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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

4 October 2019

October 2019 post

At the European Society of Cardiology Congress in Paris, the results of the GALACTIC trial were reported by Prof. Müller (Basel). Early intensive vasodilation using personalized high doses of nitrates, oral hydralazine and rapid up-titration of ACE inhibitors or angiotensin II receptor blockers did not improve 180-day mortality in a cohort of 781 acute heart failure patients. This trial is notable, among other things, for the fact that short-term use of conventional “tried and tested” (and extremely cheap) vasodilators, administered in an intensive regime and at high dose was just as ineffectual at influencing longer-term mortality as novel agents such as ularitide and serelaxin.

The inability to demonstrate survival benefit even from drugs that are established as part of the therapeutic armamentarium for AHF highlights some fundamental issues contributing to the paucity of new drug therapies in recent decades: for example, are we targeting the wrong pathological processes in our drug development programmes or are we privileging inappropriate endpoints in clinical trials and thus hampering the regulatory approval of useful new agents?

The general lack of evidence for an ongoing survival benefit from acute-phase treatments for AHF requires some reflection. While perhaps not fully subscribing to its philosophical outlook we find much to agree with in the views of McCullough [McCullough, P.A. How Trialists and Pharmaceutical Sponsors Have Failed Us by Thinking That Acute Heart Failure Is a 48-Hour Illness. Am J Cardiol 2017, 120, 505–508.], who has argued that AHF (and by extension AdHF) is a situation often long in the making and that to expect any therapy administered for <48 h to make a robust difference to survival or rehospitalization many months after the index admission is to misunderstand the pathophysiology of these conditions.

Hospitalization for heart failure, whether as a presentation of AHF or a decompensation in the context of AdHF, results in a down-shift in the trajectory of the syndrome that is associated with worsening outcomes and patient quality of life and increased costs of care. Medical progress to address these challenges has substantially stalled in the past 20 years but advances in data technology and analytics, along with developments in clinical trials design now offer opportunities to re-envision heart failure as a complex pathophysiological continuum in ways that may help to bring a new generation of therapies into clinical use. Meanwhile it would be advisable for the clinicians to evaluate if the nearly total absence of evidence of benefit with some of the traditional i.v. drugs used in AHF and AdHF (such as the catecholamines) warrants their elimination from routine use in favor of treatments where such evidence has been accrued.

10 September 2019

September 2019 post

ESC Congress 2019 was an astonishing success: over 32000 visitors at a program spanning from Saturday Aug 31 to Wednesday Sept 4 and focused on the best and latest science with renowned leaders in cardiovascular medicine. Being the largest such gathering in the world, ESC displayed more than 500 sessions during the five-day conference.

It is one of the professional events I cannot afford to miss: it is exciting to be part of a congress that covers so many interesting topics in cardiology. Everything is here together – science, practice, exhibitions, interesting people. A unique opportunity to get connected with experts coming from all over the world and present original research. At ESC Congress, I had the opportunity to keep abreast of the latest news in cardiology and talk about the results of my own research to colleagues from many other countries: ESC Congress did definitely provide a stimulus for my further research and practical work in my practice.

Now – after such a great moment - I strongly suggest everyone to review the ESC365 Congress resources: slides, videos and abstracts from ESC 2019.

Among the highlights, a satellite symposium was held in “The HUB Duras” on Monday Sept 2 from 13:00 to 13:45 on “Inodilators in Acute and Advanced Heart Failure” (John T PARISSIS (Athens, Greece) and Francesco FEDELE (Roma, Italy), as chairs, while the lectures and discussions were held by Finn GUSTAFSSON (Copenhagen, Denmark), Veli-Pekka HARJOLA (Helsinki, Finland), yours truly Gerhard PÖLZL (Innsbruck, Austria), Josep COMIN-COLET (Hospitalet De Llobregat, Spain), Piergiuseppe AGOSTONI (Milan, Italy), and Carsten TSCHOEPE (Berlin, Germany).

As it regards the LEODOR study (“repetitive use of levosimendan in advanced heart failure patients”), an investigator meeting was held to discuss about the progress in initiation of the centers and enrollment of the patients.

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.