Table Of ContentChronic
Heart Failure
I. Quality of Life
H. Viefhues W. Schoene R. Rychlik (Eds.)
II. Nitrate Therapy
A. Kimchi B. S. Lewis M. Weiss (Eds.)
With 51 Figures
and 29 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Budapest
Part I Part II
Professor Dr. Herbert Viefhues Professor Dr. med. Asher Kimchi
Furkenstrasse 35 Cedars-Sinai Medical Center
D-4630 Bochum (W) University of California
Federal Republic of Germany 8635 W. Third Street, Suite 10 80 W.
Los Angeles, CA 90048, USA
Dr. phil. Wolfgang Schoene
Institut fUr Medizinische Soziologie Professor Dr. med. Basil S. Lewis
Westfillische Wilhelms-Universitat Cardiology Department
Domagkstrasse 3 Lady Davis Carmel Hospital
D-4400 Munster (W) 7 Michal Street,
Federal Republic of Germany Haifa 34362, Israel
Professor Dr. Dr. med. R. Rychlik Dr. Marija Weiss
Medizinische Forschung International Medical Affairs
Schwarz Pharma AG Schwarz Pharma AG
Alfred-Nobel-Strasse 10 Alfred-Nobel-Strasse 10
D-4019 Monheim (W) D-4019 Monheim (W)
Federal Republic of Germany Federal Republic of Germany
ISBN-13 :978-3-642-76435-6 e-ISBN-13 :978-3-642-76433-2
DOl: 10.1007/978-3-642-76433-2
Library of Congress Cataloging in Publication Data
Chronic heart failure. p. cm.
Includes bibliographical references and index.
Contents: 1. Quality of life/Herbert Viefhues, Wolfgang Schone and Reinhard Rychlik (eds.)-
2. Nitrate therapy/Asher Kimchi, Basil S. Lewis and Marija Weiss (eds.).
ISBN-13:978-3-642-76435-6
1. Congestive heart failure. 2. Heart failure. 3. Heart failure-Patients-Rehabilitation. 4. Nitrates
Therapeutic use.
l. Viefhues, Herbert.
[DNLM: 1. Heart Failure, Congestive-drug therapy. 2. Heart Failure, Congestive-psychology.
WG370C557j
R C685. C53C4 7 1991 616.1'29-dc20 0 NLMlDLC for Library of Congress 91-5006 CIP
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Contents
Introduction . 1
A. Schneeweiss
I. Quality of Life
The Pathophysiological Basis, Clinical Presentation, and
Therapy of Chronic Heart Failure. With 7 Figures 5
M. Bohm and E. Erdmann
On the Epidemiology of Heart Failure ........... 27
H. Viefhues
Mortality Versus Quality of Life . . . . . . . . . . . . . .. 33
R.Rychlik
Quality of Life Assessment in Congestive Heart Failure:
Points of View from a Cardiologist and a Psychologist.
With 1 Figure ......................... 41
P. G. Hugenholtz and R. A. M. Erdman
From Heaven Through the World to the Earth ...... 58
H. Viefhues
Quality of Life:
Semantic History, Political and Scientific Terminology,
Measurement and Methodology, Medical Research .. 66
H. Viefhues
Measuring the Quality of Life in Patients
with Heart Failure:
Basic Principles, Methods, and Use in Clinical Studies .. 92
M. Bullinger and E. Poppel
Quality of Life after Bypass and Valvular Surgery:
Results of a Prospective Study. With 1 Figure . . . . 104
M. Bullinger and D. Naber
Guidelines for Improving Prognosis, Stress Tolerance,
and Quality of Life in Patients with Heart Failure:
Cardiological and Psychological Aspects . . . . . . . . . . 118
G. F H auf and W Langosch
Quality of Life of Infants and Children
with Cardiac Disease and Cardiac Failure
Both Before and After Cardiac Surgery. With 5 Figures . 132
E. W.Keck
Health Care and Economic Aspects
of the Quality of Life of Heart Failure Patients.
With 2 Figures .. . . . . . . . . . . . . . .. . ..... 149
W Pohl and i.-M. Grafvon del' Schulenburg
The Questionnaire as a Tool
for the Empirical Assessment of Quality of Life
in Patients with Cardiac Failure ... . . ..... 165
R. Rychlik, D. Urbahn, and P Potthoff
Quality of Life: A Relevant Endpoint. With 8 Figures .. 172
H. Troidl
Prevention:
The Risk Factor Model and Life-Styles
Relevant to Health. With 2 Figures . . . . . . . . . . . 186
1. von Troschke
II. Nitrate Therapy
The Role of Nitrates in Congestive Heart Failure.
With 1 Figure ......................... 197
i.Abrams
Chemical Pathways Proposed for the In Vitro Metabolism
of Nitrovasodilators and Their Conversion
into Vasoactive Species. With 6 Figures . . . . . . . . . . . 203
M. Feelisch and E. Noack
Effect of Intravenous Isosorbide Dinitrate Versus
Nitroglycerin in Patients with Acute Myocardial Infarction
and Elevated Pulmonary Artery Wedge Pressure.
With 1 Figure ......................... 220
G. B. Cintron and S. P Glasser
Contents VII
Effects of Isosorbide-5-Mononitrate on Haemodynamics
and Exercise Tolerance in Patients with Heart Failure:
Comparisons with Digoxin and Placebo. With 2 Figures . 227
l. Dews, C. Marks, D. Woodings, J. Stephens,
and M. VandenBurg
Improved Left Ventricular Geometry and Function
by Prolonged Nitroglycerin Therapy
After Acute Myocardial Infarction. With 4 Figures . . . . 236
B.l. Jugdutt, B. L. Michorowski, and W. T. Tymchak
Intravenous Nitroglycerin
in Acute Myocardial Infarction.
With 4 Figures . . . . . . . . . . . . . . . . . . . . . . . . . 242
B.l. Jugdutt
Effects of Intravenous Nitrates
in Acute Myocardial Infarction ............... 254
D£.. E. Rezakovic, G. Popovic, M. Popadic, J. Stalec,
and L. PaviCic
Hemodynamic Effects of a Subchronic Therapy
with 120 mg Isosorbide Dinitrate Slow-Release
in Coronary Artery Disease arid Left Heart Failure.
With 5 Figures ......................... 265
R. Wolf, A. NOtges, U. Traber, and R. Sinn
Isosorbide Dinitrate and Nitroglycerin Oral Spray
in Heart Failure ........................ 272
A. Schneeweiss, A. Marmor, and L. Reisin,
Nitrates in Heart Failure. With 2 Figures ......... 276
B. Rabinowitz
Contributors
Abrams,J. Erdmann,E.
Division of Cardiology Klinikum GroBhadern
University of New Mexico Medizinische Klinik 1
School of Medicine, Albuquerque Forschungslabor B
NM 87131, USA Universitat MUnchen
Marchioninistrasse 15
Bohm,M. 8000 MUnchen 70 (W)
Klinikum GroBhadern Federal Republic of Germany
Medizinische Klinik 1
Forschungslabor B
FeeJisch, M.
Universitat MUnchen
Abteilung Pharmakologie
Marchioninistrasse 15
Schwarz Pharma AG
8000 MUnchen 70 (W)
Alfred-Nobel-Strasse 10
Federal Republic of Germany
4019 Monheim (W)
Federal Republic of Germany
Bullinger, M.
Institut
flir Medizinische Psychologie Glasser, S. P.
Universitat MUnchen Cardiology Section (111 A)
Goethestrasse 3111 James A. Haley VA Hospital
8000 MUnchen 2 (W) 13000 Bruce B. Downs Boulevard
Federal Republic of Germany Tampa, FL 33612, USA
Cintron, G.B.
Cardiology Section (111 A) Hauf,G.F.
J ames A. Haley VA Hospital Rehabilitationszentrum
13000 Bruce B. Downs Boulevard flir Herz-und Kreislaufkranke
Tampa, FL 33612, USA SUdring 15, 7812 Bad Krozingen (W)
Federal Republic of Germany
Dews, I.
Department of Cardiology
Hugenholtz, P.G.
Queen Mary Block
SOCARSA
Oldchurch Hospital
Domaine de Leydefeur
Romford, RM7 OBE
CH-126J Givrins
United Kingdom
Switzerland
Erdman, R. A. M.
Department of Cardiology Jugdutt, B. I.
Thoraxcentrum Division of Cardiology, 2C2, 43
Erasmus University Walter Mackenzie
University Hospital Dijkzigt Health Sciences Center
P.O. Box 1738 University of Alberta
NL-3000 DR Rotterdam Edmonton, Alberta T6G 2R7
The Netherlands Canada
x Contributors
Keck,E.W. PaviCic, L.
Kardiologische Abteilung Faculty of Kinesiology
U niversitats-Kinderklinik University of Zagreb
und Poliklinik Yugoslavia
Martinistrasse 52
2000 Hamburg 20 (W) Pohl, W.
Federal Republic of Germany Institut
flir Versicherungsbetriebslehre
Universitat Hannover
Langosch, W.
Wunstorfer Strasse 14
Rehabilitationszentrum
3000 Hannover 91 (W)
flir Herz-und Kreislaufkranke
Federal Republic of Germany
Sudring 15, 7812 Bad Krozingen (W)
Federal Republic of Germany
Popadic, M.
Department of Medicine
Marks, C. University Hospital
Department of Cardiology Faculty of Medicine Sarajevo
Queen Mary Block University of Sarajevo, Yugoslavia
Oldchurch Hospital, Romford
RM7 OBE, United Kingdom Poppel,E.
Institut
Marmor,A. flir Medizinische Psychologie
Cardiology Department Universitat Munchen
Rebecca Sieff Hospital Goethestrasse 31/1
Sefat, Israel 8000 Munchen 2 (W)
Federal Republic of Germany
Michorowski, B. L. Popovic,G.
Division of Cardiology, 2C2, 43 Department of Medicine
Walter Mackenzie University Hospital
Health Sciences Center Faculty of Medicine
University of Alberta Zagreb, Yugoslavia
Edmonton, Alberta T6G 2R7
Canada Potthoff, P.
Infratest Gesundheitsforschung
Naber,D. Landsberger Strasse 338
Psychiatrische Klinik 8000 Munchen 21 (W)
Universitat Munchen Federal Republic of Germany
Nussbaumstrasse 7
8000 Munchen 2 (W) Rabinowitz, B.
Federal Republic of Germany The Chaim Sheba Medical Center
Heart Institute
Tel-Hashomer 52621, Israel
Noack,E.
Pharmakologisches Institut
Reisin, L.
der Universitat Dusseldorf
Cardiology Department
Moorenstrasse 5
Barzilai Hospital
4000 Dusseldorf (W)
Ahskelon 78471, Israel
Federal Republic of Germany
Rezakovic, Dz. E.
Notges,A. Department of Medicine
Abteilung Kardiologie I Institute of Radiology
Herz-Kreislauf-Klinik Bevensen University Hospital
Romstedter Strasse 25 Faculty of Medicine
3118 Bad Bevensen (W) Sarajevo and Zagreb
Federal Republic of Germany Yugoslavia
Contributors XI
Rychlik, R. Troschke, J. von
Medizinische Forschung Abteilung
Schwarz Pharma AG fUr Medizinische Soziologie
Alfred-Nobel-Strasse 10 Stefan-Meier-Strasse 17
4019 Monheim (W) 7800 Freiburg im Breisgau (W)
Federal Republic of Germany Federal Republic of Germany
Schneeweiss, A.
Sauerberg12, Tymchak,W. T.
6208 Bad Schwalbach (W) Division of Cardiology, 2C2, 43
Federal Republic of Germany Walter Mackenzie
Health Sciences Center
Schulenburg, J.-M. von der University of Alberta
Institut Edmonton, Alberta T6G 2R7
fUr Versicherungsbetriebslehre Canada
Universitat Hannover
Wunstorfer Strasse 14
3000 Hannover 91 (W) Urbahn,D.
Federal Republic of Germany Infratest Gesundheitsforschung
Landsberger Strasse 338
Sinn,R. 8000 Mlinchen 21 (W)
Abteilung Kardiologie I Federal Republic of Germany
Herz-Kreislauf-Klinik Bevensen
Ramstedter Strasse 25
3118 Bad Bevensen (W) VandenBurg, M.
Federal Republic of Germany Medical and Clinical Research
Consultants Ltd., Lewis House
Stalec, J. 1 Mildmay Road
Faculty of Sciences Romford,
and Mathematics Essex RM7 7DA
University of Zagreb United Kingdom
Yugoslavia
Stephens, J. Viefhues, H.
Department of Cardiology Furkenstrasse 35
Queen Mary Block 4630 Bochum (W)
Oldchurch Hospital Federal Republic of Germany
Romford, RM7 OBE
United Kingdom
Wolf, R.
Traber, U. Abteilung Kardiologie I
Abteilung Kardiologie I Herz-Kreislauf-Klinik Bevensen
Herz-Kreislauf-Klinik Bevensen Ramstedter Strasse 25
Ramstedter Strasse 25 3118 Bad Bevensen (W)
3118 Bad Bevensen (W) Federal Republic of Germany
Federal Republic of Germany
Troidl,H. Woodings, D.
Chirurgische Klinik MCRC, Lewis House
Universitat zu Kaln 1 Mildmay Road
Ostmerheimer Strasse 200 Romford,
5000 Kaln-Merheim (W) Essex RM7 7DA
Federal Republic of Germany United Kingdom
Introduction
A. Schneeweiss
Although the syndrome of congestive heart failure has been recognized many
years ago, the approach for its evaluation and treatment has until recently,
been partial and 'fragmentary'. Various aspects of the disease have been
treated according to the evaluation tools and therapeutic measures available
at each period. This approach resulted in some of the greatest achievements in
the management of heart failure but also left many aspects neglected and also
resulted in several paradoxes.
Examples of the achievements and limitations of the 'fragmentary' ap
proach are the use of diuretics and hemodynamic measurements. The devel
opment of diuretics has provided us with an important tool for helping pa
tients whose predominant problem was edema. The success of diuretics
masked the fact that their use may often be hemodynamically unsound and
that they may reduce cardiac output. Only many years after their introduction
has the use of diuretics found its appropriate place.
Hemodynamic monitoring has gone via the same path. The great contribu
tion of continuous bedside hemodynamic measurements to understanding
heart failure resulted in over-usage by many clinicians, who found themselves
treating hemodynamic charts rather than patients. It took almost a decade to
realize that hemodynamic improvement, even in the chronic setting, does not
necessarily mean symptomatic improvement or an increase in exercise capac
ity.
In recent years the complexity of the heart failure syndrome has been bet
ter realized and a more rational, multifactorial approach to its evaluation and
management has been developed. End-points of therapy concentrate on the
patient and not on parameters that are convenient to measure. Survival and
exercise capacity are two important and easily evaluated end-points of treat
ment. An equally important goal, but more difficult to measure, is quality of
life. The first part of the following presentation concerns mainly quality of life.
The second part concentrates on therapy and particularly on the use of
nitrates for heart failure patients. An important aspect in this topic is early
prevention of the post-infarction changes in the left ventricle, leading to heart
failure. Nitrates have been found effective in preventing these changes.
The material of this part is based mainly on presentations given at the first
international meeting on heart failure. My colleagues and I appreciate the ini
tiative of the Chairmen, Profs. Lewis and Kimchi, who provided that stage for
our presentation.
