Current and future therapeutic perspective in chronic heart failure

被引：51

作者：

Mascolo, Annamaria ^{[1
,2
]}

Di Mauro, Gabriella ^{[1
,2
]}

Cappetta, Donato ^{[2
]}

De Angelis, Antonella ^{[2
]}

Torella, Daniele ^{[3
]}

Urbanek, Konrad ^{[3
]}

Berrino, Liberato ^{[2
]}

Nicoletti, Giovanni Francesco ^{[4
]}

Capuano, Annalisa ^{[1
,2
]}

Rossi, Francesco ^{[1
,2
]}

机构：

[1] Campania Reg Ctr Pharmacovigilance & Pharmacoepid, Via Costantinopoli 16, I-80138 Naples, Italy

[2] Univ Campania Luigi Vanvitelli, Sect Pharmacol L Donatelli, Dept Expt Med, Via Costantinopoli 16, I-80138 Naples, Italy

[3] Magna Graecia Univ Catanzaro, Dept Expt & Clin Med, Mol & Cellular Cardiol Lab, Catanzaro, Italy

[4] Univ Campania Luigi Vanvitelli, Multidisciplinary Dept Med Surg & Dent Sci, Plast Surg Unit, Naples, Italy

来源：

PHARMACOLOGICAL RESEARCH | 2022年 / 175卷

关键词：

Chronic heart failure; Renin-angiotensin-aldosterone system; Treatment; Heart failure with preserved ejection fraction; Therapeutic perspective; CONVERTING ENZYME 2; MINERALOCORTICOID RECEPTOR ANTAGONISTS; ANGIOTENSIN-ALDOSTERONE SYSTEM; PRESERVED EJECTION FRACTION; NECROSIS-FACTOR-ALPHA; AMINOPEPTIDASE-A; SGLT2; INHIBITORS; GENE-THERAPY; ETANERCEPT; ENALAPRIL;

D O I：

10.1016/j.phrs.2021.106035

中图分类号：

R9 [药学];

学科分类号：

1007 ;

摘要：

The incidence of heart failure is primarily flat or declining for a presumably reflecting better management of cardiovascular diseases, but that of heart failure with preserved ejection fraction (HFpEF) is probably increasing for the lack of an established effective treatment. Moreover, there is no specific pharmacological treatment for patients with heart failure with mildly reduced ejection fraction (HFmrEF) since no substantial prospective randomized clinical trial has been performed exclusively in such population. According to the recent 2021 European Society of Cardiology (ESC) guidelines, the triad composed of an Angiotensin Converting Enzyme inhibitor or Angiotensin Receptor-Neprilysin Inhibitor (ARNI), a beta-blocker, and a Mineralcorticoid Receptor Antagonist is the cornerstone therapy for all patients with heart failure with reduced ejection fraction (HFrEF) but a substantial gap exists for patients with HFpEF/HFmrEF. Despite the important role of the ReninAngiotensin-Aldosterone System (RAAS) in heart failure pathophysiology, RAAS blockers were found ineffective for HFpEF patients. Indeed, even the new drug class of ARNI was found effective only in HFrEF patients. In this regard, a therapeutic alternative may be represented by drug stimulating the non-classic RAAS (ACE2 and A1-7) as well as other emerging drug classes (such as SGLT2 inhibitors). Reflecting on this global health burden and the gap in treatments among heart failure phenotypes, we summarize the leading players of heart failure pathophysiology, the available pharmacological treatments for each heart failure phenotype, and that in future development.

引用

页数：9