New in Heart Failure SGK autumn session 2012 Roger Hullin Cardiology Department of Internal Medicine Centre Universitaire Hospitaler Vaudois University of Lausanne
ESC Heart Failure Guidelines 2012 Classes of Recommendations McMurray et al. Eur Heart J 2012
ESC Heart Failure Guidelines 2012 Levels of evidence McMurray et al. Eur Heart J 2012
ESC Heart Failure Guidelines 2012 ESC Heart Failure Guidelines 2012 Diagnostic interventions in ambulatory HF patients Diagnostic Interventions in Ambulatory HF atients McMurray et al. Eur Heart J 2012
ESC Heart Failure Guidelines 2012 Brain Natriuretic Peptides in HF Patients ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Optimum EXCLUSION cut-off point for acute heart failure and chronic heart failure 2012 2012 <300 pg /ml NT-proBNP <125 pg/ml NT-proBNP <100 pg/ml BNP < 35 pg/ml BNP 2008 2008 no consensus < 400 pg/ml NT-proBNP no consensus < 100 pg/ml BNP Cohen-Solal et al. Eur Heart J 2008; McMurray et al. Eur Heart J 2012
ESC Heart Failure Guidelines 2012 Brain Natriuretic Peptides in HF Patients McMurray et al. Eur Heart J 2012
ESC Heart Failure Guidelines 2012 Diagnostic interventions in ambulatory HF patients McMurray et al. Eur Heart J 2012
ESC Heart Failure Guidelines 2012 MRI in HF Patients McMurray et al. Eur Heart J 2012
Cost effectiveness when using cardiac MR Imaging for diagnosing CAD CMR less expensive than CXA CMR more expensive Germany Germany Germany Germany United Kingdom United Kingdom Switzerland Switzerland United States United States -8% Moschetti et al. JCMR 2012
European Registry EuroCMR Secondary Effects in 17 767 cardiac MRI studies Linear CM: Gadopentate, Gadobenat, Gadodiamid Cyclic CM: Gadoteracid, Gadobutrol, Gadoteridol 30 minor complications no major complication Bruder et al. JACC Imaging 2012
ESC Heart Failure Guidelines 2012 Mineralocorticoid Receptor Antagonists class level ACE I or ARB Betablocker McMurray et al. Eur Heart J 2012
EMPHASIS-HF n=2737 patients in NYHA II with LVEF 35% First Hospitalization for Heart Failure and Cardiovascular death First Hospitalization for Heart Failure Zannad et al. N Engl J Med 2011
EMPHASIS-HF All Hospitalizations for Heart failure Heart Failure Hospitalization Cardiovascular Hospitalization that are not Heart Failure All Hospitalization that are not cardiovascular Rogers et al. Circulation 2012
EMPHASIS-HF Hospitalization for Heart failure Estimated Cumulative Rate of Heart Failure Hospitalization Risk Ration of the Cumulative Incidence of Heart Failure Hospitalizations Rogers et al. Circulation 2012
EPHESUS substudy n=5972 patients post AMI with LVEF < 40% Rossignol et al. Circulation 2012
EPHESUS substudy n=5972 patients post AMI with LVEF < 40% All cause death Rossignol et al. Circulation 2012
EMPHASIS-HF Eplerenone Decreases the Incidence of Atrial Fibrillation Swedberg et al. J Am Coll Cardiol 2012
ESC Heart Failure Guidelines 2012 Diagnostic Treatment interventions to Consider in in Heart ambulatory Failure : Ivabradine HF patients McMurray et al. Eur Heart J 2012
ESC Heart Failure Guidelines 2012 Diagnostic Treatment interventions to Consider in in Heart ambulatory Failure: Ivabradine HF patients inclusion: stable moderate to severe CHF, HR at rest >70 bpm, stable background treatment including a β-blocker if tolerated Swedberg et al. Lancet 2010
patients with first hospitalization for worsening heart failure (%) patients with cardiovascular death (%) ESC Heart Failure Guidelines 2012 Diagnostic Treatment interventions to Consider in ambulatory in Heart Failure HF patients inclusion: stable moderate to severe CHF, HR at rest >70 bpm, stable background treatment including a β-blocker if tolerated Swedberg et al. Lancet 2010
News in Heart Failure in 2012 TAVI in Heart Failure
News in Heart Failure in 2012 TAVI in Heart Failure (n=202) severe aortic stenosis: aortic valve area <1.0 cm 2 ; aortic mean gradient <40 mmhg; peak aortic velocity > 4m s -1 Gotzmann et al. Eur Heart Fail J 2012
News in Heart Failure in 2012 TAVI in Heart Failure (n=202) Gotzmann et al. Eur Heart Fail J 2012
TAVI in Heart Failure Mortality in preserved EF and reduced EF Group 1: preserved LVEF/high gradient Group 2: preserved LVEF/low gradient Group 3: reduced LVEF/high gradient Group 4: reduced LVEF/low gradient Gotzmann et al. Eur Heart Fail J 2012
ESC Heart Failure Guidelines 2012 Diagnostic Device interventions treatment in in ambulatory NYHA class II HF patients McMurray et al. Eur Heart J 2012
Heart Failure with preserved Ejection Fraction Epidemiology ALDO-DHF Lam et al. Eur J Heart Fail 2011
News in Heart Failure 2012 Heart Failure with preserved Ejection Fraction ALDO-DHF
ALDO-DHF Inclusion criteria Edelmann et al. Eur J Heart Fail 2010
ALDO-DHF study design ALDO-DHF Edelmann et al. Eur J Heart Fail 2010
BUT: ALDO-DHF Results (n=422) presented at the ESC 2012, Munich CO-PRIMARY ENDPOINTS (exercise capacity, diastolic function): 1.the tissue Doppler-echo measure improved significantly at 6 and 12 months in the treatment group 2.no significant difference for V0 2 max at month 6 and 12. While patients present echocardiographic findings compatible with early diastolic dysfunction, NT-proBNP levels were below guide-lines specified threshold for heart failure. SECONDARY ENDPOINT left ventricular mass index: Treatment group: decrease at month 6 (p=0.16) and at month 12 (p=0.009). Patients included were fit enough to perform ergospirometry. SECONDARY ENDPOINT NT-proBNP: Decrease in both groups at month 6 (p=0.09) and increase in both groups at month 12 (p=0.03) Patients had remarkably good renal function. Mortality was almost nil questioning whether the study population presents HFpEF with a mortality > 50% mortality in HF-REF. MORTALITY and HOSPITALIZATION for HF: no significant difference ESC Congress 2012
Réunion d Automne de la SSC 2012 MERCI