Heart Failure Reviews最新文献

In the past five years, rapid progress has been made in biosensor platforms for BNP and NT-proBNP detection. Innovations span fluorescence-based assays (FRET aptasensors, quantum dots, NIR persistent luminescence probes), colorimetric nanozyme-enhanced lateral flow assays, surface-enhanced Raman scattering (SERS) systems and electrochemiluminescence immunoassays. These strategies exploit advances in nanomaterials, photonic engineering, and biointerface design to achieve femtogram-to-picogram limits of detection, multiplex biomarker analysis, and smartphone-compatible readouts. Parallel work on biofouling mitigation through zwitterionic coatings, hydrogel nanocomposites, and MOF encapsulation can be adapted for further enhance sensor robustness in complex biological fluids. This review critically evaluates BNP/NT-proBNP detection technologies reported between 2020 and 2025, comparing analytical performance, material design, and translational potential. We highlight gaps between laboratory performance and clinical implementation, discuss harmonisation with established commercial assays, and outline future directions in multiplexed panels, wearable monitoring, and digital health integration. By synthesizing recent advances, this work provides a roadmap toward biosensors capable of transforming HF care through earlier diagnosis, decentralised testing, and proactive disease management.

Lung ultrasonography (LUS) is a reliable and reproducible tool across various clinical settings. Its high diagnostic accuracy, portability, and real-time imaging capabilities make it especially suitable for use in Emergency Departments, Intensive Care Units, and outpatient clinics. LUS has proven particularly effective in evaluating lung congestion. LUS also provides superior diagnostic accuracy for detecting pleural effusion and lung consolidations, offering real-time imaging with high spatial resolution and enabling precise monitoring throughout hospitalization. In the Cardiac Rehabilitation Unit, the routine use of LUS represents a reliable imaging modality for assessing patients with complex clinical conditions. In fact, early identification of lung congestion, pleural effusion, or lung consolidation in patients recovering from acute coronary syndrome, acute heart failure, or cardiac surgery is crucial for optimizing clinical management. Moreover, continuous monitoring of lung congestion can aid in the appropriate adjustment of diuretic therapy and exercise intensity. This review aims to present the latest evidence and recommendations for the use of LUS in the cardiac rehabilitation setting.

Anticoagulation management in patients supported by left ventricular assist devices (LVADs) is essential to prevent thromboembolic events while minimizing bleeding complications. Warfarin remains the standard therapy but is constrained by a narrow therapeutic index, dietary restrictions, and the need for frequent monitoring, prompting growing interest in direct oral anticoagulants (DOACs) as alternatives. The HeartMate 3 (HM3), now the predominant LVAD in clinical practice, features improved hemocompatibility and has demonstrated reduced rates of pump thrombosis and ischemic stroke compared to earlier-generation devices. These advances raise the possibility of simplified antithrombotic regimens tailored to specific device profiles. Retrospective studies suggest that DOACs, particularly apixaban, may provide comparable thromboembolic protection and potentially lower bleeding risk than warfarin, especially when aspirin is omitted. Additionally, DOACs offer more predictable pharmacokinetics, fewer interactions, and improved patient adherence due to reduced monitoring requirements. However, current evidence remains limited by small sample sizes, short follow-up durations, and heterogeneous study designs. Many existing studies include patients with older devices such as HeartMate II and HVAD, which are no longer implanted but remain in a substantial number of living patients. These legacy devices carry distinct thrombogenic risks that complicate generalizability. This review evaluates the emerging role of DOACs in the context of modern and legacy LVAD platforms. While initial data are promising, large-scale, prospective randomized trials are needed particularly in HM3-supported patients to define the optimal anticoagulation strategy.

The left ventricular ejection fraction (LVEF) is the most commonly used index to assess left ventricular systolic function and guide management in patients with heart failure (HF). This is largely due to the widespread availability of echocardiography, its practicality, rapid scan time, ease of measuring left ventricular (LV) volumes, and its extensive application in both clinical practice and research. Accordingly, a recent joint clinical consensus statement from the Heart Failure Association (HFA) and the Heart Failure Society of America (HFSA) recommends that LVEF be evaluated longitudinally to assess disease trajectory, natural history, and response to treatment in patients with heart failure (6). However, there is little, if any, evidence that serial LVEF assessment improves risk stratification or guides management in HF. Notably, LVEF may not accurately reflect overall cardiac function. While it is commonly used as a measure of systolic function, LVEF does not fully capture the status of the heart. Other parameters-such as diastolic function, ventricular size, valvular function, and right ventricular function-also play important roles in determining patient risk. This paper proposes an alternative strategy, shifting from serial LVEF evaluation to a more comprehensive approach that includes assessment of congestion, right ventricular function, and structural myocardial damage to provide more robust diagnostic and prognostic information.

The prevalence of heart failure has increased significantly in recent years, prompting investigations into novel contributory factors. Among these, alterations in the gut microbiota composition have garnered attention due to their potential association with heart failure. Disruption in the bacterial environment associated with heart failure is characterized by heightened levels of Proteobacteria and Firmicutes and decreased levels of Bifidobacteria and Bacteroides. Reduced blood supply weakens the gut barrier, facilitating the transportation of bacteria and metabolites into the bloodstream. This breach can trigger an immune response and inflammation, subsequently contributing to the pathogenesis of heart failure through the generation of harmful organic compounds in the gastrointestinal tract and bloodstream. Specific metabolites, including short-chain fatty acids, trimethylamine, and trimethylamine N-oxide also contribute to the development of heart failure. Management of heart failure includes pharmacological management, surgery, and lifestyle modifications including recommendations for the consumption of a diet high in fruits and low in animal products. Heart failure can be managed by modulating the gut microbiota. Clinical interventions include antibiotics, prebiotics, and dietary changes. However, other approaches including fecal microbial transplantation, probiotics, and natural phytochemicals are still under study in animal models. This review highlights the significant yet underexplored link between gut microbiota and heart failure, suggesting that further research could lead to new therapeutic strategies and dietary recommendations to mitigate heart failure progression.

Obesity is a major risk factor for heart failure with preserved ejection fraction (HFpEF) and is associated with a distinct pathophysiological phenotype. Individuals with obesity develop HFpEF on average a decade earlier than individuals without obesity. Despite this, systematic screening for HFpEF in individuals with obesity is not currently recommended in clinical guidelines. This review discusses the rationale for screening individuals with obesity for HFpEF, highlighting the rising prevalence of obesity-related HFpEF, its earlier onset, and its often under-recognized clinical presentation. We describe the specific pathophysiological mechanisms linking obesity to HFpEF, including inflammation, adipose tissue distribution, and hemodynamic alterations. Furthermore, we review the limitations of current diagnostic approaches in this population, including the interpretation of natriuretic peptides, echocardiographic challenges, and indexing pitfalls. Current and emerging screening tools (e.g., HFpEF-ABA score) are critically appraised, with a proposal for a stepwise screening and diagnostic pathway tailored to individuals with obesity. Given the high burden and early onset of HFpEF in people with obesity, screening strategies may enable earlier detection and timely intervention. Prospective studies are needed to determine the prevalence of (early) HFpEF in populations with obesity and to evaluate the effectiveness of structured screening approaches in clinical practice.

Hyperkalemia is a potentially life-threatening electrolyte imbalance that has traditionally posed significant challenges in the management of heart failure (HF). This review explores the complex interplay between hyperkalemia and the use of guideline-directed medical therapies (GDMT), such as renin-angiotensin-aldosterone system inhibitors (RAASi) and steroidal mineralocorticoid receptor antagonists (sMRAs), including spironolactone and eplerenone, which are currently recommended in guidelines for improving outcomes in heart failure with reduced ejection fraction (HFrEF). While these therapies reduce mortality and hospitalizations in HFrEF, their benefit in patients with heart failure with left ventricular ejection fraction (LVEF) ≥ 40% remains less conclusive. Nevertheless, their use in clinical practice is often limited by the risk of hyperkalemia, potentially leading to dose reduction or discontinuation of life-saving treatments. The prevalence of hyperkalemia in HF patients is notably higher compared to the general population, particularly in those with comorbid chronic kidney disease (CKD) and diabetes mellitus, further complicating management. This review emphasizes the importance of regular potassium monitoring, the potential benefits of combining therapies such as sodium-glucose cotransporter 2 (SGLT2) inhibitors with RAASi to reduce the risk of hyperkalemia, and the emergence of the newer non-steroidal MRA (nsMRA), finerenone, which may have a lower risk of hyperkalemia. Additionally, potassium binders such as patiromer and sodium zirconium cyclosilicate (SZC) are highlighted for their role in managing and preventing hyperkalemia, allowing patients to continue optimal RAASi and MRA therapy without interruption. By synthesizing current evidence on the incidence, risks, and management strategies of hyperkalemia in HF, this review aims to provide a comprehensive guide for clinicians to optimize patient outcomes while mitigating the risks associated with hyperkalemia.

Heart failure (HF) remains a global health challenge that imposes significant clinical and economic burden. Treatment adherence to guideline-directed medical therapy (GDMT) remains a major challenge in the management of HF, despite the availability of guideline-directed medical therapy (GDMT). Polypharmacy and regimen complexity contribute to poor adherence, particularly among older adults and in resource-limited settings. The polypill strategy, involving fixed-dose combinations of essential HF medications, has emerged as a potential solution to simplify treatment regimens, enhance adherence, and improve clinical outcomes. This review explores the potential of polypill therapy as a pragmatic strategy to simplify HF treatment and improve adherence. Drawing on its successful application in other cardiovascular diseases, we propose two implementation approaches for HF: early low-dose initiation for newly diagnosed patients or switching to a pre-specified dose polypill for stable, optimized patients. This review discusses formulations tailored to different HF phenotypes and highlights ongoing clinical trials assessing the efficacy and safety of the polypill in the HF setting. While the polypill approach offers promising benefits, i.e., improved adherence, affordability, and streamlined care, critical considerations regarding the selection of optimal drug components, identification and elimination of potential drug-drug interactions, the definition of appropriate flexible dose combinations, and patient-specific factors are crucial. Future research, particularly real-world clinical trials, is essential to comprehensively evaluate the efficacy, safety, and feasibility of polypill therapy in diverse HF patient populations, ensuring its responsible integration into clinical practice across diverse healthcare settings to mitigate the persistent burden of HF.

Infective endocarditis (IE) complicated by septic or cardiogenic shock is linked to a marked increase in morbidity and mortality rates. This systematic review and meta-analysis sought to evaluate clinical outcomes, identify prognostic factors, and assess the effects of valve surgical intervention in patients with infective endocarditis complicated by shock. Systematic searches were performed in PubMed, Cochrane Library, and Google Scholar databases, following PRISMA and MOOSE guidelines. Included were observational studies published from January 2015 to May 2025 that reported on adult patients with infective endocarditis complicated by septic or cardiogenic shock. A random-effects model was utilized for data synthesis (restricted maximum likelihood with Hartung-Knapp adjustment), and meta-regression was conducted to assess sources of heterogeneity. Seven observational studies were included (n = 183-255,838). In-hospital mortality among patients with shock was 62.3% (95% CI 48.3-74.5%). Compared with IE without shock, the pooled odds ratio for in-hospital mortality (HK-REML) was 5.83 (95% CI 1.35-25.23; 95% prediction interval 0.26-129.69), with substantial heterogeneity (I² = 90.3%). Valve surgical intervention was associated with reduced mortality, particularly in cardiogenic shock. Staphylococcus aureus was the most common pathogen in available microbiological data. Shock was frequently accompanied by acute kidney injury, neurological complications, and multiorgan dysfunction. Infective endocarditis complicated by shock carries an extremely poor prognosis, with pooled mortality exceeding 60%. Prompt recognition of shock, timely initiation of appropriate antimicrobial therapy, hemodynamic stabilization, and early valve surgery are crucial to improve outcomes in this high-risk population. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD420250652570.