Update in Heart Failure Management Disclosures

Update in Heart Failure Management
New guidelines, diagnostics and treatments

Casey Culbertson MD
Cardiology Medical Director
GE Healthcare
Co-Founder MD1World
MD1WORLD Lecture Series
January-February, 2018


Update in Heart Failure Management
Disclosures

Casey Culbertson MD is a Cardiology Medical Director at GE Healthcare

He owns no stock in the company and is not involved in sales of any GE products
((Adreview®)


Update in Heart Failure Management


Update in Heart Failure Management
Definition and Stages
“The inability of the heart to meet the metabolic demands of the body”


Update in Heart Failure Management

Update in Heart Failure Management


Update in Heart Failure Management


Update in Heart Failure Management
Guidelines


Update in Heart Failure Management


Update in Heart Failure Management
Treatment Algorithm


Update in Heart Failure Management
What if patient on maximal Guideline therapy and still symptomatic?


Update in Heart Failure Management
New HF Medication - SHIFT Study and Results
N=6505

NSR HR > 70 bpm EF < 35%


Update in Heart Failure Management
Ivabradine (Corlanor®)Mechanism of Action

CO
Force – Frequency Curve

Improving CO

Slowing HR

Slows depolarization =
slows HR

HR


Update in Heart Failure Management
New 2016 ACC/AHA/HFSA Guidelines


Update in Heart Failure Management
New HF Medication: PARADIGM-HF Study

N=8399
-20%

-20%

-21%

-16%

Update in Heart Failure Management
LCZ 696 (Entresto®) Mechanism of Action


Update in Heart Failure Management
New 2016 ACC/AHA/HFSA Guidelines

Start Entresto instead of ACE/ARB


Update in Heart Failure Management
New Diagnostics for HF – PA Pressure Monitoring


Update in Heart Failure Management
CardioMEMS® PA Pressure Monitoring System

HR
PAP
CO


Update in Heart Failure Management
“Advanced Warning” about worsening HF -> change in mortality


Update in Heart Failure Management
“Classic” Diagnostic Tests for Heart Failure

Update in Heart Failure Management
Radio-pharmaceutical agent for “prognostic” HF evaluation

Low Risk
H/M ratio > 1.6

High Risk
H/M ratio < 1.6


Update in Heart Failure Management
ADMIRE-HF Study
Myocardial Iodine-123 Meta-Iodobenzylguanidine Imaging and Cardiac Events in Heart Failure Results of the Prospective ADMIRE-HF
(AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) Study
Arnold F. Jacobson, MD, PHD,* Roxy Senior, MD,† Manuel D. Cerqueira, MD,‡ Nathan D. Wong, PHD,§ Gregory S. Thomas, MD, MPH,§ Victor A. Lopez, BS,§ Denis Agostini, MD, PHD, Fred Weiland, MD,¶
Harish Chandna, MD,# Jagat Narula, MD, PHD,§ on behalf of the ADMIRE-HF Investigators

Objectives: The ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) study prospectively evaluated iodine-123 meta-iodobenzylguanidine
(123I-mIBG) imaging for identifying symptomatic heart failure (HF) patients most likely to experience cardiac events .

Results: A total of 237 subjects (25%) experienced events (median follow-up 17 months). The hazard ratio for H/M 1.60 was 0.40 (p 0.001); the hazard ratio for
continuous H/M was 0.22 (p 0.001). Two-year event rate was 15% for H/M >1.60 and 37% for H/M <1.60; hazard ratios for individual event categories were as follows:
HF progression, 0.49 (p 0.002); arrhythmic events, 0.37 (p 0.02); and cardiac death, 0.14 (p 0.006).

(J Am Coll Cardiol 2010;55:2212–21)


Update in Heart Failure Management
Radionuclide agent for “prognostic” HF evaluation-examples

Update in Heart Failure Management
I123 IBG Scan to guide Cardiac Resynchronization Therapy (CRT)