Standard drug therapy of systolic heart failure has been evaluated in large-scale randomized clinical trials and includes angiotensin-converting enzyme (ACE) inhibi tors, which should be used as first-line therapy, diuret ics for the management of extracellular fluid volume excess, and digoxin. In combination with ACE inhibitors and diuretics, with or without digoxin, some β-adrener gic receptor blockers attenuate disease progression and improve outcome in mild-to-moderate systolic heart failure. The pharmacologic management of chronic dia stolic heart failure is largely empirical and directed at reducing symptoms. Symptoms caused by increased ventricular filling pressures may be diminished by diuret ics and nitrovasodilators. Some calcium channel antago nists and most β-blockers prolong diastolic filling time by slowing heart rate, thereby improving the symptoms of diastolic heart failure.
Get full access to this article
View all access options for this article.
References
1.
Abraham WT, Hensen J., Schrier RW: Elevated plasma noradrenaline concentrations in patients with low-output cardiac failure: Dependence on increased noradrenaline secretion rates. Clin Sci79:429-435, 1990
2.
Francis GS, Benedict C., Johnston DE, et al: Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the studies of left ventricular dysfunction (SOLVD). Circulation82:1724-1729, 1990
3.
Rundqvist B. , Elam M., Bergmann-Sverrisdottir Y., et al: Increased cardiac adrenergic drive precedes generalized sympathetic activation in human heart failure. Circulation95:169-175, 1997
4.
Agostoni PG, DeCesare N., Doria E., et al: Afterload reduction: A comparison of captopril and nifedipine in dilated cardiomyopathy. Br Heart J55:391-399, 1986
5.
Thomas JA, Marks BH: Plasma norepinephrine in congestive heart failure. Am J Cardiol41:233-243, 1978
6.
Levine TB, Francis GS, Goldsmith SR, et al: Activity of the sympathetic nervous system and renin-angiotensin system as assessed by plasma hormone levels and their relation to hemodynamic abnormalities in congestive heart failure. Am J Cardiol49:1659-1666, 1982
7.
Davis D., Baily R., Zelis R.: Abnormalities in systemic norpinephrine kinetics in human congestive heart failure. Am J Physiol254:E760-E766, 1988
8.
Hasking GJ, Esler MD, Jessnings GL, et al: Norepinephrine spillover to plasma in patients with congestive heart failure. Evidence of increased overall and cardiorenal sympathetic nervous activity. Circulation73:615-621, 1986
9.
Leimbach WN, Wallin BG, Victor RG, et al: Direct evidence from intraneural recordings for increased sympathetic outflow in patients with heart failure. Circulation73:913-919, 1986
10.
Abraham WT, Schrier RW: Body fluid volume regulation in health and disease, in Schrier RW, Abboud FM, Baxter JD, Fauci AS (eds): Advances in Internal Medicine (vol 39). Chicago, IL, Mosby Year Book , 1994, pp 23-47
11.
Abraham WT, Schrier RW: Cardiac failure, liver disease, and the nephrotic syndrome, in Schrier RW, Gottschalk CW (eds): Diseases of the Kidney (6th ed). Boston, MA, Little, Brown & Company1996, pp 2353-2392
12.
Sklar AH, Schrier RW: Central nervous system mediators of vasopressin release. Physiol Rev1243-1280, 1983
13.
Berl T., Henrich WL, Erickson AL, Schrier RW: Prostaglandins in the beta-adrenergic and baroreceptor-mediated secretion on renin. Am J Physiol235:F472-F477, 1979
14.
Cohn JN, Levine BT, Olivari MT, et al: Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med311:819-823, 1984
15.
Mann D., Kent R., Parsons B., Cooper G.: Adrenergic effects on the biology of the adult mammalian cardiocyte . Circulation85:790-804, 1992
16.
Shivalkar B. , Van Loon J., Wieland W., et al: Variable effects of explosive or gradual increase of intracranial pressure on myocardial structure and function. Circulation87:230-239, 1993
17.
White M., Weichmann R., Roden RL, et al: Cardiac β-adrenergic neuroeffector systems in acute myocardial dysfunction related to brain injury: Evidence for catecholamine-mediated myocardial damage. Circulation92:2183-2189,1995
18.
Rosenbaum JS , Ginsburg R., Billingham ME, Hoffman BB: Effects of adrenergic receptor antagonist on cardiac morphological and functional alterations in rats harboring pheochromocytoma . J Pharmacol Exp Ther241:354-360, 1987
19.
Imperato-McGinley F., Gautier T., Ehlers K., et al: Reversibility of catecholamine-induced dilated cardiomyopathy in a child with a pheochromocytoma . N Engl J Med316:793-797,1987
20.
Brod J., Fejfar Z., Fejfarová MH: The role of neurohumoral factors in the genesis of renal haemodynamic changes in heart failure. Acta Med Scand13-148:273-290, 1954
21.
Gill JR Jr, Mason DT, Bartter FC: Adrenergic nervous system in sodium metabolism: Effects of guanethidine and sodium-retaining steroids in normal man. J Clin Invest43:177-184, 1964
22.
DiBona GF, Herman PJ, Sawin LL: Neural control of renal function in edema-forming states. Am J Physiol254:1017-1024,1988
23.
Bello-Reuss E., Trevino DL, Gottschalk CW: Effect of renal sympathetic nerve stimulation on proximal water and sodium reabsorption. J Clin Invest57:1104-1107, 1976
24.
Francis GS, Goldsmith SR, Levine TB, et al: The neurohumoral axis in congestive heart failure. Ann Intern Med101:370-377, 1984
25.
Merrill AJ, Morrison JL, Branon ES: Concentration of renin in renal venous blood in patients with chronic heart failure. Am J Med1:468-472, 1946
26.
Lee WH, Packer M.: Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure . Circulation73:257-267, 1986
27.
Dzau VJ, Packer M., Lilly LS, et al: Prostaglandins in severe congestive heart failure: relation to activation of the renin-angiotensin system and hyponatremia. N Engl J Med310:347-352,1984
28.
Bonjour JP, Malvin RL: Stimulation of ADH release by the renin-angiotensin system. Am J Physiol218:1555-1559, 1970
29.
Kubo SH, Cody RJ, Laragh JH, et al: Immediate converting-enzyme inhibition with intravenous enalapril in chronic congestive heart failure. Am J Cardiol55:122-126, 1985
30.
Laragh JH, Angers M., Kelly WG, Lieberman S.: Hypotensive agents and pressor substances: The effect of epinephrine, norepinephrine, angiotensin II, and others on the secretory rate of aldosterone in man. JANIA174:234-240, 1960
31.
Hensen J., Abraham WT, Durx J., Schrier RW: Aldosterone in congestive heart failure patients: Analysis of determinants and role in sodium retention. Am J Nephrol11:441-446, 1991
32.
Meyers BD, Deen WM, Brenner BM: Effects of norepinephrine and angiotensin II on the determinants of glomerular ultrafiltration and proximal tubule fluid reabsorption in the rat . Cir Res37:101-110, 1983
33.
Abraham WT, Schrier RW: Renal salt and water handling in congestive heart failure, in Hosenpud JD, Greenberg BH (eds): Congestive Heart Failure: Pathophysiology, Diagnosis, and Comprehensive Approach to Management. New York, NY , Springer-Verlag, 1994 , pp 161-173
34.
Liu F-Y., Cogan MG: Angiotensin II: A potent regulator of acidification in the rat early proximal convoluted tubule. J Clin Invest80:272-275, 1987
35.
Eiam-Ong S. , Hilden SA, Johns CA, Madias NE: Stimulation of basolateral Na(+)-HC03-cotransporter by angiotensin II in rabbit renal cortex . Am J Physiol265:195-203, 1993
36.
Phillips PA , Rolls BJ, Ledingham Jgg, et al: Angiotensin-induced thirst and vasopressin release in man. Clin Sci68:669-674,1985
37.
Wright JW, Moerseth SL, Abhold RH, Harding JW: Pressor action and dipsogenicity induced by angiotensin II and III in rats . Am J Physiol249:514-521, 1985
38.
Pratt RE, Dzau VJ: Trophic Effects of Angiotensin on Blood Vessels and Heart, in The Renin-Angiotensin System. Robertson JI , Nicholls MG (eds): London, England, Gower Medical Publishing , 1993, pp 1:31.1-31.7
39.
Pfeffer MA, Lamas GA, Vaughan DE, et al: Effect of captopril on progressive ventricular dilatation after anterior myocardial infarction. N Engl J Med319:80-86, 1988
40.
Pfeffer MA, Braunwald E., Moye LA, et al: On behalf of the SAVE Investigators. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: Results of the Survival and Ventricular Enlargement trial. N Engl J Med327: 669-677, 1992
41.
The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators: Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet342:821-828, 1993
42.
GISSI-3: Effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction: Gruppo Italiano per lo Studio della Supravivenza nell'infarto Miocardico. Lancet343:1115-1122, 1994
43.
ISIS-4: A randomized factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction ISIS-4 (Fourth International Study of Infarct Survival) collaborative Group. Lancet345:669-685, 1995
44.
Hilgers KF, Veelken R., Rupprecht G., et al: Angiotensin II facilitates sympathetic transmission in rat hind limb circulation. Hypertension21:322-328, 1993
45.
Abraham WT, Lowes BD, Rose CP, et al: Angiotensin II selectively increases cardiac adrenergic activity in patients with heart failure. J Am Coll Cardiol23:215, 1994 (abstr)
46.
Gilbert EM, Sandoval A., Larrabee P., et al: Lisinopril lowers cardiac adrenergic drive and increases β-receptor density in the failing human heart. Circulation88:472-480,1993
47.
Bristow MR, Abraham WT: Anti-adrenergic effects of angiotensin-converting enzyme inhibitors . Eur Heart J16:37-41, 1995 (suppl K)
48.
Szatalowicz VL, Arnold PE, Chaimovitz C., et al: Radioimmunoassay of plasma arginine vasopressin in hyponatremic patients with congestive heart failure. N Engl J Med305:263-266, 1981
49.
Bichet DG, Kortas C., Mettauer B., et al: Modulation of plasma and platelet vasopressin by cardiac function in patients with heart failure. Kidney Int29:1188-1196, 1986
50.
Riegger Gaj , Liebau G., Koschiek K.: Antidiuretic hormone in congestive heart failure. Am J Med72:49-55, 1982
51.
Pruszczynski W., Vahanian A., Ardailou R., Acar J.: Role of antidiuretic hormone in impaired water excretion of patients with congestive heart failure . J Clin Endocrinol Metab58:599-603, 1984
52.
Goldsmith SR , Francis GS, Cowley AW Jr: Arginine vasopressin and the renal response to water loading in congestive heart failure. Am J Cardiol58:295-299, 1986
53.
Nicod P., Biollaz J., Waeber B., et al: Hormonal, global and regional haemodynamic responses to a vascular antagonist of vasopressin in patients with congestive heart failure with and without hyponatraemia. Br Heart J56:433-439, 1986
54.
Creager MA, Faxon DP, Cutler SS, et al: Contribution of vasopressin to vasoconstriction in patients with congestive heart failure: Comparison with the renin-angiotensin system and the sympathetic nervous system. J Am Coll Cardiol7:758-765, 1986
55.
Anderson RJ , Cadnnapaphornchai P., Harbottle JA, et al: Mechanism of effects of thoracic inferior vena cava constriction on renal water excretion . J Clin Invest54:1473-1479, 1974
56.
Ishikawa S. , Saito T., Okada K., et al: Effect of vasopressin antagonist on water excretion in inferior vena cava constriction. Kidney Int30:49-55, 1986
57.
Dahlof B., Pennert K., Hansson L.: Reversal of left ventricular hypertrophy in hypertensive patients: A metaanalysis of 109 treatment studies. Am J Hypertens5:95-110, 1992
58.
Packer M., Carver JR, Rodeheffer RJ, et al: Effect of oral milrinone on mortality in severe chronic heart failure. N Engl J Med325:1468-1475,1991
59.
TheXamoterol in Severe Heart Failure Study Group: Xamoterol in severe heart failure . Lancet336:1-6, 1990
60.
Uretsky BF, Jessup M., Konstam MA, et al: Multicenter trial of oral enoximone in patients with moderate to moderately severe congestive heart failure. Lack of benefit compared with placebo. Enoximone Multicenter Trial Group. Circulation82:774-780, 1990
61.
Cohn JN: Results of the VEST trial. Presentation at the 69th Scientific Sessions of theAHA, November 10-13, 1996, New Orleans, LA
62.
Konstam MA, Dracup K., Baker DW, et al: Heart Failure: Evaluation and Care of Patients with Left-Ventricular Systolic Dysfunction. Clinical Practice Guideline Number 11. Agency for Health Care Policy and Research, Rockville , NID 1994
63.
Williams JF , Bristow MR, Fowler MB, et al: Committee on Evaluation and Management of Heart Failure. Guidelines for the Evaluation and Management of Heart Failure . Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines . J Am Coll Cardiol5:1376-1398, 1995
64.
The Task Force of the Working Group on Heart Failure of the European Society of Cardiology. The treatment of heart failure: Guidelines . Eur Heart J18:736-753, 1997
65.
Alderman EL , Fisher LD, Litwin P., et al: Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation68:785-795, 1983
66.
Baker DW, Jones R., Hodges J., et al: Management of heart failure. III The role of revascularization in the treatment of patients with moderate or severe left ventricular systolic dysfunction. JAMA272:1528-1534, 1994
67.
Bounous EP, Mark DB, Pollock BG, et al: Surgical survival benefits for coronary disease patients with left ventricular dysfunction. Circulation78:I-151 to I-157, 1988 (3 Pt 2)
68.
Cohen M., Charney R., Hershman R., et al: Reversal of chronic ischemic myocardial dysfunction after transluminal coronary angioplasty. J Am Coll Cardiol12:1193-1198, 1988
69.
Elefteriades JA, Tolis G. Jr, Levi E., et al: Coronary artery bypass grafting in severe left ventricular dysfunction: Excellent survival with improved ejection fraction and functional state. J Am Coll Cardiol22:1411-1417, 1993
70.
Faulkner SL , Stoney WS, Alford WC, et al: Ischemic cardiomyopathy: Medical versus surgical treatment. J Thorac Cardiovasc Surg74:77-82, 1977
71.
Reinfeld HB , Samet P., Hildner FJ: Resolution of congestive failure, mitral regurgitation, and angina after percutaneous transluminal coronary angioplasty of triple vessel disease. Cathet Cardiovasc Diagn11:273-277, 1985
72.
Spencer FC, Green GE, Tice DA, et al: Coronary artery bypass grafts for congestive heart failure: A report of experiences with 40 patients. J Thorac Cardiovasc Surg62:529-542, 1971
73.
Pitt B., Chang P., Grossman W., et al: Rationale, background, and design of the randomized angiotensin receptor antagonist—angiotensin converting enzyme inhibitor study (RAAS) . Am J Cardiol78:1129-1131, 1996
74.
Morgan T., Berliner RW: A study by continuous microperfusion of water and electrolyte movements in the loop of Henle and distal tubule of the rat. Nephron6:388-405,1969
75.
Giebisch G.: Renal Potassium Excretion, in Rouiller C, Muller AF (eds): The Kidney: Morphology, Biochemistry, Physiology. New York, NYAcademic , 1971, pp 329-382
76.
Wilson JR, Reichek N., Dunkman WB, Goldberg S.: Effect of diuresis on the performance of the failing left ventricle in man . Am J Med70:234-239, 1981
77.
Bayliss J., Norell M., Canepa-Anson R., et al: Untreated heart failure: Clinical and neuroendocrine effects of introducing diuretics. Br Heart J57:17-22, 1987
78.
Ellison DH: The physiologic basis of diuretic synergism: Its role in treating diuretic resistance. Ann Intern Med114:886-894, 1991
79.
Oster JR, Epstein M., Smoller S.: Combined therapy with thiazide-type and loop diuretic agents for resistant sodium retention. Ann Intern Med99:405-406, 1983
80.
Funke Kupper A, Fintelman H., Hurge MC, et al: Crossover comparison of the fixed combination of furosemide and triamterene and the free combination of furosemide and triamterene in the maintenance treatment of congestive heart failure. EurJ Clin Pharmacol30:341-343, 1986
81.
Ribner HS, Plucinski DA, Hsieh A-M., et al: Acute effects of digoxin on total systemic vascular resistance in congestive heart failure due to dilated cardiomyopathy: A hemohynamic-hormonal study. Am J Cardiol56:896-904, 1985
82.
Ferguson DW , Berg WJ, Sanders JS, et al: Sympathoinhibitory responses to digitalis glycosides in heart failure patients. Circulation80:65-77,1989
83.
TheDigitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med336:525-533, 1997
84.
Arnold SB, Byrd RC, Meister W., et al: Long-term digitalis therapy improves left ventricular function in heart failure. N Engl J Med303:1443-1448, 1980
85.
Lee Dcs, Johnson RA, Bingham JB, et al: Heart failure in outpatients: A randomized trial of digoxin versus placebo. N Engl J Med306:699-705, 1982
86.
Uretsky BF, Young JB, Shahidi FE, Yellen LG, Harrison MC, Jolly MK, on behalf of the PROVED Investigative Group.Randomized study assessing the effect of digoxin withdrawal in patients with mild to moderate chronic congestive heart failure: Results of the PROVED trial . J Am Coll Cardiol1993;22:955-962, 1993
87.
Packer M., Gheorghiade M., Young D., et al: For the Radiance Study. Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting enzyme inhibitors . N Engl J Med1993;1-7, 1993
88.
Cohn JN, Johnson G., Ziesche S., et al: A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med325:303-310, 1991
89.
Cohn JN, Archibald DG, Ziesche S., et al: Effect of vasodilator therapy on mortality in chronic congestive heart failure: Results of a Veterans Administration Cooperative Study. N Engl J Med314:1547-1552, 1986
90.
SOLVD Investigators: Effect of enalapril on survival in patients with reduced left-ventricular ejection fractions and congestive heart failure . N Engl J Med325:293-302, 1991
91.
CONSENSUS Trial Study Group: Effects of enalapril on mortality in severe congestive heart failure. N Engl J Med316:1429-1435, 1987
92.
LeJemtel TH , Keung E., Frishman WH, Ribner HS: Hemodynamic effects of captopril in patients with severe heart failure. Am J Cardiol49:1484-1488, 1982
93.
DiCarlo L., Chatterjee K., Parmley WW, et al: Enalapril: A new angiotensin-converting enzyme inhibitor in chronic heart failure: Acute and chronic hemodynamic evaluations. J Am Coll Cardiol2:865-871, 1983
94.
Awan NA, Amsterdam EA, Hermanovich J., et al: Long-term hemodynamic and clinical efficacy of captopril therapy in ambulatory management of chronic congestive heart failure. Am Heart J103:474-479, 1982
95.
Sharpe DN, Murphy J., Coxon R., Hannan SF: Enalapril in patients with chronic heart failure: A placebo-controlled, randomized, double-blind study. Circulation70:271-278, 1984
96.
Franciosa JA , Wilen MM, Jordan RA: Effects of enalapril, a new angiotensin-converting enzyme inhibitor, in a controlled trial in heart failure. J Am Coll Cardiol5:101-107, 1985
97.
Jennings G. , Kiat H., Nelson L., et al: Enalapril for severe congestive heart failure: A double-blind study. Med J Aust141:723-726, 1984
98.
Lewis GR: Comparison of lisinopril versus placebo for congestive heart failure . Am J Cardiol63:12D-16D, 1989
99.
Magnani B., Magelli C.: Captopril in mild heart failure: Preliminary observations of a long-term, double-blind, placebo-controlled multicentre trial. Postgrad Med J62:153-158,1986 (suppl 1)
100.
McGrath BP, Arnolda L., Matthews PG, et al: Controlled trial of enalapril in congestive cardiac failure . Br Heart J54:405-414, 1985
101.
Remes J., Nikander P., Rehnberg S., et al: Enalapril in chronic heart failure, a double-blind placebo-controlled study. Ann Clin Res18:124-128, 1986
102.
TheCaptopril Multicenter Research Group. A placebo-controlled trial of captopril in refractory chronic congestive heart failure. J Am Coll Cardiol2:755-763, 1983
103.
TheCaptopril-Digoxin Multicenter Research Group: Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure . JAMA259:539-544, 1988
104.
Riegger GA : The effects of ACE inhibitors on exercise capacity in the treatment of congestive heart failure. J Cardiovasc Pharmacol15:S41-46, 1990 (suppl 2)
105.
Chalmers JP , West MJ, Cyran J., et al: Placebo-controlled study oflisinopril in congestive heart failure: A multicentre study. J Cardiovasc Pharmacol9:S89-97, 1987 (suppl 3)
106.
Elkayam U. , Roth A., Kumar A., et al: Hemodynamic and volumetric effects of venodilation with nitroglycerin in chronic mitral regurgitation . Am J Cardiol60:1106-1111,1987
107.
Schwarz M. , Katz SD, Demopoulos L., et al: Enhancement of endothelium-dependent vasodilation by low-dose nitroglycerin in patients with congestive heart failure . Circulation89:1609-1614, 1994
108.
Leier CV, Huss P., Magorien RD, Unverfderth DV: Improved exercise capacity and differing arterial and venous tolerance during chronic isosorbide dinitrate therapy for congestive heart failure. Circulation67:817-822, 1983
109.
Goldsmith SR, Cohn JN: Contrasting immediate and long-term effects of isosorbide dinitrate on exercise capacity in congestive heart failure . Am J Med69:559-560, 1980
110.
Colucci WS , Williams GH, Braunwald E.: Increased plasma norepinephrine levels during prazosin therapy for severe congestive heart failure. Ann Int Med93:452-453, 1980
111.
Goldstein RE, Boccuzzi SJ, Cruess D., Nattel S.: Diltiazem increases late-onset congestive heart failure in postinfarction patients with early reduction in ejection fraction. The Adverse Experience Committee, and the Multicenter Diltiazem Postinfarction Research Group. Circulation83:52-60, 1991
112.
Cohn JN, Ziesche SM, Loss LE, Anderson GF, V-HeFT Study Group: Effect of felodipine on short-term exercise and neurohormone and long-term mortality in heart failure: Results ofVHeFT III . Circulation92:I-1431995 (suppl 1 )
113.
Packer M., O'Connor CM, Ghali JK, et al: Effect of amlodipine on morbidity and mortality in severe heart failure. N Engl J Med335:1107-1114, 1996
114.
TheCardiac Arrhythmia Suppression Trial (CAST) Investigators: Preliminary report: Effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med321:406-412, 1989
115.
Bristow MR , O'Connell JB, Gilbert EM, et al: Dose-response of chronic beta-blocker treatment in heart failure from either idiopathic dilated or ischemic cardiomyopathy . Circulation89:1632-1642, 1994
116.
CIBIS Investigators and Committees: A randomized trial of beta-blockade in heart failure: The Cardiac Insufficiency Bisprolol Study (CIBIS). Circulation90: 1765-1773, 1994
117.
Eichhorn E. , Bedotto J., Malloy C., et al: Effect of β-adrenergic blockade on myocardial function and energetics in congestive heart failure . Circulation82:473-483, 1990
118.
Engelmeier RS, O'Connell JB, Walsh R., et al: Improvement in symptoms and exercise tolerance by metoprolol in patients with dilated cardiomyopathy: A double-blind, randomized, placebo-controlled trial. Circulation72:536-546, 1985
119.
Gilbert EM , Anderson JL, Deitchman D., et al: Long-term beta-blocker vasodilator therapy improves cardiac function in idiopathic dilated cardiomyopathy: A double-blind, randomized study of bucindolol versus placebo. Am J Med88:223-229, 1990
120.
Metra M., Nardi M., Giubbini R, DeiCas L: Effect of short- and long-term carvedilol administration on rest and exercise hemodynamic variables, exercise capacity and clinical conditions in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol24:1678-1687, 1994
121.
Olsen SL, Gilbert EM, Renlund DG, et al: Carvedilol improves left ventricular function and symptoms in chronic heart failure: A double-blind randomized study. J Am Coll Cardiol25:1225-1231, 1995
122.
Waagstein F., Bristow MR, Swedberg K., et al: Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet342:1441-1446, 1993
123.
Packer M., Bristow MR, Cohn JN, et al: for the U.S. Carvedilol Heart Failure Study Group.The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med334:1349-1355, 1996
124.
Bristow MR , Gilbert EM, Abraham WT, et al: for the MOCHA Investigators.The third-generation β-blocking agent carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. Circulation94:2807-2816, 1996
125.
Gottlieb S. , Dickstein K., Fleck E., et al: Hemodynamic and neurohormonal effects of the angiotensin II antagonist losartan in patients with congestive heart failure. Circulation88:1602-1609, 1993
126.
Crozier I. , Ikram H., Awan N. et al: for the Losartan Hemodynamic Study Group.Losartan in heart failure: Hemodynamic effects and tolerability. Circulation91: 691-697, 1995
127.
Dickstein K., Chang P., Willenheimer R., et al: Comparison of the effects of losartan and enalapril on clinical status and exercise performance in patients with moderate or severe chronic heart failure. J Am Coll Cardiol26:438-445, 1995
128.
Kon V., Fogo A., Ichikawa I.: Bradykinin causes selective efferent arteriolar dilation during angiotensin I converting enzyme inhibition. Kidney International44:545-550, 1993
129.
Pitt B., Segal R., Martinez FA, et al: Randomized trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE) . Lancet349:747-752, 1997
130.
Liang C-S., Sherman LG, Doherty JU, et al: Sustained improvement of cardiac function in patients with congestive heart failure after short-term infusion of dobutamine. Circulation69:113-119, 1984
131.
Unverferth DV, Magorien RD, Altschuld R., et al: The hemodynamic and metabolic advantages gained by a three-day infusion of dobutamine in patients with congestive cardiomyopathy . Am Heart J106:29-34, 1983
132.
Unverferth DV, Magorien RD, Lewis RP, Leier CV: Long-term benefit of dobutamine in patients with congestive cardiomyopathy. Am Heart J100:622-630, 1980
133.
Francis GS : Development of arrhythmias in the patient with congestive heart failure: Pathophysiology, prevalence, and prognosis . Am J Cardiol57:3-7, 1986
134.
Chakko CS, Gheorghiade M.: Ventricular arrhythmias in severe heart failure: Incidence, significance, and effectiveness of antiarrhythmic therapy. Am Heart J109:497-504,1985
135.
Tamburro P. , Wilber D.: Sudden death in idiopathic dilated cardiomyopathy . Am Heart J124:1035-1045, 1992
136.
Chakko S., DeMarchena E., Kessler KM, Myerburg RJ: Electrophysiology, pacing, and arrhythmia: Ventricular arrhythmias in congestive heart failure. Clin Cardiol12:525-530, 1989
137.
Stambler BS , Wood MA, Ellenbogen KA: Sudden death in patients with congestive heart failure: Future directions. PACE15:451-470, 1992
138.
Hohnloser SH, Raeder EA, Podrid PJ, et al: Predictors of antiarrhythmic drug efficacy in patients with malignant ventricular tachyarrhythmias . Am Heart J114:1-7, 1987
139.
Podrid PJ, Lampert S., Graboys TB, et al: Aggravation of arrhythmia by antiarrhythmic drugs-incidence and predictors. Am J Cardiol59:38-44, 1987
140.
Baker DW, Wright RF: Management of heart failure. IV-anticoagulation for patients with heart failure due to left ventricular systolic dysfunction. JAMA272:1614-1618,1994
141.
Meltzer RS , Visser CA, Fuster V.: Intracardiac thrombi and systemic embolization . Ann Intern Med104:689-698, 1986
142.
Dunkman WB , Johnson GR, Carson PE, et al: Incidence of thromboembolic events in congestive heart failure. The V-HeFT VA Cooperative Studies Group. Circulation87:IV-94-101, 1993 (suppl IV)
143.
Abraham WT , Oren RM, Crisman TS, et al: Effects of an oral, nonpeptide, selective V2 receptor vasopressin antagonist in patients with chronic heart failure . J Am Coll Cardiol29:169A, 1997 (suppl A)
