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DOI: 10.1055/s-0041-101018
Therapie der chronischen Herzinsuffizienz
Was (noch) nicht in den Leitlinien stehtTreatment of chronic heart failure: what‘s not (yet) in the guidelinesPublication History
Publication Date:
16 March 2015 (online)
![](https://www.thieme-connect.de/media/dmw/201506/lookinside/thumbnails/10.1055-s-0041-101018-1.jpg)
Zusammenfassung
2012 wurden beim Kongress der Europäischen Gesellschaft für Herzinsuffizienz die zurzeit gültige Leitlinie zur Diagnostik und Therapie der akuten und chronischen Herzinsuffizienz vorgestellt, deren Bearbeitung etwa 1½ Jahre vorher begonnen hatte. Sie integriert die wesentlichen Erkenntnisse der Jahre 2011 und 2012 und lässt aber auch zahlreiche Fragen aufgrund noch ungeklärter Probleme offen. Sie betreffen unteranderem Themen zur Diagnostik und Bildgebung, zu pharmakologischen und nicht-pharmakologischen Therapieansät-zen sowie zu Device Systemen und zur Herztransplantation. Im Folgenden werden wir auf einen Teil dieser Themen, zu denen nun neue Erkenntnisse hinzugekommen sind, eingehen und diskutieren, welchen möglichen Einfluss sie auf unser heutiges Handeln bereits haben könnten. Im Frühjahr 2016 wird eine weitere offizielle Aktualisierung der europäischen Herzinsuffizienzleitlinien erwartet, nach deren Veröffentlichung jedoch erst eine abschließende Bewertung unserer heutigen Einschätzung möglich sein wird.
Abstract
2012 Scientific meeting of the European Society of Cardiology (ESC), the current Guidelines on Acute and Chronic Heart Failure were introduced whose preparation had started 18 months earlier. These guidelines integrate scientific evidence of the years 2011 and 2012, leaving several questions open due to gaps in knowledge. These questions relate, amongst others, to diagnostics and imaging, non-pharmacologic and pharmacologic therapeutic approaches, mechanical support therapy, and heart transplantation. Based on recent studies, we will address some of these questions and discuss potential impact of their results on current clinical practice. A further official update of the ESC heart failure guidelines is expected for early 2016, which will then show if today’s assessment holds true.
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Literatur
- 1 McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 1787-1847
- 2 Rienstra M, Damman K, Mulder BA et al. Beta-blockers and outcome in heart failure and atrial fibrillation: a meta-analysis. JACC Heart failure 2013; 1: 21-28
- 3 Kotecha D, Holmes J, Krum H et al. on behalf of the Beta-Blockers in Heart Failure Collaborative G. Efficacy of beta blockers in patients with heart failure plus atrial fibrillation: an individualpatient data meta-analysis. Lancet 2014; 384: 2235-2243
- 4 McAlister FA, Wiebe N, Ezekowitz JA et al. Meta-analysis: betablocker dose, heart rate reduction, and death in patients with heart failure. Annals of internal Medicine 2009; 150: 784-794
- 5 Castagno D, Skali H, Takeuchi M et al. Association of heart rate and outcomes in a broad spectrum of patients with chronic heart failure: results from the CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and morbidity) program. J Am Coll Cardiol 2012; 59: 1785-1795
- 6 Mulder BA, Van Veldhuisen DJ, Crijns HJ et al. Lenient vs. strict rate control in patients with atrial fibrillation and heart failure: a post-hoc analysis of the RACE II study. Eur J Heart Fail 2013; 15: 1311-1318
- 7 The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 1997; 336: 525-533
- 8 Whitbeck MG, Charnigo RJ, Khairy P et al. Increased mortality among patients taking digoxin – analysis from the AFFIRM study. Eur Heart J 2013; 34: 1481-1488
- 9 Gheorghiade M, Fonarow GC, van Veldhuisen DJ et al. Lack of evidence of increased mortality among patients with atrial fibrillation taking digoxin: findings from post hoc propensity-matched analysis of the AFFIRM trial. Eur Heart J 2013; 34: 1489-1497
- 10 Turakhia MP, Santangeli P, Winkelmayer WC et al. Increased mortality associated with digoxin in contemporary patients with atrial fibrillation: Findings From the TREAT-AF Study. J Am Coll Cardiol 2014; 64: 660-668
- 11 Gardner DG, Chen S, Glenn DJ et al. Molecular biology of the natriuretic peptide system: implications for physiology and hypertension. Hypertension 2007; 49: 419-426
- 12 Richards AM, Wittert GA, Crozier IG et al. Chronic inhibition of endopeptidase 24. 11 in essential hypertension: evidence for enhanced atrial natriuretic peptide and angiotensin II. J Hypertens 1993; 11: 407-416
- 13 Campbell DJ. Vasopeptidase inhibition: a double-edged sword?. Hypertension 2003; 41: 383-389
- 14 McMurray JJ, Packer M, Desai AS et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014; 371: 993-1004
- 15 Jessup M. Neprilysin inhibition – a novel therapy for heart failure. N Engl J Med 2014; 371: 1062-1064
- 16 Moe GW, Ezekowitz JA, O’Meara E et al. The 2014 canadian cardiovascular society heart failure management guidelines focus update: anemia, biomarkers, and recent therapeutic trial implications. Can J Cardiol 2015; 31: 3-16
- 17 Rossignol P, Cleland JG, Bhandari S et al. Determinants and consequences of renal function variations with aldosterone blocker therapy in heart failure patients after myocardial infarction: insights from the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study. Circulation 2012; 125: 271-279
- 18 Smith GL, Lichtman JH, Bracken MB et al. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. JACC 2006; 47: 1987-1996
- 19 Juurlink DN, Mamdani MM, Lee DS et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med 2004; 351: 543-551
- 20 Rossignol P, Dobre D, McMurray JJ et al. F. Incidence, determinants, and prognostic significance of hyperkalemia and worsening renal function in patients with heart failure receiving the mineralocorticoid receptor antagonist eplerenone or placebo in addition to optimal medical therapy: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF). Circulation Heart Fail 2014; 7: 51-58
- 21 Packham DK, Rasmussen HS, Lavin PT et al. Sodium zirconium cyclosilicate in hyperkalemia. N Engl J Med 2015; 372: 222-231
- 22 Kosiborod M, Rasmussen HS, Lavin P et al. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA 2014; 312: 2223-2233
- 23 Ruschitzka F, Abraham WT, Singh JP et al. EchoCRT Study Group. Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med 2013; 369: 1395-1405
- 24 Kirklin JK, Naftel DC, Pagani FD et al. Sixth INTERMACS annual report – a 10, 000 patients database. J Heart Lung Transplant 2014; 33: 555-564
- 25 Funkat A, Beckmann A, Lewandowski J et al. Cardiac surgery in Germany during 2013: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2014; 62: 380-92
- 26 The International Society for Heart and Lung Transplantation. Heart / Lung registries: Quarterly Data Report. http://www.ishlt.org/registries/quarterlyDataReportResults.asp?organ=HR&rptType=all&continent=3 (letzter Zugriff 27.02.2015)
- 27 Rojas SV, Avsar M, Uribarri A et al. A new era of ventricular assist device surgery: less invasive procedures. Minerva Chir 2015; 70: 63-68
- 28 Riebandt J, Haberl T, Mahr S et al. Off-pump HeartWare ventricular assist device implantation with outflow graft anastomosis to the left subclavian artery. Ann Thorac Surg 2014; 97: 2214-2216
- 29 Krabatsch T, Potapov E, Stepanenko A et al. Biventricular circulatory support with two miniaturized implantable assist devices. Circulation 2011; 124 (Suppl. 11) S179-S186
- 30 Starling RC, Naka Y, Boyle AJ et al. Results of the post-U.S. Food and Drug Administration-approval study with a continuous flow left ventricular assist device as a bridge to heart transplantation: a prospective study using the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). J Am Coll Cardiol 2011; 57: 1890-1898
- 31 Milano C, Pagani FD, Slaughter MS et al. ADVANCE Investigators. Clinical outcomes after implantation of a centrifugal flow left ventricular assist device and concurrent cardiac valve procedures. Circulation 2014; Sep 9; 130(11 Suppl 1): S3-11
- 32 Patel SR, Sileo A, Bello R et al. Heart transplantation vs continuous flow LVAD: comprehensive cost at one year. J Card Fail 2015; 21: 160-166
- 33 Gandjour A. Welfare gains and losses caused by clinical practice guidelines. Expert Rev Pharmacoecon Outcomes Res 2014; 14: 27-33
- 34 Mehra MR, Kobashigawa J, Starling R et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates – 2006. J Heart Lung Transplant 2006; 25: 1024-1042
- 35 Costanzo MR, Dipchand A, Starling R et al. International Society of Heart and Lung Transplantation Guidelines. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant 2010; 29: 914-956
- 36 Alba AC, Tinckam K, Foroutan F et al. Factors associated with anti-human leukocyte antigen antibodies in patients supported with continuous-flow devices and effect on probability of transplant and post-transplant outcomes. J Heart Lung Transplant 2014; Dec 8. pii: S1053-2498[14]01489–2
- 37 Vo AA, Lukovsky M, Toyoda M et al. Rituximab and intravenous immune globulin for desensitization during renal transplantation. N Engl J Med 2008; 359: 242-451
- 38 De Vlaminck I, Valantine HA, Snyder TM et al. Circulating cell-free DNA enables noninvasive diagnosis of heart transplant rejection. Sci Transl Med 2014; 6 241ra77
- 39 Hirt SW, Bara C, Barten MJ et al. Everolimus in heart transplantation: an update. J Transplant 2013; 2013 683964
- 40 Rodriguez Cetina Biefer H, Sündermann SH, Emmert MY et al. Surviving 20 years after heart transplantation: a success story. Ann Thorac Surg 2014; 97: 499-504
- 41 Huibers MM, Gareau AJ, Vink A et al. The composition of ectopic lymphoid structures suggests involvement of a local immune response in cardiac allograft vasculopathy. J Heart Lung Transplant 2014; Dec 8. pii: S1053-2498[14]01487–9
- 42 Bellenger NG, Davies LC, Francis JM et al. Reduction in sample size for studies of remodeling in heart failure by the use of cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2000; 2: 271-278
- 43 Hendel RC, Patel MR, Kramer CM et al. ACCF / ACR / SCCT / SCMR / ASNC / NASCI / SCAI / SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness C. J Am Coll Cardiol 2006; 48: 1475-1497
- 44 Assomull RG, Prasad SK, Lyne J et al. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol 2006; 48: 1977-1985
- 45 Mahrholdt H, Goedecke C, Wagner A et al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 2004; 109: 1250-1258
- 46 Chan RH, Maron BJ, Olivotto I et al. Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation 2014; 130: 484-495
- 47 Barone-Rochette G, Piérard S, De Meester C et al. Prognostic significance of LGE by CMR in aortic stenosis patients undergoing valve replacement. J Am Coll Cardiol 2014; 64: 144-154
- 48 Abdel-Aty H, Zagrosek A, Schulz-Menger J et al. Delayed enhancement and T2-weighted cardiovascular magnetic resonance imaging differentiate acute from chronic myocardial infarction. Circulation 2004; 109: 2411-2416
- 49 Oh-Ici D, Ridgway JP, Kuehne T et al. Cardiovascular magnetic resonance of myocardial edema using a short inversion time inversion recovery (STIR) black-blood technique: diagnostic accuracy of visual and semi-quantitative assessment. J Cardiovasc Magn Reson 2012; 14: 22
- 50 Pennell DJ, Udelson JE, Arai AE et al. Cardiovascular function and treatment in β-thalassemia major: a consensus statement from the American Heart Association. Circulation 2013; 128: 281-308
- 51 Ferreira VM, Piechnik SK, Dall’armellina E et al. T1 Mapping for the diagnosis of acute myocarditis using CMR: Comparison to T2-weighted and late gadolinium enhanced imaging. JACC Cardiovasc Imaging 2013; 2013: 1048-1058
- 52 Thavendiranathan P, Walls M, Giri S et al. Improved detection of myocardial involvement in acute inflammatory cardiomyopathies using T2 mapping. Circ Cardiovasc Imaging 2012; 5: 102-110
- 53 Karamitsos TD, Piechnik SK, Banypersad SM et al. Noncontrast T1 mapping for the diagnosis of cardiac amyloidosis. JACC Cardiovasc Imaging 2013; 6: 488-497
- 54 Sado DM, White SK, Piechnik SK et al. Identification and assessment of Anderson-Fabry disease by cardiovascular magnetic resonance noncontrast myocardial T1 mapping. Circ Cardiovasc Imaging 2013; 6: 392-398
- 55 Wong TC, Piehler K, Meier CG et al. Association between extracellular matrix expansion quantified by cardiovascular magnetic resonance and short-term mortality. Circulation 2012; 126: 1206-1216
- 56 Moon JC, Messroghli DR, Kellman P et al. Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson 2013; 15: 92