April 2022 at a glance: focus on prevention, acute heart failure and heart failure with preserved ejection fraction

Abstract

Spironolactone has proven effective in reducing heart failure (HF) hospitalizations in patients with HF and preserved ejection fraction (HFpEF). 1 A recent study randomized asymptomatic patients with left ventricular dysfunction, defined as global longitudinal strain ≤16% or diastolic abnormalities, to spironolactone or placebo. The primary endpoint was incident HF. The trial was prematurely terminated, and thus unpowered, because of a 55% withdrawal of spironolactone due to decline in renal function. However, resolution of left ventricular dysfunction occurred more frequently with spironolactone versus placebo (59% vs. 33%, p = 0.01). 2 Type 2 diabetes is a well-known cardiovascular (CV) risk factor. [3][4][5] In the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study, patients with cardiac autonomic neuropathy, compared to those without, had a 2.7-fold higher risk to develop HF, over a median follow-up of 4.9 years. 6 Acute heart failureAn analysis from REPORT-HF (prospective international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure) showed the precipitating factors leading to acute HF, focusing on inter-regional differences and outcome. 7 Acute coronary syndrome (ACS) was the most common cause of new-onset HF in all regions except Western Europe and North America. 7,8 On the other hand, non-adherence to diet/medication was the most common precipitant in patients with decompensated HF in all regions, confirming its major role for patient outcomes. 7,[9][10][11] Cardiogenic shock is still burdened by high mortality, requiring an early risk stratification. 12 Beer et al. 13 proposed a novel risk score, the Cardiogenic Shock Score (CSS), which was derived in 1308 unselected patients and validated in an external cohort of 943 patients. The novel score, based on nine clinical variables (age, sex, ACS, systolic blood pressure, heart rate, pH, lactate, glucose and cardiac arrest), had a higher prediction power compared to any other score in both the index and validation cohort.