Current Heart Failure Reports最新文献

Purpose of the review: Laminopathies are a diverse group of genetic disorders caused by variants in nuclear lamina proteins, with heart failure being a major cause of morbidity and mortality in patients. By shifting the perspective from distinct clinical phenotypes to a continuous spectrum of metabolic observations in laminopathies, this review aims to elucidate the molecular mechanisms underlying metabolic dysregulation in laminopathies and their impact on cardiac health.

Recent findings: Emerging evidence links A-type lamins to cellular metabolism, with systemic metabolic changes such as lipodystrophy, insulin resistance and hypertriglyceridemia often detected in laminopathy patients before cardiac symptoms onset. At the molecular level, LMNA variants disrupt the regulation of genes involved in fatty acid, oxidation glucose utilization, and mitochondrial function. These disturbances increase cardiomyocyte susceptibility, promoting fibrosis and apoptosis. Metabolic dysregulation is a recurring observation across the laminopathy spectrum. Targeting metabolic pathways shows preclinical promise for improving cardiac outcomes in patients.

Purpose of review: This review explores the evolution of mineralocorticoid receptor antagonists (MRAs) in cardiorenal disease, comparing steroidal MRAs with newer non-steroidal MRAs and emerging aldosterone synthase inhibitors (ASIs). It examines their efficacy, safety, and positioning in heart failure (HF) and chronic kidney disease (CKD), aiming to guide optimal treatment across cardiorenal diseases.

Recent findings: Steroidal MRAs remain foundational in HF with reduced ejection fraction, but are underused due to hyperkalemia, worsening renal function, and hormonal side effects. Non-steroidal MRAs have demonstrated cardiorenal benefits in high-risk populations (e.g. diabetic kidney disease) while mitigating some safety concerns. Emerging ASIs directly inhibit aldosterone synthase, reducing aldosterone levels and potentially preventing breakthrough. Ongoing trials are further defining their roles as standalone or combination therapies. Non-steroidal MRAs expand the use of mineralocorticoid receptor blockade into populations underserved by steroidal agents. Ongoing studies will establish the role of direct aldosterone synthase inhibition.

Purpose of review: Heart failure (HF) imposes an expanding global health burden, necessitating innovative approaches to education for both patients and clinicians. This review evaluates the evolving landscape of digital health tools in HF education and examines how these technologies may enhance accessibility, personalisation, and engagement in contemporary care.

Recent findings: Emerging evidence demonstrates that digital solutions-ranging from remote educational platforms and interactive applications to AI-assisted learning and immersive reality technologies-can meaningfully improve patient self-management, support clinician knowledge acquisition, and strengthen overall care quality. These tools offer substantial advantages, including remote access to high-quality information, dynamic and interactive learning experiences, and opportunities for continuous monitoring. Nonetheless, challenges persist, particularly regarding equitable access, digital literacy, data quality, and integration into existing clinical workflows. Digital technologies hold considerable promise in optimising HF education for both patients and clinicians. When effectively implemented, they have the potential to improve patient outcomes, enhance clinical decision-making, and support more efficient healthcare delivery. Continued innovation-particularly in AI, virtual and augmented reality, and personalised learning systems-will be essential to address remaining limitations and fully realise the transformative potential of digital HF education.

Purpose of review: Timely recognition and interpretation of symptoms are crucial for effective self-care in heart failure (HF). However, many patients struggle to detect bodily sensations and interpret their meaning, leading to poor outcomes. Interoception and symptom attribution are central to this process but are often impaired. This scoping review aims to describe interventions and their characteristics aiming to enhance interoception and symptom attribution in patients with HF.

Recent findings: Recent findings indicate that patients' attributions of the causes of their symptoms strongly influence self-care, and growing attention to interoception suggests that increased awareness of bodily sensations can improve self-care symptom management. Interventions targeting interoception and symptom attribution may help improving HF patients' symptom perception and self-care symptom management. Both constructs are closely connected and contribute to timely symptom management. The heterogeneity of interventions reflects the complexity of symptom perception in HF and highlights the need for personalized, multicomponent approaches to strengthen self-care and improve outcomes.

Purpose: The goal of this paper is to advance precision health among patients with a left ventricular assist device (LVAD) and their informal care partners by examining the science of patient, care partner and dyadic management. We (1) describe the current state of self- and dyadic management science in LVAD, and (2) offer frameworks to guide LVAD patient, care partner and dyadic management research.

Recent findings: While frameworks for family and self-management exist for other chronic conditions, dyadic frameworks are rarely used for LVAD patient-care partner dyads, thus limiting research. A handful of primarily qualitative studies describe self-management tasks and skills, but facilitators, barriers, processes, behaviors and outcomes of self- and dyadic LVAD management need more study. In this paper we summarized current progress in self- and dyadic management science in LVAD and offered a preliminary framework to guide research. Future studies should include both care partners and LVAD patients, with thoughtfully selected frameworks to guide more inclusive research in LVAD self- and dyadic management, with the goal of designing the right intervention for the right person at the right time.

Purpose of review: This review examines the potential benefits of non-invasive remote monitoring in patients with heart failure (HF), focusing on early detection of clinical deterioration and reducing hospitalizations. Key questions addressed include: Can remote monitoring prevent hospitalisations in patients with HF? Does it improve quality of life and promote self-care? Is it cost-effective? Can artificial intelligence (AI) facilitate its implementation?

Recent findings: Monitoring with non-wearable and wearable devices reduces hospitalizations by detecting early signs of deterioration and enhancing self-care behaviour. While the initial investment can be high, the long-term cost-effectiveness is supported by reduced hospitalisations. AI is increasingly integrated into monitoring systems, enhancing predictive accuracy and personalized care. Remote monitoring reduces mortality and hospitalisations in patients with HF, with benefits in cost-effectiveness, and the potential to optimize care delivery by integrating AI. Future research should focus on identifying monitoring strategies for specific HF populations, such as patients with advanced HF.

Purpose of review: Current treatment strategies for heart failure primarily aim to slow disease progression. In the case of rare genetic disorders with associated cardiomyopathies, management is largely supportive. Gene therapy offers a promising alternative that is potentially curative. This review explores gene therapy strategies, vector selection and relevant molecular targets. We also examine pre-clinical and clinical trials investigating gene therapy in cardiomyopathies.

Recent findings: Clinical trials for several genetic disorders-including Danon disease, Fabry disease and Duchenne muscular dystrophy-have demonstrated encouraging results. However, with the use of viral vectors and associated immunogenicity eliciting a strong inflammatory response in some patients, there remains a substantial risk of morbidity and mortality. For rare diseases, gene therapy represents a potentially curative, one-time treatment strategy. As the field advances, further work is required to improve vector technology, reduce immunogenicity, decrease off-target effects and address the associated ethical considerations.