[Introduction to index of the failing heart syndrome]

On the occasion of the 42nd Scientific Meeting of the Japanese College of Cardiology, a presentation of the methods of the recognition or some indices of heart failure was given to encourage comprehensive discussion of failing heart syndrome. During the last 10 years, several multicenter, randomized, placebo-controlled studies of the efficacy and safety of drugs in patients with heart failure have been performed in western countries, resulting in the evolution of a new concept of heart failure based on pathophysiologic and therapeutic approaches. However, many trials of new drugs for heart failure shown to be efficacious in western countries have failed to be effective in Japan. The reasons for this discrepancy might be based on differences of the causes of chronic heart failure, but also on differences in understanding. All Japanese cardiologists know that the prevalence of left ventricular failure evolving rapidly after acute myocardial infarction in Japan is far less common than in western countries. Recent evolution of pathophysiologic concepts of heart failure is derived from the experimental and clinical observations of myocardial failure. The effects of mechanical overload on failing heart might be an unfashionable topic now, but in Japan, all factors affecting failing heart should be carefully considered when heart failure is treated, because the controlling factor inducing heart failure is hard to identify.