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Mann DL, Felker GM. Mechanisms and Models in Heart Failure: A Translational Approach. Circ Res. 2021;128(10):1435-1450doi: 10.1161/CIRCRESAHA.121.318158.
Mann, D. L., & Felker, G. M. (2021). Mechanisms and Models in Heart Failure: A Translational Approach. Circulation research, 128(10), 1435-1450. https://doi.org/10.1161/CIRCRESAHA.121.318158
Mann, Douglas L, and Felker, G Michael. "Mechanisms and Models in Heart Failure: A Translational Approach." Circulation research vol. 128,10 (2021): 1435-1450. doi: https://doi.org/10.1161/CIRCRESAHA.121.318158
Mann DL, Felker GM. Mechanisms and Models in Heart Failure: A Translational Approach. Circ Res. 2021 May 14;128(10):1435-1450. doi: 10.1161/CIRCRESAHA.121.318158. Epub 2021 May 13. PMID: 33983832; PMCID: PMC8130816.
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Circ Res. 2021 May 14;128(10):1435-1450. doi: 10.1161/CIRCRESAHA.121.318158. Epub 2021 May 13.

Mechanisms and Models in Heart Failure: A Translational Approach.

Circulation research

Douglas L Mann, G Michael Felker

Affiliations

  1. Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, MO (D.L.M.).
  2. Duke Clinical Research Institute and Duke University School of Medicine, Durham, Duke University, NC (G.M.F.).

PMID: 33983832 PMCID: PMC8130816 DOI: 10.1161/CIRCRESAHA.121.318158

Abstract

Despite multiple attempts to develop a unifying hypothesis that explains the pathophysiology of heart failure with a reduced ejection fraction (HFrEF), no single conceptual model has withstood the test of time. In the present review, we discuss how the results of recent successful phase III clinical development programs in HFrEF are built upon existing conceptual models for drug development. We will also discuss where recent successes in clinical trials do not fit existing models to identify areas where further refinement of current paradigms may be needed. To provide the necessary structure for this review, we will begin with a brief overview of the pathophysiology of HFrEF, followed by an overview of the current conceptual models for HFrEF, and end with an analysis of the scientific rationale and clinical development programs for 4 new therapeutic classes of drugs that have improved clinical outcomes in HFrEF. The 4 new therapeutic classes discussed are ARNIs, SGLT2 (sodium-glucose cotransporter 2) inhibitors, soluble guanylate cyclase stimulators, and myosin activators. With the exception of SGLT2 inhibitors, each of these therapeutic advances was informed by the insights provided by existing conceptual models of heart failure. Although the quest to determine the mechanism of action of SGLT2 inhibitors is ongoing, this therapeutic class of drugs may represent the most important advance in cardiovascular therapeutics of recent decades and may lead to rethinking or expanding our current conceptual models for HFrEF.

Keywords: angiotensin; clinical trial; drug therapy; heart failure; neprilysin; soluble guanylate cyclase

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