic catheterization varies according to the devices employed. With conventio...


    pub_type: 杂志文章,评审


    authors: Elsner M,Zeiher AM

    更新日期:1998-08-01 00:00:00

  • [Heart or lung? : Diagnostics and management of unclear exertional dyspnea].

    abstract::Exertional dyspnea is a nonspecific symptom with a variety of underlying causes. It can be challenging to differentiate a beginning cardiac disease from a pulmonary disease or from deconditioning alone. In the presence of obesity, the overall assessment is even more difficult. Rare diseases, such as pulmonary hyperten...


    pub_type: 杂志文章


    authors: Wilkens H,Held M

    更新日期:2018-09-01 00:00:00

  • Aortic intramural hematoma: aspects of pathogenesis 2011.

    abstract::Non-invasive tomographic imaging modalities have recently contributed to identifying aortic intramural hematoma, a variant form of classic dissection, which is characterized by the absence of an intimal tear and thus the absence of direct flow communication, and which represents an important disease entity in acute ao...


    pub_type: 杂志文章,评审


    authors: Song JK

    更新日期:2011-09-01 00:00:00

  • Routine clinical positron emission tomography for diagnostic cardiac imaging--a review.

    abstract::Positron emission tomography, advanced through technical developments, has now evolved into a routinely applicable method for clinical investigation. The rubidium-82 generator, without the need for a cyclotron, provides a source of positron radionuclide which enables delineation of cardiac structures. Three characteri...


    pub_type: 杂志文章


    authors: Gould KL,Mullani N

    更新日期:1987-02-01 00:00:00

  • Highly purified omega-3 polyunsaturated fatty acids in clinical development.

    abstract::Highly purified omega-3 polyunsaturated fatty acids (PUFAs) (Omacor) is the focus of an extensive and ambitious clinical development program that seeks to build on the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione study. Studies currently in progress inclu...


    pub_type: 杂志文章,评审


    authors: Vik H

    更新日期:2006-12-01 00:00:00

  • [Local drug delivery and gene therapy].

    abstract::One of the most important problems in clinical cardiology is still unresolved, i.e., the development of a restenosis following coronary balloon angioplasty. Our knowledge about the sequelae of pathophysiologic events occurring during neointima formation is still far from complete (Figure 1) and numerous therapeutic tr...


    pub_type: 杂志文章,评审


    authors: Darius H,Buerke M,Boissel JP,Grosser T,Veit K,Zacharowski K,Meyer J

    更新日期:1997-12-01 00:00:00

  • Arrhythmias in acute pericarditis. An endomyocardial biopsy study.

    abstract::It is still controversial whether the arrhythmias in acute pericarditis are of myocardial or pericardial origin. The aim of the present study was to investigate the occurrence of arrhythmias and conduction disorders in patients with acute pericarditis with no endomyocardial biopsy evidence of myocarditis (group 1: 40 ...


    pub_type: 杂志文章


    authors: Ristić AD,Maisch B,Hufnagel G,Seferovic PM,Pankuweit S,Ostojic M,Moll R,Olsen E

    更新日期:2000-12-01 00:00:00

  • Recurrent takotsubo cardiomyopathy : variable pattern of ventricular involvement.

    abstract:BACKGROUND:Takotsubo cardiomyopathy (TTC) is a transient left ventricular (LV) dysfunction that predominantly affects older women and has three main variants: apical, mid-ventricular, and basal. The recurrence rate of TTC is roughly around 11 % at 4-year follow-up. The pathogenesis of TTC is not clear and various theor...


    pub_type: 杂志文章


    authors: Singh K,Parsaik A,Singh B

    更新日期:2014-12-01 00:00:00

  • Acute stent thrombosis during percutaneous coronary intervention. Treatment with tirofiban.

    abstract::Although rarely reported, acute instent thrombosis can be life threatening, especially in cases where there are no ST segment changes. For this reason, careful history taking, follow-up, and prompt coronary angiography may be lifesaving. Herein, a case of acute stent thrombosis with no ST segment changes on electrocar...


    pub_type: 杂志文章


    authors: Canpolat U,Sunman H,Yorgun H,Atalar E

    更新日期:2012-05-01 00:00:00

  • Polymer-free biolimus-A9-coated stent for primary percutaneous coronary intervention.

    abstract:BACKGROUND:The polymer-free biolimus-A9 drug-coated stent (DCS) was reported to have superior safety and efficacy outcomes compared with a bare metal stent in the LEADERS FREE trial of high-bleeding-risk patients with acute coronary syndrome and on dual antiplatelet treatment (DAPT) for 1 month. The aim of this investi...


    pub_type: 杂志文章


    authors: Lee DJH,Loh JKK,Jafary FH,Ho HH,Watson T,Stoll HP,Ong PJL

    更新日期:2019-12-01 00:00:00

  • [Transluminal angioplasty: control of efficiency by nuclear medical methods after non-operative dilatation of critical coronary artery stenoses (author's transl)].

    abstract::Preliminary results are reported using 201Tl-myocardial scintigraphy (MSC) with quantitated analysis of redistribution kinetics immediately after ergometry (climbing step test) two to four hours later respectively and (Dual-ROI-) Equilibrium-Radionuclide-Ventriculography (ERNVG) with 99mTc-in vivo-labeled erythrocytes...


    pub_type: 杂志文章


    authors: Hör G,Kanemoto N,Standke R,Maul FD,Klepzig H Jr,Kober G,Kaltenbach M

    更新日期:1980-06-01 00:00:00

  • Pathology and pathogenesis of arrhythmogenic right ventricular cardiomyopathy.

    abstract::Arrhythmogenic right ventricular cardiomyopathy is a primary heart muscle disease characterized by progressive myocardial atrophy of the right ventricle, with transmural fatty or fibrofatty replacement, either segmental or diffuse, accounting for electrical instability at risk of life-threatening ventricular arrhythmi...


    pub_type: 杂志文章,评审


    authors: Thiene G,Basso C,Calabrese F,Angelini A,Valente M

    更新日期:2000-05-01 00:00:00

  • Prognosis in heart failure: is systolic or diastolic dysfunction more important?

    abstract::The clinical syndrome of congestive heart failure can result from inadequate myocardial contraction (systolic myocardial failure), from pseudo-heart failure due to circulatory overload, or from failure of the ventricles to fill at low pressure (diastolic myocardial failure). The presence of systolic or diastolic heart...


    pub_type: 杂志文章,评审


    authors: Warren SE,Grossman W

    更新日期:1991-09-01 00:00:00

  • [Reconstructive surgery of the aortic valve: the Ross, David, and Yacoub procedures].

    abstract::The aortic valve consists of three cusps attached to the wall of the aortic root. During the cardiac cycle, the aortic root undergoes complex movements that precede and aid opening and closing of the aortic valve. The aortic valve cusps themselves form thin-walled pocket-like structures, made from specialized tissue w...


    pub_type: 杂志文章,评审


    authors: Bechtel JF,Erasmi AW,Misfeld M,Sievers HH

    更新日期:2006-08-01 00:00:00

  • [Functional aspects of endothelial phenotypes in the human heart. Immunohistochemical study for the evaluation of endothelial adhesion molecule expression].

    abstract:BACKGROUND AND PURPOSE:The endothelial lining is a confluent monolayer of thin and rhomboid-shaped cells, that covers the inner surface of all blood vessels. However, the essential role of endothelial cells in all aspects of cardiovascular physiology, homeostasis and the pathogenesis of most cardiovascular diseases no ...


    pub_type: 杂志文章


    authors: Wilhelmi M,Leyh R,Haverich A

    更新日期:2004-05-01 00:00:00

  • Aortic diseases--do we need MR techniques?

    abstract::MR with its various imaging protocols including spin-echo MR-imaging, gradient MR imaging, flow-mapping and MR angiography is the ideal tool for noninvasive assessment of any kind of aortic diseases. The technique allows to image the aorta both in the thoracic cage and in the abdominal aspects better than any other to...


    pub_type: 杂志文章


    authors: Nienaber CA,Fattori R

    更新日期:2000-06-01 00:00:00

  • Everolimus- vs. novolimus-eluting bioresorbable scaffolds in patients with acute coronary syndrome.

    abstract:BACKGROUND:Limited data exist on bioresorbable scaffolds (BRS) in patients with acute coronary syndrome (ACS). The aim of the present study was to evaluate novolimus-eluting BRS (DESolve) as interventional treatment for patients with ACS, and to compare its 12-month outcomes with the everolimus-eluting bioresorbable sc...


    pub_type: 杂志文章


    authors: Nef HM,Wiebe J,Schmidt G,Möllmann H,Boeder NF,Dörr O,Bauer T,Blachutzik F,Liebetrau C,Elsässer A,Foin N,Hamm CW

    更新日期:2020-12-01 00:00:00

  • [Hypertrophic obstructive cardiomyopathy: surgical treatment and results].

    abstract::The natural history of hypertrophic obstructive cardiomyopathy is characterized, in particular, in younger patients by sudden cardiac death, in the majority of patients by progressive congestive heart failure [14, 26, 27, 33-36]. With the aid of beta-adrenergic receptor blockers, calcium channel blockers and antiarrhy...


    pub_type: 杂志文章


    authors: Schulte HD,Lösse B

    更新日期:1985-04-01 00:00:00

  • [Coronary disease and social security. A simulation model on cost analysis].

    abstract::A Monte Carlo simulation model is presented which allows an assessment of the costs for coronary heart disease (CHD) (from a social security perspective) to be made over a time interval of 10 years. The difference between a CHD population and a normal population is calculated whereby the CHD population corresponds in ...


    pub_type: 杂志文章


    authors: Hinzpeter B,Klever-Deichert G,Wendland G,Lauterbach KW

    更新日期:2000-08-01 00:00:00