[Pathophysiology of heart failure for clinicians]

Heart failure is the common and final pathway of all the cardiovascular diseases. Its pathophysiology has progressed during the last 20 years; although the inotropy was the main target in the 80', new paradigms have emerged such as remodelling, neurohormonal activation, and more recently desynchronisation...these new concepts have led to substantial therapeutic improvements. However, heart failure remains a severe disease with a high mortality. New therapeutic advances will be possible only by the discovery of new molecular pathways, which could represent a pharmacological target or a target for gene therapy.