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Cited by 122Heart Failure Treatment and ManagementAmyloidosis: Diagnosis, Treatment, OutcomesCardiovascular Function and Risk Factors

CCS/CHFS Heart Failure Guidelines: Clinical Trial Update on Functional Mitral Regurgitation, SGLT2 Inhibitors, ARNI in HFpEF, and Tafamidis in Amyloidosis

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O’Meara, Eileen, McDonald, Michael, Chan, Michael, Ducharme, Anique, Ezekowitz, Justin A., Giannetti, Nadia, Grzeslo, Adam, Heckman, George A. +37 more·2020·Canadian Journal of Cardiology
DOI 10.1016/j.cjca.2019.11.036
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Abstract

In this update, we focus on selected topics of high clinical relevance for health care providers who treat patients with heart failure (HF), on the basis of clinical trials published after 2017. Our objective was to review the evidence, and provide recommendations and practical tips regarding the management of candidates for the following HF therapies: (1) transcatheter mitral valve repair in HF with reduced ejection fraction; (2) a novel treatment for transthyretin amyloidosis or transthyretin cardiac amyloidosis; (3) angiotensin receptor-neprilysin inhibition in patients with HF and preserved ejection fraction (HFpEF); and (4) sodium glucose cotransport inhibitors for the prevention and treatment of HF in patients with and without type 2 diabetes. We emphasize the roles of optimal guideline-directed medical therapy and of multidisciplinary teams when considering transcatheter mitral valve repair, to ensure excellent evaluation and care of those patients. In the presence of suggestive clinical indices, health care providers should consider the possibility of cardiac amyloidosis and proceed with proper investigation. Tafamidis is the first agent shown in a prospective study to alter outcomes in patients with transthyretin cardiac amyloidosis. Patient subgroups with HFpEF might benefit from use of sacubitril/valsartan, however, further data are needed to clarify the effect of this therapy in patients with HFpEF. Sodium glucose cotransport inhibitors reduce the risk of incident HF, HF-related hospitalizations, and cardiovascular death in patients with type 2 diabetes and cardiovascular disease. A large clinical trial recently showed that dapagliflozin provides significant outcome benefits in well treated patients with HF with reduced ejection fraction (left ventricular ejection fraction ≤ 40%), with or without type 2 diabetes.

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References 57 · Cited by 122

Research works printed but not linked: 49

  1. Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol 2013;66:719-25.
  2. Cioffi G, Tarantini L, De Feo S, et al. Functional mitral regurgitation predicts 1-year mortality in elderly patients with systolic chronic heart failure. Eur J Heart Fail 2005;7:1112-7.
  3. Glower DD, Kar S, Trento A, et al. Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST II study. J Am Coll Cardiol 2014;64:172-81.
  4. Schillinger W, Hunlich M, Baldus S, et al. Acute outcomes after MitraClip therapy in highly aged patients: results from the German TRAnscatheter Mitral valve Interventions (TRAMI) Registry. Euro- Intervention 2013;9:84-90.
  5. Maisano F, Franzen O, Baldus S, et al. Percutaneous mitral valve in- terventions in the real world: early and 1-year results from the ACCESS- EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol 2013;62:1052-61.
  6. Nickenig G, Estevez-Loureiro R, Franzen O, et al. Percutaneous mitral valve edge-to-edge repair: in-hospital results and 1-year follow-up of 628 patients of the 2011-2012 Pilot European Sentinel Registry. J Am Coll Cardiol 2014;64:875-84.
  7. Kortlandt F, Velu J, Schurer R, et al. Impact of mitral valve treatment choice on mortality, according to aetiology. EuroIntervention 2019;14: 1733-9.
  8. Obadia JF, Messika-Zeitoun D, Leurent G, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med 2018;379:2297-306.
  9. Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med 2018;379:2307-18.
  10. Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echo- cardiogr 2017;30:303-71.
  11. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardi- ology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017;135:e1159-95.
  12. Metze C, Matzik AS, Scherner M, et al. Impact of frailty on outcomes in patients undergoing percutaneous mitral valve repair. JACC Cardiovasc Interv 2017;10:1920-9.
  13. Piriou N, Al Habash O, Donal E, et al. The MITRA-HR study: design and rationale of a randomised study of MITRACLIP(R) transcatheter mitral valve repair in patients with severe primary mitral regurgitation eligible for high-risk surgery. EuroIntervention 2019;15:e329-35.
  14. Merlini G, Bellotti V. Molecular mechanisms of amyloidosis. N Engl J Med 2003;349:583-96.
  15. Falk RH. Diagnosis and management of the cardiac amyloidoses. Cir- culation 2005;112:2047-60.
  16. Siddiqi OK, Ruberg FL. Cardiac amyloidosis: an update on pathophys- iology, diagnosis, and treatment. Trends Cardiovasc Med 2018;28: 10-21.
  17. Rapezzi C, Merlini G, Quarta CC, et al. Systemic cardiac amyloidoses: disease profiles and clinical courses of the 3 main types. Circulation 2009;120:1203-12.
  18. Benson MD, Buxbaum JN, Eisenberg DS, et al. Amyloid nomenclature 2018: recommendations by the International Society of Amyloidosis (ISA) nomenclature committee. Amyloid 2018;25:215-9.
  19. Pereira NL, Grogan M, Dec GW. Spectrum of restrictive and infiltrative cardiomyopathies: part 1 of a 2-part series. J Am Coll Cardiol 2018;71: 1130-48.
  20. Pinney JH, Whelan CJ, Petrie A, et al. Senile systemic amyloidosis: clinical features at presentation and outcome. J Am Heart Assoc 2013;2: e000098.
  21. Gertz MA, Brown ML, Hauser MF, Kyle RA. Utility of technetium Tc 99m pyrophosphate bone scanning in cardiac amyloidosis. Arch Intern Med 1987;147:1039-44.
  22. Hutt DF, Quigley AM, Page J, et al. Utility and limitations of 3,3- diphosphono-1,2-propanodicarboxylic acid scintigraphy in systemic amyloidosis. Eur Heart J Cardiovasc Imaging 2014;15:1289-98.
  23. Bokhari S, Castano A, Pozniakoff T, et al. (99m)Tc-pyrophosphate scintigraphy for differentiating light-chain cardiac amyloidosis from the transthyretin-related familial and senile cardiac amyloidoses. Circ Car- diovasc Imaging 2013;6:195-201.
  24. Gillmore JD, Maurer MS, Falk RH, et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation 2016;133:2404-12.
  25. Grogan M, Scott CG, Kyle RA, et al. Natural history of wild-type transthyretin cardiac amyloidosis and risk stratification using a novel staging system. J Am Coll Cardiol 2016;68:1014-20.
  26. Maurer MS, Grogan DR, Judge DP, et al. Tafamidis in transthyretin amyloid cardiomyopathy: effects on transthyretin stabilization and clin- ical outcomes. Circ Heart Fail 2015;8:519-26.
  27. Ikram A, Donnelly JP, Sperry BW, et al. Diflunisal tolerability in transthyretin cardiac amyloidosis: a single center's experience. Amyloid 2018;25:197-202.
  28. Rosenblum H, Castano A, Alvarez J, et al. TTR (transthyretin) stabilizers are associated with improved survival in patients with TTR cardiac amyloidosis. Circ Heart Fail 2018;11:e004769.
  29. Cappelli F, Martone R, Taborchi G, et al. Epigallocatechin-3-gallate tolerability and impact on survival in a cohort of patients with transthyretin-related cardiac amyloidosis. A single-center retrospective study. Intern Emerg Med 2018;13:873-80.
  30. Solomon SD, Adams D, Kristen A, et al. Effects of patisiran, an RNA interference therapeutic, on cardiac parameters in patients with hereditary transthyretin-mediated amyloidosis. Circulation 2019;139:431-43.
  31. Benson MD, Waddington-Cruz M, Berk JL, et al. Inotersen treatment for patients with hereditary transthyretin amyloidosis. N Engl J Med 2018;379:22-31.
  32. Maurer MS, Schwartz JH, Gundapaneni B, et al. Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med 2018;379:1007-16.
  33. Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol 2017;14:591-602.
  34. Redfield MM. Heart failure with preserved ejection fraction. N Engl J Med 2016;375:1868-77.
  35. Solomon SD, Zile M, Pieske B, et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet 2012;380: 1387-95.
  36. Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med 2019;381:1609-20.
  37. Solomon SD, Rizkala AR, Gong J, et al. Angiotensin receptor neprilysin inhibition in heart failure with preserved ejection fraction: rationale and design of the PARAGON-HF trial. JACC Heart Fail 2017;5:471-82.
  38. Fitchett D, Zinman B, Wanner C, et al. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME(R) trial. Eur Heart J 2016;37: 1526-34.
  39. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovas- cular and renal events in type 2 diabetes. N Engl J Med 2017;377: 644-57.
  40. Neal B, Perkovic V, Matthews DR, et al. Rationale, design and baseline characteristics of the CANagliflozin cardioVascular Assessment Study- Renal (CANVAS-R): a randomized, placebo-controlled trial. Diabetes Obes Metab 2017;19:387-93.
  41. Radholm K, Figtree G, Perkovic V, et al. Canagliflozin and heart failure in type 2 diabetes mellitus. Circulation 2018;138:458-68.
  42. Wiviott SD, Raz I, Bonaca MP, et al. The design and rationale for the Dapagliflozin Effect on Cardiovascular Events (DECLARE)-TIMI 58 trial. Am Heart J 2018;200:83-9.
  43. Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2019;380:347-57.
  44. Kato ET, Silverman MG, Mosenzon O, et al. Effect of dapagliflozin on heart failure and mortality in type 2 diabetes mellitus. Circulation 2019;139:2528-36.
  45. Verma S, McMurray JJV. SGLT2 inhibitors and mechanisms of car- diovascular benefit: a state-of-the-art review. Diabetologia 2018;61: 2108-17.
  46. Verma S, Rawat S, Ho KL, et al. Empagliflozin increases cardiac energy production in diabetes: novel translational insights into the heart failure benefits of SGLT2 inhibitors. JACC Basic Transl Sci 2018;3:575-87.
  47. Lytvyn Y, Bjornstad P, Udell JA, Lovshin JA, Cherney DZI. Sodium glucose cotransporter-2 inhibition in heart failure: potential mechanisms, clinical applications, and summary of clinical trials. Circulation 2017;136:1643-58.
  48. Lipscombe L, Booth G, Butalia S, et al. Diabetes Canada 2018 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2018;42:S316.
  49. Tang HL, Sudbodh V. Two randomized clinical trials on the treatment of secondary mitral regurgitationdcontradictory or complementary? JAMA Cardiol 2019;4:311-3.

Authors
O’Meara, E., McDonald, M., Chan, M., Ducharme, A., Ezekowitz, J. A., Giannetti, N., Grzeslo, A., Heckman, G. A., Howlett, J. G., Koshman, S. L., Lepage, S., Mielniczuk, L. M., Moe, G. W., Swiggum, E., Toma, M., Virani, S. A., Zieroth, S., De, S., Matteau, S., Parent, M.-C., Asgar, A. W., Cohen, G., Fine, N., Davis, M., Verma, S., Cherney, D., Abrams, H., Al-Hesayen, A., Cohen-Solal, A., D’Astous, M., Delgado, D. H., Desplantie, O., Estrella-Holder, E., Green, L., Haddad, H., Harkness, K., Hernandez, A. F., Kouz, S., LeBlanc, M.-H., Lee, D., Masoudi, F. A., McKelvie, R. S., Rajda, M., Ross, H. J., & Sussex, B.
Affiliations
  • Montreal Heart Institute (CA)
  • University Health Network (CA)
  • University of Alberta (CA)
  • McGill University (CA)
  • Hamilton Health Sciences (CA)
  • University of Waterloo (CA)
  • University of Calgary (CA)
  • Université de Sherbrooke (CA)
  • University of Ottawa (CA)
  • St. Michael's Hospital (CA)
  • University of British Columbia (CA)
  • University of Manitoba (CA)
  • Western University (CA)
  • Sunnybrook Health Science Centre (CA)
  • Dr. Georges-L.-Dumont University Hospital Centre (CA)
  • Royal Jubilee Hospital (CA)
  • St. Boniface Hospital (CA)
  • University of Saskatchewan (CA)
  • Duke Clinical Research Institute (US)
  • Centre intégré de santé et de services sociaux de Lanaudière (CA)
  • Institut universitaire de cardiologie et de pneumologie de Québec (CA)
  • University of Colorado Anschutz (US)
  • Queen Elizabeth II Health Sciences Centre (CA)
  • Memorial University of Newfoundland (CA)
Corresponding author
O’Meara, Eileen
ORCID
Venue
Canadian Journal of Cardiology
Publisher
Elsevier BV
Published
2020-02
Volume
36
Issue
2
Pages
159-169
ISSN
0828-282X (ISSN-L)
DOI
10.1016/j.cjca.2019.11.036
OpenAlex
W3004548118
Cited by
122
References
57
Citations by year
2026: 2 · 2025: 1 · 2024: 15 · 2023: 23 · 2022: 24 · 2021: 33 · 2020: 23
FWCI
16.12
Type
journal article
Language
en
Open access
Licence
Locations
  • Canadian Journal of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Amyloidosis: Diagnosis, Treatment, Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords
heart failure, functional mitral regurgitation, transcatheter mitral valve repair, transthyretin amyloid cardiomyopathy, tafamidis, angiotensin receptor-neprilysin inhibition, sacubitril/valsartan, heart failure with preserved ejection fraction, dapagliflozin, type 2 diabetes, guideline-directed medical therapy, multidisciplinary care
MeSH terms
Sodium-Glucose Transporter 2 Inhibitors, Amyloidosis, Benzoxazoles, Heart Diseases, Heart Failure, Humans, Mitral Valve Insufficiency, Severity of Illness Index, Stroke Volume, Neprilysin, Randomized Controlled Trials as Topic, Angiotensin Receptor Antagonists

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