p.79 抽出テキスト
(2) Diagnosis and phenotyping • Further research into the underlying characteristics, pathophysiology, diagnosis, and phenotyping of HFpEF. • Role of artificial intelligence in the diagnostic pathway for HF as well as for patient inclusion in RCTs. • Validated diagnostic protocols including deeper phenotyping for the diagnosis of HFpEF. • Validation of the historic exercise-induced pulmonary capillary wedge pressure cut-offs used in the diagnosis of HFpEF. • Prospective validation of age-related natriuretic peptide cut-offs in chronic HF. • Degree of influence of BMI on natriuretic peptides to allow for individual adjustment of expected ranges. • Prospective studies to test the diagnostic yield for endomyocardial biopsy, and whether a biopsy would affect treatment decisions and outcomes in patients with unexplained cardiomyopathy and evidence of inflammation/ infiltration/storage on CMR or CT-positron emission tomography. (3) Medical treatment and devices • Contemporary reproducibility of old trials on medical and device therapies. • Future trials on medical/device therapy for HF should adhere to contemporary FMT. • Randomized clinical trials comparing different MRAs in both HFrEF and HFpEF. • Randomized clinical trials investigating the optimal medical therapy for HFpEF. • Randomized clinical trials comparing different GLP-1 RAs. • Randomized clinical trials on the optimal sequencing when initiating FMT both in HFrEF and HFpEF. • More data on the role of potassium binders, both in patients with and without CKD. • Management strategies and therapies for HF with improved LVEF. • Indications for ICDs in specific subgroups of patients, and optimal selection of ICD candidates in HFrEF, including patients with ischaemic and non-ischaemic HF. • Efficacy of CRT in AF. • Randomized controlled trials with morbidity and mortality endpoints and long-term follow-up, comparing CSP and trans-coronary vein CRT in patients with HFrEF. • Randomized controlled trials with morbidity and mortality and long-term follow-up on interatrial shunt devices in patients with HFrEF and HFpEF. (4) Decompensated heart failure • Evidence on medical therapy with prognostic benefit in DHF. • Evidence for best decongestion protocols in patients with and without CKD and in the setting of continued/initiation of FMT. • Evidence-based use of imaging techniques and biomarkers that have an impact on patients’ clinical course in DHF. • Definition of evidence-based treatment options and therapeutic algorithms for patients with CS. • Better definition of the role of MCS in CS. • Better definition of the role of inotropes, vasopressors and vasodilators in DHF. • Studies on the best early post-discharge risk-based management protocols to reduce early readmission to hospital. (5) Advanced heart failure • Benefit of FMT, AMT, and GDIT in advanced HFrEF needs further investigation. • Which medication to down-titrate/stop first in patients with advanced HF who no longer tolerate all FMT. • Durable MCS (LVADs) vs medical treatment in INTERMACS >4 without high-risk features. • Optimal lifetime management strategies in very young adults with advanced HF. • Advances in durable MCS, including strategies to reduce the risk of infection. • Advances in medical treatment for the many patients who cannot undergo MCS or heart transplantation, including development of treatment strategies, and novel inotropes or myotropes for patients with advanced HF. (6) Cardiovascular comorbidities • Adequately powered RCTs showing the best strategy for management of AF in patients with HF. • Selection of patients with HFrEF and HFpEF that may benefit from AF ablation. • Better characterization of patients with arrhythmiaassociated HF, especially patients with AF-associated HF. • Randomized controlled trials investigating best management options for patients with AF-associated HF, both in terms of HF management and management of AF. • Randomized controlled trials to assess the role of coronary revascularization and different revascularization strategies in patients with HFrEF and HFpEF on current FMT. • Longer-term follow-up results for mitral TEER interventions in HFrEF. • Role of mitral TEER in patients with HFrEF who do not fulfil specific echocardiographic and clinical criteria. • Treatment of atrial secondary MR in patients with HFpEF. • Further RCTs to assess the role of transcatheter valve intervention in patients with HF and TR. (7) Non-cardiovascular comorbidities • More clinically appropriate definition of ID in HF. • Further RCTs, using the novel definition of ID as an inclusion criterion, to assess the prognostic role of i.v. iron supplementation. • The prognostic role of HF treatment in patients with severe kidney dysfunction (i.e. eGFR <30 mL/min/ 1.73 m2), excluded from RCTs. • The effects of GLP-1 RAs and tirzepatide on morbidity and mortality in patients with HFpEF and HFrEF. • Treatment of SDB, both central and obstructive, needs further investigation to clarify benefit and safety concerns. (8) Multidisciplinary management • Studies on optimal models for follow-up of patients with stable HF. Downloaded from academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag100/8766302 by guest on 31 August 2026