ESC 2016 Congress Highlight : ESC guidelines 2016 and what’s new in Heart failure ? Thomas MERCIER

ESC 2016 Guidelines HF : New algorithm ! 1) Clinical probability of the disease 2) The assessment of BNP 3) Transthoracic echocardiography www.escardio.org/guidelines

ESC 2016 Guidelines HF : New Classification ! Heart failure with preserved, mid-range and reduced EF It is only in patients with HFrEF that therapies have been shown to reduce both morbidity and mortality www.escardio.org/guidelines www.escardio.org/guidelines

ESC 2016 Guidelines HF : New Treatment Algorithm for HFrEF ! New therapeutic : Sacubitril/valsartan Don’t forget to manage HF comorbidites Few Changes for ICD : Wearable ICD www.escardio.org/guidelines

ESC 2016 Guidelines HF : New Changes for CRT ! QRS 120-150ms (130ms if NYHA II) : Only LBBB Only AF if NYHA III QRS > 150ms (+/- LBBB ; +/- AF) : Only LVEF < 35% if NYHA III Only LVEF < 30% if NYHA II 2016 ESC Guidelines : Longer QRS  Greater Benefit Does QRS Morphology Matter ? QRS > 130ms LVEF ≤ 35% If SR : NYHA II-IV If AF : NYHA III-IV www.escardio.org/guidelines

ESC 2016 Guidelines HF : And treatment of HFpEF ? Manage HF co-morbidities in all heart failure patients : In HFpEF, this is the only evidence based treatment approach +++. www.escardio.org/guidelines

ESC 2016 Guidelines HF : What’s new for Acute heart failure ? New treatment algorithm based mainly on clinical evaluation rather than SBP levels only Change in cut-off levels of SBP for vasodilator use Change of recommendation class for inotropes and opiates www.escardio.org/guidelines

ESC 2016 Guidelines HF : New treatment algorithm for AHF : In the management of a patient with suspected acute HF, try to shorten all diagnostic and therapeutic decisions. Apply the algorithm based on clinical profiles evaluating the presence of congestion & peripheral hypoperfusion. www.escardio.org/guidelines

ESC 2016 Highlights : Epidemiology +++ The AGES-Reykjavík study: Heart failure will more than double by 2040 and triple by 2060 ! R. Danielsen, (Reykjavik, IS), P5425 www.escardio.org/ESC2016

ESC 2016 Highlights : Failed Telemonitoring in heart failure ? REM-HF : More-Care : Remote Management of Heart Failure Using Implanted Devices and Formalized Follow-up Procedures (REM-HF) : Multicentre, prospective, randomised, non-blinded, controlled trial comparing: è Usual care + weekly Remote Monitoring vs Usual care alone ¢ Primary outcome – first event of death from any cause or unplanned CV hospitalisation ¢ Sept 2011 - March 2014: 1650 patients recruited from 9 English hospitals More-Care : Effects of Remote Monitoring on Clinical Outcomes and Use of Healthcare Resources in Heart Failure Patients with CRT M. Cowie (London, GB) FP 1223 G. Boriani (Modena, IT) FP 1226

ESC 2016 Highlights : AV and VV optimization to increase CRT Response Respond-HF : SONR Versus AV&VV Echo-guided Optimization to Increase CRT Response J. Brugada (Barcelona, ES) FP 2235

ESC 2016 Highlights : EchoCRT : CRT in HF with a Narrow QRS Complex Left Ventricular Global Longitudinal Strain (GLS) is Associated with Poor Outcome in Heart Failure Patients with Narrow QRS Left Ventricular Global Longitudinal Strain (GLS) is Associated with Poor Outcome in Heart Failure Patients with Narrow QRS LV GLS reflects LV systolic function and correlates inversely with the extent of LV myocardial scar and fibrosis J. Bax (Leiden, NL) FP 2233

ESC 2016 Highlights : Congestive Heart Failure Cardiopoietic Regenerative Therapy (Chart-1) : Primary Efficacy Endpoint Neutral Objective : To validate the efficacy and safety of cardiopoietic cells derived by cardiogenic specification of mesenchymal stem cells Population : Patient with ischemic heart failure with LVEF ≤35% / HF hospitalization or worsening within last 12 months / On guideline-directed heart failure therapy Randomized : Cardiopoietic celle therapy group vs Control group Primary Outcome as a Function of HF Severity (Post-hoc). Mann-Withney Estimator (95% CI) : Patients with ischemic heart failure with è LVEF ≤35% è Heart failure hospitalization or worsening within last 12 months è On guideline-directed heart failure therapy ¢ randomized to: è Active group: cardiopoietic cell therapy è Control group: sham procedure ¢ Cardiopoietic Cell Product: C3BS-CQR-1, Celyad, Mont Saint Guibert, BE ¢ Intramyocardial Delivery Catheter: C-Cathez, Celyad, Mont Saint Guibert, BE J. Bartunek (Aalst, BE) FP 1229

ESC 2016 Highlights : Results of the EMPA-Reg Outcome® Trial Heart Failure Outcomes with Empagliflozin in Patients with Type 2 Diabetes at High Cardiovascular Risk Empaglifozin : Sodium–Glucose Co-Transporter-2 (SGLT-2) Inhibitors Zinman et al. N Engl J Med 2015:373:2117-2128 Zinman et al. N Engl J Med 2015:373:2117-2128

Merci au Groupe des Cardiologues en Formation !!!