Advanced Heart Failure

Abstract

Advanced heart failure (AHF) is the stage of heart failure (HF) refractory to maximal medical treatment, cardiac devices (CRT - cardiac resynchronization, ICD - implantable defibrillator) and surgical treatment. AHF has become of interest through the experience and favorable results of treatment by mechanical circulatory support (MCS) and cardiac transplant (CT). The article reviews the criteria for defining the AHF (2018 ESC statement), natural history and prognosis outside the advanced treatment forms. Evaluation of risk and prognostic factors is required before the decision of advanced therapy: clinical factors (HF severity and reduction of cardiorespiratory functional capacity), RV function, biological markers and elements of organ dysfunction, as well as reduction of tolerance to conventional medication.Finally, the principles of treatment and the results of mechanical circulatory support and cardiac transplant are presented.

Ejection Fraction-Related Differences of Baseline Characteristics and Outcomes in Troponin-Positive Patients without Obstructive Coronary Artery Disease

“…Tn-I and BNP levels were significantly higher in the LVEF < 40% group compared to other groups. Increased levels of Tn-l and BNP levels are consistent with declined LVEF and a sign of higher myocardial injury [27,28]. Additionally, these parameters are related to worsened disease progression and a higher mortality rate in myocardial infarction with obstructive coronary artery disease and non-obstructive coronary artery disease [29,30].…”

“…The male-to-female ratio was nearly 1:1 (52.7% male) and the median age was 64 (50.8-75.3) years. On admission, the median LVEF values were 60 (55-65)% vs. 45 (40-46)% and 30 (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)% among groups; p < 0.001. Before discharge, the LVEF values in all groups were 60 (56-65) % vs. 40.5 (34.8-50) % and 38 ; p < 0.001 respectively (Table S1).…”