06/20/2007

Doctors trying to reverse heart failure

By Lauran Neergaard
The Associated Press

U.S. doctors are beginning a dramatic experiment to try to save patients dying from congestive heart failure — by temporarily resting their hearts and then boosting them with a drug long abused for bodybuilding.

The goal: To help the heart heal itself, and rescue patients who otherwise wouldn't survive without a heart transplant or an implanted machine to pump their hearts.

"The provocative question is, once you get to that level, is it too late or are there people still recoverable even at that point?” asks Dr. Clyde Yancy of the American Heart Association, who is closely monitoring the experiment.

The study is very small, and there's no way to predict if it will work. But British scientists reported a tantalizing hint last fall that the combination of a temporarily implanted heart pump and an asthma drug not approved for sale in this country — the athlete-abused clenbuterol — just might offer hope of recovery for this common, intractable killer.

"We think this is a completely novel way to look at the treatment of heart failure,” says Dr. Leslie Miller of Washington Hospital Center in the nation's capital, one of seven U.S. study sites.

Almost 5 million Americans, and 20 million people worldwide, have congestive heart failure. Their hearts are weakened by age, damage from a survived heart attack, or other problems. It can strike seemingly healthy young people, too.

Some drugs and pacemakers treat heart failure very well. But often the disease worsens over years, the heart getting weaker until patients find it difficult even to walk across a room. Fluid seeps into their lungs and blocks breathing.

They have few options: A transplant — and there are only about 2,200 U.S. donors a year, while 58,000 Americans die of heart failure annually — or an implanted heart pump. These devices give the heart a rest, taking over the pumping action that's normally the job of the left ventricle. But the implants only last a few years.

Here's where the plot thickens: Patients can improve remarkably on these pumps. Flabby enlarged hearts shrink. Cardiac muscle cells long thought unsalvageable instead seem to repair.

The question is how to control that repair so more people might benefit.

Last fall, British doctors reported a small but stunning success: They implanted heart pumps in 15 about-to-die patients, and used high doses of standard drugs to help the pumps shrink their hearts. Then they administered clenbuterol to stimulate, and perhaps strengthen, the heart muscle. Eleven patients recovered enough to have their implants removed, and four years later, eight still are doing well.

"To see something like this was so dramatic,” says Dr. Keith Aaronson, medical director of the University of Michigan's heart transplant program. He oversees the U.S. study, which will attempt to duplicate those results in at least 30 Americans.