1,721,116 research outputs found
Left ventricular reverse remodeling prediction in non-ischemic cardiomyopathy: present and perspectives
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Linee guida sullo scompenso cardiaco a confronto: AHA 2022 versus ESC 2021
No full textNell’ultimo decennio la pubblicazione di plurimi trial clinici randomizzati, dedicati allo studio di nuove molecole terapeutiche nell’ambito dello scompenso cardiaco (SC), ha rivoluzionato il trattamento di questa patologia, mettendo a disposizione del cardiologo un ricco armamentario terapeutico. Sacubitril/ valsartan, empagliflozin e dapagliflozin hanno dimostrato di ridurre significativamente il rischio di mortalità/ospedalizzazioni nei pazienti con SC e frazione di eiezione (FE) ≤40%; vericiguat e omecamtiv mecarbil si sono rivelati armi utili nel paziente con recente peggioramento dello SC nonostante terapia medica ottimizzata riducendo ulteriormente il rischio di ospedalizzazioni per SC; empagliflozin ha comprovato la sua efficacia nel ridurre il rischio di ospedalizzazioni per SC anche nei pazienti con FE >40%. Si è così allargato lo spettro di farmaci utili per lo SC in aggiunta a betabloccanti (BB), inibitori dell’enzima di conversione dell’angiotensina (ACEi), antagonisti recettoriali dell’angiotensina (ARB) e antagonisti del recettore dei mineralcorticoidi (MRA), storico caposaldo della terapia medica dello SC con FE ridotta. Innovativi dispositivi impiantabili e nuove evidenze nell’ambito della cardiologia interventistica hanno ripuntualizzato la terapia non farmacologica dello SC. La sfida attuale risiede nel dare ordine e corretta priorità alle varie risorse disponibili. In tal senso la Società Europea di Cardiologia (ESC) e l’American Heart Association (AHA) hanno provveduto a stilare nuove linee guida per il trattamento dello SC al fine di fornire indicazioni pratiche per la gestione di tale patologia alla luce delle nuove evidenze disponibili. Se complessivamente i “take home messages” sono sovrapponibili tra le due linee guida, su alcuni punti non trascurabili le due Società prendono posizione diversa. Questo articolo è volto a sollevare affinità e discordanze tra le due linee guida
Evidence-based Therapy in Older Patients with Heart Failure with Reduced Ejection Fraction
Full text linkOlder patients are becoming prevalent among people with heart failure (HF) as the overall population ages. However, older patients are largely under-represented, or even excluded, from randomised controlled trials on HF with reduced ejection fraction, limiting the generalisability of trial results in the real world and leading to weaker evidence supporting the use and titration of guideline-directed medical therapy (GDMT) in older patients with HF with reduced ejection fraction. This, in combination with other factors limiting the application of guideline recommendations, including a fear of poor tolerability or adverse effects, the heavy burden of comorbidities and the need for multiple therapies, classically leads to lower adherence to GDMT in older patients. Although there are no data supporting the under-use and under-dosing of HF medications in older patients, large registry-based studies have confirmed age as one of the major obstacles to treatment optimisation. In this review, the authors provide an overview of the contemporary state of implementation of GDMT in older groups and the reasons for the lower use of treatments, and discuss some measures that may help improve adherence to evidence-based recommendations in older age groups
Ventriculo-arterial uncoupling in acute heart failure: right heart is the matter
No full textRight ventricular dysfunction and pulmonary hypertension are frequently observed in chronic (heart failure) and acute heart failure (AHF), and are associated with worse outcomes
Dilated cardiomyopathy: Dilated cardiomyopathy: Clinical assessment and differential diagnosis
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Authors reply: "Does extracorporeal cardiopulmonary resuscitation improve survival with favorable neurological outcome in out-of-hospital cardiac arrest? A systematic review and meta-analysis"
No full textextracorporeal cardiopulmonary resuscitatio
Combining New Classes of Drugs for HFrEF: from Trials to Clinical Practice
No full textPharmacological approach to heart failure with reduced ejection fraction (HFrEF) is evolving, as recently published large randomized clinical trials have implemented the disposal of HFrEF treatments with four new classes of drugs, namely angiotensin receptor/neprilysin inhibitor , sodium-glucose co-transporters 2 inhibitors , soluble guanylate cyclase modulators and myosin activators, which have proved to further improve patients' quality of life and long-term outcomes. As these novel drugs target additional pathways not already intercepted by the guideline-directed medical therapy, integration of them in the management of HFrEF is desirable. This review paper aims to provide an overview of the current evolving concepts of HFrEF therapy joining the most recent evidences and to furnish practical suggestions for the use of these new classes of drugs in clinical practice
Does extracorporeal cardiopulmonary resuscitation improve survival with favorable neurological outcome in out-of-hospital cardiac arrest? A systematic review and meta-analysis
Full text linkPurpose: Extracorporeal cardiopulmonary resuscitation (E-CPR) may improve survival with favorable neurological outcome in patients with refractory out-of-hospital cardiac arrest (OHCA). Unfortunately, recent results from randomized controlled trials were inconclusive. We performed a meta-analysis to investigate the impact of E-CPR on neurological outcome compared to conventional cardiopulmonary resuscitation (C-CPR). Methods: A systematic research for articles assessing outcomes of adult patients with OHCA either treated with E-CPR or C-CPR up to April 27, 2023 was performed. Primary outcome was survival with favorable neurological outcome at discharge or 30 days. Overall survival was also assessed. Results: Eighteen studies were included. E-CPR was associated with better survival with favorable neurological status at discharge or 30 days (14% vs 7%, OR 2.35, 95% CI 1.61-3.43, I2 = 80%, p < 0.001, NNT = 17) than C-CPR. Results were consistent if the analysis was restricted to RCTs. Overall survival to discharge or 30 days was also positively affected by treatment with E-CPR (OR = 1.71, 95% CI = 1.18-2.46, I2 = 81%, p = 0.004, NNT = 11). Conclusions: In this meta-analysis, E-CPR had a positive effect on survival with favorable neurological outcome and, to a smaller extent, on overall mortality in patients with refractory OHCA
From mid-range to mildly reduced ejection fraction heart failure: A call to treat
No full textThe historical classification of heart failure (HF) has considered two distinct subgroups, HF with reduced ejection fraction (HFrEF), generally classified as EF below 40%, and HF with preserved ejection fraction (HFpEF) variably classified as EF above 40%, 45% or 50%. One of the principal reasons behind this distinction was related to presence of effective therapy in HFrEF, but not in HFpEF. Recently the expanding knowledge in the specific subgroup of patient with a LVEF between 41% and 49% and the potential benefit of new therapies and of those used in patients with LVEF below 40%, has led to rename this group as HF with mildly reduced EF (HFmrEF). In this review we discuss the reasons behind this modification, we summarize the main characteristics of HFmrEF the similarities and differences with the two other EF categories, and finally we provide a comprehensive overview of the current available evidence supporting the treatment of patients with HFmrEF
Pathophysiology of dilated cardiomyopathy: from mechanisms to precision medicine
No full textDilated cardiomyopathy (DCM) is a complex disease with multiple causes and various pathogenic mechanisms. Despite improvements in the prognosis of patients with DCM in the past decade, this condition remains a leading cause of heart failure and premature death. Conventional treatment for DCM is based on the foundational therapies for heart failure with reduced ejection fraction. However, increasingly, attention is being directed towards individualized treatments and precision medicine. The ability to confirm genetic causality is gradually being complemented by an increased understanding of genotype-phenotype correlations. Non-genetic factors also influence the onset of DCM, and growing evidence links genetic background with concomitant non-genetic triggers or precipitating factors, increasing the extreme complexity of the pathophysiology of DCM. This Review covers the spectrum of pathophysiological mechanisms in DCM, from monogenic causes to the coexistence of genetic abnormalities and triggering environmental factors (the 'two-hit' hypothesis). The roles of common genetic variants in the general population and of gene modifiers in disease onset and progression are also discussed. Finally, areas for future research are highlighted, particularly novel therapies, such as small molecules, RNA and gene therapy, and measures for the prevention of arrhythmic death
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