Anand Inder S, Florea Viorel G
Division of Cardiology, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA.
Cardiol Clin. 2008 Feb;26(1):59-72, vi. doi: 10.1016/j.ccl.2008.01.001.
Although considerable progress has been made in the pharmacologic and device management of chronic heart failure in recent decades, heart failure patients continue to remain symptomatic, with high hospitalization and mortality rates. A number of novel agents, including endothelin antagonists and tumor-necrosis factor blockers, have recently failed to improve the clinical outcomes of patients with heart failure. Have we reached a ceiling in preventing the progression of the disease? This article reviews successes and late-stage clinical trial disappointments in the treatment of patients with heart failure. Furthermore, the article discusses how agents that have beneficial effects in heart failure also generally attenuate or reverse ventricular remodeling, whereas the newer agents that have failed to improve clinical outcomes either had no effect on remodeling or have been associated with adverse remodeling.
尽管近几十年来慢性心力衰竭的药物治疗和器械管理取得了相当大的进展，但心力衰竭患者仍有症状，住院率和死亡率居高不下。包括内皮素拮抗剂和肿瘤坏死因子阻滞剂在内的一些新型药物最近未能改善心力衰竭患者的临床结局。我们在预防疾病进展方面是否已经达到了极限？本文回顾了心力衰竭患者治疗中的成功案例和晚期临床试验的失望结果。此外，本文还讨论了在心力衰竭中具有有益作用的药物通常如何减轻或逆转心室重塑，而未能改善临床结局的新型药物要么对重塑没有影响，要么与不良重塑有关。
