Heart failure monitor最新文献

Cardiac biomarkers play an important role in and provide better pathophysiological understanding of chronic heart failure (CHF). Natriuretic peptides, especially B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), were found to be useful in the diagnostic assessment and prognostic stratification of patients with CHF. However, they fail to fulfill all the criteria of an ideal biomarker. Currently, we still do not have a single biomarker or a combination of biomarkers to answer all the clinically relevant questions in CHF. Consequently, some widely available biomarkers might have been overlooked in the field of heart failure. This review discusses several biomarkers, and speculates on the possible roles of combining two or more of them. In this respect, hemoglobin, cholesterol, uric acid, and recently identified proteins may prove to be relevant to the field of CHF. Lastly, we anticipate the potential of biomarkers in a variety of chronic diseases with similar pathophysiology.

Diabetes mellitus and heart failure frequently coexist and often lead to poor prognosis. However, data regarding glycemic control and treatment patterns in heart failure are sparse, partly because clinical studies specifically targeting diabetic heart failure patients are lacking. In registry data, although patients with heart failure often have poor glycemic control, almost all hypoglycemic drug classes have safety concerns regarding use in the setting of heart failure. Furthermore, there is a poor understanding of the relative contributions of glucose and fatty acids to the metabolism of the failing heart and a poor understanding of the pathogenesis of heart failure in patients with diabetes mellitus.

Chronic heart failure (CHF) is accompanied by a dysregulated cytokine network, which is characterized by a rise in inflammatory cytokines and an inadequate elevation of anti-inflammatory mediators. This dysregulation has been implicated in the development and progression of CHF and, in the last decade, attempts have been made to modulate this imbalance in the cytokine network. With the exception of one larger mortality/morbidity study, all studies of immunomodulatory therapy in HF conducted to date have included <100 patients and the overall experience in this therapeutic area is limited compared with studies of neurohormonal antagonists, which have included several thousand patients. While trials of anti-tumor necrosis factor therapies have thus far failed, recent studies of broad-based immunomodulatory agents (e.g. intravenous immunoglobulin, thalidomide, and pentoxifylline) highlight a potential for such therapy in HF patients, in parallel with optimal cardiovascular treatment regimens. In addition to identifying the crucial factors in the immunopathogenesis of CHF in order to develop novel immunomodulatory treatment strategies, there is a clear need to confirm the results of the smaller studies conducted to date with larger placebo-controlled mortality studies that involve a diverse group of patients, with regard to the cause and severity of HF.

The number of patients with newly diagnosed heart failure continues to grow worldwide, to some extent reflecting the increase in survival after acute coronary syndromes and the aging of the population. The search for new and effective therapies for this condition remains a priority in the 21st century. The use of beta-blockers is now well established in the clinical context of mild and moderate systolic heart failure. The effects of beta-blockade on mortality are additive to those with angiotensin-converting enzyme inhibitor therapy. Recently completed, large, randomized trials provided strong evidence for the use of beta-blockers in severe (NYHA functional class IV) heart failure and in asymptomatic patients with left ventricular systolic dysfunction and recent myocardial infarction. Obviously, patient selection still remains the key to the safe use of beta-blockers in patients with heart failure. Further data from clinical trials have emerged to support similar benefits in terms of mortality and morbidity, a good safety record, and tolerability in patients at extremes of age (children and adults >70 years of age) and in specific clinical circumstances (including diabetes, chronic obstructive airways disease, renal failure, and atrial fibrillation). Recent use of beta-blockers with vasodilatory properties in patients with heart failure and preserved systolic function (so-called diastolic heart failure) appears promising but will require large-scale, long-term trials prior to widespread clinical use.

The majority of therapies used in the contemporary management of chronic heart failure (CHF) have been rigorously evaluated by means of large-scale clinical trials to assess their beneficial effects on quality of life and prognosis. Such therapies include angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and cardiac resynchronization therapy (CRT). Diuretics are the most commonly prescribed class of drugs in CHF patients and in the short term they remain the most efficacious treatment for relief from fluid congestion. There is, however, scant evidence to suggest that they confer any long term benefit in terms of disease progression or prognosis to the CHF sufferer. Injudicious use of diuretics has been demonstrated to be potentially harmful and consideration should be paid to avoiding dietary salt indiscretion as well as the pharmacokinetic properties of individual diuretics to achieve optimal diuretic response. In this article, we explore the current insight into the use of diuretics in CHF.

Hypertension is a major risk factor for the development of cardiac failure. Patients with severe heart failure and left ventricular ejection fraction <40% are excluded from the majority of hypertension trials. The European Guidelines recommend treatment of hypertension in patients with heart failure and the introduction of blood pressure-lowering drugs that deal with the underlying disease. Several of the drugs may be needed in combination to achieve target blood pressure.

Heart failure is a multifactorial and complex debilitating disease facing limitations in available pharmacological therapeutics. To cure such a disease, cardiac regeneration has been envisioned using stem cells. A few clinical trials using bone marrow-derived stem cells have been carried out without conclusive results. Stem cells of other origins should therefore be considered for future trials. In this article, the advantages and disadvantages of the most promising stem cells to be used in cell therapy are reviewed. The remaining challenges of cell therapy of heart failure are also presented.