Clenbuterol Increases Lean Muscle Mass but Not Endurance in Patients With Chronic Heart Failure

Kamalakkannan, Gayathri; Petrilli, Christopher M.; George, Isaac; LaManca, John J.; McLaughlin, Brooke T.; Shane, Elizabeth; Mancini, Donna; Maybaum, Simon

doi:10.1016/j.healun.2008.01.013

Cited by 54 publications

(51 citation statements)

References 22 publications

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“…It should be taken into consideration, however, that in a recent small, randomized controlled study, clenbuterol use in patients with chronic heart failure was associated with a significant increase in both lean mass and lean/fat ratio as well as in muscle strength, and a decrease in exercise duration (141). Thus, the effectiveness of clenbuterol in heart failure patients should be further evaluated in larger prospective trials.…”

mentioning

confidence: 99%

The Sympathetic Nervous System in Heart Failure

Triposkiadis

Karayannis

Giamouzis

et al. 2009

Journal of the American College of Cardiology

812

323

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Heart failure is a syndrome characterized initially by left ventricular dysfunction that triggers countermeasures aimed to restore cardiac output. These responses are compensatory at first but eventually become part of the disease process itself leading to further worsening cardiac function. Among these responses is the activation of the sympathetic nervous system (SNS) that provides inotropic support to the failing heart increasing stroke volume, and peripheral vasoconstriction to maintain mean arterial perfusion pressure, but eventually accelerates disease progression affecting survival. Activation of SNS has been attributed to withdrawal of normal restraining influences and enhancement of excitatory inputs including changes in: 1) peripheral baroreceptor and chemoreceptor reflexes; 2) chemical mediators that control sympathetic outflow; and 3) central integratory sites. The interface between the sympathetic fibers and the cardiovascular system is formed by the adrenergic receptors (ARs). Dysregulation of cardiac beta(1)-AR signaling and transduction are key features of heart failure progression. In contrast, cardiac beta(2)-ARs and alpha(1)-ARs may function in a compensatory fashion to maintain cardiac inotropy. Adrenergic receptor polymorphisms may have an impact on the adaptive mechanisms, susceptibilities, and pharmacological responses of SNS. The beta-AR blockers and the inhibitors of the renin-angiotensin-aldosterone axis form the mainstay of current medical management of chronic heart failure. Conversely, central sympatholytics have proved harmful, whereas sympathomimetic inotropes are still used in selected patients with hemodynamic instability. This review summarizes the changes in SNS in heart failure and examines how modulation of SNS activity may affect morbidity and mortality from this syndrome.

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mentioning

confidence: 99%

The Sympathetic Nervous System in Heart Failure

Triposkiadis

Karayannis

Giamouzis

et al. 2009

Journal of the American College of Cardiology

812

323

View full text Add to dashboard Cite

show abstract

“…43 However, this protocol did not show a significant improvement of cardiac function in another facility. 44 A larger multi-institutional study is required to elucidate the effectiveness of clenbuterol therapy.…”

Section: Strategies To Enhance Myocardial Recoverymentioning

confidence: 99%

“…14 In the same manner, the operative procedure concomitantly performed with LVAS implantation, such as mitral repair or LV restoration, may play a role in the recovery of LV performance and sustained improvement of CHF symptoms. 3,44 However, these operative adjuncts may increase the operative risk, thus careful consideration of possible benefits obtained from those procedures is required for each patient.…”

Section: Strategies To Enhance Myocardial Recoverymentioning

confidence: 99%

Myocardial Recovery by Mechanical Unloading With Left Ventricular Assist System

Matsumiya

Saitoh

Sakata

et al. 2009

Circ J

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dvanced congestive heart failure (CHF) has been generally believed to be progressive and associated with substantial morbidity and mortality. 1 Cardiac transplantation has been the only curative treatment for end-stage CHF, but the number of heart transplantation is severely limited, especially in Japan. Instead, there has been increasing application of left ventricular assist systems (LVAS) for the treatment of severe CHF. 2 The LVAS consists of an electrically or pneumatically driven pump, installed either extra-or intra-corporeally. The main purpose of the LVAS is a "bridge to transplantation", but recent refinements in the engineering of the devices have enabled long-term use as "destination therapy". 3 The pump transports blood from the left ventricle (LV) to the ascending aorta, thereby restoring the systemic circulation to normal. Moreover, the pump provides potent pressure and volume unloading of the LV. These favorable effects have lead to a new indication for the use of LVAS, because there is increasing evidence that mechanical unloading with the LVAS occasionally reverses the progress of CHF and permits device explantation. [4][5][6][7] This "bridge to recovery" with the LVAS is an attractive strategy for the treatment of patients with severe CHF for whom heart transplantation or permanent LVAS use has been the only treatment option. Interest relates not only to the treatment of severe CHF, 8-10 but also to the study of the mechanisms involved in the remodeling process and its regression (ie, "reverse remodeling"). The pathophysiological mechanisms involved in the reverse remodeling induced by mechanical unloading have become a focus of intense research, with the hope of establishing reliable indicators of sustained recovery and strategies to enhance this process. 8,9 Clinically, there still exist many questions about the application of this strategy. The evaluation of LV function while on the LVAS and the prediction of sustained recovery after device explantation have been the major concerns regarding the use of this strategy for a wider range of patients. 10,11 How to evaluate LV function and decide when LVAS explantation is performed are the focus of studies. 6,10,12 Furthermore, to promote the recovery process, pharmacological, 4,7 surgical 13,14 or cell-based therapies, 15,16 combined with LVAS, are under intense investigation. In Japan, the donor supply is severely limited and almost all patients on LVAS are waiting nearly 3 years for a heart transplant. 2 Therefore, we have been forced to adopt more generous criteria for LVAS weaning compared with those used in studies from other countries. Based on this, we evaluated the factors that predict successful explantation of the LVAS and sustained functional LV recovery to determine if we can expand the population of patients who can benefit from the LVAS as a bridge to recovery. Both the clinical and laboratory findings, including our own of bridge to recovery experience with mechanical circulatory support, are reviewed. Clinical ObservationsAn earl...

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“…23 Em relação à atrofia muscular na insuficiência cardíaca, por sua vez, vários estudos estão sendo desenvolvidos no sentido de entender suas causas e inibi-la. 24,25 Até o momento é conhecido que ela é gerada por um desequilíbrio entre vias moleculares de sín-tese e de degradação protéica 26 , que serão descritas posteriormente.…”

Section: Alterações Estruturaisunclassified

Relevância e tratamento das lesões características da insuficiência cardíaca na musculatura esquelética

Júnior

2009

Medicina (Ribeirão Preto)

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Pacientes com insuficiência cardíaca, a via final das doenças cardiovasculares e a primeira causa de internação em idosos no Brasil, apresentam deterioração do tecido muscular esquelético. Além disso, as lesões na musculatura têm relação direta com a qualidade de vida e a autonomia dos pacientes, por meio do nível de tolerância aos esforços físicos, além de constituírem um preditor independente de mortalidade na síndrome. Ao longo da presente revisão de literatura serão discutidos em relação à insuficiência cardíaca: seu conceito e um breve histórico; a importância da musculatura esquelética; as anormalidades funcionais, estruturais, bioquímicos e moleculares que acometem esse tecido; as potenciais causas dessas alterações (hiperatividade simpática, redução na ingestão alimentar, espécies reativas de oxigênio, citocinas pró-inflamatórias e diminuição do nível de atividade física e do fluxo sanguíneo); e os efeitos da principal terapia direcionada para combater essa disfunção, o treinamento físico aeróbio de intensidade moderada. Reconhecida a importância do tecido muscular esquelético na síndrome, essa é uma área da investigação científica com muitos temas ainda não estudados, como o efeito de terapias farmacológicas utilizadas pelos pacientes, de exercícios físicos aeróbios de maior intensidade e intervalados, de exercícios físicos de força, de intervenções nutricionais e de terapias celulares e gênicas. No futuro, os resultados desses estudos que serão desenvolvidos certamente contribuirão para uma menor degeneração da musculatura esquelética na doença, o que, consequentemente, vai melhorar a ualidade de vida, a autonomia e o prognóstico dos pacientes.

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Clenbuterol Increases Lean Muscle Mass but Not Endurance in Patients With Chronic Heart Failure

Cited by 54 publications

References 22 publications

The Sympathetic Nervous System in Heart Failure

The Sympathetic Nervous System in Heart Failure

Myocardial Recovery by Mechanical Unloading With Left Ventricular Assist System

Relevância e tratamento das lesões características da insuficiência cardíaca na musculatura esquelética

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