Heart failure treatment can count on several drugs, all providing an improvement in outcome, but that cannot berealistically used all together in the same patient. It would be useful to have a tool that allows arranging the most appropriate therapy cocktail in each patient. The aim of this review is to show the main differences in the effects of several drugs on cardiopulmonary function in heart failure patients, both in resting condition and during exercise, and to discuss how these differences can be taken into account when choosing the most appropriate therapeutic protocol. In summary, angiotensin converting enzyme inhibitors and angiotensin II receptor blockers act synergistically increasing exercise capacity and peak oxygen uptake, but through different mechanisms, the former improving lung diffusion and exercise ventilatory efficiency, an action that is counteracted by concomitant aspirin therapy, and the latter probably by improving muscle perfusion. As to beta-blocker, non-selective compounds, such as carvedilol, improve ventilation efficiency on one side, but interfere with lung diffusion on the other, and they are probably less tolerated in hypoxic conditions. On the contrary, β1 selective compounds, such as bisoprolol or nebivolol, have a neutral effect on both lung diffusion and ventilation efficiency. These observations could be the basis for the choice of pharmacological therapy in heart failure patients.
Contini M. Cardiopulmonary Exercise Test as a Tool to Choose Therapy in Heart Failure. Ann Am Thorac Soc 2017 Apr 4. doi: 10.1513/AnnalsATS.201611-887FR
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