Heart failure

Area of Science:

• Cardiology
• Heart Failure Pathophysiology

Background:

• Heart failure (HF) prevalence is increasing, particularly in older women with comorbidities like diabetes, obesity, and atrial fibrillation.
• HF with preserved systolic function is a growing concern, necessitating a deeper understanding of its complex mechanisms.

Purpose of the Study:

• To review the current understanding of heart failure pathogenesis.
• To discuss the role of biomarkers in identifying mechanisms, prognosis, and therapy selection.
• To highlight promising novel therapeutic strategies and the importance of preventive approaches.

Main Methods:

• Literature review of heart failure pathogenesis, biomarkers, and emerging therapies.
• Analysis of current treatment modalities including pharmacotherapy, cell therapy, gene therapy, and mechanical support.
• Emphasis on the need for multifaceted preventive strategies.

Main Results:

• Multiple pathogenetic mechanisms contribute to HF, including hemodynamic overload, ischemia, remodeling, neurohumoral imbalance, calcium cycling abnormalities, extracellular matrix dysregulation, apoptosis, and genetic factors.
• Biomarkers aid in identifying specific HF mechanisms, guiding prognosis, and tailoring treatment.
• Investigational therapies include neprilysin inhibitors, vasodilator peptides, myofilament sensitizers, sarcoplasmic reticulum calcium uptake enhancers, cell therapy, gene therapy, and ventricular assist devices.

Conclusions:

• While novel therapies show promise for managing heart failure, significant reductions in its prevalence require robust, multifaceted preventive strategies.
• Integrated biomarker analysis can personalize HF treatment and improve patient outcomes.
• Advanced mechanical circulatory support offers viable options for advanced HF management.