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Cotter G, Davison B, Cohen-Solal A, Freund Y, Mebazaa A. Targeting the 'vulnerable' period - first 3-6 months after an acute heart failure admission - the light gets brighter. Eur J Heart Fail 2023; 25:30-34. [PMID: 36519644 DOI: 10.1002/ejhf.2754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/07/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Gad Cotter
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France.,Momentum Research Inc, Durham, North Carolina, USA
| | - Beth Davison
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France.,Momentum Research Inc, Durham, North Carolina, USA
| | - Alain Cohen-Solal
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France.,Department of Cardiology, Lariboisière University hospital, Assistance Publique Hopitaux de Paris, Paris, France
| | - Yonathan Freund
- Sorbonne Université, INSERM UMRS 1166, IHU ICAN, Paris, France.,Emergency Department, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alexandre Mebazaa
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France.,Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, Paris, France
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Kalyuzhin VV, Teplyakov AT, Bespalova ID, Kalyuzhina EV, Terentyeva NN, Grakova EV, Kopeva KV, Usov VY, Garganeeva NP, Pavlenko OA, Gorelova YV, Teteneva AV. Promising directions in the treatment of chronic heart failure: improving old or developing new ones? BULLETIN OF SIBERIAN MEDICINE 2022. [DOI: 10.20538/1682-0363-2022-3-181-197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Unprecedented advances of recent decades in clinical pharmacology, cardiac surgery, arrhythmology, and cardiac pacing have significantly improved the prognosis in patients with chronic heart failure (CHF). However, unfortunately, heart failure continues to be associated with high mortality. The solution to this problem consists in simultaneous comprehensive use in clinical practice of all relevant capabilities of continuously improving methods of heart failure treatment proven to be effective in randomized controlled trials (especially when confirmed by the results of studies in real clinical practice), on the one hand, and in development and implementation of innovative approaches to CHF treatment, on the other hand. This is especially relevant for CHF patients with mildly reduced and preserved left ventricular ejection fraction, as poor evidence base for the possibility of improving the prognosis in such patients cannot justify inaction and leaving them without hope of a clinical improvement in their condition. The lecture consistently covers the general principles of CHF treatment and a set of measures aimed at inotropic stimulation and unloading (neurohormonal, volumetric, hemodynamic, and immune) of the heart and outlines some promising areas of disease-modifying therapy.
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Affiliation(s)
| | - A. T. Teplyakov
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
| | | | | | | | - E. V. Grakova
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
| | - K. V. Kopeva
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
| | - V. Yu. Usov
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
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Pagnesi M, Butler J, Metra M. Ejection fraction in heart failure: just become Emperor's new clothes? Eur J Heart Fail 2021; 24:351-352. [PMID: 34894037 DOI: 10.1002/ejhf.2399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Cotter G, Davison BA, Mebazaa A, Takagi K, Novosadova M, Freund Y, Cohen-Solal A. Medical Therapy of Heart Failure with Reduced Ejection Fraction-A Call for Comparative Research. J Clin Med 2021; 10:1803. [PMID: 33919005 PMCID: PMC8122403 DOI: 10.3390/jcm10091803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 12/11/2022] Open
Abstract
The armamentarium of therapies for patients with heart failure and reduced ejection fraction (HFREF) has increase substantially with the introduction of Angiotensin Receptor Neprilysin Inhibitor (ARNi), sodium glucose cotransport inhibitors (SGLTis), ivabradine, and Vericinguat, bringing to seven the number of potential therapies for HFREF. In the current review we highlight available data on the different classes of medications. Renin angiotensin blockers (RAASbs) and beta blockers (BBs) were shown to have very substantial effects in patients with HFREF. These medications are generic and hence relatively inexpensive. They have a 30-year track record of relatively benign short- and long-term safety profiles and should remain the cornerstone of therapy for patients with HFREF. ARNis are effective in further reducing adverse effects and should replace RAASbs in symptomatic HFREF patients, despite their relatively high prices. The addition of SGLTis (congested patients), Ivabradine (tachycardic patients), and Vericinguat (hypertensive patients) should be considered in patients who remain symptomatic despite optimal doses of RAASbs/ARNis, MRAs, and BBs. Comparative studies examining the efficacy of these medications, and strategies and prioritizing some over others should be considered as, given their similar side effects on heart rate, blood pressure, and renal function, it is highly unlikely that all can be given to the same patient.
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Affiliation(s)
- Gad Cotter
- Momentum Research, Inc., 50101 Governors Drive, Chapel Hill, NC 27517, USA; (B.A.D.); (K.T.); (M.N.)
- Inserm U942-MASCOT, 75010 Paris, France;
| | - Beth A. Davison
- Momentum Research, Inc., 50101 Governors Drive, Chapel Hill, NC 27517, USA; (B.A.D.); (K.T.); (M.N.)
- Inserm U942-MASCOT, 75010 Paris, France;
| | - Alexandre Mebazaa
- Inserm U942-MASCOT, 75010 Paris, France;
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Saint Louis Lariboisière University Hospitals, 75010 Paris, France
- School of Medicine, Université de Paris, 75010 Paris, France
| | - Koji Takagi
- Momentum Research, Inc., 50101 Governors Drive, Chapel Hill, NC 27517, USA; (B.A.D.); (K.T.); (M.N.)
| | - Maria Novosadova
- Momentum Research, Inc., 50101 Governors Drive, Chapel Hill, NC 27517, USA; (B.A.D.); (K.T.); (M.N.)
| | - Yonathan Freund
- School of Medicine, Sorbonne University, 75005 Paris, France;
- Emergency Department, Hopital Pitié-Salpêtrière, 75013 Paris, France
| | - Alain Cohen-Solal
- Service de Cardiologie, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010 Paris, France;
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