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Vilarrasa N, de Gordejuela AGR, Casajoana A, Duran X, Toro S, Espinet E, Galvao M, Vendrell J, López-Urdiales R, Pérez M, Pujol J. Endobarrier® in Grade I Obese Patients with Long-Standing Type 2 Diabetes: Role of Gastrointestinal Hormones in Glucose Metabolism. Obes Surg 2016; 27:569-577. [DOI: 10.1007/s11695-016-2311-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Lopez-Nava G, Galvao M, Bautista-Castaño I, Fernandez-Corbelle JP, Trell M. Endoscopic sleeve gastroplasty with 1-year follow-up: factors predictive of success. Endosc Int Open 2016; 4:E222-7. [PMID: 26878054 PMCID: PMC4751018 DOI: 10.1055/s-0041-110771] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 11/23/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Bariatric endoscopy has emerged as an aid in the nonsurgical treatment of obesity. The objective of this study is to critically provide the results and follow-up of endoscopic sleeve gastroplasty 1 year after the procedure. PATIENTS AND METHODS Prospective single-center follow-up study of 25 patients (5 men, 20 women) who underwent flexible endoscopic suturing for endoluminal gastric volume reduction. A multidisciplinary team provided post-procedure care. Patient outcomes were recorded at 1 year after the procedure. Linear regression analysis was done to evaluate the variables associated with best results at 1 year of follow-up. RESULTS Mean body mass index (BMI) was 38.5 ± 4.6 kg/m(2) (range 30 - 47) and mean age 44.5 ± 8.2 years (range 29 - 60). At 1 year, 22 patients continued with the follow-up (2 dropped out at 6 months and 1 at 3 months). There were no major intra-procedural, early, or delayed adverse events. Mean BMI loss was 7.3 ± 4.2 kg/m(2), and mean percentage of total body weight loss was 18.7 ± 10.7 at 1 year. In the linear regression analysis, adjusted by initial BMI, variables associated with %TBWL involved the frequency of nutritional (β = 0.563, P = 0.014) and psychological contacts (β = 0.727, P = 0.025). The number of nutritional and psychological contacts were predictive of good weight loss results. CONCLUSIONS Endoscopic sleeve gastroplasty is a feasible, reproducible, and effective procedure to treat obesity. Nutritional and psychological interaction are predictive of success.
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Affiliation(s)
- G. Lopez-Nava
- Bariatric Endoscopy Unit, Madrid Sanchinarro University Hospital
| | - M. Galvao
- Gastro Obeso Center, Gastrointestinal Surgery, São Paulo, Brazil
| | | | | | - M. Trell
- Bariatric Endoscopy Unit, Madrid Sanchinarro University Hospital
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Galvao M, Saeed O, Immekus J, Goldstein D, Brown A, Fida N, Maybaum S. Referral Patterns for Left Ventricular Assist Device as Destination Therapy in Non-Inotrope Dependent Patients: Results of the CONSENSUS-DT Survey. Heart Lung 2013. [DOI: 10.1016/j.hrtlng.2013.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Galvao M, Immekus J, Saeed O, Fida N, Browne A, Goldstein D, Maybaum S. An International Survey To Assess Referral Thresholds for Destination Therapy in Non-Inotrope Dependent Patients: Results of the CONSENSUS-DT Study. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Saddadi F, Najafi I, Hakemi M, Jahani M, Ali Moghadam K, Ghavamzadeh A, Soleimanian T, Perkowska-Ptasinska A, Wagrowska-Danilewicz M, Danilewicz M, Halon A, Komuda E, Karkoszka H, Andrzejewska A, Okon K, Kurnatowska I, Krasnicka M, Hryszko T, Kusztal M, Wiechecka-Korenkiewicz J, Marcinkowska E, Korenkiewicz J, Marszalek A, Sypniewska G, Manitius J, Cappuccino L, Verzola D, Tosetti F, Marre S, Villaggio B, Salvidio G, Garibotto G, Pasquariello A, Innocenti M, Pasquariello G, Mattei P, Samoni S, Sami N, Cupisti A, Malvar B, Viana H, Galvao M, Carvalho F, Oksa A, Demes M, Danis D, Hilhorst M, van Paassen P, van Breda Vriesman P, Cohen Tervaert JW, Perkowska-Ptasinska A, Ciszek M, Urbanowicz A, Kwiatkowski A, Durlik M, Saito T, Kawano M, Saeki T, Nishi S, Yamaguchi Y, Hisano S, Nakashima H, Yamanaka N, Oh SW, Chin HJ, Na KY, Chae DW, Ozkan G, Ulusoy S, Ersoz S, Orem A, Alkanat M, Yucesan F, Kaynar K, Al S, Simic Ogrziovic S, Bojic S, Basta Jovanovic G, Kotur Stevuljevic J, Dosaj V, Lezaic V, Yagisawa T, Kimura T, Ishikawa N, Yashi M. Renal histopathology. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Escalona A, Yáñez R, Pimentel F, Galvao M, Ramos AC, Turiel D, Boza C, Awruch D, Gersin K, Ibáñez L. Initial human experience with restrictive duodenal-jejunal bypass liner for treatment of morbid obesity. Surg Obes Relat Dis 2010; 6:126-31. [PMID: 20359665 DOI: 10.1016/j.soard.2009.12.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 12/10/2009] [Accepted: 12/28/2009] [Indexed: 01/08/2023]
Abstract
BACKGROUND The duodenal-jejunal bypass liner is an endoscopically placed and removable intestinal liner that creates a duodenal-jejunal bypass, leading to diabetes improvement and weight loss. The aim of the present study was to evaluate the clinical effects and safety of the duodenal-jejunal bypass liner combined with a restrictor orifice (flow restrictor). METHODS The device was endoscopically implanted in 10 patients (body mass index 40.8 +/- 4.0 kg/m(2)) and removed after 12 weeks. Dilation of the restrictor orifice was performed as clinically indicated with a 6-, 8-, or 10-mm diameter through-the-scope balloon. The measured outcomes included the percentage of excess weight loss, total weight loss, adverse events, and gastric emptying (GE) at baseline, weeks 4 and 12 of implantation, and 3-5 months after device removal. GE was measured by scintigraphy at 1, 2, and 4 hours after implantation. RESULTS The percentage of excess weight loss and total weight loss at explantation was 40% +/- 3% (range 21-64%) and 16.7 +/- 1.4 kg (range 12.0-26.0), respectively. The 4-hour GE was 98% +/- 1% at baseline, 72% +/- 6% at 4 weeks (P = 0.001 versus baseline), and 84% +/- 5% at 12 weeks (P <.05 versus baseline). After explantation, the rate of GE returned to normal in 7 of 8 subjects, but remained slightly delayed in 1 subject (84% at 4 hours). Episodes of nausea, vomiting, and abdominal pain required endoscopic dilation of the restrictor orifice with a 6-mm through-the-scope balloon in 7 patients and a 10-mm balloon in 1, with no clinically significant adverse events. CONCLUSION Endoscopic implantation of a combination flow restrictor and duodenal-jejunal bypass liner induced substantial weight loss. The implanted patients exhibited delayed GE that was reversed after device removal.
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Affiliation(s)
- Alex Escalona
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile Faculty of Medicine, Santiago, Chile
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Rodriguez L, Reyes E, Fagalde P, Oltra MS, Saba J, Aylwin CG, Prieto C, Ramos A, Galvao M, Gersin KS, Sorli C. Pilot clinical study of an endoscopic, removable duodenal-jejunal bypass liner for the treatment of type 2 diabetes. Diabetes Technol Ther 2009; 11:725-32. [PMID: 19905889 DOI: 10.1089/dia.2009.0063] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Bariatric surgery is associated with the rapid improvement of type 2 diabetes (T2DM). Here we report an exploratory trial of a completely endoscopic, removable, duodenal-jejunal bypass liner (DJBL) intended to treat T2DM. METHODS Obese T2DM subjects were randomized to receive a DJBL (n = 12) or sham endoscopy (n = 6) in a 24-week study, extended up to 52 weeks. Measurements included weights, hemoglobin A1c (HbA(1c)), meal tolerance testing, fasting glucose, and seven-point glucose profiles. Subjects' diets were adjusted in the first 2 weeks to obtain similar weight loss during this period. RESULTS Subjects had baseline HbA(1c) of 9.1 +/- 1.7% and body mass index of 38.9 +/- 6.1 kg/m(2) (+/- SD). In the completer population by week 1, change in fasting glucose in the DJBL arm was -55 +/- 21 mg/dL versus +42 +/- 30 mg/dL in the sham arm (P < or = 0.05; +/- SE); the seven-point glucose profiles were reduced in the DJBL arm but not in the sham arm. Mean postprandial glucose area under the curve was reduced in the DJBL arm by 20% and increased 17% in the sham arm (P = 0.016). At week 12, HbA(1c) change was -1.3 +/- 0.9% in the DJBL arm and -0.7 +/- 0.4% in the sham arm (P > 0.05), and at 24 weeks, values were -2.4 +/- 0.7% in the DJBL arm and -0.8 +/- 0.4% in the sham arm (P > 0.05). Device migrations required endoscopic removal prior to reaching 52 weeks. CONCLUSIONS The DJBL rapidly normalized glycemic control in obese T2DM subjects, a promising development in the search for novel therapies less invasive than bariatric surgery.
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Affiliation(s)
- Leonardo Rodriguez
- Centro de Cirugía de la Obesidad, Hospital Dipreca, Las Condes, Santiago de Chile, Chile
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Ramos AC, Galvao M, Murakami AH, Galvao M, Silva AC, Canseco EGC, Souza YM. P-92: Internal hernia following laparoscopic gastric bypass: Diagnostic difficulties and prevention of occurrence. Surg Obes Relat Dis 2009. [DOI: 10.1016/j.soard.2009.03.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ramos AC, Galvao M, Murakami AH, Galvao M, Silva AC, Canseco EGC, Souza YM, Campos JM, Falcão M. PL-116: Severe esophagitis and Barrett's esophagus as an important complication of adjustable gastric band. Surg Obes Relat Dis 2009. [DOI: 10.1016/j.soard.2009.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ramos AC, Galvao M, Murakami AH, Campos JM, de Moura EG, Galvao M, Silva AC, Canseco EGC, Souza YM. PL-314: Lap total gastrectomy as an alternative to treat difficult fistulas after sleeve gastrectomy. Surg Obes Relat Dis 2009. [DOI: 10.1016/j.soard.2009.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Escalona A, Yañez R, Pimentel F, Galvao M, Ibañez L, Turiel D, Boza C, Awruch D, Gersin KS. PL-303: Initial human experience with a restrictive, duodenal-jejunal bypass liner for the treatment of morbid obesity. Surg Obes Relat Dis 2009. [DOI: 10.1016/j.soard.2009.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bartov D, Murthy S, Kamalakkannan G, Smith Q, Shin J, Galvao M, Burkhoff D, Maybaum S. 84: Relationship between Skeletal Muscle Function, Peak Oxygen Consumption and Cardiac Output in Patients with Chronic Heart Failure. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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LeJemtel TH, Liang CS, Stewart DK, Kirlin PC, McIntyre KM, Robertson TH, Moore A, Cahill L, Galvao M, Wellington KL. Reduced peak aerobic capacity in asymptomatic left ventricular systolic dysfunction. A substudy of the studies of left ventricular dysfunction (SOLVD). SOLVD Investigator. Studies of Left Ventricular Dysfunction. Circulation 1994; 90:2757-60. [PMID: 7994818 DOI: 10.1161/01.cir.90.6.2757] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Peak oxygen consumption is reduced in patients with symptomatic congestive heart failure, but functional capacity of patients with asymptomatic left ventricular systolic dysfunction has not been assessed by measurement of peak oxygen consumption attained during graded exercise testing. METHODS AND RESULTS Peak oxygen consumption, that is, aerobic capacity (VO2, mL/kg per minute), was determined during graded treadmill exercise using the modified Naughton protocol in 40 patients with left ventricular systolic dysfunction (mean ejection fraction ranging from 14% to 35%; mean, 29%) who, while not receiving any cardiac medications, were totally asymptomatic, and in 41 age-matched normal subjects. Peak exercise duration and VO2 were significantly lower in patients with asymptomatic left ventricular systolic dysfunction than in normal subjects (948 +/- 273 versus 1239 +/- 372 seconds, P < .001, and 22.1 +/- 5.9 versus 29.8 +/- 7.7 mL/kg per minute, respectively, P < .001), while asymptomatic patients and normal subjects reached similar respiratory equivalents (1.14 +/- 0.11 versus 1.11 +/- 0.11 [NS]) and level of perceived exertion, using the modified Borg scale (7.4 +/- 2.6 versus 8.1 +/- 1.5 [NS]). Heart rate, systemic blood pressure, and oxygen pulse response to peak exercise were significantly lower in asymptomatic patients than in normal subjects. CONCLUSIONS Although patients with left ventricular systolic dysfunction can be totally asymptomatic in their daily activities, they have experienced a substantial reduction in peak aerobic capacity when compared with normal subjects of similar age.
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Affiliation(s)
- T H LeJemtel
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461
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Katz SD, Biasucci L, Sabba C, Strom JA, Jondeau G, Galvao M, Solomon S, Nikolic SD, Forman R, LeJemtel TH. Impaired endothelium-mediated vasodilation in the peripheral vasculature of patients with congestive heart failure. J Am Coll Cardiol 1992; 19:918-25. [PMID: 1552112 DOI: 10.1016/0735-1097(92)90271-n] [Citation(s) in RCA: 312] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Impaired endothelial-dependent vasodilation has been demonstrated in two animal models of congestive heart failure and in the coronary circulation of patients with idiopathic dilated cardiomyopathy. To determine whether this impairment contributes to the abnormal peripheral vasomotor tone in patients with congestive heart failure, the local vascular response to intraarterial infusions of graded concentrations (10(-8) M to 10(-5) M) of acetylcholine (an endothelial-dependent vasodilator) and nitroglycerin (a direct-acting vasodilator) was studied in the superficial femoral artery of 19 patients with congestive heart failure (New York Heart Association classes I to IV) and 6 age-matched normal control subjects. The local vascular response was determined from the arterial blood flow velocity pattern obtained by transcutaneous Doppler ultrasonography. Acetylcholine, 10(-5) M, induced a pattern characteristic of vasodilation in all six normal subjects; mean blood flow velocity for the group significantly increased from 11.9 +/- 2.7 to 44.8 +/- 20.9 cm/s (p less than 0.05). In contrast, the same dose of acetylcholine induced a blood flow velocity pattern characteristic of vasodilation in only 4 of the 19 patients with congestive heart failure. Group mean blood flow velocity did not change significantly. Nitroglycerin, 10(-7) M, induced vasodilation in all 6 normal subjects but in only 1 of 19 patients. Nitroglycerin, 10(-5) M, was administered to 10 patients; all 10 demonstrated a pattern characteristic of vasodilation. Thus, acetylcholine-mediated endothelial-dependent vasodilation appears to be impaired in the peripheral vasculature of patients with congestive heart failure. Both endothelial dysfunction and abnormal vascular smooth muscle responsiveness may contribute to abnormal peripheral vasomotor tone.
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Affiliation(s)
- S D Katz
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461
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Jondeau G, Klapholz M, Katz SD, Maher M, Galvao M, Levato P, LeJemtel TH. Control of arteriolar resistance in heart failure. Partial attenuation of specific phosphodiesterase inhibitor-mediated vasodilation by digitalis glycosides. Circulation 1992; 85:54-60. [PMID: 1728484 DOI: 10.1161/01.cir.85.1.54] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The vasodilatory response to local specific type III phosphodiesterase inhibition with amrinone was evaluated before and immediately after local administration of digoxin in 14 patients with severe congestive heart failure (CHF). METHODS AND RESULTS A 3F polyethylene catheter was inserted into the common femoral artery for drug administration and pressure monitoring. Mean blood flow velocity (MBFV) was continuously determined in the superficial femoral artery by transcutaneous Doppler ultrasonography. After intra-arterial administration of 10 mg amrinone, group MBFV increased from 7.7 +/- 1.4 to 16.0 +/- 2.1 cm/sec (p less than 0.05, n = 10). Local administration of 20 micrograms digoxin, which was infused over 20 minutes, did not alter group MBFV (i.e., 8.2 +/- 1.6 versus 7.6 +/- 1.5 cm/sec; p = NS, n = 10). The second administration of 10 mg amrinone, which immediately followed completion of local digoxin infusion, increased group MBFV but to a lesser extent than that produced by the first amrinone administration (i.e., 11.9 +/- 1.9 versus 16.0 +/- 2.1 cm/sec; p less than 0.05, n = 10). When placebo was administered instead of digoxin, group MBFV was similar after the first and second administrations of amrinone (i.e., 15.3 +/- 3.3 versus 15.6 +/- 3.8 cm/sec; p = NS, n = 4). CONCLUSIONS Although local administration of digoxin did not significantly alter baseline vascular tone in patients with CHF, it substantially decreased the direct vasodilatory effect induced by specific type III phosphodiesterase with amrinone.
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Affiliation(s)
- G Jondeau
- Department of Medicine, Albert Einstein College of Medicine, Bronx, N.Y
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Sales-Luís ML, Galvao M, Carvalho M, Sousa G, Alves MM, Serrão R. Treatment of familial amyloidotic polyneuropathy (Portuguese type) by plasma exchange. Muscle Nerve 1991; 14:377-8. [PMID: 2027354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Galvao M. Role of angiotensin-converting enzyme inhibitors in congestive heart failure. Heart Lung 1990; 19:505-11. [PMID: 2211159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Conventional therapy for congestive heart failure (CHF) includes sodium-restricted diet, diuretics, digitalis, vasodilators, and short-term intravenous administration of beta-adrenergic agonists during episodes of decompensation. A specific class of vasodilators, the angiotensin-converting enzyme inhibitors, has recently gained predominance in the treatment of congestive heart failure. The primary mechanism of action is to reduce production of angiotensin II by competitive inhibition of the enzyme that converts angiotensin I into angiotensin II. Reduced levels of angiotensin II, in turn, promote vasodilation and lower aldosterone production. The benefits of angiotensin-converting enzyme inhibitor therapy in chronic congestive heart failure have been demonstrated by improvement in left ventricular performance, exercise capacity, functional status (using New York Heart Association classification), and survival.
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Affiliation(s)
- M Galvao
- Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY 10461
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