Book Review

Heart Failure: Basic Science and Clinical Aspects

N Engl J Med 1994; 330:944March 31, 1994

Article

Heart Failure: Basic Science and Clinical Aspects
Edited by Judith K. Gwathmey, G. Maurice Briggs, and Paul D. Allen. 714 pp., illustrated. New York, Marcel Dekker, 1993. $195. ISBN: 0-8247-8772-2

This large book by experts in the field critically examines the scientific and clinical aspects of heart failure. It is timely and comprehensive and accomplishes its goal of bridging the gap between the basic scientist and the clinician.

Heart failure is a common clinical syndrome, and despite major advances in therapy, the associated mortality rates remain high. For a better understanding of the pathophysiology of heart failure and its treatment, knowledge of molecular and cellular aspects of the disease process as well as of the mechanisms of action of therapeutic agents is essential.

The book provides a wealth of current information on basic research and clinical aspects of therapy for heart failure. There is extensive coverage of angiotensin-converting-enzyme inhibitors, cardiac glycosides, phosphodiesterase inhibitors, calcium-channel antagonists, direct-acting vasodilators, calcium-sensitizing positive inotropic drugs, beta-blockers, and beta-adrenergic agonists. The authors make several intriguing suggestions for the development of new drugs based on an improved understanding of the pathophysiology of heart failure.

Heart Failure begins with a summary of the importance of systolic and diastolic dysfunction in heart failure, followed by detailed discussions of the structural basis for excitation-contraction coupling at the cellular level and the importance of the sarcoplasmic reticulum in determining the release and uptake of intracellular calcium. Although many challenging questions remain unanswered, this book successfully advances the understanding of the function and dysfunction of myocardial and smooth-muscle cells.

The cardiac adrenergic system is well described along with the molecular biology and pharmacology of the adrenergic receptors. This information will help readers appreciate why beta-blockers are beneficial and beta-agonists are ineffective in the long-term treatment of chronic heart failure. New insights are made into the molecular biology and function of muscarinic receptors in the heart, endothelial cell-derived factors, calcium channels, and sodium-potassium channels.

The final chapter systematically addresses the cause of heart failure with the use of widely held hypotheses based on abnormal calcium metabolism and energy imbalance; it closes with the suggestion that the two hypotheses are interrelated.

All 30 chapters are well written and contain extensive references. Mechanistic information is integrated with clinical discussions. The book, with its bench-to-bedside overview of heart failure, will be a welcome addition to the libraries of physician scientists, clinicians, basic-science researchers, and pharmacologists.

Geetha Bhat, Ph.D., M.D.
University of Cincinnati, Cincinnati, OH 45267