Kresoja K-P, Schmidt G, Kherad B, Krackhardt F, Spillmann F, Tschöpe C
Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Deutschland.
Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.
Herz. 2017 Nov;42(7):699-712. doi: 10.1007/s00059-017-4613-y.
The initial therapy of chronic heart failure is still based on diuretics, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers and in specific cases mineralocorticoid receptor antagonists. The new European Society of Cardiology (ESC) guidelines published in 2016 introduced angiotensin-receptor-neprilysin inhibitors, such as sacubitril/valsartan (LCZ 696) as new therapeutic agents in patients with chronic and progressive heart failure. New subgroup analyses for LCZ 696 have been published showing a beneficial effect in the context of various comorbidities, such as renal insufficiency, diabetes and hypotension. Furthermore, new data are available on intravenous iron substitution in chronic heart failure and on the indications for implantable converter defibrillators, cardiac resynchronization therapy and other cardiac devices. Medicinal therapy of acute heart failure is still limited. For patients who cannot be treated with medicinal therapy, mechanical circulatory support, such as extracorporeal membrane oxygenation (ECMO) should be recommended.
慢性心力衰竭的初始治疗仍以利尿剂、血管紧张素转换酶（ACE）抑制剂、β受体阻滞剂为基础，在特定情况下还会使用盐皮质激素受体拮抗剂。2016年发布的欧洲心脏病学会（ESC）新指南引入了血管紧张素受体脑啡肽酶抑制剂，如沙库巴曲/缬沙坦（LCZ 696），作为慢性进行性心力衰竭患者的新型治疗药物。关于LCZ 696的新亚组分析已发表，显示在各种合并症（如肾功能不全、糖尿病和低血压）的情况下具有有益效果。此外，关于慢性心力衰竭静脉铁剂替代以及植入式心律转复除颤器、心脏再同步治疗和其他心脏装置的适应症，也有了新的数据。急性心力衰竭的药物治疗仍然有限。对于无法接受药物治疗的患者，应推荐机械循环支持，如体外膜肺氧合（ECMO）。
