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![Graphic][1] In spite of impressive progress in the last decades, the management of heart failure remains essentially palliative in nature.1,2 Rates of re-hospitalizations and death remain high even in patients on optimal therapy, according to current guidelines.3,4 Thus, ongoing research at the basic and clinical levels is urgently needed to address this unmet clinical need. This issue of the European Heart Journal is devoted to novel insights into the mechanisms, outcomes, and treatment options in chronic and acute heart failure at the basic and clinical level.Although interfering with neurohumoral activation was most successful so far therapeutically,5,6 it is obvious that the primary problem, particularly in dilated cardiomyopathy, is due to altered cardiac muscular function. The first paper, entitled ‘ Ultrastructural features of cardiomyocytes in dilated cardiomyopathy with initially decompensated heart failure as a predictor of prognosis ’7 by Tsunenori Saito from the Department of Cardiovascular Medicine of the Nippon Medical School in Tokyo, Japan, which is accompanied by an excellent Editorial by Carsten Tschope from the Charite University in Berlin, Germany,8 attempted to characterize myocardial ultrastructural changes by electron microscopy in endomyocardial biopsy specimens of the left ventricle obtained from 250 patients with dilated cardiomyopathy presenting with decompensated heart failure. During a follow-up period of 5 years, 10% died and 27% were readmitted with heart failure. Myofilament changes, classified as either focal derangement of myofilaments (sarcomere damage) or diffuse myofilament lysis (disappearance of most sarcomeres in cardiomyocytes), were found in 66% of the patients. Multivariate analysis identified that a family history of dilated cardiomyopathy; atrial fibrillation, haemoglobin level, and diffuse myofilament lysis were independent predictors of mortality. A family history, haemoglobin, focal derangement of myofilaments, and diffuse myofilament lysis were also predictors … [1]: /embed/inline-graphic-1.gif

Novel prognostic markers and treatment options in heart failure: from palliative to regenerative medicine