New molecular insights into heart failure and cardiomyopathy: potential strategies and therapies.

BACKGROUND: In the most severely affected patients the mortality for congestive heart failure exceeds that of many cancers. While therapies are largely aimed at attenuating neurohumoral responses recent molecular insights reveal other potential targets for therapy. AIMS: To summarise some of the recent developments in the management of heart failure and provide the clinician who treats heart failure with new insights into emerging approaches.
METHODS: A literature review was conducted of the recent literature together with personal research data.
RESULTS: Large randomised trials will provide a more comprehensive understanding of the interaction of beta-blockers and other heart failure therapies with gene polymorphisms. Cytokines are important in the progression of heart failure, yet therapy aimed at blocking cytokine effects has not been successful. More selective use of anti-cytokine therapy may have beneficial effects. Gene therapy to improve heart failure has not yet reached clinical trials. The molecular genetics of hypertrophic and dilated cardiomyopathy is rapidly improving our understanding so that genetic diagnostics and counselling may soon be performed for patients and families.
CONCLUSIONS: The emergence of a molecular based understanding of heart failure will hopefully improve therapy of this common condition.