Clinical trials update from the European Society of Cardiology Meeting 2010: SHIFT, PEARL‐HF, STAR‐heart, and HEBE‐III

Abstract

This article provides information and a commentary on key trials relevant to the pathophysiology, prevention, and treatment of heart failure (HF) presented at the annual meeting of the European Society of Cardiology held in Stockholm in 2010. Unpublished reports should be considered as preliminary, since analyses may change in the final publication. The SHIFT study supports the use of ivabradine in patients with HF due to left ventricular systolic dysfunction and resting sinus rhythm rate ≥70 b.p.m. despite treatment with beta-blockers or where beta-blockers are contra-indicated. Results from PEARL-HF suggest that the potassium binding polymer RLY5016 may be useful for both prevention and treatment of hyperkalaemia in HF patients with or without concomitant chronic kidney disease. The STAR-heart study provides encouraging observational data about the potential for intracoronary stem cell transplantation in patients with HF. Results from HEBE-III showed no effect of erythropoietin on ejection fraction measured 6 weeks post-MI; although there were fewer cardiovascular events in patients assigned to erythropoietin, the study was too small to provide conclusive evidence of effect.

Signalling pathways and mechanisms of protection in pre‐ and postconditioning: historical perspective and lessons for the future

“…Investigations of other interventions which may have shown some promise in preclinical evaluations have also not been very successful. Thus, pexelizumab (APEX AMI Investigators et al ., ), an antibody to a complement component, erythropoietin (Cleland et al ., ), a stimulator of haematopoiesis in response to hypoxia, and delcasertib (Lincoff et al ., ), a selective inhibitor of PKCδ, all failed to meet the primary objectives of the trials, reduction of infarct size and improvement of the clinical status of the subjects. There is a lesson: clinical trials should probably not be undertaken until multiple preclinical laboratories have confirmed salutary effects of the intervention and until practical information about dosing and timing of administration has been established (Downey and Cohen, ).…”

Rationale and Design of the Left Atrial Pressure Monitoring to Optimize Heart Failure Therapy Study (LAPTOP-HF)

“…10,19e21 Although several devices under investigation 6,9,19e22 have shown promise in some trials and 1 has been approved, none of the current approaches directly measure left-side filling pressures. 6,7,9,19,21 Right heart measurements may not be reflective of left-side filling pressures in patients with advanced longstanding HF, who often have increased pulmonary vascular resistance. LAPTOP-HF will evaluate the safety and efficacy of an implantable device, placed by transseptal catheterization, that directly measures LAP.…”

Heart failure highlights in 2010

“…It is therefore of interest that during the European Society of Cardiology meeting in Stockholm the results of the PEARL‐HF study were presented. In this study, patients with renal failure and/or a history of hyperkalaemia who were receiving spironolactone therapy were treated with a potassium binding polymer 43. This resulted in lower potassium levels and fewer episodes of hyperkalaemia, which may have an impact on the dose of renin–angiotensin–aldosterone‐system inhibitors prescribed in this population.…”