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European Heart Journal 1995 16(Supplement F):20-31; doi:10.1093/eurheartj/16.suppl_F.20
Copyright © 1995 by the European Society of Cardiology.
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© 1995 The European Society of Cardiology

Improvement in cardiac myocyte function by biological effects of medical therapy: A new concept in the treatment of heart failure

M. R. Bristow and E. M. Gilbert

University of Colorado Health Sciences Center Denver Colorado, U.SA.

Correspondence: Professor Michael R. Bristow, Director, Division of Cardiology. University of Colorado, Health Sciences Center. Campus Box B139, 4200 East Ninth Avenue, Denver, Colorado 80262, U.S.A.

Virtually all medications used to treat cardiac problems act through a pharmacological mechanism that immediately improves electrical or mechanical function or inhibits the manifestation of a pathological process. The idea that medical therapy could exert a favourable myocardial effect by fundamentally improving the biological function of cardiac myocytes is novel, and is based on the observation that in heart failure the acute pharmacological effects of β-blocking agents on left ventricular function are completely different from their long-term effects, β-blocking agents improve intrinsic systolic function long-term, despite depressing function initially through the pharmacological effect of withdrawing adrenergic drive, indicating that the beneficial effect of this form of therapy is due to improved myocyte biology. Implicit in this observation is that improvement in the fundamental biology of failing cardiac myocytes should favourably affect the natural history of heart failure.

Key Words: β-blockers • heart failure • mocardial dysfunction • adrenergic activity.


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