Ponencia presentada por el Dr. Domingo Pascual Figal en el directo online ‘Lo mejor del Congreso Europeo de IC Atenas 2019’, realizado en la Casa del Corazón el 5 de junio de 2019

2. LATE BREAKING TRIAL I – ACUTE HEART FAILURE
Clinical phenotypes of AHF based on signs and symptoms of perfusion and congestion
at ED presentation and their relationship with patient management and outcomes
Miro O. Clinical phenotypes of AHF based on signs and symptoms of perfusion and congestion at ED presentation and their
relationship with patient management and outcomes. Late breaking trial I – Acute heart failure. ESC HF 2019 |
Javaloyes P, Eur J Heart Fail. 2019 May 24

3. Chioncel O. Acute heart failure congestion and perfusion status; impact of the clinical
classification on in-hospital and long-term outcomes; insights from the ESC EORP HFA
Heart Failure Long Term Registry. Late breaking trial I – Acute heart failure. ESC HF 2019 |
Chioncel O., et al. European Journal of Heart Failure. 2017; 19: 1242–1254.
LATE BREAKING TRIAL I – ACUTE HEART FAILURE
AHF congestion and perfusión status - impact of the clinical classification on in-hospital
and long-term outcomes; insights from the ESC EORP HFA

4. Miro C. Clinical phenotypes of AHF based on signs and symptoms of perfusion and congestion at ED presentation and their
relationship with patient management and outcomes. Late breaking trial I – Acute heart failure. ESC HF 2019 |
Miró O. Ann Intern Med. 2017;167(10):698-705. doi: 10.7326/M16-2726

5. Chioncel O. Acute heart failure congestion and perfusion
status; impact of the clinical classification on in-hospital
and long-term outcomes; insights from the ESC EORP
HFA Heart Failure Long Term Registry. Late breaking
trial I – Acute heart failure. ESC HF 2019 |
Chioncel O., et al. European Journal of Heart Failure.
2017; 19: 1242–1254. doi:10.1002/ejhf.890.

6. Chioncel O. Acute heart failure congestion and perfusion
status; impact of the clinical classification on in-hospital
and long-term outcomes; insights from the ESC EORP
HFA Heart Failure Long Term Registry. Late breaking
trial I – Acute heart failure. ESC HF 2019 |
Chioncel O., et al. European Journal of Heart Failure.
2017; 19: 1242–1254. doi:10.1002/ejhf.890.

7. LATE BREAKING TRIAL I – ACUTE HEART FAILURE
Controlled decongestion by Reprieve Therapy™ in acute heart failure: the results of the
TARGET-1 and TARGET-2 Studies
Ponikowski P. Controlled decongestion by Reprieve Therapy™ in acute heart failure: the results
of the TARGET-1 and TARGET-2 Studies. Late breaking trial I – Acute heart failure. ESC HF 2019

8. N= 1886 - Leicester, Paris, Basilea
Kozhuharov A. Activity of the Adrenomedullin system to personalize post-discharge treatment in AHF. Studies. Late breaking trial I–
Acute heart failure. ESC HF 2019 | Mullens W, et al. Eur J Heart Fail. 2019; 21(2): 137-155 I Nishikimi T, et al. Circ J. 2009; 73(5): 892-8

9. LATE BREAKING TRIAL I – ACUTE HEART FAILURE
Lung Ultrasound Guided Treatment in Ambulatory Patients with HF:
a Randomized Controlled Clinical Trial (LUS-HF study)
Rivas M. Lung Ultrasound Guided Treatment in Ambulatory
Patients with HF:a Randomized Controlled Clinical Trial
(LUS-HF study). Studies. Late breaking trial I – Acute heart
failure. ESC HF 2019 | Rivas-Lasarte M, et al. The Journal
of Heart and Lung Transplantation 38(4): S141

10. Rivas M. Lung Ultrasound Guided Treatment in Ambulatory Patients with HF:a Randomized Controlled Clinical Trial (LUS-HF study). Studies.
Late breaking trial I – Acute heart failure. ESC HF 2019 | Rivas-Lasarte M, et al. The Journal of Heart and Lung Transplantation 38(4): S141

11. End-point: mortalidad + visita a URGENCIAS + re-hospitalización por IC
(6 meses seguimiento)
Rivas M. Lung Ultrasound Guided Treatment in Ambulatory Patients with HF:a Randomized Controlled Clinical Trial (LUS-HF study). Studies.
Late breaking trial I – Acute heart failure. ESC HF 2019 | Rivas-Lasarte M, et al. The Journal of Heart and Lung Transplantation 38(4): S141

12. LUNG ULTRASOUND IN AHF
Prevalence of pulmonary congestion and associated short and long term outcomes
Platz E, et al. Lung ultrasound in acute heart
failure: prevalence of pulmonary congestion
and associated short- and long-term outcomes.
Rapid Fire 3 – Acute heart failure. ESC HF
2019 | Pierce S, et al. Nature Reviews
Cardiology. 2017; 14: 427-440

13. Doble mecanismo de acción:
1. Inhibición Na-K ATPasa del sarcolema:
Aumento de Cain sístole  Inotrópico
2. Activación SERCA2a:
Aumento Cain diástole  Lusotrópico
LATE BREAKING TRIAL I – ACUTE HEART FAILURE
Safety and Efficacy of 24-hour Istaroxime Infusion in Patients Hospitalized for
decompensated AHF
Metra M. Safety and Efficacy of 24-hour Istaroxime Infusion in Patients Hospitalized for decompensated AHF. Late breaking trial I – Acute heart
failure. ESC HF 2019 | Shah SJ, et al. Am Heart J. 2009; 157(6): 1.035-1.041. ClinicalTrials.gov Identifier: NCT02617446

14. Metra M. Safety and Efficacy of 24-hour Istaroxime Infusion in Patients Hospitalized for decompensated AHF. Late breaking trial I – Acute heart
failure. ESC HF 2019 | Shah SJ, et al. Am Heart J. 2009; 157(6): 1.035-1.041. ClinicalTrials.gov Identifier: NCT02617446

15. In-hospital initiation of sacubitril/valsartan in stabilised
patients with HrEF naïve to renin-angiotensin system blocker
Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized
patients with heart failure and reduced ejection fraction naive to renin-
angiotensin system blocker: An analysis of the TRANSITION study.
Moderate Poster Session – Chronic heart failure. ESC HF 2019
33%
67%

16. Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin-
angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019

17. Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin-
angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019

18. Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin-
angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019

19. Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin-
angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019

20. Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin-
angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019

21. 29%
71%
Initiation of sacubitril/valsartan in patients with de novo
HFrEF: an analysis of the TRANSITION study
Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin-
angiotensin system blocker: An analysis of the TRANSITION study. Moderate Poster Session – Chronic heart failure. ESC HF 2019
Parameters
de novo HF
N=286
Prior CHF
N=705
p-value†
Age (years), mean (SD) 63 (13) 69 (11) <0.001
Male, % 71 77 0.058
Caucasian, % 96 98 0.133
LVEF (%), mean (SD) 27 (8) 29 (7) <0.001
NYHA class II / III / IV, % 76 / 23 / 1 59 / 39 / 1 <0.001
eGFR* (mL/min/1.73m2), mean(SD) 67 (18) 60 (20) <0.001
Hypertension, % 58 82 <0.001
Diabetes, % 32 52 <0.001
Atrial fibrillation, % 36 53 <0.001

22. Proportion of patients (%)
7
87
63
45
3
91
72
56
0 20 40 60 80 100
97/103 mg bid S/V
49/51 or 97/103 mg
bid S/V
Any dose
Permanent
Discontinuation
due to AE
p<0.001
p=0.002
p=0.075
p=0.012
Most relevant AEs during 10 weeks
9 9
5 6
3 3
12 12
9
5 5 5
0
4
8
12
16
Proportionofpatients(%)
Prior CHFde novo HF
Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin-
angiotensin system blocker: An analysis of the TRANSITION study. Rapid Fire 4 – Chronic heart failure: Pharmacology. ESC HF 2019

23. Proportionofpatients(%)
ARBACEi BB Diuretics MRAs
de novo HF
59
1 0,3
23
1 1
56
70 6865
90 90
48
65 62
0
25
50
75
100
20
0,4 0,4
15
0 0,4
16
76 75
16
86
79
4
63 60
0
25
50
75
100
Prior CHF
Prior to admission Week 10 Week 26
de novo HF 271 258 259
Prior CHF 680 642 628
0
10
20
30
de novo HF 265 254 254
Prior CHF 661 625 606
400
800
1200
1600
2000
pg/mL
Randomisation
NT-proBNP
hs-Troponin-T
Week 4 Week 10
ng/L
Prior CHF
de novo HF
p=0.393
p<0.001 p<0.001
p=0.001
p<0.001
p<0.001
Senni M, et al. In-hospital initiation of sacubitril/valsartan in stabilized patients with heart failure and reduced ejection fraction naive to renin-
angiotensin system blocker: An analysis of the TRANSITION study. Rapid Fire 4 – Chronic heart failure: Pharmacology. ESC HF 2019

24. Initiation of sacubitril/valsartan rather than an ACE-I or an ARB may be considered
for patients hospitalised with new-onset HF or decompensated CHF to reduce
the short-term risk of adverse events and to simplify management (by avoiding
the need to titrate ACE-I first and then switch to sacubitril/valsartan).
Because these patients are already at high risk of events, there is no need to check
plasma concentrations of natriuretic peptides prior to initiating sacubitril/valsartan.
Seferovic PM, et al. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert
consensus meeting report of The Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019: ejhf.1531.

25. • La congestión residual es un elemento clave en la evaluación.
• La ecografía pulmonar como herramienta diagnóstica.
• En ausencia de terapias específicas, la optimización de los fármacos
modificadores de la enfermedad pre-alta.
• Sacubitrilo-valsartán: seguro en naïve para IECA/ARAII, y fármaco
modificador de la enfermedad en primera línea para pacientes
hospitalizados, incluidos de novo.