Myocardial fibrosis is a common feature of several heart diseases. The progressive deposition of extracellular matrix due to a persistent injury to cardiomyocytes may trigger a vicious cycle that leads to persistent structural and functional alterations of the myocardium. Some drugs (like renin-angiotensin-aldosterone system inhibitors) have been shown to reduce extracellular matrix deposition, but no primarily anti-fibrotic medications are currently used to treat patients with heart failure (HF). Pirfenidone is an oral antifibrotic agent approved for the treatment of idiopathic pulmonary fibrosis. Although its exact mechanism of action is not fully understood, pirfenidone might reduce the expression of profibrotic factors such as transforming growth factor-β (TGF-β), and proinflammatory cytokines, like tumor necrosis factor-α (TNF-α), interleukin (IL)-4, and IL-13, which could modulate the inflammatory response and inhibit collagen synthesis in lung tissue. There is some evidence that pirfenidone has antifibrotic activity in various animal models of cardiac disease. Furthermore, the positive results of the PIROUETTE trial, evaluating pirfenidone in patients with HF with preserved ejection fraction, have been very recently announced. This review summarizes the data about pirfenidone as a potential cardioprotective treatment.

中文翻译：

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吡非尼酮作为一种新的心脏保护治疗。

心肌纤维化是几种心脏病的共同特征。由于心肌细胞的持续损伤导致细胞外基质的进行性沉积可能引发恶性循环，导致心肌的持续结构和功能改变。一些药物（如肾素-血管紧张素-醛固酮系统抑制剂）已被证明可以减少细胞外基质沉积，但目前没有主要的抗纤维化药物用于治疗心力衰竭 (HF) 患者。吡非尼酮是一种被批准用于治疗特发性肺纤维化的口服抗纤维化药物。虽然其确切的作用机制尚不完全清楚，但吡非尼酮可能会降低促纤维化因子如转化生长因子-β (TGF-β) 和促炎细胞因子如肿瘤坏死因子-α (TNF-α) 的表达，白细胞介素 (IL)-4 和 IL-13，可调节炎症反应并抑制肺组织中的胶原蛋白合成。有一些证据表明吡非尼酮在各种心脏病动物模型中具有抗纤维化活性。此外，最近公布了 PIROUETTE 试验的阳性结果，该试验评估了吡非尼酮对射血分数保留的 HF 患者的疗效。本综述总结了吡非尼酮作为潜在心脏保护治疗的数据。最近宣布。本综述总结了吡非尼酮作为潜在心脏保护治疗的数据。最近宣布。本综述总结了吡非尼酮作为潜在心脏保护治疗的数据。