Journal of Cardiac Failure,
Год журнала:
2023,
Номер
30(4), С. 525 - 537
Опубликована: Окт. 9, 2023
BackgroundSTRONG-HF
demonstrated
the
safety
and
efficacy
of
rapid
up-titration
guideline-directed
medical
therapy
(GDMT)
with
high
intensity
care
(HIC)
compared
to
usual
in
patients
hospitalized
for
acute
heart
failure
(HF).
In
HIC
group,
following
indicators
were
used
guide
up-titration:
estimated
glomerular
filtration
rate
[eGFR]
<30ml/min/1.73m2,
serum
potassium
>5.0
mmol/L,
systolic
blood
pressure
(SBP)
<95mmHg,
<55bpm,
NT-proBNP
concentration
>10%
higher
than
pre-discharge
values.MethodsWe
examined
impact
protocol-specified
on
achieved
dose
GDMT
clinical
outcomes.ResultsThree-hundred-thirteen
542
arm
(57.7%)
met
at
least
one
indicator
any
follow-up
visit
1
6
weeks
after
discharge.
As
those
without,
meeting
had
more
severe
HF
symptoms,
lower
SBP
baseline
a
average
percentage
optimal
doses
(mean
difference
vs
not
reaching
indicator,
-11.0%
[95%
CI
-13.6
-8.4%],
P<0.001).
The
primary
endpoint
180-day
all-cause
death
or
re-admission
occurred
15.0%
versus
14.2%
without
(adjusted
hazard
ratio
[HR]
0.84,
95%
0.48
1.46,
P=0.540).
None
each
considered
alone,
was
significantly
associated
endpoint,
but
<
95mmHg
trend
towards
increased
180
days
mortality
HR
=
2.68
[0.94
7.64];
P
0.065)
eGFR
drop
30ml/min/1.73m2
readmissions
3.60
[1.22
10.60];
p
0.0203).
occurrence
smaller
90-day
improvement
EQ-5D
VAS
mean
-3.32
points,
-5.97
-0.66,
P=0.015).ConclusionsAmong
enrolled
STRONG-HF
arm,
administration
slightly
less
quality
life
no
significant
increase
outcome
readmission
when
appropriately
addressed
according
study
protocol.
New England Journal of Medicine,
Год журнала:
2022,
Номер
386(21), С. 2024 - 2034
Опубликована: Май 25, 2022
Gliflozins
—
sodium–glucose
cotransporter
2
inhibitors
lower
blood
glucose
and
glycated
hemoglobin
in
patients
with
type
diabetes
without
causing
hypoglycemia.
The
agents
also
improve
cardiac
function
who
have
heart
failure
or
renal
function,
few
adverse
effects.
Cell Death Discovery,
Год журнала:
2023,
Номер
9(1)
Опубликована: Июль 21, 2023
Abstract
Diabetic
cardiomyopathy
(DCM)
mainly
refers
to
myocardial
metabolic
dysfunction
caused
by
high
glucose,
and
hyperglycemia
is
an
independent
risk
factor
for
cardiac
function
in
the
absence
of
coronary
atherosclerosis
hypertension.
DCM,
which
a
severe
complication
diabetes,
has
become
leading
cause
heart
failure
diabetic
patients.
The
initial
symptoms
are
inconspicuous,
patients
gradually
exhibit
left
ventricular
eventually
develop
total
failure,
brings
great
challenge
early
diagnosis
DCM.
To
date,
underlying
pathological
mechanisms
DCM
complicated
have
not
been
fully
elucidated.
Although
there
therapeutic
strategies
available
treatment
focused
on
controlling
blood
glucose
lipids,
lack
effective
drugs
targeting
injury.
Thus,
large
percentage
with
inevitably
failure.
Given
neglected
symptoms,
intricate
cellular
molecular
mechanisms,
drugs,
it
necessary
explore
diagnostic
biomarkers,
further
understand
signaling
pathways
involved
pathogenesis
summarize
current
strategies,
new
targeted
interventions.
Journal of Diabetes and its Complications,
Год журнала:
2023,
Номер
37(2), С. 108389 - 108389
Опубликована: Янв. 3, 2023
Increasing
rates
of
obesity
and
diabetes
have
driven
corresponding
increases
in
related
cardiorenal
metabolic
diseases.In
many
patients,
these
conditions
occur
together,
further
increasing
morbidity
mortality
risks
to
the
individual.Yet
all
too
often,
risk
factors
for
disorders
are
not
addressed
promptly
clinical
practice,
leading
irreversible
pathologic
progression.To
address
this
gap,
we
convened
a
Task
Force
experts
cardiology,
nephrology,
endocrinology,
primary
care
develop
recommendations
early
identification
intervention
obesity,
diabetes,
other
diseases.The
include
screening
diagnosis,
interventions
with
lifestyle,
when
how
implement
medical
therapies.These
organized
into
secondary
prevention
along
continuum
from
through
syndrome,
prediabetes,
hypertension,
dyslipidemia,
nonalcoholic
fatty
liver
disease
(NAFLD),
atherosclerotic
cardiovascular
(ASCVD)
atrial
fibrillation,
chronic
kidney
(CKD),
heart
failure
(HF).The
goal
intensive
is
comorbidities
or
decrease
worsening
reduce
mortality.These
efforts
will
inertia
may
improve
patients'
well-being
adherence.
ESC Heart Failure,
Год журнала:
2024,
Номер
unknown
Опубликована: Май 28, 2024
Abstract
In
the
last
years,
major
progress
has
occurred
in
heart
failure
(HF)
management.
The
2023
ESC
focused
update
of
2021
HF
guidelines
introduced
new
key
recommendations
based
on
results
years
science.
First,
two
drugs,
sodium–glucose
co‐transporter‐2
(SGLT2)
inhibitors
and
finerenone,
a
novel
nonsteroidal,
selective
mineralocorticoid
receptor
antagonist
(MRA),
are
recommended
for
prevention
patients
with
diabetic
chronic
kidney
disease
(CKD).
Second,
SGLT2
now
treatment
across
entire
left
ventricular
ejection
fraction
spectrum.
benefits
quadruple
therapy
reduced
(HFrEF)
well
established.
Its
rapid
early
up‐titration
along
close
follow‐up
frequent
clinical
laboratory
re‐assessment
after
an
episode
acute
(the
so‐called
‘high‐intensity
care’
strategy)
was
associated
better
outcomes
STRONG‐HF
trial.
Patients
experiencing
worsening
might
require
fifth
drug,
vericiguat.
STEP‐HFpEF‐DM
STEP‐HFpEF
trials,
semaglutide
2.4
mg
once
weekly
administered
1
year
decreased
body
weight
significantly
improved
quality
life
6
min
walk
distance
obese
preserved
(HFpEF)
or
without
history
diabetes.
Further
data
safety
efficacy,
including
also
hard
endpoints,
needed
to
support
addition
acetazolamide
hydrochlorothiazide
standard
diuretic
regimen
hospitalized
due
HF.
meantime,
PUSH‐AHF
supported
use
natriuresis‐guided
therapy.
options
most
recent
evidence
HF,
specific
drugs
cardiomyopathies
(i.e.,
mavacamten
hypertrophic
cardiomyopathy
tafamidis
transthyretin
cardiac
amyloidosis),
device
therapies,
contractility
modulation
percutaneous
valvulopathies,
finding
from
TRILUMINATE
Pivotal
trial,
reviewed
this
article.
Biomedicines,
Год журнала:
2025,
Номер
13(3), С. 608 - 608
Опубликована: Март 3, 2025
Sodium-glucose
cotransporter-2
inhibitors
(SGLT2i),
initially
developed
as
antihyperglycemic
agents,
have
revolutionized
heart
failure
(HF)
management,
offering
substantial
benefits
across
all
stages
and
phenotypes
of
the
disease.
Regardless
left
ventricular
ejection
fraction
(LVEF),
these
agents
proven
efficacy
in
both
chronic
acute
HF
presentations.
This
review
explores
SGLT2i
applications
spanning
continuum,
from
early
(Stage
A)
at-risk
individuals
to
mitigation
progression
advanced
D).
Evidence
numerous
trials
has
shown
that
significantly
lower
rates
hospitalization,
improve
renal
function,
decreases
cardiovascular
mortality,
highlighting
their
multifaced
mechanisms
action
care.
also
highlights
potential
by
which
exert
beneficial
effects
on
systems,
each
contributing
sustained
clinical
improvements.
However,
integration
into
guideline-directed
medical
therapy
poses
practical
challenges,
including
initiation
timing,
dosing,
monitoring,
are
addressed
support
effective
treatment
adaptation
patient
populations.
Ultimately,
this
provides
a
comprehensive
assessment
foundational
HF,
emphasizing
role
an
intervention
multiple
aimed
at
improving
outcomes
entire
spectrum.
