Cardiac Failure Review最新文献

{"title":"The Emerging Role of Aldosterone Synthase Inhibitors in Overcoming Renin-Angiotensin-Aldosterone System Therapy Limitations: A Narrative Review.","authors":"Shubh K Patel, Hwee Teoh, Ahreni Saunthar, Terrence M Yau, Subodh Verma","doi":"10.15420/cfr.2025.09","DOIUrl":"10.15420/cfr.2025.09","url":null,"abstract":"<p><p>The renin-angiotensin-aldosterone system is integral to cardiorenal health, with aldosterone controlling fluid balance, blood pressure and cardiac remodelling. Despite the widespread use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and mineralocorticoid receptor antagonists, 'aldosterone escape' persists, contributing to treatment failure and adverse outcomes. Steroidal mineralocorticoid receptor antagonists also cause hyperkalaemia and anti-androgenic effects, limiting their use. Aldosterone synthase inhibitors (ASIs) selectively block cytochrome P450 11B2, reducing pathological aldosterone levels while preserving basal mineralocorticoid receptor activity, thus potentially lowering hyperkalaemia risk. This narrative review identified 41 relevant publications from a PubMed/MEDLINE search of \"aldosterone synthase inhibitor\" through 11 January 2025. Early clinical trials of ASIs (baxdrostat, lorundrostat, vicadrostat, dexfadrostat phosphate, JX09) report significant reductions in aldosterone, blood pressure and albuminuria, with promising safety. Challenges include ensuring high selectivity, mitigating hyperkalaemia and establishing long-term benefits. Ongoing Phase III trials will clarify their efficacy, safety and synergy with additional therapies - including sodium-glucose cotransporter 2 inhibitors - and clinical outcomes, positioning ASIs as an important advance in renin-angiotensin-aldosterone system modulation.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e20"},"PeriodicalIF":5.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Endothelial Dysfunction in Heart Failure: The Role of Endothelial Progenitor Cells and New Treatment Horizons.","authors":"Eugenio Carulli, Marialuisa Sveva Marozzi, Maria Cristina Carella, Andrea Igoren Guaricci, Giandomenico Tarsia, Angelo Vacca, Vanessa Desantis, Sebastiano Cicco","doi":"10.15420/cfr.2025.02","DOIUrl":"10.15420/cfr.2025.02","url":null,"abstract":"<p><p>Heart failure (HF) is closely linked to endothelial dysfunction, which contributes significantly to its progression. Endothelial dysfunction in HF is marked by reduced nitric oxide bioavailability, increased oxidative stress and inflammation, all of which impair vascular function. Endothelial progenitor cells (EPCs) - vital for vascular repair - are particularly affected, with their dysfunction further exacerbating HF outcomes. Emerging therapies targeting these mechanisms, including antioxidants, gene therapies enhancing endothelial nitric oxide synthase activity and EPCbased strategies, hold promise. Recent advances show encouraging results, especially with treatments improving EPC mobilisation and function. Additionally, pharmacological agents such as statins and sodium-glucose cotransporter 2 inhibitors demonstrate pleiotropic benefits, enhancing endothelial health and EPC activity. This review emphasises the therapeutic potential of these approaches, highlighting the critical need for further research to optimise endothelial-targeted treatments and improve outcomes for HF patients.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e21"},"PeriodicalIF":5.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Role of Glucagon-like Peptide-1 Receptor Agonists in the Treatment of Heart Failure.","authors":"Giovanni Battista Bonfioli, Matteo Pagnesi, Daniela Tomasoni, Amina Rakisheva, Marco Metra","doi":"10.15420/cfr.2025.10","DOIUrl":"10.15420/cfr.2025.10","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially developed for glycaemic control in patients with type 2 diabetes, have demonstrated significant cardiometabolic benefits beyond glucose regulation. These agents have multiple effects, including reducing body weight, improving insulin sensitivity, anti-inflammatory properties and enhancing endothelial function. All these mechanisms are potentially beneficial in patients with heart failure (HF), specifically those with HF with preserved left ventricular ejection fraction. Recent trials, including STEP-HFpEF and SUMMIT, underscore the efficacy of GLP-1 RAs in improving quality of life and exercise capacity, as well as possibly reducing major adverse cardiovascular events. Furthermore, these trials demonstrated improvements in other endpoints, such plasma N-terminal pro B-type natriuretic peptide, troponin and C-reactive protein concentrations, consistent with the beneficial effects of GLP-1 RAs on myocardial function and inflammation. Further data are needed regarding the effects of GLP-1 RAs on cardiovascular outcomes, and possibly in a broader range of patients with HF, such as those with HF reduced ejection fraction and/or patients without obesity.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e19"},"PeriodicalIF":5.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Aldosterone Story: New Chapters.","authors":"Vijay Chopra","doi":"10.15420/cfr.2025.16","DOIUrl":"10.15420/cfr.2025.16","url":null,"abstract":"","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e17"},"PeriodicalIF":5.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological Therapy of HFrEF in 2025: Navigating New Advances and Old Unmet Needs in An Eternal Balance Between Progress and Perplexities.","authors":"Massimo Mapelli, Filippo Maria Rubbo, Simona Costantino, Nicola Amelotti, Piergiuseppe Agostoni","doi":"10.15420/cfr.2024.37","DOIUrl":"10.15420/cfr.2024.37","url":null,"abstract":"<p><p>Recent advances in medical therapy have significantly improved the prognosis of patients with heart failure and reduced ejection fraction (HFrEF). The established four pillars of HFrEF treatment - β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor- neprilysin inhibitors, mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors - serve as the foundation for ongoing innovations in this domain. However, these represent only the starting point for the therapy and management of heart failure. New medications, new devices and improvements in the use of diuretic therapy are fundamental and recent advancements. This article aims to highlight the latest findings in HFrEF treatment. While emphasising the optimism these developments bring, the article also addresses the significant unresolved challenges that persist in the management of this syndrome, which remains a leading global cause of mortality, morbidity and poor quality of life with high use of resources and healthcare costs.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e18"},"PeriodicalIF":5.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Management of Patients with Heart Failure with Reduced Ejection Fraction in Clinical Practice: The Case for Angiotensin Receptor-Neprilysin Inhibitor.","authors":"Massimo Iacoviello, Filippo Maria Sarullo, Claudio Bilato, Michele Correale, Gabriele Di Gesaro, Mauro Driussi, Andrea Passantino, Alessandra Villani, Andrea Di Lenarda","doi":"10.15420/cfr.2024.39","DOIUrl":"10.15420/cfr.2024.39","url":null,"abstract":"<p><p>The high risk of adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF) demands urgent efforts in the initiation of guideline-directed medical therapy to reduce morbidity and mortality. Angiotensin receptor-neprilysin inhibitor showed substantial benefits in reducing the risks of heart failure hospitalisation and cardiovascular mortality in HFrEF patients. Therefore, the European Society of Cardiology 2021 guidelines recommend angiotensin receptor-neprilysin inhibitor as a first-line therapy for HFrEF patients. The guidelines emphasise the importance of the early use and rapid titration of the 'four pillars' in HFrEF: angiotensin receptor-neprilysin inhibitor, β-blockers, sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists. However, real-world application of the guidelines remains suboptimal, limiting patient outcomes. This statement paper investigates the barriers to the use of the 'four pillars', and aims to give guidance to improve their implementation in different HFrEF patient types.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e16"},"PeriodicalIF":5.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart Failure Management in Cardiac Amyloidosis: Towards a Paradigm Shift.","authors":"Giorgia Panichella, Alberto Aimo, Vincenzo Castiglione, Giuseppe Vergaro, Michele Emdin","doi":"10.15420/cfr.2024.33","DOIUrl":"10.15420/cfr.2024.33","url":null,"abstract":"<p><p>Heart failure (HF) and cardiac amyloidosis (CA) are significant clinical challenges, with evolving epidemiological patterns reshaping the understanding of these conditions. Traditionally linked with HF with preserved ejection fraction, CA is increasingly recognised for its specific characteristics, including a considerable subset of patients presenting with reduced left ventricular ejection fraction. This review explores how the neurohormonal activation observed in CA impacts on disease progression and management strategies. Historically, neurohormonal antagonists were considered contraindicated in CA owing to concerns about autonomic dysfunction and chronotropic incompetence. However, recent evidence suggests a paradigm shift, indicating that such agents may offer therapeutic benefits even in these patients. By examining these developments, this review provides a comprehensive overview of current therapeutic approaches, the role of neurohormonal modulation and the need for personalised care strategies to address the complexities of HF in the context of CA.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e15"},"PeriodicalIF":5.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Timing for Primary Prevention for ICD in the Current Era of Pharmacotherapy.","authors":"Anastasia Shchendrygina, Amin Yehya, Hadi Skouri","doi":"10.15420/cfr.2025.05","DOIUrl":"10.15420/cfr.2025.05","url":null,"abstract":"<p><p>Recent advances in the pharmacological therapy of heart failure with reduced ejection fraction (HFrEF) have significantly impacted the overall survival, heart failure hospitalisations and rates of sudden cardiac death (SCD). In this context, the relevant timing of placing ICDs as primary prevention is a matter of on-going debate. This manuscript provides evidence for an updated view regarding the timing of implanting ICD in eligible patients with HFrEF receiving optimal guideline-directed medical therapy, accounting for the timing to reverse cardiac remodelling (RCR) occurrence and residual SCD risks over time. Clinically significant RCR occurs beyond 3 months of optimal guideline-directed medical therapy, while the residual risks of SCDs remain low for certain HFrEF populations. However, when deciding on ICD implantation, one should always consider individual modulators of RCR and SCD risks, as well as the non-competing risks of death that can affect patients' overall outcomes. Risk stratification algorithms need to be developed and validated in future pragmatic clinical trials to further define better timing for the use of ICDs in primary prevention.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e14"},"PeriodicalIF":4.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Landiolol and Esmolol on Haemodynamic Responses During Weaning of Intensive Care Unit Patients with Reduced Ejection Fraction after Vascular Surgery.","authors":"Georgios Koukoulitsios, Kyriaki Tsikritsaki, Georgios Magklaras, Athanasios M Koutivas, Alexandros Kalogeromitros, Vasileios Papaioannou","doi":"10.15420/cfr.2024.18","DOIUrl":"10.15420/cfr.2024.18","url":null,"abstract":"<p><strong>Background: </strong>Weaning and tracheal extubation of patients after vascular surgery is a stressful procedure that triggers the sympathetic nervous system, potentially leading to deterioration of cardiac performance in patients with left ventricular dysfunction. This study compared the efficacy and safety of landiolol, a novel ultra-short-acting β₁-adrenoceptor antagonist, with that of esmolol in terms of the cardiovascular response during the extubation of patients with reduced ejection fraction (EF) admitted to the intensive care unit after major vascular surgery.</p><p><strong>Methods: </strong>This single-centre, prospective, randomised, open-label study included postoperative patients with cardiac dysfunction. Patients were randomly assigned to either landiolol or esmolol. Landiolol and esmolol infusions began as soon as the respiratory weaning procedure started, and were initiated at doses of 1 and 50 µg/kg/min, respectively (up to 10 and 200 µg/kg/min, respectively). Heart rate, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure (MAP) and cardiac rhythm were recorded every minute up to 30 minutes after extubation.</p><p><strong>Results: </strong>Thirty-nine patients with cardiac dysfunction (mean [±SD] left ventricular EF 36.6 ± 7.6%; New York Heart Association Class II/III, 32/9) were infused with either landiolol (n=19; mean rate 2.0 ± 2.1 μg/kg/min) or esmolol (n=20; mean rate 150 ± 50 μg/kg/min). Mean age, left ventricular EF, New York Heart Association class and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were similar between the two groups. Landiolol produced a more rapid and substantial decrease in heart rate than esmolol (-40 ± 20 BPM versus -30 ± 16 BPM) without haemodynamic deterioration. A significant reduction in MAP was recorded in the esmolol group.</p><p><strong>Conclusion: </strong>Landiolol produced a more rapid and potent reduction in heart rate than esmolol. A significant reduction in MAP was only seen in the esmolol group.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e13"},"PeriodicalIF":4.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life in Patients Aged 60-65 Years Receiving Mechanical versus Bioprosthetic Aortic Valve Replacement.","authors":"Meng He, Jinwei Zhang, Jianbo Yu, Xiaoqing Gao, Changwei Ren, Yongqiang Lai, Hao Cui","doi":"10.15420/cfr.2024.40","DOIUrl":"10.15420/cfr.2024.40","url":null,"abstract":"<p><strong>Background: </strong>For patients eligible for both mechanical and bioprosthetic valves, postoperative quality of life (QOL) is a key factor in determining the type of prosthetic valve used.</p><p><strong>Methods: </strong>We reviewed patients aged 60-65 years who underwent isolated aortic valve replacement at our centre. Postoperative QOL was assessed through a telephone follow-up using the 36-item Short Form Health Survey questionnaire.</p><p><strong>Results: </strong>A total of 628 valid survey responses were collected, comprising 353 patients with mechanical valves and 275 with bioprosthetic valves. The mean age of the patients was 62.5 ± 1.7 years, and 363 (57.8%) were men. The mean follow-up period was 7.3 ± 3.9 years. There were no significant differences in any QOL subscale or the overall 36-item Short Form Health Survey score between patients with mechanical and bioprosthetic valves. BMI (β=-0.109, p=0.014) and postoperative time (β=-0.251, p<0.001) were the independent predictors of QOL, after adjusting for factors, such as age at the time of surgery, sex, ejection fraction, type of prosthesis and prosthesis effective orifice area index. The rates of stroke and cardiovascular reintervention per patient-year were similar between the two groups. However, in those 12 years after aortic valve replacement, mechanical valves seemed to perform better.</p><p><strong>Conclusion: </strong>In patients aged 60-65 years undergoing isolated aortic valve replacement, there is no significant difference in postoperative QOL between those receiving mechanical or bioprosthetic valves, but mechanical valves seemed to perform better in the late period.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e12"},"PeriodicalIF":4.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}