Birs Antoinette S, Mazdeyasnan Donya, Daniels Lori B
Division of Cardiovascular Medicine, Department of Medicine, University of California, 9394 Medical Center Drive, La Jolla, San Diego, CA, USA.
University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, USA.
Curr Heart Fail Rep. 2025 Jan 29;22(1):7. doi: 10.1007/s11897-024-00694-6.
Heart failure is a complex and heterogenous disease state that affects millions worldwide. Over recent decades, advancements in medical therapy and device implementation have significantly transformed the landscape of heart failure outcomes, while improvements in imaging modalities and greater accessibility to genome sequencing have led to increasing recognition of distinct heart failure endotypes. There is rising evidence to suggest all patients do not benefit equally from intensification of guideline directed medical therapy (GDMT). Efforts to personalize medical therapy to maximize benefits while minimizing side effects remains an ongoing challenge. We review key manuscripts from The BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF), a multicenter observational study conducted across Europe, which prospectively enrolled patients with acute or worsening heart failure.
BIOSTAT-CHF was designed to characterize biological pathways associated with varied patient responses to GDMT for heart failure. Utilizing a diverse cohort of European patients, the authors were able to develop risk models to predict mortality and heart failure hospitalization from clinically available data plus standard and novel biomarkers. They also utilized modeling to refine characterization of heart failure subtypes and personalization of GDMT titration. In this review we highlight key insights from the BIOSTAT-CHF cohort and how they relate to: (1) prognosis and monitoring treatment response in heart failure, (2) personalization of heart failure treatment, and (3) elucidation of biological pathways and future directions for research. These insights summarize how BIOSTAT-CHF has contributed to a deeper understanding of heart failure, focusing on using biomarkers personalizing treatment approaches, with a goal of ultimately improving patient outcomes.
心力衰竭是一种复杂的异质性疾病状态，影响着全球数百万人。近几十年来，药物治疗和设备应用方面的进展显著改变了心力衰竭的治疗结局，而成像技术的改进以及基因组测序的更广泛应用，使得人们越来越认识到不同的心力衰竭亚型。越来越多的证据表明，并非所有患者都能从强化指南指导的药物治疗（GDMT）中平等获益。使药物治疗个性化以最大化获益同时最小化副作用仍是一项持续的挑战。我们回顾了来自“慢性心力衰竭生物研究以实现个体化治疗”（BIOSTAT-CHF）的关键手稿，这是一项在欧洲开展的多中心观察性研究，前瞻性纳入了急性或失代偿性心力衰竭患者。
BIOSTAT-CHF旨在描述与患者对心力衰竭GDMT的不同反应相关的生物学途径。作者利用来自不同欧洲患者群体的数据，得以开发风险模型，通过临床可用数据以及标准和新型生物标志物来预测死亡率和心力衰竭住院情况。他们还利用建模来完善心力衰竭亚型的特征描述以及GDMT滴定的个性化。在本综述中，我们重点介绍了BIOSTAT-CHF队列的关键见解以及它们与以下方面的关系：（1）心力衰竭的预后和治疗反应监测，（2）心力衰竭治疗的个性化，（3）生物学途径的阐明及未来研究方向。这些见解总结了BIOSTAT-CHF如何有助于更深入地理解心力衰竭，重点在于利用生物标志物使治疗方法个性化，最终目标是改善患者结局。
