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Heart Failure: New Horizons in Its Pathomechanism and Treatment

A special issue of International Journal of Molecular Sciences (ISSN 1422-0067). This special issue belongs to the section "Molecular Pathology, Diagnostics, and Therapeutics".

Deadline for manuscript submissions: closed (29 February 2024) | Viewed by 2179

Special Issue Editor


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Guest Editor
Department of Clinical Therapeutics, National and Kapodistrian University of Athens Alexandra Hospital, Athens, Greece
Interests: cardiology; arrhythmias; heart failure; cardiotoxicity; atrial fibrillation

Special Issue Information

Dear Colleagues,

Heart failure is an extremely severe and complex syndrome that is pathophysiologically caused by the over-activation of three pillars: the renin–angiotensin–aldosterone system, the sympathetic nervous system, and inflammation. Although extensive research has been conducted regarding the development of therapeutic approaches for this problem, the morbidity and mortality rate remains high. According to current guidelines, the contemporaneous application of the angiotensin-converting enzyme inhibitor, the angiotensin-receptor blocker, the angiotensin receptor–neprilysin inhibitor, Beta-blocker, the mineralocorticoid receptor antagonist and Dapagliflozin/Empagliflozin must be employed. Although there has been a reduction in the hospitalization and morbidity rate, it remains high; thus, the enigma of heart failure has not been solved. In this respect, it is urgent that new pathways are searched for in order to obtain a holistic therapy for patients with chronic heart failure.

The gut microbiota is an emerging ‘organ’ that can interact with the human homeostatic system, including its metabolic state, inflammation, neurohumoral and drug resistance, etc. Therefore, we should pay attention to and endeavor to understand this emerging pathway. Indeed, it is well known that exercise and the Mediterranean diet affect the gut microbiota in a positive way, thus protecting the cardiovascular system and reducing the prevalence of cardiovascular disease.

Ultimately, heart failure is caused by a lack of energy. Energy is contributed by the mitochondria, organelles that merit our attention and research. The organelles involved in energy production are a source of free radical production and unfolded proteins, and the promotion of inflammation. Accordingly, inflammation and heart failure are intimately related, and the addition of novel therapeutic paths is necessary. Thus, if we can obtain knowledge pertaining to these new pathways, we can hope to discover novel therapeutic horizons and enhance treatment for our patients.

Prof. Dr. Ioannis A. Paraskevaidis
Guest Editor

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Keywords

  • arrhythmias
  • cardiology
  • angiotensin
  • cardiovascular disease
  • mitochondria
  • inflammation
  • heart failure

Published Papers (1 paper)

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Review

18 pages, 309 KiB  
Review
Beyond Quadruple Therapy and Current Therapeutic Strategies in Heart Failure with Reduced Ejection Fraction: Medical Therapies with Potential to Become Part of the Therapeutic Armamentarium
by Christos Kourek, Alexandros Briasoulis, Adamantia Papamichail, Andrew Xanthopoulos, Elias Tsougos, Dimitrios Farmakis and Ioannis Paraskevaidis
Int. J. Mol. Sci. 2024, 25(6), 3113; https://doi.org/10.3390/ijms25063113 - 7 Mar 2024
Viewed by 1970
Abstract
Heart failure with reduced ejection fraction (HFrEF) is a complex clinical syndrome with significant morbidity and mortality and seems to be responsible for approximately 50% of heart failure cases and hospitalizations worldwide. First-line treatments of patients with HFrEF, according to the ESC and [...] Read more.
Heart failure with reduced ejection fraction (HFrEF) is a complex clinical syndrome with significant morbidity and mortality and seems to be responsible for approximately 50% of heart failure cases and hospitalizations worldwide. First-line treatments of patients with HFrEF, according to the ESC and AHA guidelines, include β-blockers, angiotensin receptor/neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, and mineralocorticoid receptor antagonists. This quadruple therapy should be initiated during hospital stay and uptitrated to maximum doses within 6 weeks after discharge according to large multicenter controlled trials. Quadruple therapy improves survival by approximately 8 years for a 55-year-old heart failure patient. Additional therapeutic strategies targeting other signaling pathways such as ivabradine, digoxin, and isosorbide dinitrate and hydralazine combination for African Americans, as well as adjunctive symptomatic therapies, seem to be necessary in the management of HFrEF. Although second-line medications have not achieved improvements in mortality, they seem to decrease heart failure hospitalizations. There are novel medical therapies including vericiguat, omecamtiv mecarbil, genetic and cellular therapies, and mitochondria-targeted therapies. Moreover, mitraclip for significant mitral valve regurgitation, ablation in specific atrial fibrillation cases, omecamtiv mecarbil are options under evaluation in clinical trials. Finally, the HeartMate 3 magnetically levitated centrifugal left ventricular assist device (LVAD) has extended 5-year survival for stage D HF patients who are candidates for an LVAD. Full article
(This article belongs to the Special Issue Heart Failure: New Horizons in Its Pathomechanism and Treatment)
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