Watch For of 2002 Update 2003-2004 Update Reference ASA and ACE inhibitors interaction. Standard dose of ASA in chronic coronary artery disease is 80 mg/d now, which should have less interaction with ACEI. . Tissue and Non-tissue ACE inhibitors. No more information. . Comparison between Metoprolol and Carvedilol. COMET, 2003. Carvedilol (Coreg) is superior than Metoprolol Tartrate.
Comment. (1). The Metoprolol Tartrate dose is likely not equivalent to the Carvedilol dose. (2). There is no comparison of Carvedilol to Metoprolol Succinate CR (Toprol XL).
COMET More on ARBs.
CHARM, 2003. (1). Candesartan (Atecan) is a good substiture for ACEI. (2). Adding Candesartan to ACEI, Beta blocker (and Aldosterone antagonist) is more beneficial. This statement is considered more accurate than the cautious statement from VAL-HeFT trial. (3). Candesatan is beneficial for heart failure with preserved LV systolic function.
VALIANT, 2003. (1). Valsatan is a good substitute for ACEI. (2) Add Valsatan to ACEI is not beneficial for post MI patient with heart failure. Note that the patient population is different from the CHARM trial. VALIANT Combination ACE inhibitors and ARBs. (See above) . Sleep apnea and heart failure. . . More on BNP. Wait for FUSION trial . Wait for RED HOT trial .
More on Cardiac Resynchronization Therapy.
CRT has been established for improving morbidity. It has trend to improve mortality. Not all of the patients respond to this treatment. The better way to select these responder patients has not been well worked out.
COMPANION, The first CRT trial that showed mortality rate benefit trend with CRT. The more significant benefit is from combine ICD and CRT. COMPANION DAVID, 2002. Dual chamber pacing may increase mortality and morbidity in patients with ICD who do not require pacing treatment, when compare to back up ventricular pacing at slow rate. Reason? Question raised about detrimental effect from RV pacing in heart failure patients. DAVID More on ICD, ICD/Resynchronization pacing. MADIT II. (1). ICD saves life in post MI patient with LV ejection fraction <30%. Note that ICD is benefit in patient regarding of QRS duration. However Medicare has added another criteria of QRS duration >120 msec. Reason?. (2). "New or worsened heart failure requiring hospitalization was slightly more frequent in the defibrillator group". Reason? RV pacing? SCD-HeFT (Wait for publication) . COMPANION, 2003. (See above) . DAVID, 2002. (See above) .
Endothelin, vasopressin, and cytokines.
. . EECP in heart failure. Wait for PEECH trial. .
Heart failure with anemia.
On going trial. .
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