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Acute heart failure: a new paradigm

ESC Congress 2010

Heart Failure

Recently, significant progress has been made in both research and practice of acute heart failure. In this clinical seminar entitled “Acute Heart Failure: A New Paradigm”, 5 exciting papers were presented.

Dr. Gheorghiade (USA) gave a comprehensive overview on the current status of acute heart failure under the title of “Is it a reversible condition?” After a brief introduction of epidemiology and clinical trials on acute heart failure, he emphasized the importance of BUN and body weight change as useful markers for heart failure practice. He then pointed our several issues for the improvement of heart failure practice, including the viewpoint on reversibility in the pathogenesis of heart failure, effective use of diuretics, re-appreciation of old drugs (e.g. digoxin), metabolic consideration on the disorder and the need for good clinical trials.

In his talk entitled “Myocardial energetics”, Dr. Frenneaux (UK) emphasized that cardiac energy deficiency is the central pathophysiology of acute heart failure irrespective of the cause of the disorder. After briefly mentioning myocardial metabolism, he introduced his recent interesting work in which he found the effectiveness of perhexilin, an inhibitor of free acids oxidation, in the treatment of heart failure.

Under the title of “Role of micronutrients”, Dr. Cleland (UK) concisely overviewed the importance of micronutrients in the treatment of heart failure, including minerals (e.g. Mg), vitamins (e.g. thiamine), free amino acids, CoQ10, and essential fatty acids. He pointed out many favourable effects of micronutrients, including vasodilatation, enhanced energy metabolism, myocardial protection and inhibition of arrhythmia.

Under the title of “Role of macronutrients”, Dr. Metra (Italy) mentioned that heart failure is a hyper-catabolic state with sympathetic nervous activation, RASS activation and inflammation. He also mentioned that beta blockers are effective in myocardial substrate shift from free fatty acids oxidation to glucose oxidation.

Finally, Dr. Ahmed (USA) talked under the title of “What is different in the elderly?” He emphasized that the prevalence of heart failure is increasing with ageing and a heart failure pandemic would be expected in the near future in the ageing society worldwide. He also mentioned that chronic use of loop diuretics in the elderly is associated with increased mortality and that hospice care is important for elderly heart failure patients.




Acute heart failure: a new paradigm
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.