Cardiac Failure Review最新文献

Central sleep apnoea (CSA) is a sleep-disordered breathing condition characterised by diminished or absent respiratory effort during sleep due to instability in the respiratory control system. While various treatments exist, ranging from positive airway pressure therapy to pharmacological interventions, many patients' symptoms remain refractory to standard therapies. Phrenic nerve stimulation, particularly through devices such as the remedē System, represents a novel, evidence-based therapeutic avenue for patients with moderate to severe CSA. This review provides a comprehensive overview of CSA, explores the underlying pathophysiology, evaluates conventional treatments, and examines the mechanisms, efficacy and limitations of phrenic nerve stimulation based on current literature.

Cardiac reverse remodelling (RR) is a complex process involving structural and functional recovery of the myocardium, with significant implications for the prognosis of patients with heart failure (HF). This review summarises current concepts, underlying mechanisms, therapeutic strategies, and clinical implications of RR, while distinguishing it from myocardial recovery and remission. Both pharmacological therapies and non-pharmacological interventions have shown potential to induce RR in selected populations. Clinical features, echocardiographic parameters, advanced imaging findings, and biomarkers help stratify patients according to the likelihood of recovery and risk of relapse. The management of HF with improved ejection fraction remains debated. High recurrence rates are seen after therapy discontinuation; however, evidence suggests that partial withdrawal may be safe in specific patient profiles. RR should be considered a central therapeutic goal in HF care, although its extent and stability vary widely. Differentiating between transient improvement, remission under therapy, and true myocardial recovery is critical for guiding long-term treatment decisions, highlighting the importance of individualised follow-up.

Heart failure remains a growing global health burden, and early disruptions in ventricular-arterial coupling (VAC) contribute to its pathogenesis, particularly in heart failure with preserved ejection fraction (HFpEF). We conducted an integrative bibliometric and thematic review of Web of Science records (search on 1 March 2025; coverage through December 2024) to map how VAC has evolved from a mechanistic construct to a clinically actionable framework in HFpEF. Output accelerated since 2006, with four core clusters spanning haemodynamics, right ventricle- pulmonary artery coupling, arterial stiffness, and clinical imaging. VAC has steadily moved physiological constructs toward clinical risk stratification, especially in HFpEF and right ventricular dysfunction. Important gaps include non-standardised assessment and limited prospective validation of VAC-targeted interventions. This review synthesises mechanistic and clinical evidence across the left atrial, left ventricular, and right ventricle-pulmonary artery axes and, on that basis, sets practical priorities for measurement standardisation and prospective validation within a whole-heart perspective.

Sleep-disordered breathing (SDB) represents a modifiable treatment target in patients with heart failure (HF). Despite the evolution of positive airway pressure (PAP) therapy over the past several decades, randomised controlled trials have not demonstrated a consistent benefit in reducing mortality or hospital admissions related to HF. As a result, the use of PAP therapy has been primarily limited to symptom control of SDB. However, recent trials suggest that PAP therapy is safer than previously perceived and underscore an urgent need for a phenotype-based, individualised treatment approach. Stratifying patients according to sleep apnoea phenotypes or characteristic clinical clusters may enhance the identification of individuals most likely to respond favourably to PAP therapy in terms of clinical outcomes. This narrative review provides an outline of the current evidence regarding the use of PAP therapy in patients with SDB across the spectrum of HF phenotypes.

Sleep-related breathing disorders (SRBD), particularly central sleep apnoea and obstructive sleep apnoea, are highly prevalent among individuals with heart failure (HF). Accurate classification of SRBD is critical for accurate diagnosis and to improve management by limiting treatment failures. Hypopnoeas, defined as partial reductions in airflow, represent a significant proportion of respiratory events; however, inconsistencies in their scoring across various guidelines have affected disease classification and may lead to inappropriate treatment indications. This review examines the substantial impact that variations in hypopnoea definitions and the differentiation between central and obstructive hypopnoeas have on SRBD diagnosis in HF patients. The authors underscore the clinical and epidemiological importance of standardising hypopnoea scoring and advocate for the development of refined, HF-specific methodologies in SRBD assessment.

Sleep-disordered breathing (SDB), including obstructive and central sleep apnoea, is highly prevalent in heart failure (HF) and contributes to adverse outcomes. In-lab polysomnography is the diagnostic gold standard, but is limited by cost and accessibility. Home sleep apnoea testing (HSAT) offers an accessible alternative, but its accuracy in HF populations remains under evaluation. This review explores HSAT technologies, including peripheral arterial tonometry and respiratory inductance plethysmography, and their ability to detect SDB subtypes. Differentiating obstructive sleep apnoea from central sleep apnoea in HF is complicated by overlapping physiology, comorbidities, and fluid status. With further refinement, HSAT may improve access to timely diagnosis and management of SDB in HF, potentially enhancing outcomes in this high-risk population.

Hypertrophic cardiomyopathy is a prevalent condition characterised by ventricular hypertrophy, which results in left ventricular outflow obstruction in two-thirds of patients. Traditional pharmacological therapies, including β-blockers, calcium channel blockers and disopyramide, have been the cornerstone of symptom management but lack disease-modifying effects. The introduction of cardiac myosin inhibitors as the first therapy to directly target sarcomeric hypercontractility has dramatically changed clinical practice. However, several logistical factors presently limit the widespread adoption of cardiac myosin inhibitors, and their long-term side-effects and outcomes require ongoing investigation. Emerging pharmacological approaches, including EDG-7500 and gene therapies, aim to refine treatment strategies. For patients with refractory symptoms, invasive septal reduction therapies, including surgical myectomy and alcohol septal ablation, remain critical. Innovations such as radiofrequency ablation and septal scoring along the midline endocardium (SESAME) offer promising, minimally invasive alternatives. As treatment options expand, optimising patient selection, monitoring protocols and long-term outcomes remain essential to advancing care for patients with obstructive hypertrophic cardiomyopathy.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs), established treatments for type 2 diabetes and obesity, exhibit cardiovascular benefits extending to heart failure (HF) with preserved ejection fraction (HFpEF). Mechanisms contributing to HF improvement include significant weight loss, blood pressure reduction, enhanced glycaemic control, anti-inflammatory effects and potential direct cardioprotective and vascular actions. Although cardiovascular outcome trials provided initial positive signals, dedicated HFpEF trials confirmed the efficacy of GLP-1RAs in HFpEF patients with obesity and/or diabetes. In some trials, GLP-1RAs significantly improved weight, symptoms of HF and HF events. Current evidence strongly supports GLP-1RAs in patients with HFpEF and obesity, with or without type 2 diabetes. The data do not support their use solely for HF with reduced ejection fraction.

Background: Malnutrition is common yet underrecognised in elderly patients (≥65 years) with chronic heart failure (CHF) and may accelerate disease progression through cytokine activation, autonomic dysfunction and cachexia. Early identification may improve risk stratification, but standardised diagnostic criteria are lacking. Inflammatory markers such as high-sensitivity C-reactive protein (hsCRP) and soluble urokinase plasminogen activator receptor (suPAR) may influence both the presence and prognostic implications of malnutrition, but their interaction with nutritional indices remains poorly understood. This study examined the prevalence and prognostic significance of malnutrition using Prognostic Nutritional Index (PNI) and Geriatric Nutritional Risk Index (GNRI).

Methods: From 10,027 consecutive admissions, 597 elderly patients with CHF were included. Nutritional status was assessed using PNI and GNRI. Patients meeting either the PNI or GNRI criteria for moderate or severe malnutrition were classified as malnourished; others were considered well-nourished. One-year all-cause mortality was evaluated using Cox regression models. Predictive performance was assessed using receiver operating characteristic analysis and DeLong's test.

Results: Moderate or severe malnutrition was identified in 42.2% using the PNI and in 31.2% using the GNRI. Severe malnutrition was independently associated with higher 1-year mortality (PNI: HR 1.43, p=0.038; GNRI: HR 1.78, p=0.043). GNRI showed better post-discharge discrimination (AUC 0.666 versus 0.586, p=0.002). Prognostic value of both indices varied by BMI and inflammation. GNRI-defined malnutrition showed significant interaction with hsCRP and suPAR.

Conclusion: In elderly CHF patients, malnutrition was common and independently associated with mortality. Prognostic value varied by BMI and inflammation, with GNRI showing enhanced discriminatory ability. In acute care settings, PNI and GNRI may aid nutritional risk stratification.