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Cardiol."],"abstract":"<jats:p>Resumo O \u201cQuarteto Fant\u00e1stico\u201d, termo criado em 2021 para se referir aos quatro pilares medicamentosos no tratamento da insufici\u00eancia card\u00edaca com fra\u00e7\u00e3o de eje\u00e7\u00e3o reduzida (betabloqueadores, inibidores do sistema renina-angiotensina e neprilisina, antagonistas do receptor de mineralocorticoide e inibidores do cotransportador de s\u00f3dio e glicose II, ou iSGLT2), apresenta excelente desempenho na redu\u00e7\u00e3o de morbimortalidade nesse cen\u00e1rio. No entanto, no caso da insufici\u00eancia card\u00edaca com fra\u00e7\u00e3o de eje\u00e7\u00e3o levemente reduzida ou preservada, os mesmos benef\u00edcios n\u00e3o foram observados com esse tratamento em conjunto, restando, por muitos anos, apenas o uso de diur\u00e9ticos e o controle de comorbidades como manejo recomendado nesse contexto. Contudo, recentemente, novas op\u00e7\u00f5es terap\u00eauticas demonstraram efic\u00e1cia na redu\u00e7\u00e3o dos desfechos cardiovasculares nesse grupo espec\u00edfico da insufici\u00eancia card\u00edaca com fra\u00e7\u00e3o de eje\u00e7\u00e3o levemente reduzida ou preservada: a \u201cDupla Din\u00e2mica\u201d composta pelos iSGLT2 e Finerenona, al\u00e9m despontamento da semaglutida como tratamento \u201ccoringa\u201d para essa condi\u00e7\u00e3o associada \u00e0 obesidade. Embora ainda seja necess\u00e1ria a busca por novas op\u00e7\u00f5es terap\u00eauticas que reduzam, de fato, a mortalidade geral nesse contexto, esses novos tratamentos impactaram efetivamente a diminui\u00e7\u00e3o da hospitaliza\u00e7\u00e3o e dos sintomas desses pacientes. Por isso, inicia-se uma nova era no manejo da insufici\u00eancia card\u00edaca.<\/jats:p>","DOI":"10.36660\/abc.20240676","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T10:45:43Z","timestamp":1748342743000},"source":"Crossref","is-referenced-by-count":0,"title":["A \u201cDupla Din\u00e2mica\u201d: O Novo Manejo no Tratamento Medicamentoso da Insufici\u00eancia Card\u00edaca com Fra\u00e7\u00e3o de Eje\u00e7\u00e3o Levemente Reduzida ou Preservada"],"prefix":"10.36660","volume":"122","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7545-2683","authenticated-orcid":false,"given":"Pl\u00ednio Jos\u00e9 Whitaker","family":"Wolf","sequence":"first","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edileide Barros","family":"Correia","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o Manoel","family":"Rossi Neto","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco Aurelio","family":"Finger","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina Casadei","family":"Santos","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcos de Oliveira","family":"Vasconcellos","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3799-9466","authenticated-orcid":false,"given":"Larissa Ventura Ribeiro","family":"Bruscky","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7909-5326","authenticated-orcid":false,"given":"Ana Cristina de Souza","family":"Murta","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil; Centro de Refer\u00eancia e Treinamento DST\/Aids-SP,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yon\u00e1 Afonso","family":"Francisco","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabiano Castro","family":"Albrecht","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1990-3798","authenticated-orcid":false,"given":"Juliana Jangelavicin","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo Mikio","family":"Sassaki","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno Noshang","family":"Blaas","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4188-1799","authenticated-orcid":false,"given":"Bianca Fernandes T\u00e1vora","family":"Arruda","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda de Brito","family":"Fortuna","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7061-0238","authenticated-orcid":false,"given":"Victor Bemfica de Mello","family":"Mattos","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"22636","published-online":{"date-parts":[[2025]]},"reference":[{"issue":"18","key":"ref1","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1016\/j.jacc.2023.03.393","article-title":"2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure with Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee","volume":"81","author":"Kittleson MM","year":"2023","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"ref2","first-page":"436","article-title":"Diretriz Brasileira de Insufici\u00eancia Card\u00edaca Cr\u00f4nica e Aguda","volume":"111","author":"Rohde LEP","year":"2018","journal-title":"Arq Bras Cardiol"},{"issue":"36","key":"ref3","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure","volume":"42","author":"McDonagh TA","year":"2021","journal-title":"Eur Heart J"},{"issue":"9","key":"ref4","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1002\/ejhf.822","article-title":"Do Patients Have Worse Outcomes in Heart Failure than in Cancer? 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