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Acute and Advanced Heart Failure Blog

Professor Gerhard Pölzl is Chief of the Heart Failure and Heart Transplant Program at the Medical University Innsbruck. His research is focused on clinical studies in advanced and chronic heart failure and on translational studies in cardiomyopathies.

He has been Principal Investigator of the LevoRep clinical trial that tested the efficacy and safety of pulsed infusions of levosimendan in outpatients with advanced heart failure. He is now P.I. of the clinical trial LEODOR, on repetitive use of levosimendan in advanced heart failure.

This blog is focused on the therapeutic options for Acute and Advanced Heart Failure: new data, new studies, new opinions, new trends.


Latest posts

1 August 2019

August 2019 post

The countdown to ESC Congress 2019 is nearing its end. The world's premier Cardiovascular congress is now just less than 4 weeks away! The program spans from Saturday Aug 31 to Wednesday Sept 4.

Among the late-breaking science session, Prof. Müller will present the data of the GALACTIC trial (“Goal-directed AfterLoad Reduction in Acute Congestive Cardiac Decompensation: a randomized controlled trial”) at 11:36 on Monday in the main auditorium.

Also the main results of THEMIS (“Effect of Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study”) and ISAR-REACT 5 (“Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome”) will be presented and discussed.

The ESC TV services will broadcast throughout the congress. As an example, the PARAGON-HF (“Angiotensin Receptor Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction”) t will be discussed on TV by Scott Solomon on Sunday at 16:25. Stay tuned in the right channel.

To be mentioned also that the data of AFIRE (“Rivaroxaban monotherapy versus combination therapy in patients with atrial fibrillation and stable coronary artery disease”) will be disclosed.

As it regards the LEODOR study (“repetitive use of levosimendan in advanced heart failure patients”), an investigator meeting will be held to discuss about the progress in initiation of the centers and enrollment of the patients. The study protocol will be discussed in a satellite symposium in “The HUB Duras” on Monday Sept 2  from 13:00 to 13:45

The chairpersons of the symposium will be John T PARISSIS (Athens, Greece) and Francesco FEDELE (Roma, Italy), while the lectures and discussions will be held by Finn GUSTAFSSON (Copenhagen, Denmark), Veli-Pekka HARJOLA (Helsinki, Finland), yours truly Gerhard POLZL (Innsbruck, Austria), Josep COMIN-COLET (Hospitalet De Llobregat, Spain), Piergiuseppe AGOSTONI (Milan, Italy), and Carsten TSCHOEPE (Berlin, Germany).

The use of inotropes for correcting hemodynamic dysfunction and relieving symptoms in patients with congestive heart failure will be debated. Unfortunately, negative or insufficient data has been collected on the effects of cardiac glycosides, cathecolamines and phosphodiesthrase inhibitors on quality of life and survival. However, drugs which are both calcium sensitizers and potassium channels openers – such as levosimendan - have been proposed as safer inodilators in acute and advanced heart failure.  

3 June 2019

June 2019 post

Back from the HEART FAILURE congress in Athens with pleasant memories, new acquaintances, and a big bag with information and ideas.

LEODOR study on “repetitive use of levosimendan in advanced heart failure patients” has been discussed in the main program (see presentation in MyESC) and an investigator meeting has been held to discuss about the progress in initiation of the centers and enrollment of the patients.

As it regards the inodilator levosimendan, many posters were presented and a series of tutorials on i.v. vasoactive drugs in the treatment of acute and advanced heart failure was held by 12 speakers from Austria, Cyprus, Finland, Germany, Greece, Hungary, Italy, Spain, Sweden, and Switzerland. The lectures were recorded and the videos are available on the landing page www.acutehf.com/hf for educational purposes.

The speakers agreed that, despite the use of i.v. vasoactive drugs, diuretics, vasodilators and inotropes, for correcting hemodynamic dysfunction in patients with congestive heart failure has been described over many decades, insufficient data has been collected on their effects on Quality of life (QoL) and long term survival. Of particular note is that for inotropes belonging to the cardiac glycoside, catecholamine, and phosphodiesterase inhibitor families, data on the impact of these agents on QoL and survival are not positive and in several cases indicate an increase in mortality risk.

In acute heart failure, selecting the proper agent according to patients’ clinical profile and limiting usage to the shortest time at the lowest effective dose are important considerations to optimize inotrope use. In these settings, levosimendan bears an advantage also due to its beneficial renal effects. Levosimendan’s overall hemodynamic profile and clinical tolerability, combined with its extended duration of effect, has encouraged its intermittent use also in patients with advanced heart failure, to promote functional independence and quality of life and avert the need for unplanned hospitalizations resulting from episodes of decompensation. Further clinical research is in progress to refine the drug’s use for this purpose.

 

 

 

14 May 2019

May 2019 post

The HEART FAILURE meeting in Athens is approaching. On the web pages of the ESC it is already possible to have a glance over the final program of the congress.

Organised by the Heart Failure Association of the European Society of Cardiology, the Heart Failure Congress is a unique forum where cardiologists, interventional heart failure  specialists, cardiac surgeons, internists, practicing general physicians, basic scientists,  epidemiologists, cardiac nurses, industry affiliates and others have the opportunity to meet and exchange ideas and information.

The HFA congress is an international event open to healthcare professionals interested in any aspect of heart failure from epidemiology, through basic and translational science to prevention (reviewing the treatment of hypertension and post-infarction care), diagnosis (including novel imaging modalities and biomarkers), monitoring (together with remote monitoring), prognostication (risk stratification as well as use of biomarkers), medical and nursing management (including drugs, devices, tele-care and surgery).

I will be there presenting a rapid fire abstract on “repetitive levosimendan infusion” on Monday at 09:40 on the AGORA 2 stage: see you there!

Included in the program, some tutorials on how to use medications and devices are also accessible to the participants. As an example Orion Pharma will organize a series of 12 lectures on the use of inotropes for correcting hemodynamic dysfunction in patients with congestive heart failure. Over many decades, negative or insufficient data has been collected on the effects of cardiac glycosides, cathecolamines, and phosphodiesthrase inhibitors on quality of life and survival. More recently, the calcium sensitizer and potassium channel opener levosimendan have been proposed as a safer inodilator. The tutorials lectures in Athens will focus on how to use safely and effectively levosimendan in acute and advanced heart failure.