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New Promise in Repairing Damage from Heart Failure

Breaking News - April 2006 - Week 4

(Apr 26, 2006)

Healthcare in  the News

-- Body builders sometimes turn, illicitly, to the asthma medication clenbuterol to build up their muscles. Now, researchers say the medication might also help heart failure patients stay strong without the need for a heart transplant.

Picture of an electrocardiogram strip

The first US study of the medication found it was safe in a small number of study participants with heart failure.

The medication was also found to increase skeletal muscle mass and strength, although there was no significant change in heart function.

Heart failure is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body's other organs. The heart keeps pumping, but not as efficiently as a healthy heart.

Usually, the loss in the heart's pumping action is a symptom of an underlying heart problem. Heart failure (HF) affects nearly 5 million US adults. It is on the rise with an estimated 400,000 to 700,000 new cases each year.

Searching for Better Heart Failure Treatments

The trial, which is a precursor to bigger trials, is an example of how far physicians will go to find solutions to the growing problem of heart failure.

And like many other avenues of research, the promise is still a faint one.

"We've learned the hard way that any pharmacological intervention in this very fragile group of patients needs to be studied very cautiously and thoroughly," cautions Dr. Ann Bolger, a spokeswoman for the American Heart Association and professor of medicine at the University of California, San Francisco. "Something that looks to be positive early on may not still be positive later on."

The end step for many heart failure patients is a heart transplant. But with a worldwide shortage of organ donors, many end-stage heart failurepatients have todepend on heart pumps to survive.

Is there a way to avoid both heart pumps and transplants? Possibly, the experts say.

"The idea is to one day develop strategies to promote cardiac recovery while patients are supported with a heart pump. That would obviate the need for heart transplants," says Dr. Simon Maybaum, medical director of the Center for Advanced Cardiac Therapy and the Cardiac Transplant and Assist Device Program at Montefiore Medical Center and Albert Einstein College of Medicine in New York City.

"This is a growing area of research, and both novel pharmacological agents and cellular therapy [stem cells] will be studied. This research is crucial because of the critical lack of organs for patients with end-stage heart failure," Dr. Maybaum continues.

Dr. Maybaum was lead author of the study, which was presented recently at a meeting of the International Society of Heart and Lung Transplantation in Madrid, Spain.

"We're looking for ways to make the transition off the pump and potentially go forward from there," Bolger added. "We need more tools to save lives."

Promising Results from a Small Study

Other studies done by one British center found that clenbuterol resulted in significant improvement in cardiac function in patients with heart pumps awaiting heart transplants.

In fact, thepumps could be taken out in more than half of the patients, meaning they were no longer in need of transplant. Those studies used doses of clenbuterol 20 times those typically used by asthma patients and athletes.

Clenbuterol is not approved in the US and, in fact, has a checkered history: Some people fell ill after eating livestock that had been treated with the medication.

Dr. Maybaum, however, managed to obtain permission from the US Food and Drug Administration (FDA) to conduct a small pilot study using high-dose clenbuterol.

There were two parts to the study: The first part tested high-dose clenbuterol in heart pumppatients. The second part focused on whether the drug in lower doses would improve muscle function and quality of life in heart failure patients withoutheart pumps(those with milder heart failure). Seven patients completed the study.

Clenbuterol did increase skeletal muscle mass and strength, and was safe at the doses given - 10 to 15 times that usually taken by asthmatics and athletes. There was no significant change in heart function measures, however.

However, Dr. Maybaum points out that the study was not designed to look at this.

Data from the second part of the study is still blinded to researchers, and therefore not yet available.

More Study Needed

The next step will be to conduct a multi-center trial in the United States to try to replicate the British findings with heart pump patients.

However, some experts voiced major concerns.

"Patients in heart failure have a pretty broad spectrum of responses to all kinds of therapies, so we have to be very careful. In some situations, this type of drug can be very dangerous with respect to arrhythmias, blood pressure changes and even stroke," Dr. Bolger says.

"Medications that seem to give the heart an extra boost sometimes make patients feel better, but increase early mortality," she says.

On the other hand, Dr. Bolger adds, muscle-building strategies including physical fitness, have already been shown to benefit heart failure patients.

Even the study authors were cautious about the odds of success.

"Whenever there are such novel results which have the potential to dramatically affect such a difficult disease process, we go into the research with a mixture of excitement and skepticism," Dr. Maybaum acknowledges.

"We're optimistic that we will find a solution, but we're not sure which one will bear out. We will definitely live in an era where we will be able to repair the heart as opposed to replace it," he adds.

Always consult your physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.


Treatment for Heart Failure

Heart failure (HF) occurs when the heart muscle becomes too weakened to pump effectively.

The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been lost.

The cause of an individual's heart failure will dictate the treatment protocol established.

If the heart failure is caused by a valve disorder, then surgery is usually performed. If the heart failure is caused by a disease, such as hypothyroidism, then the disease is treated.

And, although there is no cure for heart failure due to a damaged heart muscle, many forms of treatment have proven to be successful.

The goal of treatment is to improve a person's quality of life by making the appropriate lifestyle changes and implementing drug therapy.

Many types of medications are used to help strengthen the heart. However, heart failure may progress to a stage in which some medications have a reduced effect.

When medications areless effective in treating HF, devices may be used to assist the heart's function.

Types of devices that may be used in treating HF include biventricular pacemakers, implantable cardioverter defibrillators (ICDs), intra-aortic balloon pumps (IABPs), and ventricular assist devices (VADs).

pacemaker
A type of pacemaker, called a biventricular pacemaker, may be used for cardiac resynchronization therapy. This type of pacemaker paces both sides of the heart simultaneously to coordinate contractions and improve pumping ability.

implantable cardioverter defibrillator (ICD)
An ICD is a device similar to a pacemaker that senses when the heart is beating too fast and delivers an electrical shock to convert the fast, irregular rhythm to a normal rhythm. People with heart failure frequently have heart rhythm problems and can benefit from ICD therapy.

intra-aortic balloon pump (IABP)
An IABP consists of a long, thin balloon that is inserted into the aorta (usually through the groin). The tip of the balloon is placed in the aorta. The balloon is attached to a pump. When the heart relaxes after each contraction, the balloon is inflated with helium. The balloon is deflated just before each heart contraction. The inflation and deflation of the balloon assists the heart function by improving flow to the coronary arteries that supply blood to the heart muscle and also by passively decreasing the force needed to pump blood out of the heart.

ventricular assist device (VAD)
A VAD is a mechanical device that is used to take over the pumping function for one or both of the heart’s ventricles. Some VADs are designed to support the right heart alone (right ventricular assist device, or RVAD) or both ventricles (biventricular assist device, or BiVAD), but commonly the left ventricle (left ventricular support device, or LVAD) is the primary point of support. VADs are most commonly implanted during an open heart surgical procedure.

Always consult your physician for more information.


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