Your Heart Function Has Normalized-What Next After TRED-HF?

IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Current Heart Failure Reports Pub Date : 2023-12-01 Epub Date: 2023-11-24 DOI:10.1007/s11897-023-00636-8
Alexandros Kasiakogias, Aaraby Ragavan, Brian P Halliday
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Abstract

Purpose of review: With the widespread implementation of contemporary disease-modifying heart failure therapy, the rates of normalization of ejection fraction are continuously increasing. The TRED-HF trial confirmed that heart failure remission rather than complete recovery is typical in patients with dilated cardiomyopathy who respond to therapy. The present review outlines key points related to the management and knowledge gaps of this growing patient group, focusing on patients with non-ischaemic dilated cardiomyopathy.

Recent findings: There is substantial heterogeneity among patients with normalized ejection fraction. The specific etiology is likely to affect the outcome, although a multiple-hit phenotype is frequent and may not be identified without comprehensive characterization. A monogenic or polygenic genetic susceptibility is common. Ongoing pathophysiological processes may be unraveled with advanced cardiac imaging, biomarkers, multi-omics, and machine learning technologies. There are limited studies that have investigated the withdrawal of specific heart failure therapies in these patients. Diuretics may be safely withdrawn if there is no evidence of congestion, while continued therapy with at least some disease-modifying therapy is likely to be required to reduce myocardial workload and sustain remission for the vast majority. Understanding the underlying disease mechanisms of patients with normalized ejection fraction is crucial in identifying markers of myocardial relapse and guiding individualized therapy in the future. Ongoing clinical trials should inform personalized approaches to therapy.

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你的心脏功能已经恢复正常——在接受了心脏病治疗后,下一步该怎么办?
综述目的:随着当代疾病改善性心力衰竭治疗的广泛实施,射血分数正常化率不断提高。TRED-HF试验证实,在对治疗有反应的扩张型心肌病患者中,心衰缓解而不是完全恢复是典型的。目前的综述概述了与这一日益增长的患者群体的管理和知识差距相关的关键点,重点是非缺血性扩张型心肌病患者。最近的研究发现:在射血分数归一化的患者中存在实质性的异质性。特定的病因可能会影响结果,尽管多发表型是常见的,如果没有全面的特征可能无法确定。单基因或多基因遗传易感性是常见的。正在进行的病理生理过程可以通过先进的心脏成像、生物标志物、多组学和机器学习技术来解开。有有限的研究调查了这些患者的特定心力衰竭治疗的退出。如果没有充血的证据,利尿剂可以安全地停药,而对于绝大多数患者来说,可能需要继续治疗,至少需要一些疾病改善治疗,以减少心肌负荷并维持缓解。了解正常射血分数患者的潜在疾病机制对于确定心肌复发标志物和指导未来的个体化治疗至关重要。正在进行的临床试验应该为个性化的治疗方法提供信息。
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来源期刊
Current Heart Failure Reports
Current Heart Failure Reports Medicine-Emergency Medicine
CiteScore
5.30
自引率
0.00%
发文量
44
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of heart failure. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as investigative, pharmacologic, and nonpharmacologic therapies, pathophysiology, and prevention. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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