Lo mejor del Congreso Europeo de Insuficiencia Cardiaca ESC-HF París 2017 10/05/2017 18:00h http://ic17.secardiologia.es #PostIC17 Novedades en insuficiencia cardiaca aguda Dr. Josep Masip Utset, Consorci Sanitari Integral (Barcelona). Hospital Sant Joan Despí Moisès Broggi i Hospital General de l'Hospitalet (Barcelona)

2. Lo mejor
en insuficiencia cardiaca aguda
Josep Masip
Consultor: Cardiorentis, Novartis, Brahms
Beca Viaje - Conferenciante: Menarini, Orion, Boehringer Ingelheim

3. Primary endpoints
6545 AHF patients <16h
48h infusion: 30 µg/kg/24h vs. placebo
P= 0.3857
8.7%
8.9%
J. Teerlink
WHF through Day 5CV mortality through Day 180
6.9%
7.7%
P= 0.0968
HR: 0.89 (0.75, 1.07)

4. Key secondary endpoint
P= 0.3890 P= 0.2744
All-cause mortality CV death or rehospitalization
due to heart/renal failure

5. 0
10
20
30
40
50
60
70
80
90
100
Mean Age (years)
Gender (male, %)
Race (white, %)
Hypertension (%)
Ischemic heart disease (%)
Atrial fibrillation/flutter at presentation (%)
Diabetes Mellitus (%)
Stroke or other cerebrovascular event (%)
History of CHF (1 month prior to admission) (%)
NYHA class III/IV (1 month prior to admission) (%)
Historical ejection fraction (mean)
Number of hospitalization in past year (mean)
NT-proBNP (pg/mL) (median X 10-2)
eGFR (mean)
IV nitrates at randomization (%)
Mean time from presentation to randomization (hours)
RELAX-AHF n=1161
RELAX-AHF-2 n=6545
RELAX-AHF vs. RELAX-AHF-2:
Key selected variables
Teerlink JR, et al. Lancet. 2013; 381:.29-39
Metra M, et al. J Am Coll Cardiol. 2013; 61: 196-206
NT-proBNP (pg/mL) (median X 10-2)

6. NT-proBNP Cystatin C
1,00
1,05
1,10
1,15
1,20
Days
* p=0.003
2 5 14 40 600
0,4
0,5
0,6
0,7
0,8
0,9
1,0
Days
* P=0.0007
2 5 140
hs-Troponin T
0,75
0,80
0,85
0,90
0,95
1,00
1,05
1,10
Ratiooffollow-uptobaseline
Days
Placebo
Serelaxin*
p=0.0209
2 5 140
*
*
p=0.0034
p=0.0209
Ratiooffollow-uptobaseline
(n=521)
(n=510)
Biomarkers Substudy:
Changes in cardiac and renal biomarkersn= 1052

7. CV Death -180 days
WHF through 5 days
Biomarkers
Substudy
n= 1052

8. 2157 patients
156 centers. 23 countries
6.1 h from admission
48 h infusion ularitide vs. placebo
15 months of follow-up
TRUE-AHF
Ularitide
M. Packer
WHF

11. John McMurray

13. NITROXIL (HNO)OMECANTIV MECARBIL
VERICIGUAT
J. ButlerJ.R. Teerlink
B. Pieske
TRV027
G. Cotter
BLAST Trial

14. Less renal impairment at 30 days in
patients administered lower doses
(1 mg/h of TRV-027), especially in
pts with higher baseline SBP
TRV-027 Substudy: Results on RENAL FAILURE and
PRIMARY ENDPOINT in LOW DOSES and SBP >127 mmHg
In these patients with SBP >127
mmHg, 1 mg/h of TRV027 was also
associated with lower rate of 180 days
mortality and HF readmission
G. Cotter

15. Pre-clinical and early clinical
experience
Elamipretide
Hani N. Sabbah
By improving mitochondrial function
in HF, elamipretide offers a unique
approach in the treatment of HF

16. Bromocriptine
for the Treatment of Peripartum Cardiomyopathy:
A Multicenter Randomized Study
Denise Hilfiker-Kleiner
1W vs. 8W

19. Management recommendation for peripartum cardiomyopathy

20. Sc Pharmaceuticals
Subcutaneous
Furosemide

21. CATECHOLAMINES in cardiogenic shock J. Lassus

22. Utility of Lung Ultrasound in Heart Failure
Elke Platz

23. 195 Outpatient NYHA II-IV
LUS 8 zones
Congestion in AHF – Lung Ultrasound
E. Platz. Eur Heart J 2016
T3 vs. T1 Adj HR 4.08, p <0.001

24. Nicolas GIRERD
Congestion in AHF – Echocardiography

25. Filling pressures:
E/A, Dt, E/e’, TR, LAVi
Natriuretic peptides
Estimated plasma volume
Nicolas GIRERD

26. Iida. JACC Heart Failure 2016

27. Continuous flow
Biphasic flow
Monophasic flow
Intrarenal
Venous
Flow
Death from cardiac
causes and HF
hospitalizations
Iida. JACC Heart Failure 2016

28. Prognostic
impact of
RV function
in AHF
2-year survival in
patients with RV
dysfunction
Chiara Daneluzzi

29. Patients with AHF able to secrete
relaxin-2 at pregnancy concentrations
Oscar Miró

30. Una pequeña proporción
(2%) de pacientes con
ICA secretan
concentraciones de
relaxina 2 similares a las
observadas en el
embarazo.
Este subgrupo de
pacientes tiene mayor
supervivencia (HR= 0,39)

31. Conclusiones
Los fármacos con acción inotrópica o hemodinámica no
han demostrado ser efectivos en la ICA
Los biomarcadores, la ecografía y la bioimpedancia son
herramientas fundamentales para la detección y el control
de la congestión en la ICA
Los nuevos estudios deben definir claramente la
población diana que estudiar, dado que la heterogeneidad
de la población con ICA es muy amplia y puede impactar
en los resultados