Emerging role of serelaxin in the therapeutic armamentarium for heart failure

Serelaxin, recombinant human relaxin-2, for heart failure patients: A systematic review and meta-analysis

BACKGROUND

Serelaxin, recombinant human relaxin-2, is a hormone with vasodilatory and end-organ protective effects. Recently, it has been licensed to treat acute decompensated heart failure. Here, a systematic review and meta-analysis on randomized controlled trials (RCTs) was performed to assess the effect of serelaxin on mortality and dyspnea improvement in patients with heart failure.

METHODS

RCTs comparing serelaxin treatment to other heart failure treatments were searched in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. The main endpoints were mortality and dyspnea improvement. Pooled data were assessed by using a random effects model.

RESULTS

A total of 451 studies were identified, of which 8 studies (8477 participants) were eligible and included in our analysis. Compared with other heart failure treatment group, serelaxin group had no effect on 30-day, 60-day, and 180-day mortality (OR, 0.79; 95% CI, 0.65-0.96). Compared with control group, there was no effect on dyspnea improvement.

CONCLUSION

Serelaxin treatment is irrelevant with the mortality, and it cannot improve dyspnea of heart failure patients.

Combined Assessment of Relaxin and B-Type Natriuretic Peptide Improves Diagnostic Value in Patients With Congestive Heart Failure

BACKGROUND

To improve the poor prognosis of congestive heart failure (CHF), early and accurate diagnosis is necessary. Relaxin is an endogenous cardiovascular peptide, and its plasma level is usually increased in patients with CHF. In this pilot study, we aimed to determine the diagnostic value of relaxin and B-type natriuretic peptide (BNP) in patients with and without CHF.

MATERIALS AND METHODS

The plasma level of relaxin was measured by enzyme-linked immunosorbent assay and plasma level of BNP by fluorescence immunoassay. The area under the receiver operating characteristic curve was used to assess the diagnostic value of relaxin and BNP.

RESULTS

We included 81 patients with decompenstated CHF and 36 controls. Plasma levels of relaxin and BNP were both higher in CHF patients than in controls. The correlation between plasma levels of relaxin and BNP and between relaxin or BNP and cardiac function was nonlinear. Relaxin had medium diagnostic value, and BNP had higher value for cardiac function and CHF. At a cutoff of 39.76pg/mL relaxin, sensitivity was 82.7%, specificity 55.6%, sum of the highest positive predictive value 80.5% and negative predictive value 58.8%. Although the diagnostic value was not better for relaxin than BNP, their combined assessment improved the sensitivity and specificity of diagnosis for CHF as compared with BNP alone.

CONCLUSIONS

Combined assessment of relaxin and BNP may improve the diagnosis of decompensated CHF, which may have potential application in the clinic.

Novel therapeutic strategies targeting fibroblasts and fibrosis in heart disease

Our understanding of the functions of cardiac fibroblasts has moved beyond their roles in heart structure and extracellular matrix generation and now includes their contributions to paracrine, mechanical and electrical signalling during ontogenesis and normal cardiac activity. Fibroblasts also have central roles in pathogenic remodelling during myocardial ischaemia, hypertension and heart failure. As key contributors to scar formation, they are crucial for tissue repair after interventions including surgery and ablation. Novel experimental approaches targeting cardiac fibroblasts are promising potential therapies for heart disease. Indeed, several existing drugs act, at least partially, through effects on cardiac connective tissue. This Review outlines the origins and roles of fibroblasts in cardiac development, homeostasis and disease; illustrates the involvement of fibroblasts in current and emerging clinical interventions; and identifies future targets for research and development.