Smoldering inflammation: The silent flame driving heart failure

Area of Science:

• Cardiology
• Immunology
• Pathophysiology

Background:

• Heart failure (HF), especially HFpEF, involves complex mechanisms.
• Chronic low-intensity inflammation, termed smoldering inflammation (SI), is increasingly recognized in HF pathogenesis.

Purpose of the Study:

• To review and consolidate current literature on the role of SI in HFpEF.
• To illustrate the interplay between SI, neurohormonal activation, metabolic derangements, and comorbidities in HFpEF.

Main Methods:

• Comprehensive literature search across major databases (PubMed, Wiley, Scopus, Web of Science).
• Inclusion of peer-reviewed articles, reviews, and clinical/observational studies on SI in HF.
• Exclusion of studies limited to acute coronary syndrome.

Main Results:

• SI is linked to structural changes and hemodynamic issues in HFpEF.
• Biomarkers like CRP, IL-6, sST2, and Gal-3 indicate inflammation and have prognostic value.
• SGLT-2 inhibitors and GLP-1 receptor agonists show efficacy in modulating SI.

Conclusions:

• Smoldering inflammation is a key driver in HFpEF pathogenesis and comorbidity progression.
• Understanding SI can enhance risk stratification and treatment strategies for HFpEF.
• Targeting SI with anti-inflammatory therapies offers potential for improved HF management.