Comment on ESC/CSC Guidelines
Diagnosis of heart failure

Czech version

Authors: J. Hradec
Authors‘ workplace: III. interní klinika 1. LF UK a VFN v Praze
Published in: Kardiol Rev Int Med 2016, 18(4): 230-233

Overview

This year the European Society of Cardiology (ESC) published updated guidelines for the diagnosis and treatment of acute and chronic heart failure. This article summarises new approaches in the diagnostics of heart failure. Firstly, a new term was introduced for the patients with heart failure and ejection fraction value in the range 0.40–0.49. Until now these patients were comprised in the category of patients with heart failure and preserved ejection fraction (HFpEF). Now they have been categorised separately as patients with heart failure and mid-range ejection fraction (HFmrEF). It was shown that these patients have a slightly different phenotype and they also react differently to treatment. Also, the algorithm for the diagnosis of heart failure in the non-acute setting has been changed to also include an estimation of probability of heart failure. Echocardiography still remains the key examination and where it is not available the examination of plasma levels of natriuretic peptides is gaining significance, especially for excluding heart failure when the plasma levels are normal. The algorithm for the diagnosis of HFpEF has been simplified, requiring objective evidence of a structural and/or functional myocardial abnormality leading to decreased cardiac output and/or increase of intracardiac pressure at rest or during exercise.

Keywords:
diagnostics – heart failure – heart failure with reduced ejection fraction – HFrEF – heart failure with mid-range ejection fraction – HFmrEF – heart failure with preserved ejection fraction – HFpEF

Sources

1. Ponikowski P, Voors AA, Anker SD et al. for 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. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016; 37(27): 2129– 2200. doi: 10.1093/ eurheartj/ ehw128.

2. Špinar J, Hradec J, Špinarová L et al. Summary of the 2016 ESC Guidelines on the diagnosis and treatment of acute and chronic heart failure. Prepared by the Czech Society of Cardiology. Cor Vasa 2016; 58(5): 597– 636. doi: 10.1016/ j.crvasa.2016.09.004.

3. Solomon SD, Claggett B, Lewis EF et al. Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Eur Heart J 2016; 37(5): 455– 462. doi: 10.1093/ eurheartj/ ehv464.

4. Lam CS, Solomon SD. The middle child in heart failure: heart failure with mid-range ejection fraction (40– 50 %). Eur J Heart Fail 2014; 16(10): 1049– 1055. doi:10.1002/ ejhf.159.