心力衰竭药物治疗：新进展与展望

王华; 杨杰孚

doi:10.13201/j.issn.1001-1439.2025.02.001

心力衰竭药物治疗：新进展与展望

王华¹,
杨杰孚^1, ,

- 北京医院心内科国家老年医学中心中国医学科学院老年研究院(北京，100730)

详细信息

通讯作者: 杨杰孚，E-mail：yangjiefu2011@126.com

中图分类号: R541.6

收稿日期: 2025-01-16

刊出日期: 2025-02-13

Drug therapy for heart failure: new progress and prospects

WANG Hua¹,
YANG Jiefu^1, ,

- Department of Cardiology, Beijing Hospital, National Geriatric Center, Institute of Geriatrics, Chinese Academy of Medical Sciences, Beijing, 100730, China

More Information

Corresponding author: YANG Jiefu, E-mail: yangjiefu2011@126.com

Received Date: 16 January 2025

Publish Date: 13 February 2025

摘要

摘要: 近年来心力衰竭(心衰)药物治疗领域有诸多进展。神经内分泌抑制剂方面，血管紧张素受体脑啡肽酶抑制剂降低心衰事件和肾功能恶化风险；新型非甾体类盐皮质激素受体拮抗剂非奈利酮降低左室射血分数≥40%的心衰患者心衰恶化和心血管死亡风险。改善代谢的药物如钠葡萄糖共转运蛋白2抑制剂和胰高血糖素样肽-1受体激动剂在心衰中的获益不断被证实，特别是钠葡萄糖共转运蛋白2抑制剂已被用于全射血分数心衰。作用于细胞信号通路的药物如维立西呱改善射血分数减低心衰患者预后。中药芪苈强心胶囊临床研究取得重要进展，使射血分数减低心衰患者心血管死亡或心衰恶化风险降低。基于这些治疗进展，指南不断更新，遵循指南规范用药才能更好改善心衰患者预后。
- 心力衰竭 /
- 药物治疗 /
- 规范化
Abstract: In recent years, there have been numerous advancements in the field of pharmacological treatment for heart failure(HF). Angiotensin receptor neprilysin inhibitors have been proven to reduce the risk of HF events and deterioration of renal function. The novel non-steroidal mineralocorticoid receptor antagonist, finerenone, lowers the risk of HF worsening and cardiovascular death in patients with left ventricular ejection fraction ≥ 40%. The benefits of metabolic-improving drugs such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in HF are constantly being confirmed. Particularly, sodium-glucose co-transporter 2 inhibitors have been utilized in HF with all ejection fractions. Vericiguat, a drug targeting cellular signaling pathways, has been shown to improve the prognosis of patients with HF with reduced ejection fraction. Notably, significant progress has been achieved in a randomized controlled study of the traditional Chinese medicine, Qiliqiangxin Capsule, which has been proven to reduce the risk of cardiovascular death or HF deterioration in patients with HF with reduced ejection fraction. Based on these therapeutic advancements, guidelines are constantly updated, and it is necessary to follow the guidelines for proper medication use to improve the prognosis of patients with HF.
- heart failure /
- medication /
- standardization

HTML全文

参考文献(31)

[1]	Wang H, Chai K, Du M, et al. Prevalence and incidence of heart failure among urban patients in china: a national population-based analysis[J]. Circ Heart Fail, 2021, 14(10): e008406. doi: 10.1161/CIRCHEARTFAILURE.121.008406
[2]	Wang H, Li Y, Chai K, et al. Mortality in patients admitted to hospital with heart failure in China: a nationwide Cardiovascular Association Database-Heart Failure Centre Registry cohort study[J]. Lancet Glob Health, 2024, 12(4): e611-e622. doi: 10.1016/S2214-109X(23)00605-8
[3]	McMurray JJ, Packer M, Desai AS, et al. PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure[J]. N Engl J Med, 2014, 371(11): 993-1004. http://europepmc.org/abstract/MED/25176015
[4]	中华医学会全科医学分会, 中华医学会《中华全科医师杂志》编辑委员会, 中国老年医学学会心电与心功能分会, 等. 中国心力衰竭基层诊疗与管理指南(2024年)[J]. 中华全科医师杂志, 2024, 23(6): 549-577. doi: 10.3760/cma.j.cn114798-20231227-00476
[5]	Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction[J]. N Engl J Med, 2019, 381(17): 1609-1620. doi: 10.1056/NEJMoa1908655
[6]	Mentz RJ, Ward JH, Hernandez AF, et al. Angiotensin-neprilysin inhibition in patients with mildly reduced or preserved ejection fraction and worsening heart failure[J]. J Am Coll Cardiol, 2023, 82(1): 1-12. doi: 10.1016/j.jacc.2023.04.019
[7]	Vaduganathan M, Mentz RJ, Claggett BL, et al. Sacubitril/valsartan in heart failure with mildly reduced or preserved ejection fraction: a pre-specified participant-level pooled analysis of PARAGLIDE-HF and PARAGON-HF[J]. Eur Heart J, 2023, 44(31): 2982-2993. doi: 10.1093/eurheartj/ehad344
[8]	Agarwal R, Filippatos G, Pitt B, et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis[J]. Eur Heart J, 2022, 43(6): 474-484. doi: 10.1093/eurheartj/ehab777
[9]	Solomon SD, McMurray JJV, Vaduganathan M, et al. Finerenone in heart failure with mildly reduced or preserved ejection fraction[J]. N Engl J Med, 2024, 391(16): 1475-1485. doi: 10.1056/NEJMoa2407107
[10]	Marassi M, Fadini GP. The cardio-renal-metabolic connection: a review of the evidence[J]. Cardiovasc Diabetol, 2023, ;22(1): 195. doi: 10.1186/s12933-023-01937-x
[11]	Velliou M, Polyzogopoulou E, Ventoulis I, et al. Clinical pharmacology of SGLT-2 inhibitors in heart failure[J]. Expert Rev Clin Pharmacol, 2023, 16(2): 149-160. doi: 10.1080/17512433.2023.2173574
[12]	Joshi SS, Singh T, Newby DE, et al Sodium-glucose co-transporter 2 inhibitor therapy: mechanisms of action in heart failure[J]. Heart, 2021, 107(13): 1032-1038.
[13]	Solomon J, Festa MC, Chatzizisis YS, et al. Sodium-glucose co-transporter 2 inhibitors in patients with chronic kidney disease[J]. Pharmacol Ther, 2023, 242: 108330. doi: 10.1016/j.pharmthera.2022.108330
[14]	Herrington WG, Savarese G, Haynes R, et al. Cardiac, renal, and metabolic effects of sodium-glucose co-transporter 2 inhibitors: a position paper from the European Society of Cardiology ad-hoc task force on sodium-glucose co-transporter 2 inhibitors[J]. Eur J Heart Fail, 2021, 23(8): 1260-1275. doi: 10.1002/ejhf.2286
[15]	McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction[J]. N Engl J Med, 2019, 381(21): 1995-2008. doi: 10.1056/NEJMoa1911303
[16]	Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure[J]. N Engl J Med, 2020, 383(15): 1413-1424. doi: 10.1056/NEJMoa2022190
[17]	Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction[J]. N Engl J Med, 2021, 385(16): 1451-1461. doi: 10.1056/NEJMoa2107038
[18]	Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction[J]. N Engl J Med, 2022, 387(12): 1089-1098. doi: 10.1056/NEJMoa2206286
[19]	Svanström H, Mkoma GF, Hviid A, et al. SGLT-2 inhibitors and mortality among patients with heart failure with reduced ejection fraction: linked database study[J]. BMJ, 2024, 387: e080925.
[20]	Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in patients with chronic kidney disease[J]. N Engl J Med, 2020, 383(15): 1436-1446. doi: 10.1056/NEJMoa2024816
[21]	Butler J, Jones WS, Udell JA, et al. Empagliflozin after acute myocardial infarction[J]. N Engl J Med, 2024, 390(16): 1455-1466. doi: 10.1056/NEJMoa2314051
[22]	Hernandez AF, Udell JA, Jones WS, et al. Effect of empagliflozin on heart failure outcomes after acute myocardial infarction: Insights From the EMPACT-MI Trial[J]. Circulation, 2024, 149(21): 1627-1638. doi: 10.1161/CIRCULATIONAHA.124.069217
[23]	Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity[J]. N Engl J Med, 2023, 389(12): 1069-1084. doi: 10.1056/NEJMoa2306963
[24]	Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction: A Report of the American College of Cardiology Solution Set Oversight Committee[J]. J Am Coll Cardiol, 2023, 81(18): 1835-1878. doi: 10.1016/j.jacc.2023.03.393
[25]	Deanfield J, Verma S, Scirica BM, et al. Semaglutide and cardiovascular outcomes in patients with obesity and prevalent heart failure: a prespecified analysis of the SELECT trial[J]. Lancet, 2024, 404(10454): 773-786. doi: 10.1016/S0140-6736(24)01498-3
[26]	Armstrong PW, Pieske B, Anstrom KJ, et al. Vericiguat in patients with heart failure and reduced ejection fraction[J]. N Engl J Med, 2020, 382(20): 1883-1893. doi: 10.1056/NEJMoa1915928
[27]	Li X, Zhang J, Huang J, et al. A multicenter, randomized, double-blind, parallel-group, placebo-controlled study of the effects of qili qiangxin capsules in patients with chronic heart failure[J]. J Am Coll Cardiol, 2013, 62(12): 1065-1072. doi: 10.1016/j.jacc.2013.05.035
[28]	Cheang I, Yao W, Zhou Y, et al. The traditional Chinese medicine Qiliqiangxin in heart failure with reduced ejection fraction: a randomized, double-blind, placebo-controlled trial[J]. Nat Med, 2024, 30(8): 2295-2302. doi: 10.1038/s41591-024-03169-2
[29]	Mebazaa A, Davison B, Chioncel O, et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure(STRONG-HF): a multinational, open-label, randomised, trial[J]. Lancet, 2022, 400(10367): 1938-1952. doi: 10.1016/S0140-6736(22)02076-1
[30]	Malgie J, Wilde MI, Clephas PRD, et al. Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients: First data from the TITRATE-HF study[J]. Eur J Heart Fail, 2024, 26(7): 1549-1560. doi: 10.1002/ejhf.3267
[31]	心血管健康联盟, 中国老年医学学会心电与心功能分会, 心衰中心联盟专家委员会. 中国心衰中心联盟心力衰竭医疗质量报告(2022年)[J]. 中华全科医师杂志, 2023, 22(6): 557-568.