Heart Failure Reviews最新文献

Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality, with inflammation recognized as a key cause and byproduct. Despite observational studies linking elevated indices of inflammation with HF severity, as well as experimental models highlighting the centrality of inflammation to the pathogenesis of various types of HF, clinical trials of anti-inflammatory therapies in HF have produced inconsistent results. This variability may relate to the substrate included - differences in HF stage and/or clinical phenotype - as well as the mechanisms and target of therapeutics, whether aimed at preventing new-onset HF or treating established disease. This review evaluates clinical trials directly targeting inflammation in HF, with a focus on disease stage and symptomatology. Ultimately, by highlighting the importance of HF staging and the timing of therapeutics in prior inflammation-targeted interventions, we aim to inform more precise targets from a disease substrate perspective when designing trials of inflammation-modulating therapies in HF.

Diabetes and its complications represent a global burden to human health. Among diabetic microvascular and macrovascular complications, diabetic cardiomyopathy (DCM) remains the primary and most prevalent condition leading to decreased cardiomyocyte function and risk of cardiac morbidities and mortality rate. Decreased cardiomyocyte function is mediated by the pathophysiological mechanisms broadly including glucotoxicity, endoplasmic reticulum stress, metabolic insulin signaling, mitochondrial dysfunction, oxidative stress, renin-angiotensin-aldosterone system activation, impaired calcium handling, apoptosis of cardiomyocytes, and cardiac lipotoxicity, which could be favorable targets for new therapeutic interventions. Currently, the treatment given in DCM is not enough in terms of cure; therefore, there is a need to introduce novel potential treatment options. Not any single therapeutic agent would treat DCM completely, so a variety of approaches are needed. The approaches can be a balanced outset of lifestyle modification, use of herbal and nutraceuticals, glucose control medication, antioxidants, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors to reduce the progression of DCM and effectively treat the patients. In the current review, emphasis has been made on the molecular mechanisms involved in the onset of DCM. We summarize the findings from preclinical and clinical studies including non-pharmacological strategies that might provide the directions for the development of targeted treatment approaches. Additionally, we discuss the novel and emerging therapeutic targets aimed at the management of DCM.

This review comprehensively examines the complex influence of demographic factors on heart failure with preserved ejection fraction (HFpEF), an increasingly common clinical syndrome. We examine the impact of age, sex, race/ethnicity, and socioeconomic status on HFpEF, investigating how these factors contribute to disparities in prevalence, risk profiles, diagnostic challenges, treatment responses, and clinical outcomes. Key findings highlight the significant role of age, with HFpEF incidence rising with advancing age advances and distinct pathophysiological mechanisms noted across age groups. Gender disparities are also evident, with women showing a greater predisposition to HFpEF, possibly linked to physiological differences and sex-specific risk factors. The review also addresses racial and ethnic disparities, recognizing the limitations in current data while stressing the need for more inclusive research to comprehend the specific impact of race on HFpEF. Finally, the essential role of socioeconomic factors is examined, illustrating how income and education can affect access to care, treatment adherence, and overall outcomes. Furthermore, we aim to underscore the importance of a holistic approach to HFpEF, recognizing the interplay of demographic factors in shaping disease trajectory and patient experiences. By synthesizing current evidence and identifying key knowledge gaps, we aim to inform future research directions, promote equitable healthcare delivery, and ultimately improve the lives of individuals affected by this complex condition.

Although geographic variations exist in heart failure (HF), the prevalence of HF is increasing worldwide with a higher rise in low-income countries (LICs) and lower-middle-income countries (L-MICs). HF has enormous socioeconomic impact and is a leading contributor to global healthcare expenditure. Individual and composite measures of socioeconomic deprivation (SED) have consistently been linked to HF incidence as well as HF-related hospitalization and mortality. In socioeconomically disadvantaged populations, composite measures of SED are more powerful predictors of HF outcomes than individual indices. The relationship between SED and HF is bi-directional. While SED predisposes to HF, HF on its part aggravates economic hardship due to increased time away from work, job loss, and financial instability. In this review, we will discuss the associations between individual and composite measures of SED and HF, while highlighting the differences that exist between LICs, L-MICs, upper-middle-income countries (U-MICs), and high-income countries (HICs). We will also propose actionable items that could be pursued to mitigate the adverse effects of SED on HF.

Athlete's heart comprises various structural and functional adaptations, imposed by systematic training and intended to serve the increased needs of the body during exercise. In most cases, athletic cardiac remodeling presents mild characteristics that are easily distinguishable from pathologic entities. However, common inherited cardiomyopathies such as hypertrophic, dilated, or arrhythmogenic may also affect athletes or athletic individuals, while athlete's heart in a more pronounced form (frequently called "gray" zone) should be distinguished from early stages of the above-mentioned cardiomyopathies. Based on these assumptions, cardiovascular imaging remains the key process that should be applied to accurately differentiate between normal and abnormal phenotypes, facilitating thus pre-participation screening along with early detection and handling of underlying cardiomyopathies. Recent advances in both echocardiography and cardiovascular magnetic resonance offer new diagnostic potentials, making, however, "method" and "time" selection rather complicated. The aim of this review is to provide a short and comprehensive guide for differentiating athlete's heart in the gray zone from cardiomyopathies, encompassing all contemporary tools of imaging modalities into easily applicable and hierarchically appropriate algorithms.

Heart failure is a chronic condition that can result from multiple causes and occurs when the heart cannot pump enough blood to meet the body's needs. Heart failure is often classified by ejection fraction (or 'heart squeeze'), into three categories: preserved, mildly reduced, or reduced ejection fraction. Diagnosing heart failure can be challenging. Common symptoms such as fatigue and shortness of breath may overlap with other conditions and can be missed by healthcare professionals. While heart failure can lead to serious health problems, it is a manageable condition through medical interventions that target the underlying causes along with nutrition and lifestyle approaches. Comprehensive care should also include addressing the impact of heart failure on mental health. Effective therapies can help patients with heart failure feel better, function better, stay out of hospital, and live longer. Working towards acceptance of a heart failure diagnosis and embracing self-care are key positive steps for improving quality of life. Effective healthcare professional-patient relationships are critical. Open communication allows healthcare providers, including specialist nurses and clinicians, along with primary healthcare professionals, to fully understand a patient's condition and recommend suitable treatment approaches. It may also motivate patients to adhere to therapies and adopt lifestyle changes. This review aims to empower patients with heart failure by providing clear information on diagnosis and treatment, as well as providing real-life patient perspectives that can support effective communication with healthcare providers.

Left ventricular assist device (LVAD) implantation is an important surgical option for patients with advanced heart failure (HF) who are not eligible for heart transplantation (destination therapy) or who are not expected to survive to transplant without durable mechanical circulatory support (bridge-to-transplant). Despite the hemodynamic support provided by LVAD, both atrial and ventricular arrhythmias (AAs and VAs, respectively) are prevalent and contribute to morbidity and mortality, primarily due to right ventricular failure and arrhythmic storm. Management strategies are extrapolated from recommendations for patients with HF with reduced ejection fraction, since available data are limited. Controlling heart rate is a crucial therapeutic approach for AAs since restoration of sinus rhythm often has a minimum effect on hemodynamics. Management of VAs is further complicated by factors unique to LVAD patients, such as suction events. Antiarrhythmic drugs may not work for both AAs and VAs, necessitating escalation therapy or catheter ablation. Given the technical challenges of catheter ablation, a strict cooperation between HF specialists and electrophysiologists is warranted. This review aims to summarize the current scientific evidence and provide clinical guidance for managing arrhythmias in this complex patient group, characterized by significant knowledge gaps.

Randomised controlled trials (RCTs) in heart failure (HF) have progressively broadened their primary endpoints over recent decades. Early landmark HF trials demonstrated the life-saving effects of new therapies using all-cause mortality as the definitive endpoint. As HF therapies improved survival, trial designers incorporated additional endpoints such as HF hospitalisations and quality of life. Most recently, advances in digital health have introduced wearable devices for collecting digital endpoints, enabling continuous monitoring of patient activity and physiology. This review critically examines the evolution of HF trial endpoints from a sole focus on mortality alone to modern composite and patient-reported outcomes and discusses the current challenges and opportunities of using wearable-derived endpoints in HF RCTs. Finally, we consider future directions for HF trial methodology, including regulatory and methodological considerations for integrating novel digitally collected endpoints alongside traditional measures to enhance a broad evaluation of new therapies.

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with various causes and a pathophysiology that leads to diverse spectrum of phenotypes. In contrast to a wide range of established treatments for heart failure with reduced ejection fraction (HFrEF), effective medical treatment options for HFpEF are relatively limited with excessively high residual risk of morbidity and mortality. Device-based therapies have emerged as a promising strategy to improve outcomes in patients with HFpEF. Herein, we present data on devices in HFpEF targeting various unique mechanisms including structural inventions, autonomic modulation, and electrophysiologic modulation as well as remote monitoring devices. While early studies of these therapeutic devices have not definitively demonstrated clinical benefits in HFpEF, growing evidence suggests potential benefits in select patient populations for some of these emerging technologies.