Heart failure-potential new targets for therapy.

INTRODUCTION/

BACKGROUND

Heart failure is a major cause of cardiovascular morbidity and mortality. This review covers current heart failure treatment guidelines, emerging therapies that are undergoing clinical trial, and potential new therapeutic targets arising from basic science advances.

SOURCES OF DATA: A non-systematic search of MEDLINE was carried out. International guidelines and relevant reviews were searched for additional articles.

AREAS OF AGREEMENT: Angiotensin-converting enzyme inhibitors and beta-blockers are first line treatments for chronic heart failure with reduced left ventricular function.

AREAS OF CONTROVERSY: Treatment strategies to improve mortality in heart failure with preserved left ventricular function are unclear.

GROWING POINTS: Many novel therapies are being tested for clinical efficacy in heart failure, including those that target natriuretic peptides and myosin activators. A large number of completely novel targets are also emerging from laboratory-based research. Better understanding of pathophysiological mechanisms driving heart failure in different settings (e.g. hypertension, post-myocardial infarction, metabolic dysfunction) may allow for targeted therapies.

AREAS TIMELY FOR DEVELOPING RESEARCH: Therapeutic targets directed towards modifying the extracellular environment, angiogenesis, cell viability, contractile function and microRNA-based therapies.