Rev Prat. 2020 Nov;70(9):977-982.
ABSTRACT
New treatments for systolic heart failure. Cardioprotective pharmacological treatments, cardiac resynchronization and defibrillators, percutaneous interventional and surgical treatments have led to a dramatic improvement in survival, quality of life and decrease of hospitalizations of heart failure (HF) patients. At the same time, major diagnostic progress has been made in imaging and genetics, allowing early etiological diagnosis and the implementation of preventive or curative strategies before irreversible cardiac remodeling. However, morbidity and mortality remain significant at the most advanced stages when the pathophysiological processes responsible for the alteration of cardiac function cannot be prevented or effectively reversed. After a prolific period during the 1980's - 2000's when therapeutic trials laid the foundations for modern cardioprotective treatment, they then stalled for about ten years with the failure of many new molecules that did not demonstrate a reduction in mortality. But since 2010, new molecules acting on complementary pathophysiological processes have been showing positive results. Recalling the recommended algorithm for optimizing the treatment of HF, we discuss in this article the mechanisms of action and the results of the latest clinical trials with SGLT2 inhibitors (gliflozines), vericiguat and percutaneous treatment of functional mitral regurgitation that will in the very short term modify the prescriptions of our HF patients.
PMID:33739754