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Pubblicazioni recenti - cardio-oncology
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Cardio-oncology: Clinical and imaging perspectives for optimal cardiodetection and cardioprotection in patients with cancer.
Arch Cardiovasc Dis2019 Sep;():. doi: S1875-2136(19)30142-1.
Thuny Franck, Huttin Olivier, Ederhy Stéphane,
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Continued exposure of anti-cancer drugs to human iPS cell-derived cardiomyocytes can unmask their cardiotoxic effects.
J Pharmacol Sci2019 Aug;():. doi: S1347-8613(19)35701-9.
Sakamoto Kazuho, Sakatoku Kohei, Sugimoto Shintaro, Iwasaki Nanami, Sano Yusuke, Yamaguchi Masahiko, Kurokawa Junko,
Abstract
Although the cardiotoxicity of anti-cancer drugs is an important issue, the underlying mechanisms remain unknown. To develop a sensitive assay system for cardiotoxicity, we examined effects of anti-cancer drugs on contractile functions of human iPS cell-derived cardiomyocytes by using non-invasive motion field imaging analysis with extended drug exposure time. We succeeded in continuously measuring stable contractile function. The continued exposure revealed that the difference in cardiotoxicity between cardiotoxic doxorubicin and less toxic erlotinib was more evident after 8 days of treatment than with 3 days of treatment, suggesting that continued exposure improved the predictive power for cardiotoxicity of anti-cancer drugs.
Copyright © 2019 The Authors. Production and hosting by Elsevier B.V. All rights reserved.
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A Cardio-Oncology Data Commons: Lessons from Pediatric Oncology.
Curr Cardiol Rep2019 Sep;21(10):128. doi: 10.1007/s11886-019-1212-y.
Mandawat Anant, Eberly Logan, Border William,
Abstract
PURPOSE OF REVIEW:
To describe the role of big data in cardio-oncology.
RECENT FINDINGS:
There is a trend towards developing cloud-based, integrated registries to improve data collection, access, and analysis. Using a template from pediatric oncology, a cardio-oncology data commons is a novel opportunity to integrate data elements into a cloud-based platform. A cloud-based registry provides advantages of multi-institutional collaboration, rapid data access, a virtual visualization, and analytic tools to reduce infrastructure redundancy. The data commons would include integrated clinical data, blood samples, and genomic data to streamline discovery and analysis for researchers. A cardio-oncology data commons would be a large step forward in bringing cardio-oncology to the forefront of big data.
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Arterial Thrombosis in Cancer: Spotlight on the Neglected Vessels.
Anticancer Res2019 Sep;39(9):4619-4625. doi: 10.21873/anticanres.13642.
Canale Maria Laura, Bisceglia Irma, Lestuzzi Chiara, Parrini Iris, ,
Abstract
Cancer patients are at risk for both venous and arterial thrombotic events. Accumulating evidence suggests a link between cancer and arterial thrombosis events. The pathophysiology of arterial thrombosis in cancer is complex and multifactorial. The risk of arterial thrombosis in cancer patients relies on individual risk factors, on cancer-related hypercoagulability, on anticancer drugs and radiotherapy often via a common underlying mechanism of endothelial dysfunction. This review describes the mechanisms involved in the development of arterial thrombotic events and their clinical manifestations. Furthermore, it provides an overview on therapeutic agents associated with arterial thrombosis.
Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Cardiotoxicity from immune checkpoint inhibitors.
Int J Cardiol Heart Vasc2019 Dec;25():100420. doi: 10.1016/j.ijcha.2019.100420.
Michel Lars, Rassaf Tienush, Totzeck Matthias,
Abstract
Immune checkpoint inhibitor (ICI) therapy has greatly improved treatment of various advanced cancers but increasing use of ICI therapy has exposed the risk of ICI-related cardiovascular side effects. Immune checkpoints are inhibitory regulators of T cell activation and mediate T cell effector functions during physiological responses to shield from autoimmune reactions. ICI therapy for advanced cancers promotes immune activity against tumors and is applied within a broad collective of cancer patients. Widespread use of ICI therapy has revealed the burden of immune related adverse events with various organ manifestations and characteristics. Since immune checkpoints are highly relevant for maintaining myocardial homeostasis as emerging evidence implicates, inhibition of immune checkpoint pathways has been associated with various forms of cardiotoxicity in preclinical models and patients. Although ICI-related cardiotoxicity is rare, it has significant relevance due to high mortality rates. This review focuses on current knowledge about cardiac ICI-related toxicity. We summarize the most common forms and delineate incidence, presentation, and treatment. Clinical characteristics are correlated to potential underlying pathomechanisms. We outline epidemiology, risk factors, and course of disease. Recommendations for monitoring and critical diagnostic measures are specified within the context of different forms of cardiac involvement. Different therapeutic implications for suspected ICI-related cardiotoxicity and their limitations are critically summarized. We highlight current gaps of knowledge concerning the underlying pathomechanisms and clinical characteristics of ICI-related cardiotoxicity. Future challenges are depicted for optimum cardio-oncology care of patients receiving ICI therapy.
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Imaging in Cardio-oncology: An Overview of an Emerging Medical Discipline.
J Thorac Imaging2019 Sep;():. doi: 10.1097/RTI.0000000000000442.
Gilon Dan, Leibowitz David, Durst Ronen, Iakobishvili Zaza,
Abstract
The world of cardio-oncology is an evolving field involving the assessment of cardiovascular disease in patients suffering from cancer. Cancer and cardiovascular diseases are the two leading causes of morbidity and mortality in the developed world. Globally, cancer is diagnosed in 12.7 million patients annually, and cancer incidence is projected to increase by 40% in high-income countries from 2008 to 2030. Chemotherapy is the main treatment for most cancers and improves survival, but is associated with significant cardiotoxicity. In recent years, the introduction of new biological anti-cancer treatments in addition to "classic" chemotherapy has further improved survival, but has also introduced new cardiovascular side effects beyond "pure" myocardial damage. The increasing number of patients with cancer and cancer survivors, and the growing complexity of cancer treatment and cardiovascular side effects, call for teamwork including cardiologists with specific training and expertise working in teams with oncologists, hematologists, and others. The purpose of this review was to describe the clinical background and importance of cardio-oncology, with an emphasis on the use of imaging in this clinical setting.
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Influence of hormones on the immunotolerogenic molecule HLA-G: a cross-sectional study in patients with congenital adrenal hyperplasia.
Eur J Endocrinol2019 Sep;():. doi: 10.1530/EJE-19-0379.
Nguyen Lee S, Rouas-Freiss Nathalie, Funck-Brentano Christian, Leban Monique, Carosella Edgardo, Touraine Philippe, Varnous Shaida, Bachelot Anne, Salem Joe-Elie,
Abstract
BACKGROUND:
HLA-G is an immune checkpoint molecule, naturally expressed during pregnancy, playing a critical role in the tolerance of the fetal semi-allograft from the maternal immune system. While HLA-G expression levels are associated with progesterone, the influence of other hormones is still unclear. Congenital adrenal hyperplasia (CAH) represents an adequate model to study the hormonal influence on biomarkers as it leads to impaired cortisol biosynthesis and increased progesterone and androgens production due to 21-hydroxylase enzyme deficiency.
METHODS:
In a cross-sectional study of CAH patients matched on sex and age with healthy control, the association between circulating levels of soluble HLA-G and hormones was assessed by use of non-parametric analyses tests. Multivariable linear regressions were performed on normalized data.
RESULTS:
Overall, 83 CAH patients and 69 healthy controls were included. Among CAH patients, all were under glucocorticoid and 52 (62.6%) were under mineralocorticoid supplementation. Compared to controls, CAH patients had increased HLA-G levels (15 vs 8 ng/mL, p=0.02). In controls, HLA-G level was independently associated with progesterone and estradiol (?= 0.44 (0.35;1.27) and -0.44 (-0.94;-0.26) respectively, both p-values = 0.001). In CAH patients, HLA-G level was independently associated with mineralocorticoid supplementation dosage (?= 0.25 (0.04;0.41), p=0.001) and estradiol (?= -0.22 (-0.57;-0.02), p<0.001).
CONCLUSION:
CAH patients had higher HLA-G levels than healthy controls. HLA-G level was positively associated with progesterone and corticosteroid supplementation, and negatively with estradiol. The association between mineralocorticoid, renin and HLA-G levels may suggest a role of the renin-angiotensin system in the expression of soluble HLA-G.
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The Effects of Serum hs-CRP on the Incidence of Lung Cancer in Male Patients with Pulmonary Tuberculosis.
Iran J Public Health2019 Jul;48(7):1265-1269.
Jiang Youhua, Ni Kewei, Fang Meiyu, Li Junling,
Abstract
Background:
This study intended to investigate the effects of serum high-sensitivity C-reactive protein (hs-CRP) on the incidence of lung cancer in male patients with pulmonary tuberculosis.
Methods:
A total of 1091 male patients with pulmonary tuberculosis in Zhejiang Cancer Hospital, Hangzhou, China from Jan 2009 to Jan 2012 were selected as the research objects. All patients were followed up from the beginning of hospitalization. According to serum hs-CRP level, patients were divided into two groups: group A (hs-CRP < 1 mg/L) and group B (hs-CRP > 3 mg/L). The relationship between baseline hs-CRP and the risk of lung cancer in patients with pulmonary tuberculosis was analyzed by multivariate Cox proportional risk regression model, and the serum levels of hs-CRP between lung cancer patients in all groups and other non-lung cancer patients were compared.
Results:
There were differences in age, drinking, smoking, diabetes history, body mass index (BMI), thyroglobulin (TG), history of hypertension and hyperglycemia among the three groups (=0.036, 0.018, 0.040, 0.029, 0.006, 0.034, 0.020, 0.010). The serum levels of hs-CRP in patients with squamous carcinoma, adenocarcinoma and small cell carcinoma were significantly higher than those in non-lung cancer patients (=0.022, 0.043, 0.011). The incidence rates of lung cancer in patients in group B and C were 1.37 and 1.69 times higher than that in group A, respectively.
Conclusion:
The increased serum level of hs-CRP will increase the incidence rate of lung cancer in male patients with pulmonary tuberculosis.
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Anthracycline-Induced Cardiotoxicity: Time to Focus on Cardioprotection Again.
Heart Lung Circ2019 Oct;28(10):1454-1456. doi: S1443-9506(19)31379-4.
Croft A J, Ngo D T M, Sverdlov A L,
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Sec3 knockdown inhibits TGF-? induced epithelial-mesenchymal transition through the down-regulation of Akt phosphorylation in A549 cells.
Biochem Biophys Res Commun2019 Sep;():. doi: S0006-291X(19)31674-2.
Qian Xiaohan, Zhou Xiaoxu, Shentu Ping, Yao Yuanfa, Jiao Demin, Chen Qingyong, Zhou Jianying, Xu Yingke,
Abstract
The exocyst, an evolutionarily conserved octomeric protein complex, has been demonstrated as an essential component for vesicle tethering during cell exocytosis, and participates in various physiological processes in the cell. Although subunits of the exocyst complex have been reported to be involved in the regulation of TGF-? induced cancer cell migration and epithelial-mesenchymal transition (EMT), the potential function of Sec3 in these regulated processes remains unclear. Here, we show that Sec3 knockdown abolishes TGF-? stimulated A549 lung cancer cell migration in vitro and causes defects in the regulated EMT process. In addition, we find that depletion of Sec3 significantly inhibits TGF-? stimulated Akt phosphorylation in A549 cells, whereas the increase of Smad2 phosphorylation is unaffected. Furthermore, replenishment of an RNAi-resistant form of Sec3 is shown to restore the defects of TGF-? induced cell migration, EMT and Akt signaling activation. In summary, our study provides evidence that Sec3 is involved in TGF-? induced cell migration and EMT processes, presumably through the regulation of PI3K/Akt signaling activation in A549 cancer cells.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Prediction nomogram for Ga-PSMA-11 PET/CT in different clinical settings of PSA failure after radical treatment for prostate cancer.
Eur J Nucl Med Mol Imaging2019 Sep;():. doi: 10.1007/s00259-019-04505-2.
Ceci Francesco, Bianchi Lorenzo, Borghesi Marco, Polverari Giulia, Farolfi Andrea, Briganti Alberto, Schiavina Riccardo, Brunocilla Eugenio, Castellucci Paolo, Fanti Stefano,
Abstract
OBJECTIVE:
The objective of this study was to develop a clinical nomogram to predict gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (Ga-PSMA-11-PET/CT) positivity in different clinical settings of PSA failure.
MATERIALS AND METHODS:
Seven hundred three (n =?703) prostate cancer (PCa) patients with confirmed PSA failure after radical therapy were enrolled. Patients were stratified according to different clinical settings (first-time biochemical recurrence [BCR]: group 1; BCR after salvage therapy: group 2; biochemical persistence after radical prostatectomy [BCP]: group 3; advanced-stage PCa before second-line systemic therapies: group 4). First, we assessed Ga-PSMA-11-PET/CT positivity rate. Second, multivariable logistic regression analyses were used to determine predictors of positive scan. Third, regression-based coefficients were used to develop a nomogram predicting positive Ga-PSMA-11-PET/CT result and 200 bootstrap resamples were used for internal validation. Fourth, receiver operating characteristic (ROC) analysis was used to identify the most informative nomogram's derived cutoff. Decision curve analysis (DCA) was implemented to quantify nomogram's clinical benefit.
RESULTS:
Ga-PSMA-11-PET/CT overall positivity rate was 51.2%, while it was 40.3% in group 1, 54% in group 2, 60.5% in group 3, and 86.9% in group 4 (p ?10%.
CONCLUSIONS:
This novel nomogram proved its good accuracy in predicting a positive scan, with values ??40% providing the most informative cutoff in counselling patients to Ga-PSMA-11-PET/CT. This tool might be important as a guide to clinicians in the best use of PSMA-based PET imaging.
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Clinical characterization of men with long QT syndrome and torsades de pointes associated with hypogonadism: A review and pharmacovigilance study.
Arch Cardiovasc Dis2019 Aug;():. doi: S1875-2136(19)30140-8.
Salem Joe-Elie, Bretagne Marie, Lebrun-Vignes Benedicte, Waintraub Xavier, Gandjbakhch Estelle, Hidden-Lucet Francoise, Gougis Paul, Bachelot Anne, Funck-Brentano Christian, ,
Abstract
BACKGROUND:
Long QT syndrome (LQTS) can cause the potentially fatal ventricular tachycardia torsades de pointes (TdP). QT interval corrected for heart rate (QTc) is shorter in men than in women, with testosterone contributing to shorten QTc. We recently described male hypogonadism as a reversible risk factor for acquired LQTS and TdP, but the clinical characteristics of such patients have not been characterized.
AIMS:
To describe the clinical characteristics of men with acquired LQTS or TdP associated with hypogonadism caused by endocrine conditions or androgen deprivation therapy (ADT), and to evaluate the relationship between testosterone concentrations and electrocardiographic changes.
METHODS:
We searched MEDLINE (to 04 January 2019) and the French pharmacovigilance database (to 09 August 2018) to identify male cases of acquired LQTS and TdP associated with endocrine hypogonadism or ADT; their narratives were gathered from reporting collaborators.
RESULTS:
We identified seven cases of TdP (one fatal) with endocrine hypogonadism, abnormally long QTc and morphologically abnormal T-wave notches. After reversion of low testosterone concentrations in the surviving patients (N=6), QTc shortened, T-wave morphology normalized and there was no TdP recurrence. Among these cases, none had mutation in the LQTS genes, three men required testosterone and three had reversible hypogonadism after resolution of a concurrent acute severe illness. We found an additional 27 reports of men with LQTS (N=6), TdP (N=9; 2/9 fatal) or sudden death (N=12; 10/12 fatal) suspected to be induced or favoured by ADT (24/27 for prostate cancer). Generally, after ADT withdrawal, QTc shortened and no TdP recurred.
CONCLUSION:
We propose seeking for hypogonadism caused by endocrine conditions or ADT in men presenting with TdP. Caution is warranted when ADT is used in situations at risk of TdP. Testosterone may be useful to treat or prevent TdP.
Copyright © 2019. Published by Elsevier Masson SAS.
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Editors' Picks Cardio-oncology and Hypertension.
Hypertension -
Clinical Applications of Echo Strain Imaging: a Current Appraisal.
Curr Treat Options Cardiovasc Med2019 Aug;21(10):50. doi: 10.1007/s11936-019-0761-0.
Fava Agostina M, Meredith Dane, Desai Milind Y,
Abstract
PURPOSE OF REVIEW:
This article reviews recent advances in echocardiographic strain imaging, particularly in its ability to prognosticate in cardiovascular outcomes and impact clinical decision making.
RECENT FINDINGS:
Strain has been proposed as a sensitive tool in detecting early ventricular dysfunction. Left ventricular global longitudinal strain (LV-GLS) detects subtle changes in myocardial function, often not quantifiable by ejection fraction alone. Thus, LV-GLS provides the opportunity for early decision-making, and the implementation of more effective treatments, improving outcomes in a variety of diseases such as valvular heart diseases, cardio-oncology, ischemic heart disease, cardiomyopathies, heart transplantation, and pericardial diseases and cardiomyopathies. Strain is a promising tool for the early detection of myocardial dysfunction in patients with preserved left ventricular ejection fraction and can prognosticate long-term outcomes.
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Hypertensive Heart Failure: Sprinting to the Finish Line to Prevent End-Organ Damage.
Heart Fail Clin2019 Oct;15(4):xiii-xv. doi: S1551-7136(19)30050-9.
Baliga Ragavendra R, Bossone Eduardo, Bakris George L,
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Hypertension in the Cardio-Oncology Clinic.
Heart Fail Clin2019 Oct;15(4):487-495. doi: S1551-7136(19)30048-0.
Hassen Lauren J, Lenihan Daniel J, Baliga Ragavendra R,
Abstract
As cancer therapies improve, the population of survivors of cancer has increased, and the long-term effects of cancer treatments have become more apparent. Cardiotoxicity is a well-established adverse effect of many antineoplastic agents. Hypertension is common in survivors of cancer, can be caused or worsened by certain agents, and has been shown to increase the risk of other cardiovascular diseases including heart failure. Pretreatment risk assessment and careful monitoring of blood pressure during therapy is essential. Aggressive management of preexisting or incident hypertension in survivors of cancer is paramount to decrease the risk of heart failure and other cardiovascular diseases in these patients.
Copyright © 2019 Elsevier Inc. All rights reserved.
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GDF-15 in Solid versus Non-Solid Treatment-Naïve Malignancies.
Eur J Clin Invest2019 Aug;():e13168. doi: 10.1111/eci.13168.
Arfsten Henrike, Cho Anna, Freitag Claudia, Raderer Markus, Goliasch Georg, Bartko Philipp E, Wurm Raphael, Strunk Guido, Gisslinger Heinz, Marosi Christine, Kornek Gabriela, Zielinski Christoph, Hülsmann Martin, Pavo Noemi,
Abstract
AIM:
GDF-15 is an established cardiovascular risk marker but is equally implicated in tumor biology. Elevated levels of GDF-15 have indeed been observed in distinct tumor entities. This study aimed to explore the relation of GDF-15 to other cardiac biomarkers and the general association of GDF-15 on prognosis in an unselected cohort of treatment-naïve cancer patients.
METHODS:
We prospectively enrolled 555 consecutive patients at time of diagnosis of malignant disease prior receiving anticancer therapy. Plasma GDF-15 concentrations were determined alongside other cardiac and routine laboratory markers. All-cause mortality was defined as primary endpoint.
RESULTS:
GDF-15 levels were 338ng/l (IQR:205-534) for the total cohort and values were comparable for different tumor entities except breast cancer. Metastatic disease was characterized by higher plasma GDF-15 [435ng/l (IQR:279-614) vs. 266ng/l (IQR:175-427), p<0.001]. GDF-15 correlated positively with inflammatory status reflected by CRP, SAA and IL-6 [r=0.31,p<0.001, r=0.23,p<0.001 and r=0.14,p=0.002] and cardiac biomarkers as NT-proBNP, hsTnT, MR-proADM and CT-proET-1 [r=0.46;r=0.46;r=0.59 and r=0.50;p<0.001 for all]. GDF-15 was significantly associated with all-cause mortality after multivariate adjustment [adj.HR for ln(GDF-15) 1.78, 95%CI:1.47-2.16,p<0.001]. There was a significant interaction between solid and hematologic malignancies with loss of association of GDF-15 with outcome in myelodysplastic and myeloproliferative disease.
CONCLUSIONS:
Elevated plasma GDF-15 is associated with progressing disease severity and poor prognosis in solid tumors of treatment-naïve cancer patients. GDF-15 increase is accompanied by worsening systemic inflammation and a subclinical functional impairment of different organs including the heart. GDF-15 represents a promising target for our pathophysiologic understanding in cardio-oncology linking conditions of both cardiac and neoplastic disease. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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[Cardiac arrhythmias in oncological diseases, during radiotherapy, chemotherapy].
Herzschrittmacherther Elektrophysiol2019 Sep;30(3):268-273. doi: 10.1007/s00399-019-00634-1.
Lehmann Lorenz H, Katus Hugo A, Scholz Eberhard P,
Abstract
Patients with oncological diseases frequently show cardiac arrhythmias. This is explained by an increased risk in this specific patient cohort and is frequently associated with specific oncological therapies. So far, it is unclear how to deal with the occurrence of arrhythmias diagnostically and therapeutically, since the current clinical data do not provide satisfying answers to these questions. Clinical care of high-risk patients in specialized teams with a focus on cardio-oncology is recommended. Based on the current clinical studies and the position papers of the European Society of Cardiology (ESC), we give a brief overview of arrhythmias in malignant diseases and their therapies.
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Metastatic squamous cell carcinoma to the heart: an unusual cause of ST elevation-a case report.
Eur Heart J Case Rep2019 Jun;3(2):. doi: ytz029.
Tandon Varun, Kethireddy Nikhila, Balakumaran Kathir, Kim Agnes S,
Abstract
BACKGROUND:
Cardiac tumours are typically secondary in nature, and the most common malignancies metastasizing to the heart are cancers of the lung, breast, oesophagus, melanoma, and lymphoma. We present a unique case of squamous cell carcinoma of the tongue, metastasizing to the heart and manifesting with ST elevation in the inferior-leads on electrocardiogram (ECG).
CASE SUMMARY:
A 25-year-old woman was initially diagnosed with squamous cell carcinoma of the tongue at the age of 23 and treated with hemi-glossectomy with clear-margins. Sixteen months later, the tumour recurred in the oropharynx and the left upper lobe of the lung. She was treated with chemotherapy; however, the tumour progressed. Thus, she was initiated on immunotherapy and radiation therapy. One month later, she presented with chest pain. Electrocardiogram revealed ST elevation in the inferior-leads. Troponin-I was elevated. Transthoracic echocardiogram revealed focal areas of thickening within the left and right ventricular myocardium with associated hypokinesis. These findings suggested ECG changes were likely secondary to infiltrative metastases and not acute-coronary-syndrome. Cardiac magnetic resonance imaging showed infiltrative masses with increased T2-signal and heterogeneous enhancement on perfusion and delayed enhancement sequences. Imaging also demonstrated numerous extra-cardiac metastases. She was treated with analgesics and discharged to home hospice.
DISCUSSION:
Head and neck cancers are a rare cause of cardiac metastasis. ST elevation and troponin release are thought to be due to tumour extension into the myocardium. Cardiac metastases usually present in patients with advanced widespread malignancy. In a cancer patient with cardiac symptoms or ECG changes, it is important to consider a broad differential diagnosis and entertain the possibility of cardiac metastasis.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Therapeutic progress and knowledge basis about natriuretic peptide system in heart failure.
Curr Top Med Chem2019 Aug;():. doi: 10.2174/1568026619666190826163536.
Fu Shihui, Chang Zhenyu, Luo Leiming, Deng Juelin,
Abstract
Notwithstanding substantial improvements in diagnosis and treatment, heart failure (HF) remains a major disease burden with high prevalence and poor outcomes worldwide. Natriuretic peptides (NPs) modulate whole cardiovascular system and exhibit multiple cardio-protective effects, including the counteraction of renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS), promotion of vasodilatation and natriuresis, and inhibition of hypertrophy and fibrosis. Novel pharmacological therapies based on NPs may achieve a valuable shift in managing patients with HF from inhibiting RAAS and SNS to reversal of neurohormonal imbalance. Enhancing NP bioavailability through exogenous NP administration and inhibiting neutral endopeptidase (NEP) denotes valuable therapeutic strategies for HF. On the one hand, NEP-resistant NPs may be more specific as therapeutic choices in patients with HF. On the other hand, NEP inhibitors (NEPIs) combined with RAAS inhibitors have proved to exert beneficial effects and reduce adverse events in patients with HF. Highly effective and potentially safe angiotensin receptor blocker neprilysin inhibitors (ARNIs) have been developed after the failure of NEPIs and vasopeptidase inhibitors (VPIs) due to lacking efficacy and safety. Therapeutic progress and knowledge basis about NP system in HF was summarized in the current review.
Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
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