The Role of Macrophage Activation and Polarization in Heart Failure and the Intervention of Traditional Chinese Medicine

Heart failure (HF) is a clinical syndrome characterized by insufficient cardiac output due to structural or functional abnormalities of the heart, resulting in inadequate tissue perfusion. It typically presents with symptoms such as dyspnea and pulmonary congestion or edema. HF is associated with high morbidity and mortality and is often accompanied by persistent activation of the immune system and systemic inflammatory responses. The imbalance of M1/M2 macrophage polarization plays a critical role in the processes of inflammation, fibrosis, and angiogenesis in HF. Traditional Chinese medicine (TCM) has demonstrated unique advantages in regulating macrophage polarization, suppressing inflammation, and delaying HF progression through its multi-target and multi-pathway actions, which have gained increasing attention from researchers both domestically and internationally. This review focuses on the characteristics and metabolic mechanisms of macrophage polarization, highlights their roles in inflammation, metabolic reprogramming, and myocardial fibrosis in HF, and summarizes recent advances in TCM-based interventions targeting macrophage polarization in HF. It aims to provide theoretical support and research directions for developing novel therapeutic strategies and expanding the clinical application of TCM.