Das Bibhuti B
Department of Pediatrics, Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
Children (Basel). 2024 Jul 16;11(7):859. doi: 10.3390/children11070859.
This review delves into the most recent therapeutic approaches for pediatric chronic heart failure (HF) as proposed by the International Society for Heart and Lung Transplantation (ISHLT), which are not yet publicly available. The guideline proposes an exhaustive overview of the evolving pharmacological strategies that are transforming the management of HF in the pediatric population. The ISHLT guidelines recognize the scarcity of randomized clinical trials in children, leading to a predominance of consensus-based recommendations, designated as Level C evidence. This review article aims to shed light on the significant paradigm shifts in the proposed 2024 ISHLT guidelines for pediatric HF and their clinical ramifications for pediatric cardiology practitioners. Noteworthy advancements in the updated proposed guidelines include the endorsement of angiotensin receptor-neprilysin inhibitors (ARNIs), sodium-glucose cotransporter 2 inhibitors (SGLT2is), and soluble guanylate cyclase (sGC) stimulators for treating chronic HF with reduced ejection fraction (HFrEF) in children. These cutting-edge treatments show potential for enhancing outcomes in pediatric HFrEF. Nonetheless, the challenge persists in validating the efficacy of therapies proven in adult HFrEF for the pediatric cohort. Furthermore, the proposed ISHLT guidelines address the pharmacological management of chronic HF with preserved ejection fraction (HFpEF) in children, marking a significant step forward in pediatric HF care. This review also discusses the future HF drugs in the pipeline, their mechanism of actions, potential uses, and side effects.
本综述深入探讨了国际心肺移植学会（ISHLT）提出的针对小儿慢性心力衰竭（HF）的最新治疗方法，这些方法尚未公开。该指南对正在改变小儿HF治疗管理的不断发展的药理学策略进行了详尽概述。ISHLT指南认识到儿童随机临床试验的稀缺性，导致基于共识的建议占主导地位，被指定为C级证据。本文旨在阐明2024年ISHLT小儿HF指南中提出的重大范式转变及其对小儿心脏病学从业者的临床影响。更新后的拟议指南中的显著进展包括认可血管紧张素受体脑啡肽酶抑制剂（ARNI）、钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）和可溶性鸟苷酸环化酶（sGC）刺激剂用于治疗小儿射血分数降低的慢性HF（HFrEF）。这些前沿治疗方法显示出改善小儿HFrEF预后的潜力。尽管如此，在验证成人HFrEF中已证实的疗法对小儿队列的疗效方面，挑战依然存在。此外，拟议的ISHLT指南涉及小儿射血分数保留的慢性HF（HFpEF）的药物管理，这标志着小儿HF护理向前迈出了重要一步。本综述还讨论了正在研发中的未来HF药物、它们的作用机制、潜在用途和副作用。
