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Future targets in systolic heart failure management: pharmacological therapy, new artificial hearts, complete cardiac regeneration therapies and upcoming devices

Moderator: R C Vidal Perez (Santiago De Compostela, ES)

Session presentations
  • Pharmacological therapy in SHF: from past therapies to the new guidelines. Is there still a place for improvement in the future? Presented by J J V McMurray (Glasgow, GB) congress 365
  • From heart transplant to new artificial pumps: will hearts be replaced by machines? Presented by M H Yacoub (Harefield, GB)congress 365
  • Complete cardiac regeneration from stem cells: when will we get there? Presented by D A Taylor (Houston, US) congress 365
  • New devices in heart failure management: recent developments and promising technologies for the future? Presented by K Dickstein (Stavanger, NO)congress 365
Basic Sciences, Pharmacology, Genomics and Cardiovascular Pathology


This session, organised by the ESC Cardiologists of Tomorrow, was part of a pioneer project of live transmission of some ESC Congress sessions through the internet. Outside Munich, a large and worldwide virtual audience had the opportunity to follow the session and interact with the speakers by submitting questions.

It was a fantastic and very futuristic session looking into the management of Heart Failure in the next decades, going from new pharmacological targets and complete cardiac regeneration with stem cell therapy, to the future roles of new devices and mechanical pumps.

“There are plenty of new pharmacological agents being tested for chronic heart failure” – Prof McMurray
About 100 clinical trials are now registered and under way in chronic heart failure. New pharmacological agents being tested are non-steroidal mineraloreceptor antagonists, new ways of AT1 receptor blockade (TRV120027), PDE-5 inhibitors (eg. sildenafil), ErbB receptor antagonists (recombinant human neuregulin 1-β, used also for breast cancer treatment), and new agents for comorbidities management such as new antidiabetic agents (focus on SLGT-2 inhibitors). Gene therapy can also be the future. Also in acute heart failure (AHF) there are promising new agents being tested but we must be cautious because, in the last several years, AHF has been “the graveyard” of several therapies.
 
Answering a question from the “virtual” audience about the impact of economic restrains in heart failure research, Prof McMurray stated that, for now, HF clinical trials have not been seriously affected.

“I am still a believer in the biological heart” - Sir Magdi Yacoub
The heart has several functions (pump, endocrine, regulation of the cardiovascular system) and, therefore, hearts will never be totally replaced by machines. However, 60 years ago, heart transplantation was also a “fantasy for the future” and now is in the clinical ground, worldwide.

Nevertheless, the long term follow-up of patients after heart transplantation is somewhat disappointing (only 12.5-25% are alive after 20 years) which led Prof Yacoub to cite Winston Churchill that heart transplantation is “at the end of the beginning”, leaving room for an integrated approach between new artificial pumps and the biological heart for the next decades. But, for now, “heart transplantation is here to stay for a long time”.

Complete cardiac regeneration from stem cells to create a “bioartificial heart” – the Taylor Heart
Stem cell therapy is one of the most promising fields of investigation in Cardiology with about 150 clinical studies now recruiting patients. In her fantastic talk, Prof Doris Taylor showed her results of trying to build a multi-chambered functional heart with contracting and blood-pumping capabilities – a “bioartificial heart”. After decellularizing a pig’s heart (leaving only extracellular matrix protein scaffold) it was possible to recellularize the matrix using stem cells. The future, although still far, is open for an autologous cardiac transplantation.

New devices for HF management: new therapeutic targets and improved monitoring technologies – Prof K. Dickstein
Several companies have new devices being tested and developed for HF management. The efforts concentrate on two important areas: improved sensing/monitoring capacities and new therapeutic alternatives.

To improve monitoring of HF patients, devices that continuously measure left atrium pressure or monitor intracardiac impedance are under development.

Regarding new therapeutic devices, the focus goes to autonomic modulation therapies (spinal cord stimulation, baroreflex activation therapy and vagal nerve stimulation), percutaneous ventricular restoration device (Parachute) and new cardiac pumps. One of the most promising therapies, ready to be tested in the short term, seems to be renal denervation therapy also in HF. 

Conclusion
In this session, “science fiction” met reality, and we had a glimpse into the future of heart failure management

References


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SessionTitle:

Future targets in systolic heart failure management: pharmacological therapy, new artificial hearts, complete cardiac regeneration therapies and upcoming devices

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.