RESUMEN
PURPOSE OF REVIEW: Heart failure is a clinical syndrome with signs and symptoms from underlying cardiac abnormality and evidence of pulmonary or systemic congestion on laboratory testing or other objective findings (Bozkurt et al. in Eur J Heart Fail 23:352-380, 2021). Heart failure with reduced ejection fraction (HFrEF), when heart failure is due to underlying reduction in ejection fraction to ≤ 40. The goal of this review is to briefly describe the mechanisms and benefits of the various pharmacological interventions described in the 2022 AHA/ACC/HFSA Guidelines focusing on Stage C: Symptomatic Heart Failure HFrEF, while providing basic guidance on safe use of these medications. RECENT FINDINGS: Use of medications from each class as recommended in the 2022 Guidelines can provide significant morbidity and mortality benefits for our patients. Despite advances in therapeutics for patients with HFrEF, patients are frequently under treated and more research is needed to help optimize management of these complicated patients.
Asunto(s)
Insuficiencia Cardíaca , Volumen Sistólico , Humanos , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Guías de Práctica Clínica como Asunto , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Fármacos Cardiovasculares/uso terapéuticoRESUMEN
Transcatheter edge-to-edge repair (TEER) of the mitral valve has become standard of care for the treatment of high-risk patients with severe mitral regurgitation. Patients with end stage renal disease (ESRD) on hemodialysis were either excluded or severely underrepresented in all seminal trials proving the safety and efficacy of TEER. There have been few studies that evaluated the effectiveness or complications of TEER in ESRD patients. Using the United States Renal Data System (USRDS), we identified all ESRD patients who underwent TEER from October 2015 to December 31, 2019. Major comorbidities were recorded and Kaplan-Meier curves were generated for survival and freedom from hospitalization or death. The study population included 965 patients, of which 576 (59.7%) were male. The median age at the time of TEER was 72.5 (IQR: 64.4-79.1) years. There were 130 (13.2%) patients with heart failure with reduced ejection fraction (HFrEF), 110 (11.2%) with heart failure with preserved ejection fraction (HFpEF) and 745 (74.6%) with an indeterminate ejection fraction. During follow-up, strokes occurred in 61 (6.3%) patients, infective endocarditis in 42 (4.4%) patients, mitral stenosis in 13 (1.3%) and valve embolism in less than 11 patients. One-year survival was 56.9%, and 2-year survival was 33.9%. In patients with ESRD undergoing TEER, only a preserved ejection fraction (HR: 0.70, 95% CI: 0.50-0.99, P = 0.041) was a significant predictor of survival in a cox proportional hazards model. Despite favorable in-hospital outcomes one-year mortality rates surpass those reported in broader patient cohorts. The increased incidence of infective endocarditis and mitral stenosis is likely related to increased risk intrinsic to those with ESRD.