Title: Heart Failure Society of America – Summary
Topic: Heart Failure/Transplant
Interviewee: Sue Wingate RN, DNSc, CRNP
The 11th Annual Scientific Meeting of the Heart Failure Society of America was held in Washington, DC,
September 16-19, 2007. Here are a few highlights:
The results of several late-breaking clinical trials were presented.
Cook et al. reported on results from the DAVID II trial, which compared outcomes from back-up ICD pacing set at either AAI rate 70 or VVI rate 40 and found that there were no differences in mortality or hospital admissions for heart failure. These results were somewhat surprising, given that DAVID I showed untoward outcomes from RV pacing in patients with heart failure.
A second late-breaking presentation was from the ECLIPSE study (Udelson et al.), which examined the acute hemodynamic effects of tolvaptan, a vasopressin receptor blocker, in 600 patients with symptomatic heart failure and systolic dysfunction, with baseline mean pulmonary capillary wedge pressure (PCWP) of >18 mmHg. Patients randomized to tolvaptan (single oral dose of 15, 30, or 60 mg.) experienced a change in PCWP of -6.4 mmHg (P =.003), -5.7 mmHg (P =.04), and -5.7 mmHg (P =.03) in the 15, 30, and 60 mg dose groups, respectively, compared to -4.2 mmHg in the placebo group.
There were several other studies of particular interest to CCAs. Ramasubbu et al. reported on a meta-analysis of statin use and survival in patients with both ischemic and non-ischemic heart failure. Ten studies evaluating over 85,000 patients were evaluated; statin use was associated with a 28% decrease in mortality risk, with a similar effect seen for both ischemic and non-ischemic heart failure, suggesting that non-lipid-lowering effects of statins may be the predominant mechanism for these favorable effects.(1)
Dyke et al. reported on data from 231 patients enrolled in a clinical trial of the HeartMate II LVAD implanted as a bridge to transplant. Functional capacity and quality of life were measured at baseline before implantation and at one, three, and six months on LVAD support. These patients had early, sustained, and marked improvement in functional capacity and quality of life (74% improvement in 6 minute walk test and 86% improvement in the Kansas City Cardiomyopathy Questionnaire scores at six months as compared to baseline).(2)
Lenihan et al. reported on 109 patients with various cancers undergoing chemotherapy and measured ejection fraction and biomarkers (troponin I and BNP) at baseline and after six cycles of chemotherapy. An elevated BNP during chemotherapy conferred greater than 58 times higher risk of developing cardiotoxicity and was more sensitive than ejection fraction for detecting cardiotoxicity. The authors suggest that BNP be monitored during chemotherapy, especially for those regimens containing anthracyclines.(3)
References
Ramasubbu K, White DL, Mann DL, et al. Statin use and survival in patients with ischemic and non-ischemic heart failure: Results of a meta-analysis. J Card Fail 2007;13:S78-
Dyke DB, Pagani FD, Russell SD, et al. HeartMate II continuous flow left ventricular assist device improves functional capacity and quality of life. J Card Fail 2007;13:S111-
Lenihan DJ, Massey MR, Baysiner KB, et al. Superior detection of cardiotoxicity during chemotherapy using biomarkers. J Card Fail 2007;13:S151-
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