The prevalence of heart failure (HF) has been steadily increasing and it now creates an enormous social and economic burden. HF is a syndrome characterized by a high mortality rate, frequent hospitalization, a reduced quality of life, and a complex therapeutic regimen. In the last three decades, major progress in both the diagnosis and management of HF has taken place, and the pharmacologic and non-pharmacologic advances have led to a significant improvement in survival and symptoms in HF patients. After an accurate diagnosis, a proper HF management plan requires a multi-level team approach comprised of the correct combination of drug therapy, device therapy, and surgery, including heart transplantation. In this review, we focused on the pharmacologic and non-pharmacologic treatment strategies for HF with reduced ejection fraction. The goal was to develop treatment guidelines based on significant evidence derived from large clinical trials.
Diagnosis ; Drug Therapy ; Heart Failure* ; Heart Failure, Systolic ; Heart Transplantation ; Hospitalization ; Humans ; Mortality ; Prevalence ; Quality of Life

Congestive heart failure (HF) is a morbidity that is increasing worldwide due to the aging population and improvement in (acute) care for patients with cardiovascular diseases. The prognosis for patients with HF is very poor without treatment. Furthermore, (repeated) hospitalizations for cardiac decompensation cause an increasing economic burden. Modern drugs and the consequent implementation of therapeutic recommendations have substantially improved the morbidity and mortality of HF patients. This paper provides an overview of the current pharmacological management of HF patients, based on the 2016 guidelines of the European Society of Cardiology (ESC).
Aging ; Cardiology* ; Cardiovascular Diseases ; Drug Therapy* ; Heart Failure* ; Heart* ; Hospitalization ; Humans ; Mortality ; Prognosis

The prevalence of heart failure (HF) is rapidly increasing throughout the world, and is closely associated with serious morbidity and mortality. In particular, acute HF is one of the main causes of hospitalization and mortality, especially in elderly individuals. In Korea, the socioeconomic burden of HF is substantial. Because of this, the Korean HF society developed chronic and acute HF management guidelines in 2017, adapted process while including as much data from Korean studies as possible. The scope of the current review, which is based on the Korean HF guidelines, includes the definition, diagnosis, and treatment of acute HF with reduced or preserved ejection fractions of various etiologies.
Aged ; Diagnosis ; Heart Failure ; Heart ; Hospitalization ; Humans ; Korea ; Medication Therapy Management ; Mortality ; Prevalence

PURPOSE: In the prethrombolytic era, patients with non-Q myocardial infarction (non-MI) exhibited a lower short-term mortality, but were at higher risk for inhospital and long-term reinfarction, leading to a higher long-term mortality rate than for patients with Q MI. The objective of this study was to determine whether the incidence of non-Q MI among and the prognosis for patients with ST-segment elevation and thrombolytic therapy were different from those among patients who did not have thrombolytic therapy. METHODS: A retrospective chart review was done for 222 patients of acute myocardial infarction with ST-segment elevation The analysis compared the rate of transformation of ST-elevation to Q MI and non-Q MI and the clinical outcome (30-day mortality, reinfarction, recurrent angina, left ventricular (LV) dysfunction, and new congestive heart failure (CHF)) of patients who subsequently developed a Q or non-Q MI postthrombolysis to those for the controls. RESULTS: The rate of non-Q MI was not significantly higher among patients receiving thrombolysis than among the control (31% vs 25%, p>0.1). Among patients receiving thrombolysis, the 30-day mortality (2.6% vs 0%), the inhospital reinfarction (10.3% vs 11.5%), and recurrent angina (20.6% vs 14.5%) were not significantly lower for those who developed a non-Q MI compared with either those who developed a Q MI or the control patients who developed non-Q MI, but left ventricular dysfunction (35.9% vs 55.2%) and new congestive heart failure (0 vs 10.3%) were significantly lower compared with those who developed Q MI. CONCLUSION: Patients receiving thrombolysis do not necessarily develop a non-Q MI and do not have a better prognosis than those who either develop a postthrombolysis Q MI or a non-Q MI after no thrombolysis.
Heart Failure ; Humans ; Incidence ; Mortality ; Myocardial Infarction* ; Prognosis* ; Retrospective Studies ; Thrombolytic Therapy ; Ventricular Dysfunction, Left

PURPOSE: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy (CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). MATERIALS AND METHODS: We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heart failure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP included all-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT response criteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absolute increase in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discrimination of improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. RESULTS: HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographic criteria significantly increased with time. In ischemic group, CRT response rate did not significantly change with time. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (area under the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fair agreement with HCCEP (κ=0.391, p < 0.001). CONCLUSION: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.
Cardiac Resynchronization Therapy* ; Discrimination (Psychology) ; Echocardiography ; Heart ; Heart Failure ; Hospitalization ; Humans ; Male ; Mitral Valve Insufficiency ; Mortality ; Stroke Volume*

Echocardiographic parameters can predict cardiovascular events in several clinical settings. However, which echocardiographic parameter is most predictive of each cardiovascular or non-cardiovascular event in patients starting hemodialysis remains unresolved. Echocardiography was used in 189 patients at the time of starting hemodialysis. We established primary outcomes as follows: cardiovascular events (ischemic heart disease, cerebrovascular disease, peripheral artery disease, and acute heart failure), fatal non-cardiovascular events, all-cause mortality, and all combined events. The most predictable echocardiographic parameter was determined in the Cox hazard ratio model with a backward selection after the adjustment of multiple covariates. Among several echocardiographic parameters, the E/e' ratio and the left ventricular end-diastolic volume (LVEDV) were the strongest predictors of cardiovascular and non-cardiovascular events, respectively. After the adjustment of clinical and biochemical covariates, the predictability of E/e' remained consistent, but LVEDV did not. When clinical events were further analyzed, the significant echocardiographic parameters were as follows: s' for ischemic heart disease and peripheral artery disease, LVEDV and E/e' for acute heart failure, and E/e' for all-cause mortality and all combined events. However, no echocardiographic parameter independently predicted cerebrovascular disease or non-cardiovascular events. In conclusion, E/e', s', and LVEDV have independent predictive values for several cardiovascular and mortality events.
*Echocardiography ; Female ; Heart Failure/*diagnosis/mortality ; Humans ; Kidney Failure, Chronic/mortality/*therapy ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; *Renal Dialysis ; Risk Factors ; Ventricular Function, Left/*physiology

BACKGROUNDThe optimal revascularization strategy in patients with heart failure with preserved ejection fraction (HFPEF) remains unclear. The aim of the present study was to compare the effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with HFPEF.

METHODSFrom July 2003 through September 2005, a total of 920 patients with coronary artery disease (CAD) and HFPEF (ejection fraction ≥ 50%) underwent PCI (n = 350) or CABG (n = 570). We compared the groups with respect to the primary outcome of mortality, and the secondary outcomes of main adverse cardiac and cerebral vascular events (MACCE), including death, myocardial infarction, stroke and repeat revascularization, at a median follow-up of 543 days.

RESULTSIn-hospital mortality was significantly lower in the PCI group than in the CABG group (0.3% vs. 2.5%, adjusted P = 0.016). During follow-up, there was no significant difference in the two groups with regard to mortality rates (2.3% vs. 3.5%, adjusted P = 0.423). Patients receiving PCI had higher MACCE rates as compared with patients receiving CABG (13.4% vs. 4.0%, adjusted P < 0.001), mainly due to higher rate of repeat revascularization (adjusted P < 0.001). Independent predictors of mortality were age, New York Heart Association (NYHA) class and chronic total occlusion.

CONCLUSIONAmong patients with CAD and HFPEF, PCI was shown to be as good as CABG with respect to the mortality rate, although there was a higher rate of repeat revascularization in patients undergoing PCI.

Aged ; Angioplasty, Balloon, Coronary ; mortality ; Coronary Artery Bypass ; mortality ; Female ; Heart Failure ; physiopathology ; therapy ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Stents

Heart failure (HF) is an important cardiovascular disease because of its increasing prevalence, significant morbidity, high mortality and rapidly expanding health care costs. The number of HF patients is increasing worldwide and Korea is no exception. Temporal trends of four representative Korean hospitalized HF registries–the Hallym HF study, the Korean Multicenter HF study, the Korean Heart Failure (KorHF) registry and the Korean Acute Heart Failure (KorAHF) registry showed mild survival improvement reflecting overall HF patient care development in Korea despite the increased severity of enrolled patients with higher incidence of multiple comorbidities. Moreover, device therapies such as implantable cardioverter defibrillator and cardiac resynchronization therapy and definitive treatment such as heart transplantation have been increasing in Korea as well. To prevent HF burden increase, it is essential to set up long term effective prevention strategies for better control of ischemic heart disease, hypertension and diabetes, which might be risk factors for HF development. Moreover, proper HF guidelines, performance measures, and performance improvement programs might be necessary to limit HF burden as well.
Cardiac Resynchronization Therapy ; Cardiovascular Diseases ; Comorbidity ; Defibrillators ; Health Care Costs ; Heart Failure* ; Heart Transplantation ; Heart* ; Hospitalization ; Humans ; Hypertension ; Incidence ; Korea* ; Mortality ; Myocardial Ischemia ; Patient Care ; Prevalence ; Risk Factors

Although the estimates from limited studies vary on the proportion of patients with heart failure who also have ventricular dyssynchrony as reflected by a prolonged QRS complex, often in the form of left bundle branch block, the number of such patients is large (27% to 53%) and it is certainly in excess of the rate for the general population. Among these patients, 10% to 15% are candidates for cardiac resynchronization therapy (CRT) via biventricular pacing. Accumulated evidence from randomized controlled studies over the last few years has indicated that significant hemodynamic and clinical improvement is conferred by CRT to the class III or IV heart failure patients with idiopathic or ischemic dilated cardiomyopathy and who also have a low left ventricular ejection fraction (< or =35%) and a wide QRS complex (> or =120-150 ms). Newer data suggest a significant reduction in mortality and heart failure hospitalization, particularly when CRT is combined with an automatic defibrillator backup. This technique has transformed the traditional concepts associated with stimulation of the heart, and it is now being applied not only to restore an appropriate heart rate, but also to change the process of cardiac mechanical activation. Since this treatment must be integrated within a comprehensive and multidisciplinary CHF management program, CRT has altered the medical practice of heart experts in the field of cardiac pacing. Technical advances with percutaneous methods that access the tributaries of the cardiac veins have raised the success rate of implanting left ventricular leads to >90%. Further confirmation from ongoing trials is eagerly awaited, and more data from the studies on this procedure's cost effectiveness are needed before CRT is considered as a prime therapy in the heart failure population.
Bundle-Branch Block ; Cardiac Resynchronization Therapy* ; Cardiomyopathy, Dilated ; Cost-Benefit Analysis ; Defibrillators ; Heart ; Heart Failure ; Heart Rate ; Hemodynamics ; Hospitalization ; Humans ; Mortality ; Stroke Volume ; Veins

Congestive heart failure is a major cause of morbidity and mortality as well as a major health care cost in the developed world. Despite the introduction of highly effective heart failure medical therapies and simple devices such as cardiac resynchronization therapy that reduce mortality, improve cardiac function and quality of life, there remains a large number of patients who do not respond to these therapies or whose heart failure progresses despite optimal therapy. For these patients, cardiac transplantation is an option but is limited by donor availability as well as co-morbidities which may limit survival post-transplant. For these patients, left ventricular assist devices (LVADs) offer an alternative that can improve survival as well as exercise tolerance and quality of life. These devices have continued to improve as technology has improved with substantially improved durability of the devices and fewer post-implant complications. Pump thrombosis, stroke, gastrointestinal bleeding and arrhythmias post-implant have become less common with the newest devices, making destination therapy where ventricular assist device are implanted permanently in patients with advanced heart failure, a reality and an appropriate option for many patients. This may offer an opportunity for long term survival in many patients. As the first of the totally implantable devices are introduced and go to clinical trials, LVADs may be introduced that may truly be alternatives to cardiac transplantation in selected patients. Post-implant right ventricular failure remains a significant complication and better ways to identify patients at risk as well as to manage this complication must be developed.
Arrhythmias, Cardiac ; Cardiac Resynchronization Therapy ; Exercise Tolerance ; Health Care Costs ; Heart Failure ; Heart Transplantation ; Heart-Assist Devices ; Hemorrhage ; Humans ; Mortality ; Quality of Life ; Stroke ; Thrombosis ; Tissue Donors