Murphy Katie M, Rosenthal Julie L
Mayo Clinic Phoenix, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA.
Curr Treat Options Cardiovasc Med. 2017 Jul;19(7):50. doi: 10.1007/s11936-017-0552-4.
The therapeutic heart failure armamentarium has evolved from drugs to transplantation to devices through further understanding of its complex pathophysiology and pathogenesis. Current medications capitalize on our evolving understanding of the sympathetic and renin-angiotensin-aldosterone systems that subsequently promote both beneficial and maladaptive responses that ultimately yield a decrease in cardiac function. Despite these advancements, the prevalence of heart failure continues to rise and carries a significant burden on our patients and health care system. This presents a clinical dilemma on how best to care for a growing, complex, and heterogeneous cohort. Ideal treatments should decrease morbidity and mortality while providing an improvement in quality of life and functional capacity. New interventions will continue to become incorporated into everyday practice, but awareness and prevention should remain the mainstay followed by optimization of guideline-directed therapies. It is equally important to individually tailor our therapeutic approach. While strategies to treat heart failure with reduced ejection fraction continue to advance, our understanding of how best to treat specific etiologies remain in question. This review will focus on current and proposed novel interventions for the management of chronic, systolic heart failure including angiotensin receptor-neprilysin inhibitor, I channel antagonist, sodium-glucose cotransporter-2 inhibitors, and oral potassium binders.
通过对心力衰竭复杂病理生理学和发病机制的进一步了解，治疗心力衰竭的手段已从药物发展到移植再到器械。目前的药物利用了我们对交感神经和肾素-血管紧张素-醛固酮系统不断深入的认识，这些系统随后会引发有益和适应不良的反应，最终导致心脏功能下降。尽管取得了这些进展，但心力衰竭的患病率仍在持续上升，给我们的患者和医疗保健系统带来了沉重负担。这就带来了一个临床难题，即如何最好地照顾这一不断增长、复杂且异质性的患者群体。理想的治疗方法应降低发病率和死亡率，同时提高生活质量和功能能力。新的干预措施将继续融入日常实践，但认识和预防仍应是主要手段，其次是优化指南指导的治疗。根据个体情况量身定制治疗方法同样重要。虽然治疗射血分数降低的心力衰竭的策略不断进步，但我们对如何最好地治疗特定病因的认识仍存在疑问。本综述将重点关注目前和提议的用于治疗慢性收缩性心力衰竭的新型干预措施，包括血管紧张素受体脑啡肽酶抑制剂、I 通道拮抗剂、钠-葡萄糖协同转运蛋白 2 抑制剂和口服钾结合剂。
