Φαρμακευτική θεραπεία της μετεμφραγματικής καρδιακής ανεπάρκειας. Α. Καραβίδας Υπεύθυνος ιατρείου καρδιακής ανεπάρκειας Γ.Ν.Α Γ.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Φαρμακευτική θεραπεία της μετεμφραγματικής καρδιακής ανεπάρκειας. Α. Καραβίδας Υπεύθυνος ιατρείου καρδιακής ανεπάρκειας Γ.Ν.Α Γ."

Transcription

1 Φαρμακευτική θεραπεία της μετεμφραγματικής καρδιακής ανεπάρκειας Α. Καραβίδας Υπεύθυνος ιατρείου καρδιακής ανεπάρκειας Γ.Ν.Α Γ.Γεννηματάς

2 Clinical Trials on Fibrinolysis N = AMI pts, ( GUSTO I, GUSTOIIb, GUSTO III, ASSENT III) HF at admission 12.5% HF at any time during admission 29.4% Hasdai et al. Am Heart J. 23 N = 66.5 AMI pts, National Registry of Myocardial Infarction HF at admission 2.4% HF after admission 8.6% Spencer FA et al. Circulation 22 N = 5566 pts with AMI admitted to 84 hospitals in 9 countries (VALIANT registry) HF after admission 23.1% Velazquez Velazquez EJ et al.eur Heart J 24 Heart Failure is a common occurrence after AMI

3

4 Ν=7.773pts >65 years without a history of HF

5 HF-free survival N= AMI pts from 1994 to 1999, 24% underwent invasive coronary revascularization (PCI) FU mean 32 months The use of primary PCI was associated with lower rates of heart failure in hospital (17% versus 24%) and at discharge (4% versus 7%) Am J Cardiol 28

6 Heart Failure Complicating AMI Presents an Early and Sustained Increase in Mortality 3- to 4-fold 4 increase in mortality 1,2,3 NRMI-2 1 Hasdai et al 2 GRACE 3 Hospital admission 3 days 6 Months 1 National Registry Myocardial Infarction-2 Wu et al. J Am Coll Cardiol.. 22;4: Hasdai et al. Am Heart J. 23;145: Global Registry of Acute Coronary Events Steg et al. Circulation. 24;19:

7 Goals in the management of post-myocardial infarction with left ventricular dysfunction Prevent future coronary events (CAD progression) Improve symptoms Attenuate progressive pathologic LV remodeling (reduce progression of disease) Adapted from Gheorgiade and Bonow. Circulation 1998 Prolong survival by preventing CAD progression, SCD or progression of HF

8 Natural history of Congestive Heart Failure Index event 6% EF % 2% Secondary damage Neurohormonal activation Sympathetic system activity SNSnervous RAAS Endothelin Reninetc Angiotensin- Aldosterone System activity Asymptomatic Time (years) Symptomatic Mann DL.et al. Circulation 25

9 The Pathophysiology of Heart Failure Results from Neurohormonal Activation RAS activation Angiotensin II Aldosterone SNS activation Norepinephrine Hypertrophy,apoptosis,ischemia,arrhythmias, remodeling, fibrosis Mortality and disease progression

10 Early Use of ACE-Inhibitors in Post-MI Trials Patients (n) Mean Follow-up Target Dose LVEF (%) Effects on all-cause mortality SAVE Captopril yrs 5 N/A mg tid 4 AIRE Ramipril yrs 5 mg I III bid N/A TRACE yrs 4mg N/Aqd 35 Trandorapril SAVE Radionuclide EF 4% Pfeffer MA et al. N Eng J Med 1992 AIRE Clinical and/or radiographic signs of HF Acute Infarction Ramipril Efficacy study Investigators. Lancet 1993 All-cause mortality: 19%(p=.19) All-cause mortality: 27%(p=.2) All-cause mortality: 22%(p=.1) TRACE Echocardiographic EF 35% Kober L et al. N Eng J Med 1995

11 SAVE Radionuclide EF 4% AIRE Clinical and/or radiographic signs of HF TRACE Echocardiographic EF 35%.4 All-Cause Mortality.35 Probability of Event N=5966 pts Placebo ACE-I 26% reduction Placebo: 866/2971 (29.1%) ACE-I: 72/2995 (23.4%) OR:.74 (.66.83) Years ACE-I Placebo Flather MD, et al. Lancet. 2;355:

12 4 SAVE Radionuclide EF 4% ACE-I (n = 2995) AIRE Clinical and/or radiographic signs of HF Death and Major CV Events Placebo (n = 2971) TRACE Echocardiographic EF 35% 25% reduction Events (%) % reduction.73* (.63.85) 2% reduction.8* (.69.95).75* (.67.83) 1 n = 355 n = 46 Readmission for HF n = 324 n = 391 Reinfarction n = 149 n = 1244 Death/MI or Readmission for HF *odds ratio (95% CI) Flather MD, et al. Lancet. 2;355:

13 Echocardiographic substudy of SAVE The protective effects of Captopril Ν=42 AMI pts 2D echo was performed soon after AMI and after 1 year St John SM et al. Circulation 1994

14 Echocardiographic substudy of SAVE The protective effects of Captopril Ν=42 AMI pts 2D echo was performed soon after AMI and after 1 year 35% reduction St John SM et al. Circulation 1994

15 VALIANT: Mortality by Treatment Probability of Event Months Captopril Valsartan Valsartan + Captopril N= 1473 AMI pts EF 35 on echo and/ or EF 4 on radionuclide ventriculography Mean FU 2years Valsartan vs. Captopril: HR = 1.; P =.982 Valsartan + Captopril vs. Captopril: HR =.98; P = Captopril Valsartan Valsartan + Cap Pfeffer, McMurray, Velazquez, et al. N Engl J Med 23;349

16 Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN STUDY) All-Cause Mortality N=1.959 acute MI pts, EF<4%, FU 1.3 years ACE inhibitor 97%, aspirin 86%, thrombolysis/primary angioplasty 46% 1 Proportion Event-Free % reduction P =.31 Carvedilol Placebo The CAPRICORN Investigators. Lancet 21 Years

17 CAPRICORN STUDY RR of Sudden Cardiac Death 26% 25% 41% The CAPRICORN Investigators. Lancet 21

18 Ν=127 acute MI patients with LVSD FU echo after 6 months of therapy EF had increased in the carvedilol group by 5% after 6 months of treatment with no change with placebo

19 Patients With HF Complicating AMI Receive Suboptimal Medical Treatment Medication within 24*h Beta-blockers PO IV ACE Inhibitors No HF (%) HF (% Wu et al. J Am Coll Cardiol.. 22 A review of medical records from > 2. patients with a history of MI found that only 34% received β-blockers Abraham W et al. Am J Cardiol 28

20 K Weber, N Engl J Med 21 Η Αλδοστερόνη προάγει την περιαγγειακή ίνωση και την αγγειακή αναδιαμόρφωση Αλλαγές σε μοριακό,κυτταρικό επίπεδο με προοδευτική αποδόμηση της εξωκυττάριας θεμέλειας ουσίας

21 Eplerenone Post-AMI Heart Failure Efficacy and Survival Study (EPHESUS): Design patients with acute MI complicated by systolic left ventricular dysfunction ( EF < 4%) and heart failure Acute MI in prior 3-14 Days Heart Failure (in not diabetics but not required for diabetics) Eplerenone 25-5 mg QD n=3,313 Primary endpoints: Secondary endpoints: Other endpoints: Optimal medical therapy (ACE inhibitors or angiotensinreceptor blockers(87%),diuretics, and beta-blockers (75%), coronary reperfusion therapy) at mean of 16 month follow-up Placebo n=3,319 All-cause mortality CV mortality + CV hospitalization CV mortality CV hospitalization All-cause mortality + all-cause hospitalization New onset of atrial fibrillation/flutter NYHA functional class QOL AMI=acute myocardial infarction; QOL=quality of life. Reproduced with permission: Pitt B, et al. Cardiovasc Drugs Ther. 21;15:79-87.

22 Primary Endpoint: All-Cause Mortality % reduction Cumulative Incidence (%) RR =.85 (95% CI, ) P =.8 Placebo Eplerenone Months Since Randomisation Placebo Eplerenone Pitt B et al. N Eng J Med 23; 348:

23 Primary Endpoint: CV Mortality/CV Hospitalization Cumulative Incidence (%) RR =.87 (95% CI, ) P =.2 13% reduction Placebo Eplerenone Months Since Randomization Placebo Eplerenone Pitt B et al. N Eng J Med 23; 348:

24 RR of Sudden Cardiac Death 1 All Patients Cumulative incidence (%) 5 Placebo Eplerenone RR=.79 (95% CI, ) P=.3 21% reduction Months since randomization Pitt B, et al. N Engl J Med. 23;348:

25 HF Hospitalizations 2 Eplerenone Placebo 7 23% risk reduction P = % risk reduction P = Percent (%) 1 Number of Episodes Patients Hospitalized for Heart Failure Episodes of Heart Failure Hospitalization Pitt B et al. N Eng J Med 23; 348:

26 Effects on Potassium Homeostasis % absolute decrease P < ,1 1 Patients (%) % absolute increase P =.2 8,4 Eplerenone Placebo 4 2 5,5 3,9 Serious Hyperkalaemia (K + 6. mmol/l) Hypokalaemia (K + < 3.5 mmol/l) Pitt B et al. N Eng J Med 23; 348:

27 EPHESUS: Eplerenone Survival Benefits at 3 Days Support Urgency to Treat 12 13% Eplerenone Placebo Cumulative Incidence (%) % % All-cause mortality RR=.69 (95% CI,,54-,89) CV mortality CV hospitalizations RR=.87 (95% CI,,74-1,1) CV mortality RR=.68 (95% CI,,53-,88)88 Pitt et al. JACC 25;46;

28 EPHESUS TM : Sudden Cardiac Death at 3 Days Post-Randomization Sudden Cardiac Death (Secondary End Point) 5 RR=.63 (95% CI,.4-1.) Cumulative Incidence (%) Placebo + standard therapies (n=3313) Eplerenone + standard therapies (n=3319) 37% reduction Days From Randomization P=.51 Pitt B, White H, Nicolau J, et al. J Am Coll Cardiol. 25;46:

29 21% reduction All cause mortality 15% Effects of eplerenone in Pts with EF<3% 21% reduction CV mortality/hospitalization 13% 33% reduction Sudden cardiac death 21% Pitt et al. Eur J Heart Fail 26

30 Effects of eplerenone within 3 days in patients with EF<3% 29% 43% 58% Pitt et al. Eur J Heart Fail 26

31 Eplerenone suppress post-acute myocardial infarction collagen turnover changes (EPHESUS substudy) N = 476 pts PINP- PIIINP= βιολογικοί δείκτες ορού σύνθεσης κολλαγόνου Eplerenone Placebo Iraqi W et al. Crculation 29

32 Post-MI LV Dysfunction: Current therapeutic strategies ACE inhibitors (SAVE, AIRE, TRACE) Carvedilol (CAPRICORN) ARBs alternatively to ACEi (VALIANT) Eplerenone (EPHESUS) - Statins - Aspirine

33 Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation Long term Management of Heart Failure or LV Dysfunction Recommendations Oral beta-blockers in all patients without contraindications Class LOE I A ACE inhibitors in all patients without contraindications ARB (Valsartan) in all patients without contraindications who do not tolerate ACE-inhibitors Aldosterone antagonists if EF<4% and signs of heart failure or diabetes if creatinine is < 2.5mg/dL (221μmol/L) in men and < 2. mg/dl (177μmol/L) in women and potassium < 5mmol/L I A I B I B ESC GUIDELINES 28

ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure

ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure - 2005 Karl Swedberg Professor of Medicine Department of Medicine Sahlgrenska University Hospital/Östra Göteborg University Göteborg

More information

LXIV: DRUGS: 4. RAS BLOCKADE

LXIV: DRUGS: 4. RAS BLOCKADE LXIV: DRUGS: 4. RAS BLOCKADE ACE Inhibitors Components of RAS Actions of Angiotensin i II Indications for ACEIs Contraindications RAS blockade in hypertension RAS blockade in CAD RAS blockade in HF Limitations

More information

HFpEF, Mito or Realidad?

HFpEF, Mito or Realidad? HFpEF, Mito or Realidad? Ileana L. Piña, MD, MPH Professor of Medicine and Epidemiology/Population Health Associate Chief for Academic Affairs -- Cardiology Montefiore-Einstein Medical Center Bronx, NY

More information

Evaluation of eplerenone in the subgroup of EPHESUS patients with baseline left ventricular ejection fraction 30%

Evaluation of eplerenone in the subgroup of EPHESUS patients with baseline left ventricular ejection fraction 30% The European Journal of Heart Failure 8 (2006) 295 301 www.elsevier.com/locate/ejheart Evaluation of eplerenone in the subgroup of EPHESUS patients with baseline left ventricular ejection fraction 30%

More information

Severe Left Ventricular Dysfunction: Evolving Revascularization Strategies

Severe Left Ventricular Dysfunction: Evolving Revascularization Strategies Severe Left Ventricular Dysfunction: Evolving Revascularization Strategies Robert O. Bonow, MD, MS, MACC Northwestern University Feinberg School of Medicine Bluhm Cardiovascular Institute Northwestern

More information

Drugs acting on the reninangiotensin-aldosterone

Drugs acting on the reninangiotensin-aldosterone Drugs acting on the reninangiotensin-aldosterone system John McMurray Eugene Braunwald Scholar in Cardiovascular Diseases, Brigham and Women s Hospital, Boston & Visiting Professor, Harvard Medical School

More information

SHOULD BETA BLOCKERS AND ACE INHIBITORS BE USED ROUTINELY IN POST MI PATIENTS WITH PRESERVED LV FUNCTION?

SHOULD BETA BLOCKERS AND ACE INHIBITORS BE USED ROUTINELY IN POST MI PATIENTS WITH PRESERVED LV FUNCTION? SHOULD BETA BLOCKERS AND ACE INHIBITORS BE USED ROUTINELY IN POST MI PATIENTS WITH PRESERVED LV FUNCTION? Doron Zahger, MD Department of Cardiology, Soroka University Medical Center, Faculty of Health

More information

Combination of renin-angiotensinaldosterone. how to choose?

Combination of renin-angiotensinaldosterone. how to choose? Combination of renin-angiotensinaldosterone system inhibitors how to choose? Karl Swedberg Professor of Medicine Sahlgrenska Academy University of Gothenburg karl.swedberg@gu.se Disclosures Research grants

More information

Heart Failure A Team Approach Background, recognition, diagnosis and management

Heart Failure A Team Approach Background, recognition, diagnosis and management Heart Failure A Team Approach Background, recognition, diagnosis and management Speaker bureau: Novartis At the conclusion of this activity, participants will be able to: Recognize signs and symptoms of

More information

DISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.

DISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics. DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this

More information

Cosa c è di nuovo nelle LLGG e nella gestione del paziente con scompenso cardiaco. Maurizio Volterrani IRCCS San Raffaele Rome Capri, 24 April 2015

Cosa c è di nuovo nelle LLGG e nella gestione del paziente con scompenso cardiaco. Maurizio Volterrani IRCCS San Raffaele Rome Capri, 24 April 2015 Cosa c è di nuovo nelle LLGG e nella gestione del paziente con scompenso cardiaco Maurizio Volterrani IRCCS San Raffaele Rome Capri, 24 April 2015 Treatment options for patients with chronic symptomatic

More information

New Winners in the World of Heart Failure. Laura Steffens PharmD Candidate 2016 CICU Presentation August 12, 2015

New Winners in the World of Heart Failure. Laura Steffens PharmD Candidate 2016 CICU Presentation August 12, 2015 New Winners in the World of Heart Failure Laura Steffens PharmD Candidate 2016 CICU Presentation August 12, 2015 Jessup 2014 Shaking Things Up 2003: FDA approved eplerenone for the treatment of heart failure

More information

Management of Stage B Heart Failure

Management of Stage B Heart Failure KSC 2017 Management of Stage B Heart Failure Byung Su Yoo, MD., PhD. Division of Cardiology, Wonju College of Medicine, Yonsei University, South Korea Focused on Symptom ASLVSD, ASLVDD LVH HF progression

More information

CABG alone. It s enough? / Μόνο η αορτοστεφανιαία παράκαμψη είναι αρκετή;

CABG alone. It s enough? / Μόνο η αορτοστεφανιαία παράκαμψη είναι αρκετή; LV Aneurysm and VSD in Ischaemic Heart Failure / Στεφανιαία νόσος, ανεύρυσμα αριστεράς κοιλίας και VSD CABG alone. It s enough? / Μόνο η αορτοστεφανιαία παράκαμψη είναι αρκετή; THEODOROS KARAISKOS CONSULTANT

More information

The Hearth Rate modulators. How to optimise treatment

The Hearth Rate modulators. How to optimise treatment The Hearth Rate modulators How to optimise treatment Munich, ESC Congress 2012 Prof. Luigi Tavazzi GVM Care&Research E.S. Health Science Foundation Cotignola, IT Disclosure Cooperation with: Servier, Medtronic,

More information

Heart Failure with Preserved EF (HFPEF) Epidemiology and management

Heart Failure with Preserved EF (HFPEF) Epidemiology and management Heart Failure with Preserved EF (HFPEF) Epidemiology and management Karl Swedberg Senior Professor of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg, Sweden e-mail: karl.swedberg@gu.se

More information

Guideline-Directed Medical Therapy

Guideline-Directed Medical Therapy Guideline-Directed Medical Therapy Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation OPTIMAL THERAPY (As defined in

More information

presenters 2010 Sameh Sabet Ain Shams University

presenters 2010 Sameh Sabet Ain Shams University Guidelines for PCI in late STEMI presenters 2010 Sameh Sabet Assistant Professor of Cardiology Ain Shams University 29% of MI patients have STEMI. NRMI 4 (Fourth National Registry of Myocardial Infarction),

More information

Revascularization for Patients with HFrEF: CABG and PCI and the Concept of Myocardial Viability

Revascularization for Patients with HFrEF: CABG and PCI and the Concept of Myocardial Viability Revascularization for Patients with HFrEF: CABG and PCI and the Concept of Myocardial Viability 22nd Annual Heart Failure 2018: an Update on Therapy April 2018 Eric J. Velazquez, MD, FACP, FACC, FASE,

More information

12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices. Heart Rate as a Cardiovascular Biomarker

12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices. Heart Rate as a Cardiovascular Biomarker 12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices Heart Rate as a Cardiovascular Biomarker Inder Anand, MD, FRCP, D Phil (Oxon.) Professor of Medicine,

More information

Outline. Pathophysiology: Heart Failure. Heart Failure. Heart Failure: Definitions. Etiologies. Etiologies

Outline. Pathophysiology: Heart Failure. Heart Failure. Heart Failure: Definitions. Etiologies. Etiologies Outline Pathophysiology: Mat Maurer, MD Irving Assistant Professor of Medicine Definitions and Classifications Epidemiology Muscle and Chamber Function Pathophysiology : Definitions An inability of the

More information

HEART FAILURE. Heart Failure in the US. Heart Failure (HF) 3/2/2014

HEART FAILURE. Heart Failure in the US. Heart Failure (HF) 3/2/2014 HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center March 2014 Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading

More information

Updates in Heart Failure (HF) 2016: ACC / AHA and ESC

Updates in Heart Failure (HF) 2016: ACC / AHA and ESC Updates in Heart Failure (HF) 2016: ACC / AHA and ESC Patrick McBride, MD, MPH Professor of Medicine & Family Medicine, UW School of Medicine and Public Health Special thanks to: Clyde W. Yancy, MD, MSc

More information

From PARADIGM-HF to Clinical Practice. Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group

From PARADIGM-HF to Clinical Practice. Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group From PARADIGM-HF to Clinical Practice Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group PARADIGM-HF: Inclusion Criteria Chronic HF NYHA FC II IV with LVEF

More information

Disclosure Statement. Heart Failure: Refreshers and Updates. Objectives. CHF: Chronic Heart Failure. Definitions. Definitions 2/19/2018

Disclosure Statement. Heart Failure: Refreshers and Updates. Objectives. CHF: Chronic Heart Failure. Definitions. Definitions 2/19/2018 Disclosure Statement Heart Failure: Refreshers and Updates Tracy K. Pettinger, PharmD Clinical Associate Professor College of Pharmacy The planners and presenter of this presentation have disclosed no

More information

The Role of ICD Therapy in Cardiac Resynchronization

The Role of ICD Therapy in Cardiac Resynchronization The Role of ICD Therapy in Cardiac Resynchronization The Korean Society of Circulation 15 April 2005 Angel R. León, MD Carlyle Fraser Heart Center Division of Cardiology Emory University School of Medicine

More information

WHAT S NEW IN HEART FAILURE

WHAT S NEW IN HEART FAILURE WHAT S NEW IN HEART FAILURE Drugs, Devices and Diagnostics John M. Herre, MD, FACC, FACP Director, Advanced Heart Failure Program Sentara Helathcare Professor of Medicine Eastern Virginia Medical School

More information

Optimal Adrenergic Blockades in Heart Failure. Jae-Joong Kim MD, PhD Asan Medical Center, University of Ulsan, Seoul, Korea

Optimal Adrenergic Blockades in Heart Failure. Jae-Joong Kim MD, PhD Asan Medical Center, University of Ulsan, Seoul, Korea Optimal Adrenergic Blockades in Heart Failure Jae-Joong Kim MD, PhD Asan Medical Center, University of Ulsan, Seoul, Korea Contents Harmful effects of adrenergic system in heart failure Clinical studies

More information

Ejection Fraction in Patients With Chronic Heart Failure. Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction

Ejection Fraction in Patients With Chronic Heart Failure. Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction Keith Miller MD Diastolic Heart Failure Risk Factors Common Risk Factors Aging Female gender Obesity Hypertension Diabetes mellitus

More information

Outline. Classification by LVEF Conventional Therapy New Therapies. Ivabradine Sacubitril/valsartan

Outline. Classification by LVEF Conventional Therapy New Therapies. Ivabradine Sacubitril/valsartan New Pharmacological Therapies for Heart Failure Mark Drazner, MD, MSc Clinical Chief of Cardiology Medical Director, CHF/VAD/Transplant James M. Wooten Chair in Cardiology UT Southwestern Medical Center

More information

LCZ696 A First-in-Class Angiotensin Receptor Neprilysin Inhibitor

LCZ696 A First-in-Class Angiotensin Receptor Neprilysin Inhibitor The Angiotensin Receptor Neprilysin Inhibitor LCZ696 in Heart Failure with Preserved Ejection Fraction The Prospective comparison of ARNI with ARB on Management Of heart failure with preserved ejection

More information

Coronary interventions

Coronary interventions Controversial issues in the management of ischemic heart failure Coronary interventions Maciej Lesiak Department of Cardiology, University Hospital in Poznan none DECLARATION OF CONFLICT OF INTEREST CHF

More information

RAS Blockade Across the CV Continuum

RAS Blockade Across the CV Continuum A Summary of Recent International Meetings RAS Blockade Across the CV Continuum Copyright New Evidence Presented at the 2009 Congress of the European Society of Cardiology (August 29-September 2, Barcelona)

More information

Management of chronic heart failure: update J. Parissis Attikon University Hospital

Management of chronic heart failure: update J. Parissis Attikon University Hospital Management of chronic heart failure: update 2015 J. Parissis Attikon University Hospital Disclosures: received honoraria for lectures from Servier, Pfizer, Novartis Discharges in Thousands Heart Failure

More information

Disclosures. Advances in Chronic Heart Failure Management 6/12/2017. Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017

Disclosures. Advances in Chronic Heart Failure Management 6/12/2017. Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017 Advances in Chronic Heart Failure Management Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017 I have nothing to disclose Disclosures 1 Goal statement To review recently-approved therapies

More information

ST2 in Heart Failure. ST2 as a Cardiovascular Biomarker. Competitive Model of ST2/IL-33 Signaling. ST2 and IL-33: Cardioprotective

ST2 in Heart Failure. ST2 as a Cardiovascular Biomarker. Competitive Model of ST2/IL-33 Signaling. ST2 and IL-33: Cardioprotective ST2 as a Cardiovascular Biomarker Lori B. Daniels, MD, MAS, FACC Professor of Medicine Director, Coronary Care Unit University of California, San Diego ST2 and IL-33: Cardioprotective ST2: member of the

More information

Is Heart Rate a Treatment Target?

Is Heart Rate a Treatment Target? Is Heart Rate a Treatment Target? M. Böhm Innere Medizin III (Kardiologie / Angiologie / Internistische Intensivmedizin) Universitätsklinikum des Saarlandes Homburg/Saar michael.boehm@uks.eu Heart Rate

More information

Cardiogenic Shock. Carlos Cafri,, MD

Cardiogenic Shock. Carlos Cafri,, MD Cardiogenic Shock Carlos Cafri,, MD SHOCK= Inadequate Tissue Mechanisms: Perfusion Inadequate oxygen delivery Release of inflammatory mediators Further microvascular changes, compromised blood flow and

More information

Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy

Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy Evan Adelstein, MD, FHRS John Gorcsan III, MD Samir Saba, MD, FHRS

More information

Acute Coronary Syndrome. Sonny Achtchi, DO

Acute Coronary Syndrome. Sonny Achtchi, DO Acute Coronary Syndrome Sonny Achtchi, DO Objectives Understand evidence based and practice based treatments for stabilization and initial management of ACS Become familiar with ACS risk stratification

More information

2016 Update to Heart Failure Clinical Practice Guidelines

2016 Update to Heart Failure Clinical Practice Guidelines 2016 Update to Heart Failure Clinical Practice Guidelines Mitchell T. Saltzberg, MD, FACC, FAHA, FHFSA Medical Director of Advanced Heart Failure Froedtert & Medical College of Wisconsin Stages, Phenotypes

More information

Management of ST-elevation myocardial infarction Update 2009 Late comers: which options?

Management of ST-elevation myocardial infarction Update 2009 Late comers: which options? European Society of Cardiology Annual Session 2009 Management of ST-elevation myocardial infarction Update 2009 Late comers: which options? Antonio Abbate, MD Assistant Professor of Medicine Virginia Commonwealth

More information

New Agents for Heart Failure: Ivabradine Jeffrey S. Borer, MD

New Agents for Heart Failure: Ivabradine Jeffrey S. Borer, MD New Agents for Heart Failure: Ivabradine Jeffrey S. Borer, MD Professor of Medicine, Cell Biology, Radiology and Surgery Director, The Howard Gilman Institute for Heart Valve Disease and the Schiavone

More information

Disclosures for Presenter

Disclosures for Presenter A Comparison of Angiotensin Receptor- Neprilysin Inhibition (ARNI) With ACE Inhibition in the Long-Term Treatment of Chronic Heart Failure With a Reduced Ejection Fraction Milton Packer, John J.V. McMurray,

More information

Role of Clopidogrel in Acute Coronary Syndromes. Hossam Kandil,, MD. Professor of Cardiology Cairo University

Role of Clopidogrel in Acute Coronary Syndromes. Hossam Kandil,, MD. Professor of Cardiology Cairo University Role of Clopidogrel in Acute Coronary Syndromes Hossam Kandil,, MD Professor of Cardiology Cairo University ACS Treatment Strategies Reperfusion/Revascularization Therapy Thrombolysis PCI (with/ without

More information

Management of Heart Failure in Older Adults

Management of Heart Failure in Older Adults Management of Heart Failure in Older Adults New Data, New Guidelines, New Challenges JOSE NATIVI, MD, MSCI Assistant Professor of Medicine Cardiovascular Director Amyloidosis Program DISCLOSURES - Advisory

More information

Heart Failure A Disease for the Internist?

Heart Failure A Disease for the Internist? Heart Failure A Disease for the Internist? Dr Chris Davidson Sussex Cardiac Centre BRIGHTON UK Hot Topics in Heart Failure Drug treatments Valsartan / neprilysin inhib Investigations BNP and others Devices

More information

Devices and Other Non- Pharmacologic Therapy in CHF. Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine

Devices and Other Non- Pharmacologic Therapy in CHF. Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine Devices and Other Non- Pharmacologic Therapy in CHF Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine Disclosure None University of Miami vs. OSU Renegade Miami football

More information

Heart Failure New Drugs- Updated Guidelines

Heart Failure New Drugs- Updated Guidelines Heart Failure New Drugs- Updated Guidelines Eileen Handberg, PhD, ANP-BC, FAHA, FACC Professor of Medicine Division of Cardiovascular Medicine University of Florida Disclosures 1. 3 2. 6 3. 8 4. 11 Dunlay

More information

Heart Failure 101 The Basic Principles of Diagnosis & Management

Heart Failure 101 The Basic Principles of Diagnosis & Management Heart Failure 101 The Basic Principles of Diagnosis & Management Bill Tran, MD Non Invasive Cardiologist February 24, 2018 What the eye does not see and the mind does not know, does not exist. DH Lawrence

More information

Heart Failure. Disclosures. Objectives: 8/28/2017. This is not a virus. It doesn t go away. none

Heart Failure. Disclosures. Objectives: 8/28/2017. This is not a virus. It doesn t go away. none Heart Failure This is not a virus. It doesn t go away Shelley Wojtaszczyk, FNP-C, CHFN Heart Failure Program Coordinator Mercy Hospital of Buffalo none Disclosures Objectives: Defining and identifying

More information

Quality Payment Program: Cardiology Specialty Measure Set

Quality Payment Program: Cardiology Specialty Measure Set Quality Payment Program: Cardiology Specialty Set Title Number CMS Reporting Method(s) Heart Failure (HF): Angiotensin- Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for

More information

Diagnosis is it really Heart Failure?

Diagnosis is it really Heart Failure? ESC Congress Munich - 25-29 August 2012 Heart Failure with Preserved Ejection Fraction From Bench to Bedside Diagnosis is it really Heart Failure? Prof. Burkert Pieske Department of Cardiology Med.University

More information

Practice-Level Executive Summary Report

Practice-Level Executive Summary Report PINNACLE Registry Metrics 0003, Test Practice_NextGen [Rolling: 1st April 2015 to 31st March 2016 ] Generated on 5/11/2016 11:37:35 AM American College of Cardiology Foundation National Cardiovascular

More information

Saudi Arabia February Pr Michel KOMAJDA. Université Pierre et Marie Curie Hospital Pitié Salpétrière

Saudi Arabia February Pr Michel KOMAJDA. Université Pierre et Marie Curie Hospital Pitié Salpétrière Prevention of Cardiovascular events with Ivabradine: The SHIFT Study Saudi Arabia February 2011 Pr Michel KOMAJDA Université Pierre et Marie Curie Hospital Pitié Salpétrière Paris FRANCE Declaration Of

More information

Hypertension Management Focus on new RAAS blocker. Disclosure

Hypertension Management Focus on new RAAS blocker. Disclosure Hypertension Management Focus on new RAAS blocker Rameshkumar Raman M.D Endocrine Associates of The Quad Cities Disclosure Speaker bureau Abbott, Eli Lilly, Novo Nordisk, Novartis, Takeda, Merck, Solvay

More information

Highlight Session Heart failure and cardiomyopathies Michel KOMAJDA Paris France

Highlight Session Heart failure and cardiomyopathies Michel KOMAJDA Paris France Highlight Session 2014 Heart failure and cardiomyopathies Michel KOMAJDA Paris France # esccongress www.escardio.org/esc2014 HEART FAILURE AND CARDIOMYOPATHIES TOPIC 1 Drug Therapy TOPIC 2 Device Therapy

More information

Toledo Hospital Clinical Quality Indicators. Effective - Heart Attack

Toledo Hospital Clinical Quality Indicators. Effective - Heart Attack Effective - Heart Attack This page shows information on effective measures for patients who had heart attacks. "Effective care" means patients are given treatments that scientific evidence has shown leads

More information

Updated and Guideline Based Treatment of Patients with STEMI

Updated and Guideline Based Treatment of Patients with STEMI Updated and Guideline Based Treatment of Patients with STEMI Eli I. Lev, MD Director, Cardiac Catheterization Laboratory Hasharon Hospital, Rabin Medical Center Associate Professor of Cardiology Tel-Aviv

More information

VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION

VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION Dr Catherine BESEME Paris 6 th December 2005 6 th International Congress of Bangladesh Society of Medicine Hypertension is a risk factor at the source, with

More information

Optimal antiplatelet and anticoagulant therapy for patients treated in STEMI network

Optimal antiplatelet and anticoagulant therapy for patients treated in STEMI network Torino 6 Joint meeting with Mayo Clinic Great Innovation in Cardiology 14-15 Ottobre 2010 Optimal antiplatelet and anticoagulant therapy for patients treated in STEMI network Diego Ardissino Ischemic vs

More information

Objectives. Outline 4/3/2014

Objectives. Outline 4/3/2014 Jessica Litke PGY1 ISHP Spring Meeting April 12, 2014 Objectives Appreciate the significance of heart failure (HF) to a patient and to the health care system Understand 2013 ACCF/AHA guidelines for the

More information

HFpEF 2016 : Comorbidities and Outcomes

HFpEF 2016 : Comorbidities and Outcomes HFpEF 2016 : Comorbidities and Outcomes Christopher M. O Connor, MD, FACC CEO and Executive Director, Inova Heart and Vascular Institute Professor of Medicine, Duke University Editor in Chief, JACC: Heart

More information

Sacubitril/Valsartan in HFrEF for All Protagonist View George Honos MD FRCPC FCCS FACC

Sacubitril/Valsartan in HFrEF for All Protagonist View George Honos MD FRCPC FCCS FACC Sacubitril/Valsartan in HFrEF for All Protagonist View George Honos MD FRCPC FCCS FACC Head of Cardiology Medical Manager / CV Program CHUM Disclosure Statement Within the past two years: I have had an

More information

G-CSF ATTENUATES VENTRICULAR REMODELLING AFTER ACUTE STEMI. RESULTS OF STem cells Mobilization in Acute Myocardial Infarction

G-CSF ATTENUATES VENTRICULAR REMODELLING AFTER ACUTE STEMI. RESULTS OF STem cells Mobilization in Acute Myocardial Infarction ESC CONGRESS 2010 Stockholm 28 August-1 September G-CSF ATTENUATES VENTRICULAR REMODELLING AFTER ACUTE STEMI. RESULTS OF STem cells Mobilization in Acute Myocardial Infarction C. Malafronte MD Alessandro

More information

Treatment of Stable Coronary Artery Disease Pharmacotherapy

Treatment of Stable Coronary Artery Disease Pharmacotherapy Treatment of Stable Coronary Artery Disease Pharmacotherapy José López-Sendón Hospital Universitario La Paz. Madrid. Spain Conflict of interest: I will discuss off label use and/or investigational use

More information

Beyond neuro-hormonal blockade

Beyond neuro-hormonal blockade Beyond neuro-hormonal blockade Giuseppe M.C. Rosano, MD, PhD, MSc, FESC, FHFA St George s Hospitals NHS Trust University of London KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833

More information

Beta-blockers: Now what? Annemarie Thompson, MD Assistant Professor of Anesthesia and Medicine Vanderbilt University Medical Center

Beta-blockers: Now what? Annemarie Thompson, MD Assistant Professor of Anesthesia and Medicine Vanderbilt University Medical Center Beta-blockers: Now what? Annemarie Thompson, MD Assistant Professor of Anesthesia and Medicine Vanderbilt University Medical Center Beta-blockers: What s known 30 Years 30 Careers Physician clarity regarding

More information

Cardiotoxicity from Chemotherapy : From Early Predictors to Therapeutics

Cardiotoxicity from Chemotherapy : From Early Predictors to Therapeutics Cardiotoxicity from Chemotherapy : From Early Predictors to Therapeutics Richard Sheppard MD FRCPC Director of Heart Failure Research Heart Function Clinic Jewish General hospital Objectives 1. Discuss

More information

Heart Failure with preserved ejection fraction (HFpEF)

Heart Failure with preserved ejection fraction (HFpEF) Heart Failure with preserved ejection fraction (HFpEF) Dr. Pierpaolo Pellicori Hull York Medical School Kingston-upon-Hull United Kingdom Conflict of interest: none Heart failure is a contemporary problem

More information

The Window for Fibrinolysis. Frans Van de Werf, MD, PhD Leuven, Belgium

The Window for Fibrinolysis. Frans Van de Werf, MD, PhD Leuven, Belgium The Window for Fibrinolysis Frans Van de Werf, MD, PhD Leuven, Belgium ESC STEMI Guidelines : December 2008 Reperfusion Therapy: Fibrinolytic Therapy Recommendations Class LOE In the absence of contraindications

More information

Dobutamine-induced increase in heart rate is blunted by ivabradine treatment in patients with acutely decompensated heart failure

Dobutamine-induced increase in heart rate is blunted by ivabradine treatment in patients with acutely decompensated heart failure Dobutamine-induced increase in heart rate is blunted by ivabradine treatment in patients with acutely decompensated heart failure Yuksel Cavusoglu, KU Mert, A Nadir, F Mutlu, E Gencer, T Ulus, A Birdane

More information

Catheter-based mitral valve repair MitraClip System

Catheter-based mitral valve repair MitraClip System Percutaneous Mitral Valve Repair: Results of the EVEREST II Trial William A. Gray MD Director of Endovascular Services Associate Professor of Clinical Medicine Columbia University Medical Center The Cardiovascular

More information

Chronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G.

Chronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G. Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center

More information

Effect of upstream clopidogrel treatment in patients with ST-segment elevation myocardial infarction undergoing primary PCI

Effect of upstream clopidogrel treatment in patients with ST-segment elevation myocardial infarction undergoing primary PCI Effect of upstream clopidogrel treatment in patients with ST-segment elevation myocardial infarction undergoing primary PCI Dr Sasha Koul, MD Dept of Cardiology, Lund University Hospital, Lund, Sweden

More information

Feast after Famine: The New Drugs for the Treatment of Heart Failure

Feast after Famine: The New Drugs for the Treatment of Heart Failure Feast after Famine: The New Drugs for the Treatment of Heart Failure Maria Rosa Costanzo, M.D., F.A.C.C., F.A.H.A., F.E.S.C. Medical Director, Advocate Medical Group-Midwest Heart Specialists Heart Failure

More information

Update on pharmacological treatment of heart failure. Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy

Update on pharmacological treatment of heart failure. Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy Update on pharmacological treatment of heart failure Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy Presenter Disclosures Dr. Maggioni : Serving in Committees of studies sponsored

More information

Vitals HR 90 BP 125/58 Tmax 98.7F O2 Sat 97% on NC 2L/min BMP SCr 1.78 K 3.9 Gluc 194 A1c 7.5 Cardiac LVEF 55% NTproBNP 9,200 Troponin 0.

Vitals HR 90 BP 125/58 Tmax 98.7F O2 Sat 97% on NC 2L/min BMP SCr 1.78 K 3.9 Gluc 194 A1c 7.5 Cardiac LVEF 55% NTproBNP 9,200 Troponin 0. ALDOSTERONE ANTAGONIST IN HEART FAILURE WITH PRESERVED EJECTION FRACTION ABBREVIATIONS BMP: basic metabolic panel HPI: history of present illness CAD: coronary artery disease HR: heart rate PINHUI (JUDY)

More information

Cardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003

Cardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003 Authorized By: Medical Management Guideline Committee Approval Date: 12/13/01 Revision Date: 12/11/03 Beta-Blockers Nitrates Calcium Channel Blockers MEDICATIONS Indicated in post-mi, unstable angina,

More information

Summary/Key Points Introduction

Summary/Key Points Introduction Summary/Key Points Introduction Scope of Heart Failure (HF) o 6.5 million Americans 20 years of age have HF o 960,000 new cases of HF diagnosed annually o 5-year survival rate for HF is ~50% Classification

More information

Reducing Hospital Readmissions and Increasing Time to Hospital Readmission in Blacks with Heart Failure

Reducing Hospital Readmissions and Increasing Time to Hospital Readmission in Blacks with Heart Failure 10th Annual National Summit on Health Disparities CBC Health Braintrust Meeting April 22 April 23, 2013, Washington, DC Reducing Hospital Readmissions and Increasing Time to Hospital Readmission in Blacks

More information

Evidence-based drug therapy in the management of heart failure

Evidence-based drug therapy in the management of heart failure Evidence-based drug therapy in the management of heart failure Marise Gauci BPharm (Hons), MSc Clinical Pharmacist, Rehabilitation Hospital Karin Grech, G Mangia, Malta. Email: marise.gauci@um.edu.mt Educational

More information

Cardiac Viability Testing A Clinical Perspective Annual Cardiac Imaging Symposium. Lisa M Mielniczuk MD FRCPC University of Ottawa Heart Institute

Cardiac Viability Testing A Clinical Perspective Annual Cardiac Imaging Symposium. Lisa M Mielniczuk MD FRCPC University of Ottawa Heart Institute Cardiac Viability Testing A Clinical Perspective Annual Cardiac Imaging Symposium Lisa M Mielniczuk MD FRCPC University of Ottawa Heart Institute 62 year old male Anterior STEMI late presentation, occluded

More information

Heart failure (HF) is a clinical syndrome associated with significant

Heart failure (HF) is a clinical syndrome associated with significant review efficacy and safety of mineralocorticoid receptor antagonist therapy in heart failure with reduced ejection fraction Arden R Barry BSc BSc(Pharm) PharmD ACPR 1, Sheri L Koshman BScPharm PharmD ACPR

More information

Risk Stratification in Heart Failure: The Role of Emerging Biomarkers

Risk Stratification in Heart Failure: The Role of Emerging Biomarkers Risk Stratification in Heart Failure: The Role of Emerging Biomarkers David G. Grenache, PhD Associate Professor of Pathology, University of Utah Medical Director, ARUP Laboratories Salt Lake City, UT

More information

Quality Payment Program: Cardiology Specialty Measure Set

Quality Payment Program: Cardiology Specialty Measure Set Measure Title * Reportable via PINNACLE α Reportable via Diabetes Collaborative CQMC v1.0 Measure High Priority Measure Cross Cutting Measure Heart Failure (HF): Angiotensin- Converting Enzyme (ACE) Inhibitor

More information

Left Ventricular Ejection Fraction >35%

Left Ventricular Ejection Fraction >35% Controversies in Cardiac Resynchronisation Therapy Left Ventricular Ejection Fraction >35% Professor John GF Cleland University of Hull Kingston-upon-Hull United Kingdom Conflict of Interest: I have received

More information

Επεισόδια μη εμμένουσας κοιλιακής ταχυκαρδίας σε μετεμφραγματικό ασθενή και διατηρημένο ΚΕ. Είναι υποψήφιος για απινιδωτή;

Επεισόδια μη εμμένουσας κοιλιακής ταχυκαρδίας σε μετεμφραγματικό ασθενή και διατηρημένο ΚΕ. Είναι υποψήφιος για απινιδωτή; Επεισόδια μη εμμένουσας κοιλιακής ταχυκαρδίας σε μετεμφραγματικό ασθενή και διατηρημένο ΚΕ. Είναι υποψήφιος για απινιδωτή; Δημήτριος Τσιαχρής Διευθυντής Εργαστηρίου Ηλεκτροφυσιολογίας και Βηματοδότησης

More information

Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis

Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Dipak Kotecha, MD PhD on behalf of the Selection of slides presented at the European

More information

UPDATES IN MANAGEMENT OF HF

UPDATES IN MANAGEMENT OF HF UPDATES IN MANAGEMENT OF HF Jennifer R Brown MD, MS Heart Failure Specialist Medstar Cardiology Associates DC ACP Meeting Fall 2017 Disclosures: speaker bureau for novartis speaker bureau for actelion

More information

Μαρία Μαρκέτου Επιμ. Α Καρδιολογική Κλινική ΠαΓΝΗ

Μαρία Μαρκέτου Επιμ. Α Καρδιολογική Κλινική ΠαΓΝΗ Μαρία Μαρκέτου Επιμ. Α Καρδιολογική Κλινική ΠαΓΝΗ Ischemic Heart Disease Mortality Rate in Each Decade of Age IHD mortality (floating absolute risk and 95% CI) 256 128 64 32 16 8 4 2 SBP 256 128 64 32

More information

The Role of ACEI and ARBs in AF prevention

The Role of ACEI and ARBs in AF prevention The Role of ACEI and ARBs in AF prevention Dr. Sameh Shaheen MD, FESC Prof. of cardiology Ain-Shams university Time course of atrial substrate remodeling in relation to the clinical appearance of AF and

More information

Entresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction

Entresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction Cardio-Metabolic Franchise Entresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction Randy L Webb, PhD Rutgers Workshop October 21, 2016 Heart

More information

Rikshospitalet, University of Oslo

Rikshospitalet, University of Oslo Rikshospitalet, University of Oslo Preventing heart failure by preventing coronary artery disease progression European Society of Cardiology Dyslipidemia 29.08.2010 Objectives The trends in cardiovascular

More information

How Do You Mend a Broken Heart: The New Agents to Treat HF Paradigm Shift or Just the Same Old Drugs?

How Do You Mend a Broken Heart: The New Agents to Treat HF Paradigm Shift or Just the Same Old Drugs? How Do You Mend a Broken Heart: The New Agents to Treat HF Paradigm Shift or Just the Same Old Drugs? Gregg C. Fonarow, MD FACC, FAHA, FHFSA Co-Chief UCLA Division of Cardiology Director, Ahmanson-UCLA

More information

HF and CRT: CRT-P versus CRT-D

HF and CRT: CRT-P versus CRT-D HF and CRT: CRT-P versus CRT-D Andrew E. Epstein, MD Professor of Medicine, Cardiovascular Division University of Pennsylvania Chief, Cardiology Section Philadelphia VA Medical Center Philadelphia, PA

More information

Acute Coronary Syndromes

Acute Coronary Syndromes Overview Acute Coronary Syndromes Rabeea Aboufakher, MD, FACC, FSCAI Section Chief of Cardiology Altru Health System Grand Forks, ND Epidemiology Pathophysiology Clinical features and diagnosis STEMI management

More information