Reversal of heart failure remodeling in women.

Epidemiological studies suggest that women with heart failure differ from men with heart failure in that their survival is better. Therapeutic trials have not clearly demonstrated a survival benefit for women. This study was to determine the tolerance for high doses of angiotensin-converting enzyme (ACE) inhibitor-nitrates in women versus men and to compare their symptomatic response, exercise tolerance, and ventricular functional improvement over 1 year. Eighty-eight sequential patients with heart failure, 54 men and 34 women with left ventricular ejection fraction ≤ 35%, were prospectively followed for 1 year. For all patients, ACE inhibitor-nitrate therapy was intensified. Each patient had three 6-monthly echocardiograms at baseline, at 6 months, and at 1 year, and metabolic stress testing. Patients were 57.3 ± 12.3 years old, with New York Heart Association (NYHA) class severity 2.6 ± 1.0. Lisinopril dosages were raised from 14 ± 14 mg/day to 57 ± 26 mg/day, isosorbide mononitrate from 15 ± 27 mg/day ...