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(Circulation. 1998;98:623-624.)
© 1998 American Heart Association, Inc.

Editorials

Regression of Left Ventricular Hypertrophy

New Hope for Dying Hearts

Arnold M. Katz, MD

From the Cardiology Division, Department of Medicine, University of Connecticut, Farmington.

Correspondence to Arnold M. Katz, MD, Cardiology Division, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030-2249.

Key Words: Editorials • hypertrophy • remodeling • heart failure

Only a decade ago, end-stage heart failure was viewed as an irreversible condition for which therapy could offer only transient symptomatic relief. This led to a sense of hopelessness that resembled the prevailing attitude toward coronary occlusive disease 50 years ago, when atherosclerosis was thought to be an inevitable feature of natural aging. In the case of heart failure, as recently as the mid-1980s it was believed that little could be done to improve the natural history in patients with advanced chronic heart failure and a severely dilated ventricle. Yet within a few years, work from unexpected directions demonstrated that the progressive deterioration of the failing heart can be slowed and prognosis improved.

The first class of drugs shown in large clinical trials to improve prognosis in these patients was vasodilators.¹ Because unloading the failing heart has an obvious energy-sparing effect and because virtually all vasodilators alleviate symptoms over the short term, it came as a surprise that not all of these drugs improve prognosis and that some accelerate deterioration of the failing heart² and shorten survival.^{3 4 5 6} Equally counterintuitive was the finding that positive inotropic agents, which, like vasodilators initially improve symptoms, also increase mortality.^{7 8} Perhaps the most surprising finding of the clinical trials in heart failure was that long-term administration of ß-adrenergic receptor blockers, although they initially worsen symptoms, reduce long-term morbidity and improve survival.^{9 10 11} Taken together, these clinical findings have led to a paradigm shift in our understanding of heart failure, one that by highlighting long-term mortality as . . . [Full Text of this Article]

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