Fucili Alessandro, Cimaglia Paolo, Severi Paolo, Giannini Francesco, Boccadoro Alberto, Micillo Marco, Rapezzi Claudio, Tavazzi Luigi, Ferrari Roberto
Cardiovascular Research Centre, Ferrara University, Via Aldo Moro 8, 44124 Ferrara, Italy.
Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Via Corriera 1, 48033 Cotignola, Italy.
J Clin Med. 2021 Sep 23;10(19):4325. doi: 10.3390/jcm10194325.
After almost a decade of stagnation in clinical research for HF treatment, five large randomized trials recently published have supported the use of four new classes of drugs, namely: angiotensin receptor/neprilysin inhibitor, sodium-glucose co-transporters 2 inhibitors, soluble guanylate cyclase modulators, and myosin activators. Each treatment has proved to be beneficial for both long-term outcomes and quality of life. Beside their clinical relevance, all these novel treatments have a different mechanism of action beyond the usual neuro-hormonal blockage. These different pathways, together with the unquestionable clinical evidence, advocate a re-thinking of HF treatment and of the appropriate drug to integrate with the existing standard therapy, according to different characteristics of HFrEF patients. This study aimed to offer a synthetic overview of the mechanisms of action of the new drugs and to propose a more personalized approach, considering patients' characteristics and safety profiles. To this end, we have identified seven profiles for patients with chronic heart failure with reduced ejection fraction and two for pre-discharge patients.
在心力衰竭（HF）治疗的临床研究停滞近十年后，最近发表的五项大型随机试验支持使用四类新型药物，即：血管紧张素受体/脑啡肽酶抑制剂、钠-葡萄糖协同转运蛋白2抑制剂、可溶性鸟苷酸环化酶调节剂和肌球蛋白激活剂。每种治疗方法都已证明对长期预后和生活质量有益。除了它们的临床相关性外，所有这些新型治疗方法都具有不同于常见神经激素阻断的作用机制。这些不同的途径，连同确凿的临床证据，主张根据射血分数降低的心力衰竭（HFrEF）患者的不同特征，重新思考HF治疗以及与现有标准治疗相结合的合适药物。本研究旨在综合概述新药的作用机制，并根据患者的特征和安全性提出一种更个性化的方法。为此，我们确定了七类射血分数降低的慢性心力衰竭患者和两类出院前患者的特征。
