PDF(Pubmed)
Abstract：
Worsening heart failure (WHF) is a severe and dynamic condition characterized by significant clinical and hemodynamic deterioration. It is characterized by worsening HF signs, symptoms and biomarkers, despite the achievement of an optimized medical therapy. It remains a significant challenge in cardiology, as it evolves into advanced and end-stage HF. The hyperactivation of the neurohormonal, adrenergic and renin-angiotensin-aldosterone system are well known pathophysiological pathways involved in HF. Several drugs have been developed to inhibit the latter, resulting in an improvement in life expectancy. Nevertheless, patients are exposed to a residual risk of adverse events, and the exploration of new molecular pathways and therapeutic targets is required. This review explores the current landscape of WHF, highlighting the complexities and factors contributing to this critical condition. Most recent medical advances have introduced cutting-edge pharmacological agents, such as guanylate cyclase stimulators and myosin activators. Regarding device-based therapies, invasive pulmonary pressure measurement and cardiac contractility modulation have emerged as promising tools to increase the quality of life and reduce hospitalizations due to HF exacerbations. Recent innovations in terms of WHF management emphasize the need for a multifaceted and patient-centric approach to address the complex HF syndrome.
摘要：
恶化性心力衰竭（WHF）是一种严重的动态状况，其特征是临床和血液动力学显着恶化。它的特点是HF症状恶化，症状和生物标志物，尽管实现了优化的药物治疗。它仍然是心脏病学的一个重大挑战，因为它演变成高级和终级HF。神经激素的过度激活，肾上腺素能和肾素-血管紧张素-醛固酮系统是众所周知的参与HF的病理生理途径。已经开发了几种药物来抑制后者，导致预期寿命的提高。然而，患者暴露于不良事件的残余风险，需要探索新的分子途径和治疗靶点。这篇评论探讨了WHF的现状，强调造成这一危急状况的复杂性和因素。最近的医学进步引入了尖端的药理学药物，如鸟苷酸环化酶刺激剂和肌球蛋白激活剂。关于基于设备的治疗，有创肺压测量和心脏收缩力调节已成为提高生活质量和减少因HF加重而住院的有前景的工具。最近在WHF管理方面的创新强调需要多方面和以患者为中心的方法来解决复杂的HF综合征。
