Chronische und akute Herzinsuffizienz

Zusammenfassung

Im Juni 2012 wurden von der Europäischen Gesellschaft für Kardiologie (ESC) die neuen europäischen Leitlinien zur akuten und chronischen Herzinsuffizienz mit reduzierter sowie erhaltener Ejektionsfraktion vorgestellt. Die Gabe von Mineralokortikoid-Rezeptor-Antagonisten (MRA) ist nun in allen Stadien der unter Betablockade und ACE-Hemmer-Therapie weiterhin symptomatischen chronischen Herzinsuffizienz indiziert. Dies beruht auf den Ergebnissen der EMPHASIS-HF-Studie. Patienten mit Herzinsuffizienz NYHA II–IV, einer EF < 35 % und einem Sinusrhythmus mit einer Herzfrequenz > 70 /min vor dem Hintergrund einer vollständigen medikamentösen Herzinsuffizienztherapie einschließlich maximal tolerierter Betablockade, sollten mit dem If-Kanal-Hemmer Ivabradin behandelt werden. Diese Empfehlung basiert auf der SHIFT-Studie und einigen Anschlussanalysen. Die RAFT-Studie begründete die erweiterte Indikation für CRT-Systeme bei Patienten im Sinusrhythmus und einer Kammerkomplexbreite von > 130 ms mit Linksschenkelblock-Konfiguration. Im Bereich der akuten Herzinsuffizienz hat die RELAX-AHF-Studie mit dem Derivat des Schwangerschaftshormons Relaxin hoffnungsvolle Ergebnisse gezeigt, die zur Durchführung großer Placebo-kontrollierter Studien mit harten klinischen Endpunkten auffordert. Die nachfolgende Übersicht befasst sich mit den Innovationen dieser Leitlinien und fasst die zugrundeliegenden Studien zusammen, wobei sie sich auf die chronische systolische und die akute Herzinsuffizienz fokussiert.

Schlüsselwörter

ESC-Leitlinien - akute und chronische Herzinsuffizienz - pharmakologische Behandlung - Devicetherapie

Keywords

ESC guidelines - acute and chronic heart failure - pharmacological treatment - device therapy

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