Role of Neurohumoral Modulation in Congestive Heart Failure: Focus on the New Generation Calcium Channel Blockers
Bibliographic record
Abstract
ABSTRACT Despite improvement in the control of risk factors such as coronary artery disease and systemic hypertension, the incidence of congestive heart failure (CHF) is actually increasing. Wide use of angiotensin-converting enzyme inhibitors has influenced the survival of patients in the community but mortality in patients with advanced disease remains about 15% after one year. It has become clear that, while neurohumoral activation is important in supporting cardiac function after the loss of myocardial tissue following infarction, such simulation contributes to the further deterioration of the cardiac muscle and this is detrimental in patients with CHF. An increase in regional cardiac adrenergic activity has been associated with an adverse outcome in patients with CHF. The effects of certain drugs that work to dilate the arteries without activating the overall neurohumoral system, and more specifically the adrenergic nervous system, may help to explain the success of these medications in CHF. Current trials indicate second-generation calcium channel blockers such as amlodipine are well tolerated and improve the neurohumoral milieu in CHF. Accordingly, these agents may prove useful as adjunctive treatments for congestive heart failure. RESUME Role de la modulation neurohormonale dans le traitement de l'insuffisance cardiaque congestive : plein feux sur la nouvelle generation d'inhibiteurs des canaux calciques. Malgre les avances clans la maitrise des facteurs de risque comme les coronaropathies et l'hypertension, l'incidence de l'insuffisance cardiaque congestive (ICC) est actuellement a la hausse. L'usage repandu des inhibiteurs de l'enzyme de conversion de l'angiotensine a eu une influence sur la survie des patients dans la communaute, mais la mortalite chez les patients dont la maladie est avancee est toujours d'environ 15 % apres un an. Il est maintenant evident que, bien que l'activation neurohormonale joue un role important dans le maintien de la fonction cardiaque suite a une necrose du tissu myocardique consecutive a un infarctus, la stimulation cardiaque soutenue contribue a la deterioration du muscle cardiaque et qu'elle est deletere chez les patients atteints d'ICC. Un accroissement de l'activite adrenergique cardiaque locale a ete associee a une issue indesirable chez les patients atteints d'lCC. Les effets de certains medicaments qui ont une activite dilatatrice sur les arteres, mais non sur tout le systeme neurohormonal et plus particulierement le systeme sympathique, pourraient expliquer le succes de ces medicaments dans le traitement de l'ICC. Les essais actuels revelent que les inhibiteurs des canaux calciques de deuxieme generation, comme l'amlodipine, sont bien toleres et ameliorent le milieu neurohormonal des patients souffrant d'ICC. Par consequent, ces agents pourraient s'averer utiles comme traitement adjuvant clans l'insuffisance cardiaque congestive.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".