2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

ACC/AHA
: American College of Cardiology/American Heart Association
ACCF/AHA
: American College of Cardiology Foundation/American Heart Association
ACE
: angiotensin-converting enzyme
ACEI
: angiotensin-converting enzyme inhibitor
ACS
: acute coronary syndrome
AF
: atrial fibrillation

/pdf/2016-esc-guidelines-for-the-diagnosis-and-treatment-of-acute-z18hg30pp1.pdf

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

/pdf/2016-esc-guidelines-for-the-diagnosis-and-treatment-of-acute-53v7yllhiz.pdf

/pdf/2021-esc-guidelines-for-the-diagnosis-and-treatment-of-acute-4pqhe8c49t.pdf

2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.

KEGG(Kyoto Encyclopedia of Genes and Genomes)〔和文〕 (特集 ゲノム医学の現在と未来--基礎と臨床) -- (データベース)

Myeloma and amyloid


 Background:
 Tafamidis was associated with reduction in cardiovascular hospitalizations and all-cause mortality in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) in the ATTR-ACT trial. However, real-world data on the efficacy of tafamidis are limited.
 
 
 Methods:
 We conducted a retrospective, observational cohort study using the TriNetX research network, a multicenter federated research network with data pooled from electronic health records. Patients with wild-type TTR amyloidosis and heart failure (HF) were identified based on ICD-10 codes on or before May 15, 2021. The study cohort was then divided into two groups based on treatment with tafamidis. Propensity score matching (PSM) was performed to balance the confounders. Rates of heart failure exacerbations (HFE) and all-cause mortality at 12 months were compared between the two cohorts.
 
 
 Results:
 We identified 1362 patients with wild-type ATTR amyloidosis with HF (tafamidis group =553, non-tafamidis group =809). After PSM, there were 421 patients in each group (mean age: 76 years, Female 14%, White race 64%). During the 12-month follow-up period, 38 (9.0%) patients experienced HFE in the tafamidis group compared to 58 (13.8%) patients in the non-tafamidis group (OR 0.62; CI0.40-0.95, p=0.030). Patients treated with tafamidis had lower all-cause mortality compared to the non-tafamidis group (10.7% vs. 16.4%; OR 0.61, CI 0.40-0.91, p=0.016). The treated cohort had a higher probability of event-free survival for HFE (HR 0.61; 95% CI 0.40-0.92, Log-Rank p= 0.018) and all-cause mortality (HR 0.619; 95% CI 0.425, 0.901, Log-Rank p= 0.011).
 
 
 Conclusion:
 This real-world analysis confirms that tafamidis use is associated with reduced HF exacerbations and all-cause mortality in patients with wild-type TTR amyloidosis and HF. Longer term follow-up is needed to better understand the utility of tafamadis given the increasing recognition of ATTR-CM and its high cost.
 
 
 


Abstract 13273: Real-World Efficacy of Tafamidis in Patients With Transthyretin Amyloidosis and Heart Failure

We graciously acknowledge the expert opinion of Steiner and Hellmann regarding statements about cardioprotection during anthracycline-based chemotherapy. In our review, we did acknowledge that dexrazoxane was a therapeutic option for cardioprotection and referenced a major review on the use of cardioprotectants. Because our review was focused on late cardiac effects of cancer treatment, we were unable to carefully detail all of the relevant studies that potentially addressed early or acute cardiotoxicity from anthracyclines, although we do agree conceptually with Steiner and Hellmann that prevention is the best strategy. Furthermore, we recognize that American Society of Clinical Oncology 2008 Clinical Practice Guideline suggests the use of dexrazoxane in specific adult patients (patients with breast cancer who have received 300 mg/m of anthracyclines) on the basis of work from Swain and others. Additionally, Lipshultz has published authoritative reports on the effective use of dexrazoxane in childhood leukemia. However, it is certainly our observation and that of others that dexrazoxane has a significantly limited use in adult patients who receive anthracyclines. This may be in part a result of attenuation of the cancer efficacy of anthracyclines or the potential concern of late effects, such as secondary leukemia. In fact, the use of dexrazoxane in children is not recommended in Europe. Conversely, angiotensinconverting enzyme inhibitors and carvedilol are ubiquitously used clinically, and their long-term safety is well established. These classic cardiac medications are known to be cardioprotective with chemotherapy, especially anthracyclines, and the ease of administering this medication(s) during chemotherapy is understood. We agree that no study has directly compared dexrazoxane cardioprotection with angiotensin-converting enzyme inhibitors or carvedilol in the context of anthracycline chemotherapy, and it seems highly unlikely that such a study will be performed.

Reply to R. Steiner et al

e19517 Background: Anthracycline-induced cardiotoxicity (AIC) is a well-known phenomenon, but event rates and predictors may not be as robust as commonly perceived. We performed a systematic review and meta-analysis to elucidate AIC definitions, incidence rates and predictors. Methods: 5323 reports were identified via searching Medline, Embase, and Scopus. Inclusion criteria for full text review included minimum of 100 lymphoma patients receiving ACs; median/mean follow up of at least 12 months; and specified evaluation of left ventricular ejection fraction. We investigated the definition, reported incidence, and predictors of AIC including subclinical AIC as detected by decrease in left ventricular systolic dysfunction. Meta-analysis was performed with Meta-analyst software with random effects model. Results: A total of 19 studies were included in the analysis. The overall incidence of AIC in 13926 patients was 13.8% (95% CI 4.8-22.8, I2 99.6% p < 0.001) at a mean/median follow-up ranging from 1 to 8 years. Subclinical AIC was seen in 8.2% of 5464 patients (95% CI 6.4 to 10%, I2 78.9%, p < 0.001) at a mean/median follow-up ranging from 1 to 20 years. Subclinical AIC is defined in most studies as asymptomatic decrease in LVEF by 10-15% from baseline of 50-55%. Older age, increasing AC dose or number of cycles, GLS (global longitudinal strain), and prior comorbidities such as CAD, HTN, DM and dyslipidemia were found to predict AIC. However, Heterogeneity was seen in definition of AIC, risk factor assessment and follow-up protocol, which limited the extent of correlative analyses for cardiotoxicity predictors. Conclusions: The overall incidence of clinical HF and subclinical AIC among lymphoma patients was 13.8% and 8.2% respectively. Older age, increasing AC dose or number of cycles, GLS, and prior comorbidities such as CAD, HTN, DM and dyslipidemia were found to predict AIC.

Anthracycline-related cardiotoxicity among patients with lymphoma: Systematic review and meta-analysis.

Loop diuretics are a cornerstone of symptom management for nearly all patients with heart failure. Diuretic resistance is a clinical problem with similar presentation despite diverse and multiple etiologies. Although the exact incidence is not known, diuretic resistance occurs frequently and can increase the length of hospitalization. Despite the prevalence of loop diuretic prescription in heart failure and frequency of diuretic resistance, current heart failure guidelines provide nonspecific guidance on strategies to restore diuretic efficacy. Providers are left with many questions regarding the optimum diuretic titration strategy in the setting of diuretic resistance. In light of these highly prevalent uncertainties, we present a case vignetteestructured literature review of the mechanisms of diuretic resistance and recommend therapeutic strategies based on the resistance etiology to improve diuretic response in acute decompensated heart failure. (J Cardiac Fail 2014;20:611e622)

Daniel J. Lenihan

Papers

Myeloma and amyloid

Abstract 13273: Real-World Efficacy of Tafamidis in Patients With Transthyretin Amyloidosis and Heart Failure

Reply to R. Steiner et al

Anthracycline-related cardiotoxicity among patients with lymphoma: Systematic review and meta-analysis.

Review Articles Loop Diuretic Resistance in Heart Failure: Resistance EtiologyeBased Strategies to Restoring Diuretic Efficacy