What Are the Keys to Hemodynamic Improvement in Heart Failure Patients?

摘要

Heart failure diagnosis has been growing world-wide during the last decade [1] because of population aging and because improved treatment for acute cardiac events prevents some early deaths, thus leading to chronic disease [2]. Cases of heart failure world-wide have been estimated to be as high as 22.5 million people (6.5 million of them in Europe and 4.8 million in the United States). The incidence of new cases has been calculated at 2 000 000 new patients per year (470 000 in Europe and 480 000 in the United States). Drug therapy may be effective in improving symptoms and survival [3-5], but the long-term prognosis of patients with heart failure is severely affected by the high incidence of progressive refractory heart dysfunction and sudden cardiac death [6]. Myocardial revasculariza-tion (through either percutaneous techniques or coronary artery bypass graft), valve disease surgery, and prevention and surgical treatment of congenital heart disease may play a major role in selected patients. Heart transplantation represents the gold standard for end-stage heart failure, but it cannot be made available to large populations. More recently, cardiac resynchronization therapy through atrio-biventricular pacing has been introduced with the aim of improving the electromechanical activation pattern of the heart [7,8].