Heart failure in the last year: progress and perspective

Abstract

Research about heart failure (HF) has made major progress in the last years. We give here an update on the most recent findings. Landmark trials have established new treatments for HF with reduced ejection fraction. Sacubitril/valsartan was superior to enalapril in PARADIGM‐HF trial, and its initiation during hospitalization for acute HF or early after discharge can now be considered. More recently, new therapeutic pathways have been developed. In the DAPA‐HF and EMPEROR‐Reduced trials, dapagliflozin and empagliflozin reduced the risk of the primary composite endpoint, compared with placebo [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65–0.85; P < 0.001 and HR 0.75; 95% CI 0.65–0.86; P < 0.001, respectively]. Second, vericiguat, an oral soluble guanylate cyclase stimulator, reduced the composite endpoint of cardiovascular death or HF hospitalization vs. placebo (HR 0.90; 95% CI 0.82–0.98; P = 0.02). On the other hand, both the diagnosis and treatment of HF with preserved ejection fraction, as well as management of advanced HF and acute HF, remain challenging. A better phenotyping of patients with HF would be helpful for prognostic stratification and treatment selection. Further aspects, such as the use of devices, treatment of arrhythmias, and percutaneous treatment of valvular heart disease in patients with HF, are also discussed and reviewed in this article.

Well-Known and Novel Serum Biomarkers for Risk Stratification of Patients with Non-ischemic Dilated Cardiomyopathy

“…Circulating microRNAs are small non-coding RNAs that influence protein translation and has gained much interest as potential genomic biomarkers. Their evaluation could help with the differentiation of the etiology behind heart failure (ischemic vs. nonischemic) and possibly with the prediction of the future course of the disease [ 87 , 88 ]. Although current evidence is lacking, there are some small studies that discovered high plasma levels of miRNA-16 in patients with ischemic and familial dilated cardiomyopathy, confirming its relationship with these etiologies [ 89 , 90 , 91 ].…”

Overview of Sodium-Glucose Co-transporter 2 (SGLT2) Inhibitors for the Treatment of Non-diabetic Heart Failure Patients

“…The cardioprotective effects of the SGLT2 inhibitors extend beyond glycemic control in patients with HF [ 12 , 24 ]. The metabolic impact of these agents are associated with the elevation of ketone body production, activation of anti-inflammatory and antioxidative pathways, and reduction of advanced glycation end-products mediated effects [ 24 , 25 ] Therefore, the mechanism of action of the SGLT2 inhibitors is complex and multifactorial [ 12 , 25 ]. While these findings justify the administration of SGLT2 inhibitors for patients with HFrEF and diabetes, recent trials reported comparable benefits in nondiabetic HF patients [ 10 ].…”

“…DAPA‐HF is the primary trial proving a critical advantage of dapagliflozin in HFrEF with a significant drop in hospitalizations due to the cardiovascular complications and exacerbation of heart failure amongst patients with HFrEF (HR 0.74; 95% CI 0.65-0.85) [ 25 ]. The analysis of the DAPA-HF trial has shown the benefits of dapagliflozin in mitigating the risk of heart failure progression and cardiac mortality, emphasizing the importance of early therapy initiation in all hospitalized patients with HFrEF [ 26 ].…”

“…The EMPEROR-Reduced trial revealed a reduction in cardiovascular deaths and exacerbation of HF with HFrEF (HR 0.75; 95% CI 0.65-0.86) [ 25 ] and had demonstrated the impact of empagliflozin on lowering the HFH and the risk of cardiovascular mortality compared to the placebo group regardless of diabetes status [ 28 ]. However, the EMPEROR-Reduced trial involved patients with more serious GFR and LV systolic dysfunction [ 25 ].…”

Risk factors and diagnostic significance of the N-terminal pro-brain natriuretic peptide as a marker in patients with acute decompensated heart failure and diabetic kidney disease

“…Известно, что оптимальные концентрации натрийуретических пептидов (НУП) для диагностики ОДСН у пациентов с острой одышкой в отделении неотложной помощи выше по сравнению с теми, которые используются для диагностики хронической сердечной недостаточности (ХСН) у пациентов с одышкой при физической нагрузке в амбулаторных условиях, и зависят от возраста [4].…”