Advanced heart failure: state of the art and future directions.

Andrea Petraio,Daniele Masarone,Giuseppe Pacileo,Michelle Kittleson

doi:10.31083/j.rcm2302048

Abstract

Advanced heart failure is a clinical challenge that requires a pathophysiological-based approach. As the field has been the subject of multiple reviews, the objective of this paper is not to duplicate these publications but rather to offer practical tips for the clinical cardiologist to enable the optimal management of patients with advanced heart failure. Advanced heart failure is defined as a clinical syndrome characterized by severe and persistent symptoms, most commonly with severe ventricular dysfunction, despite optimized medical therapy. This review covers the management of the advanced heart failure patient from pharmacologic therapy with disease-modifying drugs, to the use of electrical therapy devices, percutaneous valve repair and finally to the role of left ventricular assist devices and heart transplantation. The review also explores future directions in the management of advanced heart failure, including translational perspectives for the treatment of this syndrome.

Highlights

IntroductionAdvanced heart failure (HF) (AdvHF) is defined as a clinical syndrome characterized by severe and persistent symptoms, often with severe ventricular dysfunction, despite optimized medical therapy [3]
Despite improvements in pharmacological and nonpharmacological treatments for patients with heart failure (HF) with reduced ejection fraction (HFrEF) [1], up to 13% of patients do not respond to conventional approaches, resulting in disease progression to the most advanced stage of HF [2].Advanced HF (AdvHF) is defined as a clinical syndrome characterized by severe and persistent symptoms, often with severe ventricular dysfunction, despite optimized medical therapy [3]
Since the use of devices for the prevention of sudden death occurs predominantly in the early stages of HFrEF; and given the fact that AdvHF patients’ mortality is essentially related to the progression of HF, rather than sudden death, we describe the roles of cardiac resynchronization therapy (CRT) and contractility– modulation therapy (CCM) in patients with AdvHF

Summary

Introduction

Advanced HF (AdvHF) is defined as a clinical syndrome characterized by severe and persistent symptoms, often with severe ventricular dysfunction, despite optimized medical therapy [3]. Patients with AdvHF present a management challenge for the clinical cardiologist. For these patients, triage to options including titration of diseasemodifying drugs [4], myocardial revascularization, repair of severe mitral or tricuspid valvular insufficiency [5], implantation of a ventricular assist device [6], or heart transplant evaluation [7] requires additional knowledge, skills, and experience beyond that acquired during a fellowship in cardiovascular medicine. To help clinical cardiologists better manage this challenging clinical syndrome, this review summarizes the pathophysiology, diagnosis, and therapeutic options of AdvHF

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Conclusion