Transcript ESC 2016 - Blog du GCF

ESC 2016 Congress Highlight :
ESC guidelines 2016 and
what’s new in Heart failure ?
Thomas MERCIER
ESC 2016 Guidelines HF :
New algorithm !
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1) Clinical probability of the disease
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2) The assessment of BNP
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3) Transthoracic echocardiography
www.escardio.org/guidelines
ESC 2016 Guidelines HF :
New Classification !
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Heart failure with preserved, mid-range and reduced EF
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It is only in patients with HFrEF that therapies have been shown to reduce
both morbidity and mortality
www.escardio.org/guidelines
ESC 2016 Guidelines HF :
New Treatment Algorithm for
HFrEF !
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New therapeutic : Sacubitril/valsartan
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Don’t forget to manage HF comorbidites
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Few Changes for ICD : Wearable ICD
www.escardio.org/guidelines
ESC 2016 Guidelines HF :
New Changes for CRT !
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2012 ESC Guidelines :
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2016 ESC Guidelines :
QRS 120-150ms (130ms if NYHA II) :
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Only LBBB
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Only AF if NYHA III
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QRS > 130ms
LVEF ≤ 35%
If SR : NYHA II-IV
If AF : NYHA III-IV
QRS > 150ms (+/- LBBB ; +/- AF) :
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Only LVEF < 35% if NYHA III
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Longer QRS  Greater Benefit
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Only LVEF < 30% if NYHA II
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Does QRS Morphology Matter ?
www.escardio.org/guidelines
ESC 2016 Guidelines HF :
And treatment of HFpEF ?
Manage HF co-morbidities in all heart failure patients : In HFpEF, this is the
only evidence based treatment approach +++.
www.escardio.org/guidelines
ESC 2016 Guidelines HF :
What’s new for Acute heart failure ?
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New treatment algorithm based mainly on clinical
evaluation rather than SBP levels only
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Change in cut-off levels of SBP for vasodilator use
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Change of recommendation class for inotropes and
opiates
www.escardio.org/guidelines
ESC 2016 Guidelines HF :
New treatment algorithm for AHF :
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In the management of a patient with suspected
acute HF, try to shorten all diagnostic and
therapeutic decisions.
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Apply the algorithm based on clinical profiles
evaluating the presence of congestion &
peripheral hypoperfusion.
www.escardio.org/guidelines
ESC 2016 Highlights :
Epidemiology +++
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The AGES-Reykjavík study: Heart failure will more than double by 2040 and
triple by 2060 !
R. Danielsen, (Reykjavik, IS), P5425
www.escardio.org/ESC2016
ESC 2016 Highlights :
Failed Telemonitoring in heart failure ?
REM-HF :
More-Care :
M. Cowie (London, GB) FP 1223
G. Boriani (Modena, IT) FP 1226
ESC 2016 Highlights :
AV and VV optimization to increase CRT Response
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Respond-HF : SONR Versus AV&VV Echo-guided Optimization to Increase CRT
Response
J. Brugada (Barcelona, ES) FP 2235
ESC 2016 Highlights :
EchoCRT : CRT in HF with a Narrow QRS Complex
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Left Ventricular Global Longitudinal Strain (GLS) is Associated with Poor
Outcome in Heart Failure Patients with Narrow QRS
J. Bax (Leiden, NL) FP 2233
ESC 2016 Highlights :
Congestive Heart Failure Cardiopoietic Regenerative
Therapy (Chart-1) : Primary Efficacy Endpoint Neutral
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Objective : To validate the efficacy and safety of cardiopoietic cells derived by
cardiogenic specification of mesenchymal stem cells
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Population : Patient with ischemic heart failure with LVEF ≤35% / HF hospitalization or
worsening within last 12 months / On guideline-directed heart failure therapy
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Randomized : Cardiopoietic celle therapy group vs Control group
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Primary Outcome as a Function of HF Severity (Post-hoc). Mann-Withney Estimator (95% CI) :
J. Bartunek (Aalst, BE) FP 1229
ESC 2016 Highlights :
Results of the EMPA-Reg Outcome® Trial
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Heart Failure Outcomes with Empagliflozin in Patients with Type 2 Diabetes
at High Cardiovascular Risk
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Empaglifozin : Sodium–Glucose Co-Transporter-2 (SGLT-2) Inhibitors
Zinman et al. N Engl J Med 2015:373:2117-2128
Merci au Groupe
des Cardiologues
en Formation !!!