Heart & Vascular Institute Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
J Am Coll Cardiol. 2014 Jun 3;63(21):2188-98. doi: 10.1016/j.jacc.2014.01.068. Epub 2014 Mar 19.
New therapeutic targets, agents, and strategies are needed to prevent and treat heart failure (HF) after a decade of failed research efforts to improve long-term patient outcomes, especially in patients after hospitalization for HF. Conceptually, an accurate assessment of left ventricular structure is an essential step in the development of novel therapies because heterogeneous pathophysiologies underlie chronic HF and hospitalization for HF. Improved left ventricular characterization permits the identification and targeting of the intrinsic fundamental disease-modifying pathways that culminate in HF. Interstitial heart disease is one such pathway, characterized by extracellular matrix (ECM) expansion that is associated with mechanical, electrical, and vasomotor dysfunction and adverse outcomes. Previous landmark trials that appear to treat interstitial heart disease were effective in improving outcomes. Advances in cardiovascular magnetic resonance now enable clinicians and researchers to assess the interstitium and quantify ECM expansion using extracellular volume fraction measures and other derangements in cardiovascular structure. These capabilities may provide a mechanistic platform to advance understanding of the role of the ECM, foster the development of novel therapeutics, and target specific disease-modifying pathways intrinsic to the ventricle. Refocusing on the interstitium may potentially improve care through the identification and targeted treatment of key patient subgroups.
需要新的治疗靶点、药物和策略，以预防和治疗心力衰竭（HF），此前改善长期患者预后的研究努力失败了十年，特别是在 HF 住院患者中。从概念上讲，准确评估左心室结构是开发新疗法的重要步骤，因为慢性 HF 和 HF 住院的病理生理学是异质的。改善左心室特征可识别和靶向导致 HF 的内在根本疾病修正途径。间质心脏疾病就是这样一种途径，其特征是细胞外基质（ECM）扩张，与机械、电和血管舒缩功能障碍和不良结局相关。以前似乎治疗间质心脏疾病的标志性试验在改善结局方面是有效的。心血管磁共振的进步现在使临床医生和研究人员能够评估间质并使用细胞外体积分数测量等方法来量化 ECM 扩张和心血管结构的其他紊乱。这些能力可能为深入了解 ECM 的作用提供一个机制平台，促进新型治疗药物的开发，并针对心室内在的特定疾病修正途径。重新关注间质可能通过识别和靶向关键患者亚组来改善治疗。
