Gallo Giovanna, Volpe Massimo, Battistoni Allegra, Russo Domitilla, Tocci Giuliano, Musumeci Maria Beatrice
Cardiology Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Front Physiol. 2021 Aug 23;12:652163. doi: 10.3389/fphys.2021.652163. eCollection 2021.
Heart failure (HF) is a complex syndrome caused by a variety of structural or functional cardiac abnormalities as a consequence of several involved pathophysiological pathways. In the last decades, left ventricular ejection fraction (LVEF) has represented the principal criterion used to stratify HF, to interpret ventricular function and to identify therapeutic strategies. However, this chimeric parameter oversimplifies the multiple pathways and mechanisms underlying the progression of HF. Indeed, HF should be more appropriately considered as the final stage of multiple disease states, characterized by distinct phenotypes on the basis of key clinical and molecular variables, such as underlying etiologies and conditions, demographic and structural features and specific biomarkers. Accordingly, HF should be viewed as a continuous spectrum in which the specific phenotypes need to be accurately identified with the aim to improve the disease management with a more tailored approach. In such a complex and heterogeneous scenario, the clinical benefits of an angiotensin receptor neprilysin inhibition strategy, namely in the single pill sacubitril/valsartan (S/V), have been shown across the entire HF continuum, representing a fundamental therapeutic strategy, although with different magnitudes depending on the severity and the stage of the clinical syndrome. In this viewpoint paper we have reconsidered the role of S/V in the light of different HF phenotypes and on the basis of HF considered as a whole spectrum.
心力衰竭（HF）是一种复杂的综合征，由多种结构或功能上的心脏异常引起，这些异常是多种病理生理途径共同作用的结果。在过去几十年中，左心室射血分数（LVEF）一直是用于对HF进行分层、解释心室功能以及确定治疗策略的主要标准。然而，这个拼凑的参数过于简化了HF进展背后的多种途径和机制。实际上，HF应更恰当地被视为多种疾病状态的终末期，根据关键的临床和分子变量（如潜在病因和病情、人口统计学和结构特征以及特定生物标志物）具有不同的表型。因此，HF应被视为一个连续谱，其中需要准确识别特定表型，以便采用更具针对性的方法改善疾病管理。在这样一个复杂且异质性的情况下，血管紧张素受体脑啡肽酶抑制策略（即单片制剂沙库巴曲/缬沙坦[S/V]）的临床益处已在整个HF连续谱中得到证实，这代表了一种基本的治疗策略，尽管根据临床综合征的严重程度和阶段其程度有所不同。在这篇观点论文中，我们根据不同的HF表型并将HF视为一个整体谱，重新审视了S/V的作用。
