Clinical trials update from the American College of Cardiology meeting 2010: DOSE, ASPIRE, CONNECT, STICH, STOP‐AF, CABANA, RACE II, EVEREST II, ACCORD, and NAVIGATOR

Abstract

This article provides information and a commentary on trials relevant to the pathophysiology, prevention and treatment of heart failure presented at the annual meeting of the American College of Cardiology held in March 2010. Unpublished reports should be considered as preliminary, since analyses may change in the final publication. Results from DOSE suggest that giving diuretics using a high-dose, bolus strategy may be better than using lower doses or a continuous infusion for patients with acute decompensated heart failure. In the ASPIRE study, addition of aliskiren to standard therapy failed to attenuate left ventricular remodelling in post-MI patients and was associated with more adverse events. In CONNECT, remote monitoring reduced the time from CRT-D-or ICD-detected events to clinical decision and this was associated with fewer clinic visits and shorter hospitalizations. An analysis from STICH testing the effects of surgical ventricular reconstruction showed no benefit in the sub-group of patients who achieved a greater reduction in LV volume. STOP-AF and CABANA did not provide convincing evidence of the effectiveness or safety of catheter ablation for the treatment of AF. RACE II suggests that lenient heart rate control might be as effective as strict rate control in patients with permanent atrial fibrillation. In EVEREST II, a catheter-based mitral valve repair procedure using the MitraClip w system had similar efficacy to traditional surgery but with fewer short-term adverse effects. Valsartan reduced progression to diabetes in patients with impaired glucose tolerance but had no effect on cardiovascular events in NAVI-GATOR. In ACCORD, strict blood pressure control failed to reduce the risk of overall cardiovascular events in high-risk diabetic patients.--

Impact of Atrial Fibrillation on Exercise Capacity and Mortality in Heart Failure With Preserved Ejection Fraction: Insights From Cardiopulmonary Stress Testing

“…Although the largest trial to date in the preablation era, the AFFIRM (Atrial Fibrillation Follow‐Up Investigation of Rhythm Management) trial,7 has shown no survival benefit, we are still waiting for long‐term results of more contemporary trials that examine this question in the era of ablation 28. In addition to the detrimental effects of AF on exercise capacity, our study also found a significant survival difference in patients with HFpEF with versus without AF with early curve separation.…”

Renal dysfunction in acute and chronic heart failure: prevalence, incidence and prognosis

“…Effective diuresis in patients with severe congestion can lead to a paradoxical improvement in renal function, possibly due to a reduction in renal venous pressure [19][20][21][22]. Use of higher doses of diuretics in acute heart failure is associated with a greater rise in serum creatinine, but this does not translate into a worse prognosis [45,46]. Switching from diuretics to ultrafiltration [47] or arginine vasopressin antagonists [48] does not reduce the rate of renal dysfunction and may exacerbate it, implying that renal dysfunction is a generalised problem with 'dehydrating' therapies.…”

Safety and Efficacy of Aliskiren in the Treatment of Hypertension and Associated Clinical Conditions

“…The Aliskiren Study in Post-MI patients to reduce remodelling (ASPIRE) showed that the addition of aliskiren to the standard therapy in patients recovering from a heart attack did not limit the adverse changes to the left ventricle. In addition, more patients developed high levels of potassium in the blood [79].…”