Pathophysiology and Emerging Therapeutic Targets in Heart Failure

This chapter offers an integrative analysis of the complex and multifactorial pathophysiology of heart failure, encompassing neurohormonal dysregulation, myocardial remodeling, mitochondrial dysfunction, and cardiomyocyte loss. It reviews the mechanistic rationale and clinical evidence supporting established therapies while examining emerging targets including SGLT2 inhibition, myosin activators, soluble guanylate cyclase stimulators, and anti-inflammatory strategies. Special attention is given to the growing recognition of distinct phenotypes — including heart failure with preserved ejection fraction — and their differential therapeutic implications.