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

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

3. 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

4. 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

5. ESC 2016 Guidelines HF : New Changes for CRT !
QRS ms (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

6. 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 +++.

7. 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

8. 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.

9. 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

10. 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 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

11. 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

12. 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

13. 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

14. 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:
Zinman et al. N Engl J Med 2015:373:

15. Merci au Groupe des Cardiologues en Formation !!!