Heart Failure Reviews最新文献

For over a decade, non-invasive myocardial work (MW) analysis, employing pressure-strain loops derived from strain deformation echocardiography, has been extensively studied across various left heart conditions. Recently, interest in MW variation during physical exercise or pharmacological stress testing has emerged. However, existing studies often involve heterogeneous populations, leaving the clinical significance of MW indices variation poorly understood. This review aims to systematically evaluate the literature on non-invasive MW parameter techniques and their changes during stress testing. MW analysis provides critical insights into cardiac function, aiding in the detection of underlying disease, such as coronary artery disease and heart failure. While numerous studies in diverse clinical settings have focused on MW assessment at rest, stress MW indices may more effectively predict treatment response and prognosis. Nevertheless, the current literature remains limited. Future research should prioritize addressing these knowledge gaps to fully harness the potential of MW analysis in clinical practice.

Hyponatraemia remains the most prevalent electrolyte disturbance in heart failure, complicating clinical management and correlating with adverse outcomes. While traditionally viewed as a biomarker of disease severity, mounting evidence suggests that hyponatraemia reflects specific pathophysiological mechanisms that demand targeted intervention alongside standard decongestion strategies. This mini review synthesises contemporary evidence to provide clinicians with an updated, mechanistically grounded approach to hyponatraemia in heart failure. We emphasise the critical distinction between dilutional hypervolaemic states driven by arginine vasopressin dysregulation and depletional hypovolaemic states arising from aggressive diuresis or sodium losses. Recent trials challenge longstanding practices: fluid restriction in stable chronic heart failure shows no quality-of-life benefit despite guideline recommendations, whilst emerging biomarkers such as early urine chloride offer promise in identifying diuretic resistance. We critically appraise the role of vasopressin antagonists, which correct sodium biochemically but lack mortality benefit, and explore oral urea as a pragmatic alternative supported by recent observational data. For acute severe presentations, we detail hypertonic saline protocols with strict correction limits and discuss proactive desmopressin strategies to prevent osmotic demyelination. Important knowledge gaps persist, including optimal diagnostic algorithms in diuretic-exposed patients, patient-centred outcome data for sodium-correcting therapies, and validation of safe-correction protocols. Overall, this review equips clinicians to integrate mechanistic understanding with evidence-based practice whilst identifying priorities for future investigation.

Congestion represents the principal clinical manifestation and hemodynamic hallmark of heart failure (HF), reflecting elevated cardiac filling pressures. It remains the leading cause of HF hospitalization and is consistently associated with adverse outcomes across all stages of the disease. Despite its major prognostic implications, the assessment of congestion remains suboptimal in both acute and chronic settings, with up to one-third of patients discharged while still fluid overloaded. This review, developed following the Critical Care Clinical Trialists (3CT) Workshop 2025, summarizes current and well-established approaches for evaluating congestion, and introduces new and emerging tools that may simplify its recognition and management while allowing for a more accurate and timely assessment. We further discuss how integrating clinical, imaging, hemodynamic, and patient-centered strategies may enable optimal congestion management and support a paradigm shift from reactive decongestion to proactive, individualized care.

Heart failure with preserved ejection fraction (HFpEF) has limited therapeutic options. Abnormal calcium handling through impaired sarcoplasmic/endoplasmic reticulum Ca²⁺ ATPase 2a (SERCA2a) activity contributes to diastolic dysfunction. AAV1.SERCA2A, an Adeno-Associated Virus Serotype 1 (AAV1) vector encoding SERCA2a, may improve myocardial relaxation in HFpEF. Modulation of SERCA2a of Intra-myocytic Calcium Trafficking in Heart Failure With Preserved Ejection Fraction (MUSIC-HFpEF) is a Phase 1b, open-label, multicenter trial (NCT06061549) currently enrolling 10 patients with hemodynamically confirmed HFpEF. Patients receive a one-time intracoronary infusion of AAV1.SERCA2A. The primary objective is to assess safety and tolerability; secondary endpoints include effects on resting and exercise hemodynamics, echocardiographic measures of relaxation, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and functional status. MUSIC-HFpEF is the first-in-human trial of SERCA2a gene therapy in HFpEF. Findings will inform the feasibility, safety, and potential clinical benefit of targeted gene therapy in this population. The study is enrolling participants and aims to clarify the safety profile and potential benefits of administering a single dose of AAV1.SERCA2A to individuals with HFpEF.

Cardiac glycosides have been used for more than two centuries in patients with heart failure with reduced ejection fraction (HFrEF), but their use has steadily declined in recent decades, largely due to safety concerns raised by observational studies and the availability of outcome-modifying therapies with more favorable safety profiles. Evidence from earlier randomized trials suggested that digoxin improves symptoms and reduces heart-failure hospitalizations without affecting survival, but these studies were conducted before the widespread adoption of contemporary guideline-directed medical therapy (GDMT). Digitoxin is a cardiac glycoside that differs from digoxin through its hepatic clearance and more stable pharmacokinetics, diminishing the impact of renal dysfunction and serum concentration fluctuations, thereby improving safety and facilitating long-term use in routine care. Here, we critically discuss in the context of available evidence the findings of the recently published DIGIT-HF (Digitoxin to Improve Outcomes in Patients with Advanced Chronic Heart Failure) trial, which for the first time evaluated the efficacy and safety of digitoxin in contemporary patients with HFrEF.

Evaluation of ejection fraction (EF) is paramount for patients with symptoms of heart failure. While transthoracic echocardiography (TTE) is the most common way to evaluate EF, recent advances in artificial intelligence (AI) have opened the door for alternative methods to screen for reduced EF with smaller and more portable technology. The DAMSUN-HF study evaluated the accuracy of an AI-based stethoscope for detecting reduced EF (≤40%) in patients with symptoms of heart failure in a region with geographic and economic barriers to obtaining timely TTE. This mini-review examines the DAMSUN-HF study and highlights the potential clinical implications of the study findings.

Non-obstructive hypertrophic cardiomyopathy (nHCM) is defined by exertional limitation without left ventricular outflow tract obstruction and lacks approved targeted therapies. ODYSSEY-HCM was a phase 3, randomized, double-blind, placebo-controlled trial that enrolled adults with symptomatic nHCM and left ventricular ejection fraction ≥ 60% to receive mavacamten, a selective cardiac myosin inhibitor, or placebo for 48 weeks with dose titration guided by serial echocardiography. The co-primary endpoints were the change in peak oxygen uptake and the 23-item Kansas City Cardiomyopathy Questionnaire clinical summary score. Mavacamten produced clear pharmacodynamic effects manifested by reductions in circulating markers of myocardial stress and imaging indices consistent with modest reverse remodelling, but it did not produce statistically significant improvement in the prespecified co-primary clinical endpoints at 48 weeks. Treatment was associated with an increased incidence of reversible reductions in ejection fraction necessitating protocol-mandated dose interruption, indicating a constrained therapeutic window in this cohort. Collectively, the data demonstrate target engagement without definitive patient-centered benefit over the study interval. Further evaluation is required, including randomized trials of agents with alternative pharmacokinetic and titration properties, studies with extended exposure, and phenotype-enriched enrollment, to determine whether biomarker and imaging responses can be translated into sustained improvements in functional capacity and health-related quality of life in patients with nHCM.