Ileana L. Piña, MD, MPH


July 19, 2019

This transcript has been edited for clarity.

Hello. I'm Ileana Piña from Wayne State University in Detroit, Michigan, and this is my blog. I am recording from the European Society of Cardiology–Heart Failure Association (HFA) 2019 meeting in Athens, Greece. It is an exciting time for the HFA.

I want to chat with you a bit about acute heart failure. I attended an excellent session that focused on the question: What are we doing with acute heart failure? I don't have to tell this audience how many trials we have conducted that have been either negative or neutral, including the latest RELAX-AHF-2 trial,[1] which reflected a lot of promise for the drug serelaxin, which didn't bear out when the randomized trial was completed.

Are we interpreting acute heart failure appropriately? We don't have great guidelines on this so everyone kind of does what they think they should do. But this session included a few very interesting points having to do with high-sensitivity (hs) troponins. Most of our labs in the United States are now adopting the hs-troponin assay and we're beginning to see that it's not the troponin levels that go up a little and then come back down that are important. We've been seeing that for years. But now we're seeing that some patients have true myocardial damage and perhaps those patients are a bit different from the rest of the patients with acute heart failure. Perhaps those patients should be reappraised, as we have reappraised our patients with acute coronary syndrome (ACS). As patients get older, they don't necessarily have chest pain with ACS; they tend to have shortness of breath, even when they're ischemic.

So it pays to take a look at the high hs-troponin level. And if it's going up and staying up before coming down, consider taking that patient to the cath lab, and if there is an artery that needs to be opened, open it, because reperfusion will be better for that patient.

We've never conducted a randomized controlled trial on this and now we have devices that we want to put into these patients. The American Heart Association is developing a new clinical statement on shock and we will be reviewing all the data on shock. Hopefully we will have some pathways to clarity, because maybe acute heart failure isn't one single group. We've been talking about HFpEF (heart failure with preserved ejection fraction). Patients with HFpEF don't comprise one single group, so perhaps patients with acute heart failure don't either. Take a look at your own patients in your own hospitals and see if you can detect some of those differences. I'll be back with more on this.

Thank you. This is Ileana Piña, signing off.

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