[Heart failure: symptomatic treatment versus prognostic modification]

While the prognosis of patients with heart failure is related to the progression of left ventricular dysfunction and to the activation of several regulatory systems--neurohormones, cytokines and others--the symptoms relate to hemodynamic and skeletal muscle disturbances. This is why the relief of symptoms by pharmacological intervention is not always accompanied by an improvement in prognosis. Hemodynamic improvement is no longer the main issue of therapy. The antagonism of the neurohormonal and other regulatory systems, as a means to influence prognosis, stands as the main challenge for the future. Until now only ACE inhibitors, beta-blockers, spironolactone, the combination of nitrates and hydralazine, and heart transplantation have achieved this goal.