CCS/CHFS Heart Failure Guidelines: Clinical Trial Update on Functional Mitral Regurgitation, SGLT2 Inhibitors, ARNI in HFpEF, and Tafamidis in Amyloidosis
Eileen O’meara
(1)
,
Michael Mcdonald
(2)
,
Michael Chan
(3)
,
Anique Ducharme
(1)
,
Justin A Ezekowitz
(3)
,
Nadia Giannetti
(4)
,
Adam Grzeslo
(5)
,
George A Heckman
(6)
,
Jonathan G Howlett
(7)
,
Sheri L Koshman
(3)
,
Serge Lepage
(8)
,
Lisa M Mielniczuk
(9)
,
Gordon W Moe
(10, 2)
,
Elizabeth Swiggum
(11)
,
Mustafa Toma
(11)
,
Sean A Virani
(11)
,
Shelley Zieroth
(12)
,
Sabe De
(13)
,
Sylvain Matteau
(8)
,
Marie-Claude Parent
(1)
,
Anita W Asgar
(1)
,
Gideon Cohen
(10, 2)
,
Nowell Fine
(7)
,
Margot Davis
(11)
,
Subodh Verma
(10, 2)
,
David Cherney
(2)
,
Howard Abrams
(2)
,
Abdul Al-Hesayen
(14)
,
Alain Cohen-Solal
(15, 16)
,
Michel D’astous
(17)
,
Diego H Delgado
(2)
,
Olivier Desplantie
(18)
,
Estrellita Estrella-Holder
(19)
,
Lee Green
(3)
,
Haissam Haddad
(20)
,
Karen Harkness
(21)
,
Adrian F Hernandez
(22)
,
Simon Kouz
(23)
,
Marie-Hélène Leblanc
(24)
,
Douglas Lee
(2)
,
Frederick A Masoudi
(25)
,
Robert S Mckelvie
(26)
,
Miroslaw Rajda
(27)
,
Heather J Ross
(2)
,
Bruce Sussex
(28)
1
Montreal Heart Institute - Institut de Cardiologie de Montréal
2 University of Toronto
3 University of Alberta
4 MUHC - McGill University Health Center [Montreal]
5 McMaster University [Hamilton, Ontario]
6 University of Waterloo [Waterloo]
7 University of Calgary
8 UdeS - Université de Sherbrooke
9 University of Ottawa [Ottawa]
10 St. Michael's Hospital
11 UBC - University of British Columbia
12 University of Manitoba [Winnipeg]
13 UWO - University of Western Ontario
14 St. Michael’s Hopsital [Toronto, ON, Canada]
15 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
16 Hôpital Lariboisière-Fernand-Widal [APHP]
17 CHUDGLD - Dr. Georges-L.-Dumont University Hospital Centre
18 RJH - Royal Jubilee Hospital [Victoria, BC, Canada]
19 St. Boniface Hospital Albrechtsen Research Centre [Winnipeg]
20 U of S - University of Saskatchewan [Saskatoon, Canada]
21 Hamilton Health Sciences
22 DCRI - DURHAM - Duke Clinical Research Institute
23 CHRDL - Centre Hospitalier Régional de Lanaudiere [Joliette, QC, Canada]
24 IUCPQ - Institut Universitaire de Cardiologie et de Pneumologie de Québec
25 University of Colorado Anschutz [Aurora]
26 Western University [London, ON, Canada]
27 HSC - QEII Health Sciences Centre [Halifax, NS, Canada]
28 MUN - Memorial University of Newfoundland = Université Memorial de Terre-Neuve [St. John's, Canada]
2 University of Toronto
3 University of Alberta
4 MUHC - McGill University Health Center [Montreal]
5 McMaster University [Hamilton, Ontario]
6 University of Waterloo [Waterloo]
7 University of Calgary
8 UdeS - Université de Sherbrooke
9 University of Ottawa [Ottawa]
10 St. Michael's Hospital
11 UBC - University of British Columbia
12 University of Manitoba [Winnipeg]
13 UWO - University of Western Ontario
14 St. Michael’s Hopsital [Toronto, ON, Canada]
15 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
16 Hôpital Lariboisière-Fernand-Widal [APHP]
17 CHUDGLD - Dr. Georges-L.-Dumont University Hospital Centre
18 RJH - Royal Jubilee Hospital [Victoria, BC, Canada]
19 St. Boniface Hospital Albrechtsen Research Centre [Winnipeg]
20 U of S - University of Saskatchewan [Saskatoon, Canada]
21 Hamilton Health Sciences
22 DCRI - DURHAM - Duke Clinical Research Institute
23 CHRDL - Centre Hospitalier Régional de Lanaudiere [Joliette, QC, Canada]
24 IUCPQ - Institut Universitaire de Cardiologie et de Pneumologie de Québec
25 University of Colorado Anschutz [Aurora]
26 Western University [London, ON, Canada]
27 HSC - QEII Health Sciences Centre [Halifax, NS, Canada]
28 MUN - Memorial University of Newfoundland = Université Memorial de Terre-Neuve [St. John's, Canada]
Eileen O’meara
- Fonction : Auteur correspondant
Anique Ducharme
- Fonction : Auteur
- PersonId : 1214339
- ORCID : 0000-0003-1681-9187
Serge Lepage
- Fonction : Auteur
- PersonId : 1214376
- ORCID : 0000-0002-4242-9740
Elizabeth Swiggum
- Fonction : Auteur
- PersonId : 1214377
- ORCID : 0000-0002-4544-4057
Shelley Zieroth
- Fonction : Auteur
- PersonId : 1214338
- ORCID : 0000-0002-6145-9814
Sabe De
- Fonction : Auteur
- PersonId : 1214378
- ORCID : 0000-0001-8417-9877
Olivier Desplantie
- Fonction : Auteur
- PersonId : 1214379
- ORCID : 0000-0001-5341-2218
Estrellita Estrella-Holder
- Fonction : Auteur
- PersonId : 1214380
- ORCID : 0000-0003-4253-2120
Haissam Haddad
- Fonction : Auteur
- PersonId : 1214382
- ORCID : 0000-0003-4821-3577
Résumé
In this update, we focus on selected topics of high clinical relevance for health care providers who treat patients with heart failure (HF), on the basis of clinical trials published after 2017. Our objective was to review the evidence, and provide recommendations and practical tips regarding the management of candidates for the following HF therapies: (1) transcatheter mitral valve repair in HF with reduced ejection fraction; (2) a novel treatment for transthyretin amyloidosis or transthyretin cardiac amyloidosis; (3) angiotensin receptor-neprilysin inhibition in patients with HF and preserved ejection fraction (HFpEF); and (4) sodium glucose cotransport inhibitors for the prevention and treatment of HF in patients with and without type 2 diabetes. We emphasize the roles of optimal guideline-directed medical therapy and of multidisciplinary teams when considering transcatheter mitral valve repair, to ensure excellent evaluation and care of those patients. In the presence of suggestive clinical indices, health care providers should consider the possibility of cardiac amyloidosis and proceed with proper investigation. Tafamidis is the first agent shown in a prospective study to alter outcomes in patients with transthyretin cardiac amyloidosis. Patient subgroups with HFpEF might benefit from use of sacubitril/valsartan, however, further data are needed to clarify the effect of this therapy in patients with HFpEF. Sodium glucose cotransport inhibitors reduce the risk of incident HF, HF-related hospitalizations, and cardiovascular death in patients with type 2 diabetes and cardiovascular disease. A large clinical trial recently showed that dapagliflozin provides significant outcome benefits in well treated patients with HF with reduced ejection fraction (left ventricular ejection fraction ≤ 40%), with or without type 2 diabetes.
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