Dear Colleagues,

Heart failure (HF) is one of the biggest challenges face by modern cardiology. In 2021, the 3rd ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure were published, updated according to the latest findings from both clinical research and randomized clinical trials. In addition to imaging methods, natriuretic peptides, genetic examinations and myocardial biopsies are used in diagnosis.

New algorithms for the strategy of administering pharmacological and non-pharmacological treatment are also being introduced.

ACE inhibitors or angiotensin receptor-neprilysin inhibitor (ARNI), beta-blockers, mineralocorticoid receptor antagonist (MRA) and inhibitors of renal SGLT2 receptors have been reported. We provide diuretics for fluid retention. Ivabradine is indicated for sinus tachycardia with the above-mentioned treatment.

The next step is verociquat—a soluble guanylate cyclase stimulator worth considering in patients with NYHA class II-IV who have had worsening HF despite treatment with an ACE-I (or ARNI), a beta-blocker and an MRA to reduce the risk of CV mortality or HF hospitalization.

Digoxin may be considered in patients with symptomatic HFrEF with sinus rhythm despite treatment with an ACE-I (or ARNI), a betablocker and an MRA, to reduce the risk of hospitalization (both all-cause and HF hospitalizations).

Inotropes are still needed for treatment of patients with low cardiac output and hypotension. They should be reserved for patients with LV systolic dysfunction, low cardiac output and low SBP (e.g. <90 mmHg) resulting in poor vital organ perfusion. However, they must be used with caution, starting at low doses and uptitrating them with close monitoring. 

Non-pharmacological treatment means implantable cardioverter-defibrillator (ICD) in patients with LVEF ≤35% and QRS <130 ms, where appropriate, and cardiac resynchronization therapy with defibrillator (CRT-D) in patients with SR and LVEF ≤35% and QRS ≥130 ms.

Long-term MCS is indicated in selected patients when MT is insufficient or when short-term MCS has not led to cardiac recovery or clinical improvement, to prolong life and improve QOL, or to keep the patient alive until transplantation (bridge to transplantation, BTT) or to reverse contraindications to heart transplantation (bridge to candidacy, BTC), or as destination therapy (DT).

In my opinion, the challenge for 2022, in addition to the introduction of the above procedures, includes the expansion of the palliative approach to patients in whom all procedures are already failing.

Prof. Dr. Jiří Vítovec
Guest Editor

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• ACE Inhibitors
• angiotensin receptor-neprilysin inhibitor
• beta-blockers
• mineralocorticoid receptor antagonist
• inhibitors of renal SGLT2 receptors
• diuretics
• ivabradine
• verociquat
• paliative care