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- Komajda Michel
- Department of Cardiology, Pitie-Salpetriere Hospital, Pierre & Marie Curie University (ICAN)
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The management of chronic heart failure (HF) with low ejection fraction (EF) has changed considerably over the past 30 years: the introduction of angiotensin-converting enzyme inhibitors (ACEIs), β-blockers, angiotensin-receptor blockers, mineralocorticoid-receptor antagonists and recently, the Ifblocker, ivabradine, has led to a significant reduction in overall mortality and HF mortality. Recently, a trial testing a dual inhibitor blocking the angiotensin-II receptor and neprylisin, the enzyme responsible for B-type natriuretic peptide degradation, showed that this complex molecule improved clinical outcomes compared with the ACEI enalapril. However, challenges remain in the management of HF, with suboptimal implementation of guideline-recommended therapies, a changing profile of patients who are older and have multiple comorbidities and a high rate of early rehospitalization for HF. Use of devices such as implantable cardiac defibrillators and cardiac resynchronization therapy are also associated with an improvement in outcomes in this condition. HF with preserved EF (HFpEF), a growing fraction of the HF population, remains a clinical dilemma: no pharmacological intervention has so far demonstrated any convincing benefit on outcome. Heterogeneity of the populations tested, role of comorbidities, difficulties in identifying patients with HFpEF, as well as a mismatch between the clinical phenotypes and the treatments tested, can explain the failure to find beneficial interventions. Overall, the management of HF after discharge remains fragmented and concerted action by all professionals concerned is needed. (Circ J 2015; 79: 948–953)
収録刊行物
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- Circulation Journal
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Circulation Journal 79 (5), 948-953, 2015
一般社団法人 日本循環器学会
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詳細情報
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- CRID
- 1390282680085707136
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- NII論文ID
- 130005066279
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- NII書誌ID
- AA11591968
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- ISSN
- 13474820
- 13469843
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- NDL書誌ID
- 026342471
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- PubMed
- 25877621
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- 本文言語コード
- en
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- データソース種別
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- JaLC
- NDL
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- PubMed
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