Physiological variables as markers for symptoms, risk, and interventions in heart failure

Heart failure is characterized by hemodynamic abnormalities, impaired exercise capacity, and shortened life - expectancy. The risk of death is influenced by a number of physiological abnormalities, the severities of which are not closely correlated. Impaired left ventricular function can be improved by vasodilator or inotropic therapy, but improvement in exercise capacity is more difficult to document. A reduction in long-term mortality has been demonstrated in response to therapy with the vasodilator combination of hydralazine and isosorbide dinitrate as well as with the converting enzyme inhibitors. The mechanism by which survival is improved is not known but appears to include a sustained increase in left ventricular ejection fraction. Prevention of progression of the syndrome will require more effective strategies to interfere with the myocardial and peripheral factors contributing to the process.