Heart Failure PDF

Preface

Since the publication of the First Edition of this text, heart failure has grown as a health care problem in both developed and developing countries, with both an increase in the number of patients and greater awareness of the disease among clinicians. Progress in our understanding of the cellular mechanisms of cardiac dysfunction has occurred, and contributions from the areas of developmental biology and regulation of cell survival continue to inform strategies to prevent and treat heart failure. During the past fi ve years, our appreciation for the role of extracardiac organs in the pathophysiology of heart failure has increased, particularly changes in pulmonary and systemic vascular function, gas exchange in the lungs, and in the central nervous system.

In response to the advances in our understanding of the biology of cardiac function and pathophysiology of the heart failure syndrome, the treatment of heart failure has also evolved. Although several new pharmacotherapies have entered late-stage clinical trial since the publication of the First Edition of this text, perhaps the greatest advance has been in the development of devices to treat heart failure, such as resynchronization therapy, ultrafi ltration, and mechanical circulatory support. In addition to improving cardiovascular function, these devices also are capable of providing feedback to clinicians and patients that allow them to respond to changes in circulatory physiology and optimization of treatment.

In order to inform the reader of recent progress in our understanding of the pathophysiology and treatment of heart failure, signifi cant additions have been made to each of the sections of the text. Part I, "Cellular and Molecular Basis for Heart Failure" has been revised to include a chapter covering the relevance of developmental biology to the pathophysiology of cardiac dysfunction, including a discussion of the recurrence of expression of fetal genes in the adult with heart failure. A chapter describing animal models of heart failure has been added. The latter chapter provides particular insight into the debate regarding pharmacologic manipulation of the alterations that occur in cardiomyocyte substrate utilization. The second section of the text, "Pathophysiology of Heart Failure," now contains chapters describing recent advances in the understanding of alterations of renal sodium and water excretion that occur in heart failure. A third section, "The Demographics, Diagnosis, and Monitoring of Heart Failure" has been newly added to the text. Chapters in this section describe the classic methods of clinical diagnosis of heart failure as well as the utility of newer imaging modalities that identify the causes and severity of cardiac impairment. It is now recognized that the major cause of hospitalization in heart failure patients is the occurrence of acute decompensated heart failure, and repeated admissions leads to the progression of myocardial and end-organ dysfunction. In response, diagnostic methods have recently been developed to identify the physiologic and neurohormonal changes that precede decompensation. The effective utilization of this information to guide modifi cation of therapy is discussed in this section, as are advances in the use of biomarkers to guide the diagnosis and treatment of heart failure.

The second half of the book focuses on the treatment of heart failure. The fi rst section of this half, "The Medical Treatment of Clinical Heart Failure," reviews the current state of the art of pharmacologic therapies. Challenges remain in the pharmacologic treatment of the disease, yet there are promising advances in the development of agents that address novel targets in the vasopressin and adenosine signaling pathways as well as of immune system modulators and type 5 phosphodiesterase inhibitors. Also discussed in this section are agents for acute decompensated heart failure that target the "cardiorenal" syndrome as defi ned in Part II. New to this section from the previous edition is a discussion of medical device therapies, such as resynchronization therapy and ultrafi ltration. This leads to a discussion of surgical heart failure therapy, and the last section of the text looks to the future, with an update of the progress in gene and cell-based therapies that have been recently made.

The editors of this Edition of Heart Failure gratefully acknowledge the work of the authors and editors that preceded them, as they set a high standard for clarity and scientifi c rigor in the previous edition. It is hoped that the readers of the Second Edition fi nd it to be an informative resource guiding further investigation and care of the patient with heart failure.