<International Circulation>: Reverse cardiac remodeling in heart failure is fact not fiction. What are your thoughts on the  current clinical approach to antifibrotic strategies in the treatment of cardiac hypertrophy and heart failure， and perhaps more importantly， what does the future hold?

 《国际循环》：当前，逆转心力衰竭患者的心脏重塑已经成为可能。在心脏肥大和心力衰竭中的抗纤维化治疗策略前景广阔，请您谈一下，目前临床上应该如何正确应用这一治疗手段？

    Dr Adams:  We really have established for a number of years the value of aldosterone blockade but the way it worked， in the clinical trial data that we had， wasn’t comprehensive across the entire spectrum of heart failure. Now， at least with the preliminary data from the EMPHASIS-HF trial， we have suggested data that completes the picture that this fibrotic activity is a different type of remodeling. It is not enlarging of the heart cells， or stretching or thickening of the heart cells， but it is changes in the tissue matrix that the heart cells are embedded in. For years， we have had multiple animal data suggesting this fibrosis in this tissue matrix was harmful， but now we have multiple clinical trials suggesting at least that this might be one way in which aldosterone blockade is working to decrease these changes in this matrix tissue. Now from EMPHASIS-HF， and I should reiterate that this is preliminary information at this point， it does appear that this study will be positive and join RALES and EPHESUS and that really arms us with additional ways to help patients with heart failure.

    Adams博士：在心力衰竭患者中拮抗醛固酮的价值已经发现和确立了数年，但就之前的临床数据而言，它在整个心衰过程中的作用我们并不清楚。现在，至少从EMPHASIS-HF试验的原始数据中，我们找到了支持纤维化 是一种不同类型的重塑的最终证据，不是心肌细胞的扩大、延伸或、变厚，而是心脏细胞中“深藏”着的组织基质的变化。多年来，有多个动物试验的数据说明组织基质纤维化的变化是有害的，但现临床试验至少能够提示这可能是醛固酮阻断剂减少组织基质中的这些变化的一种方式。。现在，从EMPHASIS试验来看，我要重申，这是在这方面的初步信息，提示这项研究可能是阳性结果；加上RALES试验和EPHESUS试验，帮助我们发现更多的方法控制来帮助心脏衰竭患者。

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