ESC Congress 2016 - 9

Your FREE access to ESC Congress content all year long www.escardio.org/365 ESC CONGRESS 2016 IN REVIEW Table 8. Recommendations to Prevent or Delay Development of Overt HF or Prevent Death Before Symptom Onset The guidelines define HF as a clinical syndrome characterized by typical symptoms (eg, breathlessness, ankle swelling, and fatigue) that may be accompanied by signs (eg, elevated jugular venous pressure, pulmonary crackles, and peripheral edema) caused by a structural or functional cardiac abnormality, resulting in reduced cardiac output or elevated intracardiac pressure at rest or during stress. The new classification defines three categories of HF: HF with reduced ejection fraction (HFrEF), HF with mid-range EF (HFmrEF), and HF with preserved EF (HFpEF). All three are typically characterized by HF symptoms and the presence or absence of HF signs. LVEF is < 40% in HFrEF, 40% to 49% in HFmrEF, and ≥ 50% in HFpEF. HFmrEF and HFpEF are also defined by the presence of elevated natriuretic peptide and relevant structural heart disease or diastolic dysfunction. The guidelines recommend assessment of chronic HF probability with clinical history, physical examination, and ECG, followed by natriuretic peptides and echocardiography if indicated (Figure 4). Table 8 summarizes recommended interventions aimed at modifying risk factors to delay onset of HF and prolong life. Recommendations Class Level Treatment of hypertension I A Treatment with statins in patients with or at high risk of CAD I A Treatment with ACE inhibitors in patients with asymptomatic LV dysfunction and a history of MI I A Treatment with ACE inhibitors in patients with asymptomatic LV dysfunction without a history of MI I B Treatment with ß-blockers in patients with asymptomatic LV dysfunction and a history of MI I B ICD in patients with asymptomatic LV systolic dysfunction of ischemic origin, who are at least 40 days after acute MI, and in patients with asymptomatic nonischemic dilated cardiomyopathy who receive OMT I B AACE, angiotensin-converting enzyme; CAD, coronary artery disease; ICD, implantable cardioverter-defibrillator; LV, left ventricular; MI, myocardial infarction; OMT, optimal medical therapy. Adapted from Ponikowski P et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail. 2016; 37: 2129-2200. doi:10.1093/eurheartj/ ehw128. By permission of John Wiley & Sons on behalf of the European Society of Cardiology. Figure 4. Algorithm for Diagnosis of Chronic Heart Failure 9 PATIENT WITH SUSPECTED HF (non-acute onset) ASSESSMENT OF HF PROBABILITY 1. Clinical history; 2. Physical examination; 3. ECG ≥ 1 present Assessment of natriuretic peptides not routinely done in clinical practice all absent NATRIURETIC PEPTIDES * NT-proBNP ≥ 125 pg/mL * BNP ≥ 35 pg/mL no HF unlikely: consider other diagnosis yes normal ECHOCARDIOGRAPHY If HF confirmed (based on all available data): determine aetiology and start appropriate treatment BNP, B-type natriuretic peptide; ECG, electrocardiogram; HF, heart failure. Reprinted from Ponikowski P et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail. 2016; 37: 2129-2200. doi:10.1093/eurheartj/ehw128. By permission of John Wiley & Sons on behalf of the European Society of Cardiology. Official Peer-Reviewed Highlights From ESC Congress 2016 9 http://www.escardio.org/365

Table of Contents for the Digital Edition of ESC Congress 2016