Heart Failure Reviews最新文献

{"title":"Effects of heart failure pharmacotherapy on natriuresis and diuresis: A narrative review.","authors":"Berenika Jankowiak, Piotr Ponikowski, Jan Biegus","doi":"10.1007/s10741-026-10676-6","DOIUrl":"10.1007/s10741-026-10676-6","url":null,"abstract":"<p><p>Neurohormonal overactivation and the resulting sodium avidity, driving sodium retention, are important mechanisms underlying the signs and symptoms of heart failure (HF). Blockade of the renin-angiotensin-aldosterone and adrenergic systems therefore represents a central therapeutic target and cornerstone of HF pharmacotherapy, theoretically counteracting sodium avidity. Paradoxically, evidence on how neurohormonal blockade affects markers of sodium avidity, natriuresis, and diuresis remains fragmented, with no integrated summary to date. This review aims to synthesize available evidence on the impact of guideline-directed medical therapy and other HF therapies on sodium excretion/diuresis in HF [Fig. 1]. Here we present comprehensive review of available data on this topic. The scarcity of high-quality studies, small sample sizes, and conflicting results preclude definitive conclusions; accordingly, we refrain from formulating any. Interpretation is further limited by the lack of a standardized method for assessing sodium excretion independent of confounders such as renal function and dietary sodium intake, which restricts reproducibility across studies.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":"31 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac implantable electronic devices in heart failure: needs, challenges, and real-world implementation.","authors":"David Žižek, Miha Mrak, Anja Zupan Mežnar, Maja Ivanovski, Tadej Žlahtič, Christopher F Barrientos, Andrew P Ambrosy, Zlatko Fras, Mauro Biffi, Mitja Lainscak","doi":"10.1007/s10741-026-10672-w","DOIUrl":"10.1007/s10741-026-10672-w","url":null,"abstract":"<p><p>Cardiac implantable electronic devices (CIEDs) are integral to heart failure (HF) management, providing therapies for bradyarrhythmias, cardiac resynchronization therapy (CRT), sudden cardiac death (SCD) prevention, and remote monitoring. This review summarizes current and potential future indications, emerging technologies, and challenges in the implementation of CIEDs in HF. Conventional right ventricular pacing in HF patients is increasingly being replaced by biventricular pacing (BVP) and left bundle branch area pacing (LBBAP), while leadless pacing pacemakers have emerged as an alternative to conventional transvenous systems, offering the potential to reduce lead- and device-related complications. As BVP remains the standard approach for CRT, recent data bestow LBBAP as a promising alternative and integration platform. Newer implantable cardioverter-defibrillator technologies, including subcutaneous and extravascular systems, may reduce lead-related complications while maintaining effective arrhythmia termination and recognition. Advances in atrial fibrillation management, implantable hemodynamic monitoring, and novel pacing indications such as atrioventricular recoupling and personalized pacing in HF with preserved ejection fraction are expanding the therapeutic potential of CIEDs. However, the adoption of these innovations is challenged by limited randomized evidence, procedural complexity, and substantial disparities in access and implementation across healthcare systems. Ongoing clinical trials will help define the role of emerging device technologies and monitoring strategies, while efforts to improve guideline adherence, value-based procurement, and equitable access remain essential to maximize the benefits of CIED therapy in patients with HF.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":"31 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive assessment in heart failure: clinical value, timing, and practical tools.","authors":"Soenarno Hoetomo, Desmond Hoetomo, Mya Zin Tun","doi":"10.1007/s10741-026-10673-9","DOIUrl":"10.1007/s10741-026-10673-9","url":null,"abstract":"<p><p>This narrative review examines the clinical value of cognitive assessment in heart failure, highlighting optimal timing, practical tools, and the epidemiology, pathophysiology, and clinical implications of cognitive impairment. The relationship between heart failure (HF) and cognitive impairment (CI) increasingly represents a growing challenge at the intersection of the heart and brain. Current hypotheses suggest a bidirectional relationship driven by multifactorial mechanisms, including chronic cerebral hypoperfusion, blood-brain barrier disruption, neuroinflammation, while shared proteinopathy remains a preliminary and unconfirmed hypothesis. Although CI affects approximately 41% of patients with HF, it remains frequently underdiagnosed in routine practice. The neurocognitive phenotype in HF is characterised predominantly by deficits in executive function, attention, and memory, which critically undermine patient self-management and medication adherence. We critically evaluate available screening modalities, highlighting the limitations of tools like the Mini-Mental State Examination (MMSE) in detecting executive dysfunction. This review emphasises screening cognitive impairment in stable heart failure and atrial fibrillation as early as possible with appropriate screening tools in order to be referred to CDAMS or memory clinics for prompt management. Rather than identifying a single superior tool, this review emphasises that the overarching clinical priority is the routine application of multidomain cognitive assessments sensitive to these specific deficits. The review concludes that integrating routine cognitive assessment into HF management is essential for accurate risk stratification, individualised therapeutic planning, and ultimately reducing the neurocognitive burden in this population.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":"31 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bidirectional impact between cardiovascular comorbidities and heart failure: an updated position paper from the Italian society of cardiology (SIC) working group on heart failure.","authors":"Andrea Salzano, Lucia Tricarico, Matteo Beltrami, Valentina Mercurio, Maria Cristina Carella, Giuseppe Ambrosio, Umberto Attanasio, Giuseppe Armentaro, Roberto Badagliacca, Michele Ciccarelli, Marco Matteo Ciccone, Giulia Crisci, Giuseppe Dattilo, Mariafrancesca Di Santo, Francesco Fioretti, Stefano Ghio, Riccardo Maria Inciardi, Francesco Loria, Damiano Magrì, Stefania Paolillo, Gianfranco Parati, Gaetano Maria Ruocco, Angela Sciacqua, Paolo Severino, Carlo Gabriele Tocchetti, Carmine Dario Vizza, Piergiuseppe Agostoni, Francesco Barillà, Frank Lloyd Dini, Erberto Carluccio, Pasquale Perrone Filardi, Savina Nodari, Alberto Palazzuoli, Gianfranco Sinagra, Michele Correale","doi":"10.1007/s10741-026-10667-7","DOIUrl":"10.1007/s10741-026-10667-7","url":null,"abstract":"<p><p>Heart failure (HF) and cardiovascular (CV) diseases (CVD) are closely interconnected through a complex and bidirectional relationship. HF frequently represents the final common pathway of several CV conditions; in contrast, CV comorbidities often act as key drivers of disease progression along the HF continuum, from stage A (individuals at risk) to overt symptomatic HF (stages C-D). The coexistence of multiple CV comorbidities-including arterial hypertension, atrial fibrillation, coronary artery disease, peripheral artery disease, and valvular heart disease-is associated with a more severe clinical profile, reduced functional capacity, impaired quality of life, and increased risk of hospitalization and mortality. Importantly, CV comorbidities may significantly influence the implementation and optimization of guideline-directed medical therapy (GDMT), frequently limiting appropriate up-titration due to haemodynamic instability, drug intolerance, or increased susceptibility to adverse events. The prevalence, pathophysiological interactions, and prognostic impact of CV comorbidities vary across HF phenotypes, contributing to the heterogeneity of disease presentation and clinical outcomes. An integrated and phenotype-oriented approach is therefore essential to optimize risk stratification and personalize therapeutic strategies. Since the publication of the 2019 manifesto on HF comorbidities from the Working Group on Heart Failure of the Italian Society of Cardiology (SIC), substantial new evidence has emerged regarding the epidemiology, pathophysiology, and management of CV comorbidities in HF. In this updated position paper, the SIC Working Group on Heart Failure provides a comprehensive and clinically oriented overview of the current evidence on major CV comorbidities in HF, with the aim of supporting clinicians in improving diagnostic pathways, optimizing therapeutic strategies, and ultimately enhancing clinical outcomes.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":"31 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trials and tribulations of spironolactone in heart failure with preserved ejection fraction: Insights from the SPIRIT-HF trial.","authors":"Christian Basile, Luca Monzo, Dimitrios Farmakis, Kalliopi Keramida, Sotiria Liori, Chris J Kapelios, Aaron L Sverdlov, Avishay Grupper, Andrew P Ambrosy, Mario Enrico Canonico","doi":"10.1007/s10741-026-10675-7","DOIUrl":"10.1007/s10741-026-10675-7","url":null,"abstract":"<p><p>Heart failure with preserved ejection fraction represents a clinical challenge, accounting for at least 50% of heart failure (HF) cases globally, with a historical lack of efficacious and disease-modifying therapies. Mineralocorticoid receptor antagonists, specifically the steroidal agent spironolactone, have a strong theoretical potential to mitigate systemic inflammation, microvascular endothelial dysfunction, and myocardial fibrosis, which commonly affect patients with HF. However, the clinical validation of spironolactone has been influenced by methodological inconsistencies and safety concerns. The pivotal TOPCAT trial yielded neutral primary outcome results globally, confounded by significant geographical disparities. To provide further evidence the SPIRIT-HF trial evaluated spironolactone in a population with HF and mildly reduced or preserved ejection fraction. This trial was affected by critical operational issues related to the COVID-19 pandemic, resulting in an underpowered study population with a very high study drug discontinuation rate. The trial ultimately failed to demonstrate a cardiovascular benefit on any of the evaluated outcomes. The ongoing SPIRRIT-HFpEF trial represents a pragmatic, registry-based study to overcome traditional enrollment barriers, while evidence from the FINEARTS-HF trial on finerenone, a novel non-steroidal antagonist, has finally highlighted a major role for mineralocorticoid receptor antagonism in patients with HF and mildly reduced or preserved ejection fraction. This meeting report examines the SPIRIT-HF trial and place its results within the broader evidence on steroidal and nonsteroidal MRA in patients with HFpEF.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":"31 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The social context and environment as targets for heart failure prevention.","authors":"Edidiong I Akpabio, Duke Appiah, David A Liem, Modele O Ogunniyi, Martin Cadeiras, Imo A Ebong","doi":"10.1007/s10741-026-10674-8","DOIUrl":"10.1007/s10741-026-10674-8","url":null,"abstract":"<p><p>The prevalence of heart failure (HF) continues to rise and disproportionately affects disadvantaged populations. This has created an urgent need to concurrently tackle HF prevention and therapeutics, and to look beyond traditional HF risk factors. Several aspects of the social context and environment such as race/ethnicity, social isolation/loneliness, marginalization/segregation, socioeconomic position, air pollution, noise pollution, extreme temperatures, food environment, geographical location and neighborhood socioeconomic status have been recognized as modifiers of HF risk. These factors can be effectively targeted for comprehensive HF prevention. The pathways that link the social context and environment to HF involve psychological, behavioral, and biological mechanisms as well as limited access to care. This review outlines key domains of HF prevention and discusses the evidence linking the social context and environment with HF. We also addressed the mechanistic underpinnings that drive the associations reported and highlight key features of effective HF prevention programs. Finally, we discussed challenges to implementing social and environmental factors as components of HF prevention. To achieve maximal effect, HF prevention should be approached at multiple tiers using a life course approach.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":"31 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why guideline-directed medical therapy depends on more than guidelines: microeconomics of medication use in heart failure.","authors":"Austin J Milton, Spencer J Carter, Roberta Florido, Alison Brann, James C Fang, Anees Daud, Josef Stehlik, Stavros G Drakos, Thomas C Hanff, Joshua A Jacobs","doi":"10.1007/s10741-026-10670-y","DOIUrl":"10.1007/s10741-026-10670-y","url":null,"abstract":"<p><p>Despite substantial mortality benefits, fewer than 25% of individuals with heart failure with reduced ejection fraction (HFrEF) receive all four pillars of guideline-directed medical therapy (GDMT), with underuse driven in part by economic and policy factors. Three clinician- and policy-relevant considerations may improve GDMT optimization. First, reduce patient cost sharing for GDMT at the public policy level. Evidence from national surveys demonstrates medication cost is a significant driver of nonadherence, particularly among economically vulnerable populations. Economic analyses have repeatedly shown GDMT produces high value welfare gains and cost-efficient savings through hospitalization and morbidity reduction. Second, enhance medication price transparency which is often obscured by insurance benefit design and complex rebate flows. Third, reduce overly burdensome administrative and formulary barriers. Cost containment mechanisms including prior authorizations and formulary limitations may delay or prevent initiation when applied to high-value therapies such as GDMT. Addressing these economic factors at both the policy-level and clinician-level is essential for translating GDMT into population-level survival gains. Therefore, this review integrates publicly available microeconomic data, economic theory, and health policy evidence to identify structural barriers to equitable GDMT optimization as well as provide pragmatic, policy-relevant solutions to aid clinicians in improving national adoption of GDMT.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":"31 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The long road to recognition: a historical review of amyloidosis from early pathology to disease-modifying therapy.","authors":"Lauren N Halverson, Brett W Sperry","doi":"10.1007/s10741-026-10666-8","DOIUrl":"10.1007/s10741-026-10666-8","url":null,"abstract":"<p><p>Within the last several decades, great strides are being made in both the diagnosis and treatment of cardiac amyloidosis, yet the condition itself has been a severely under-recognized cause of heart failure for centuries. For much of medical history, the accumulation of these insoluble fibril deposits was an enigmatic finding, observed primarily post-mortem in patients suffering from chronic inflammatory conditions. This review traces the fascinating evolution of amyloidosis: from its origins as a botanical term mistakenly applied to human pathology, through the serendipitous discoveries of histological stains like Congo red, to the molecular triumphs that identified the specific precursor proteins driving the AL, AA, and ATTR subtypes. By understanding the historical roadblocks and breakthroughs, we can better appreciate the modern diagnostic imaging and targeted therapies that are finally bringing this complex disease out of the shadows.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":"31 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148827665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: The spongy heart paradox: balancing bleeding and clotting risk in left ventricular noncompaction cardiomyopathy.","authors":"Tagbo Charles Nduka, Andrew Ndakotsu, Kuseme Udoh, Afamefuna Obumneme Onyeogulu, Fab-Emerenini Eziokwu Bright, Elijah Oluwasegun Adetunji, Abdulkareem Opeoluwa Lukan, Esosa Odigie-Okon","doi":"10.1007/s10741-026-10669-5","DOIUrl":"https://doi.org/10.1007/s10741-026-10669-5","url":null,"abstract":"","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":"31 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148827701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant cell myocarditis: from immune pathogenesis to contemporary management.","authors":"Ivan Vosko, Markus Wallner","doi":"10.1007/s10741-026-10668-6","DOIUrl":"https://doi.org/10.1007/s10741-026-10668-6","url":null,"abstract":"<p><p>Giant cell myocarditis (GCM) is a rare but devastating inflammatory cardiac disease characterized by rapid hemodynamic deterioration, malignant arrhythmias, and high rates of death or heart transplantation. Without immunosuppressive treatment, median transplant-free survival is approximately three months. Current evidence identifies GCM as a predominantly T cell-mediated autoimmune disorder driven by a breakdown of immune tolerance, with contributions from macrophage-derived multinucleated giant cells and neutrophil extracellular trap formation. Viral infections and environmental factors have been implicated as potential triggers. GCM typically affects middle-aged adults, with concomitant non-cardiac autoimmune diseases present in approximately 20% of cases. Early diagnosis remains challenging, as clinical presentation and imaging findings are nonspecific and overlap considerably with cardiac sarcoidosis. Endomyocardial biopsy continues to represent the diagnostic gold standard, with a sensitivity of 85%, while cardiac biomarkers including cardiac troponins and NT-proBNP provide important prognostic information. Cardiac magnetic resonance imaging and FDG-PET contribute to the diagnostic workup but cannot reliably differentiate GCM from cardiac sarcoidosis. Management requires prompt initiation of combination immunosuppressive therapy-typically corticosteroids combined with T cell-targeted agents such as cyclosporine and azathioprine or tacrolimus and mycophenolate mofetil, which has substantially improved survival in contemporary registries. Mechanical circulatory support and heart transplantation are frequently required for refractory cases. Given the high arrhythmic burden, systematic evaluation for implantable cardioverter-defibrillator placement is recommended. This review provides a comprehensive overview of the pathogenesis, diagnosis, and current management of GCM and highlights priorities for future research, including noninvasive diagnostic tools and standardized treatment protocols.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":"31 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}