April 26, 2017

PARIS, FRANCE —The world of heart-failure therapy may seem upside down these days, following a large "positive" trial with surprisingly little impact and large "negative" ones with what may be unexpected potential to alter clinical practice.

Fresh interpretations of both the PARADIGM-HF and TRUE-AHF trials, respectively, first-time presentations of new trials, exploration of recent controversies about implantable defibrillator (ICD) use, and other gems are on the agenda at the European Society of Cardiology (ESC) Heart Failure 2017 and 4th World Congress on Acute Heart Failure, which are convening here April 29, 2017 for the first time in La Ville Lumière.

Late-Breaking Trials I

The Saturday session features what meeting organizers are calling a "deep dive" into two major studies of IV vasodilators for acute decompensated heart failure (ADHF), neither of which were "positive" but both of which, taken together, may have a lot to say about the pathophysiology and best strategies for the acute syndrome.

On the schedule is a post hoc analysis of TRUE-AHF, which could cast the previously reported "negative" ularitide (Cardiorentis) trial in a new light; and a close examination of the RELAX-AHF-2 study, which, in recently unveiled top-line results, failed to show a long-term benefit for another IV vasodilator in ADHF, serelaxin (RLX030, Novartis).

And at a Grand Debate the following day, two TRUE-AHF researchers will help clarify the role of early vasodilators in ADHF, putting that trial in context with RELAX-AHF-2. Indeed, was TRUE-AHF "the end of the beginning" or "the beginning of the end" for the ADHF strategy of early IV vasodilation?

Late Breaking Trials II

Highlights of the Sunday session include potential insights into a new frontier in chronic heart failure, cardiovascular indications for some drugs primarily for type 2 diabetes. An analysis based on the EMPA-REG OUTCOME trial but stratified by baseline heart-failure status claims that empagliflozin (Jardiance, Boehringer Ingelheim/Lilly) is associated with "decreased risk of kidney-function decline in type 2 diabetes." The 2015 trial's primary outcomes famously showed a mortality reduction in diabetics with CV disease who took the sodium glucose cotransporter-2 (SGLT-2) inhibitor.

Also among those scheduled for the session: the randomized EDIFY trial looking at the potential for the heart-rate–lowering agent ivabradine in heart failure with preserved ejection fraction (HFpEF).

Late Breaking Trials III

Regarding the use of cardiac resynchronization therapy (CRT) in Europe, what difference does a decade make? That's the question behind a comparison of the CRT Survey II and the first such survey presented in 2009 and reported then by heartwire from Medscape. That first survey showed how CRT was being used at the time in European clinical practice; with evolving indications and technology over the years, how has the device therapy evolved?

Other Grand Debates

Leading off other debates on Sunday: What's the current role of valsartan/sacubitril (Entresto, Novartis), which showed outcomes advantages over an ACE inhibitor in patients with reduced-EF heart failure (HFrEF)? After years of lament in the field about a dearth of new drug options for the syndrome, isn't valsartan/sacubitril "ready for prime time as first-line therapy?" A PARADIGM-HF leader argues yes, an author of HF guidelines on both sides of the Atlantic argues no.

On Monday, a follow-up of sorts to emerging questions about the appropriateness of primary-prevention ICDs in all patients with nonischemic heart failure, a question raised last year at the ESC 2016 Congress in a presentation on the randomized, controlled DANISH trial. Although the debate is phrased in stark yes-or-no terms, DANISH had found primary-prevention ICD benefit in some nonischemic HF patient subgroups, especially those who were younger.

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