Contribution of ventricular assist devices to the recovery of failing hearts: a review and the Berlin Heart Center Experience

Ventricular assist‐device (VAD) implantation is a life‐saving therapy which will later become either a bridge‐to‐transplantation or definitive therapy if heart transplantation (HTx) is not possible. VAD‐supported failing hearts often recover at the molecular and cellular level, but translation of these changes into functionally stable cardiac recovery allowing long‐term HTx/VAD‐free outcomes after VAD removal is relatively rare, related to the aetiology, severity, and duration of myocardial damage. The reason for the discrepancy between high recovery rates on cellular and molecular levels and the low rate of cardiac recovery allowing VAD explantation is unknown. For selected patients VAD explantation is feasible. HTx/VAD‐free outcomes for >15 years are possible even if recovery remains incomplete and the underlying cause for VAD implantation was idiopathic dilated cardiomyopathy. Echocardiography and right heart catheterization are necessary to assess clinically relevant cardiac recovery. Certain echo parameters appeared highly predictive for post‐weaning cardiac function and reliable for weaning decisions. The elective therapeutic use of VADs for heart failure (HF) reversal in its earlier stages is a future goal possibly achievable by development of tools to predict HF reversibility already before VAD implantation and increase the number of weaning candidates by improvement of adjunctive therapies to optimize unloading‐promoted recovery. The present article summarizes the knowledge about unloading‐promoted myocardial recovery and reviews the available data on its clinical relevance, its post‐explant stability, and its assessment for decision‐making in favour of or against VAD explantation. The review also aims to provide a theoretical and practical basis for clinicians intending to be engaged in this field.     

Chronic obstructive pulmonary disease in heart failure: accurate diagnosis and treatment

Coincidence of COPD and heart failure (HF) is challenging as both diseases interact on multiple levels with each other, and thus impact significantly on diagnosis, disease severity classification, and choice of medical therapy. The current overview aims to educate caregivers involved in the daily management of patients with HF and (possibly) concurrent COPD in how to deal with clinically relevant issues such as interpreting spirometry, the potential role of extensive pulmonary function testing, and finally, the potential beneficial, but also detrimental effects of medication used for HF and COPD on either disease.     

心力衰竭治疗药物的新变革

心力衰竭是一项极其重要的危害人类健康的全球性公共卫生问题,是心血管疾病发展的终末阶段,其发病率、再住院率及病死率在逐年不断的增长,这使得进一步开发更为有效的新型心力衰竭治疗药物迫在眉睫,而具有血管紧张素受体脑啡肽酶抑制剂双重作用机制的沙库巴曲缬沙坦的上市为心力衰竭患者的治疗带来了新的变革.