Embracing an era of targeted combination therapy for heart failure with preserved ejection fraction.

IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Failure Reviews Pub Date : 2024-11-01 Epub Date: 2024-08-27 DOI:10.1007/s10741-024-10432-8
Satoshi Shoji, Stephen J Greene, Robert J Mentz
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Abstract

The concept of quadruple therapy as a "one-size-fit-all" approach is effective among all eligible patients with heart failure with reduced ejection fraction, with consistent and significant clinical benefits including reduced mortality across various subgroups. However, with exception of sodium-glucose cotransporter 2 inhibitors, the consistency of benefit with therapies does not extend to patients with heart failure with preserved ejection fraction. The clinical benefits of other promising medical therapies, such as angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists, have been demonstrated only in certain phenotypes of the highly heterogenous heart failure with preserved ejection fraction population. This variability can confuse frontline practicing cardiologists, potentially leading to the under-implementation of these medications. Therefore, we propose a simple approach: "targeted" combination therapy. This strategy aims to optimize evidence-based medications in heart failure with preserved ejection fraction by tailoring treatments to specific subgroups within the heart failure with preserved ejection fraction population where significant benefits are most evident.

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迎接射血分数保留型心力衰竭靶向综合疗法时代的到来。
四联疗法作为一种 "放之四海而皆准 "的方法,对所有符合条件的射血分数降低型心力衰竭患者都有效,在不同的亚组中具有一致且显著的临床疗效,包括降低死亡率。然而,除了钠-葡萄糖共转运体 2 抑制剂外,其他疗法的持续获益并没有扩展到射血分数保留的心衰患者。血管紧张素受体-奈普利酶抑制剂、矿物质皮质激素受体拮抗剂和胰高血糖素样肽-1受体激动剂等其他有前景的药物疗法,仅在射血分数保留的高度异质性心力衰竭人群的某些表型中显示出临床疗效。这种差异性会使一线心脏病医生感到困惑,可能导致这些药物的使用不足。因此,我们提出了一种简单的方法:"靶向 "联合疗法。这一策略的目的是针对射血分数保留型心力衰竭患者中获益最明显的特定亚组,量身定制治疗方案,从而优化射血分数保留型心力衰竭患者的循证药物治疗。
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来源期刊
Heart Failure Reviews
Heart Failure Reviews 医学-心血管系统
CiteScore
10.40
自引率
2.20%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Heart Failure Reviews is an international journal which develops links between basic scientists and clinical investigators, creating a unique, interdisciplinary dialogue focused on heart failure, its pathogenesis and treatment. The journal accordingly publishes papers in both basic and clinical research fields. Topics covered include clinical and surgical approaches to therapy, basic pharmacology, biochemistry, molecular biology, pathology, and electrophysiology. The reviews are comprehensive, expanding the reader''s knowledge base and awareness of current research and new findings in this rapidly growing field of cardiovascular medicine. All reviews are thoroughly peer-reviewed before publication.
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