Rassegnein tema di terapia dello scompenso cardiaco

During the last years, the results of several trials on heart failure treatment were published or presented at international meetings. The new perspectives concern drug therapy and non-pharmacological strategies, such as cardioverter-defibrillators, biventricular resynchronization and implantable assist devices. Trials on beta-blockers extended the indication to patients with advanced heart failure, but the choice of the “best” beta-blocker to use remains an unsolved issue. Moreover, the concomitant use of ACE-inhibitors and angiotensin II receptor antagonists is a recent acquisition. However, the Val-HeFT results underscored that the add-on hypothesis of a more complete inhibition obtained with the combination of multiple agents was not confirmed in patients already taking ACE-inhibitors and beta-blockers. Regarding the new neurohormonal modulators (omapatrilat, etanercept, endothelin receptor blockers, arginine-vasopressin antagonists), more data are needed before using them in clinical practice. After the publication of the MADIT-II results, the cardioverter-defibrillator implantation will probably spread in patients with previous myocardial infarction and left ventricular dysfunction to prevent sudden death, but the cost-effectiveness ratio is still to be clarified. In the advanced or end-stage heart failure, when the improvement of quality of life represents the main target of therapy, ventricular resynchronization and implantable assist devices may play a role in clinical settings. Before considering them like a real therapeutic option, final results from ongoing investigations should be awaited.