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Akute und chronische Herzinsuffizienz im Spiegel der neuen ESC-Leitlinie

Acute and chronic heart failure in light of the new ESC guidelines

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Zusammenfassung

Im Juni 2012 wurden die neuen Leitlinien zur Behandlung der akuten und der chronischen Herzinsuffizienz der Europäischen Gesellschaft für Kardiologie publiziert. Nach der EMPHASIS-HF Studie sind Mineralokortikoidrezeptorantagonisten nun in allen Stadien der unter Betablockade und ACE-Hemmer-Therapie symptomatischen Herzinsuffizienz indiziert. Basierend auf der SHIFT-Studie sollten Patienten mit Herzinsuffizienz NYHA II–IV, einer Ejektionsfraktion unter 35% und einem Sinusrhythmus mit einer Herzfrequenz über 70/min vor dem Hintergrund einer vollständigen medikamentösen Herzinsuffizienztherapie einschließlich maximal tolerierter Betablockade mit Ivabradin behandelt werden. Die RAFT-Studie begründete die erweiterte Indikation für CRT-Systeme. Im Bereich der akuten Herzinsuffizienz hat die RELAX-AHF-Studie mit Serelaxin ermutigende Ergebnisse gezeigt. Diese Übersicht fasst die Innovationen dieser Leitlinien und die zugrunde liegenden Studien zusammen.

Abstract

In June 2012, the New Guidelines for the Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology were published. According to the EMPHASIS-HF trial, mineralocorticoid receptor antagonists are indicated in all stages of symptomatic chronic heart failure under treatment with β-blockers and ACE inhibitors. Based on the SHIFT trial, patients with class NYHA II–IV heart failure, an ejection fraction <35%, and sinus rhythm with a heart rate of >70/min despite pharmacological treatment including β-blockers at the maximum tolerated dose should be treated with ivabradin. The RAFT trial justified the extended indication for CRT systems. In acute heart failure, the RELAX-AHF trial showed promising results with serelaxin. This manuscript summarizes the innovations of the new guidelines and the underlying clinical trials.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Pöss und A. Link geben an, dass kein Interessenkonflikt besteht. M. Böhm hat Sprecherhonorare von Servier, Boehringer Ingelheim, Medtronic, Pfizer, St. Jude Medical und Bayer erhalten.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrbergerstr., 66421, Homburg/Saar, Deutschland

    J. Pöss, A. Link & M. Böhm

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Correspondence to J. Pöss.

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Pöss, J., Link, A. & Böhm, M. Akute und chronische Herzinsuffizienz im Spiegel der neuen ESC-Leitlinie. Herz 38, 812–820 (2013). https://doi.org/10.1007/s00059-013-3986-9

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