New ESC Guidelines

Рекомендации, соглашения и прочие документы: ссылки и обсуждение
Practice guidelines, statements etc.
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Pyankov Vasily
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New ESC Guidelines

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Third Universal Definition of Myocardial Infarction

http://www.escardio.org/guidelines-surv ... arc_FT.pdf

Valvular Heart Disease

http://www.escardio.org/guidelines-surv ... Dis_FT.pdf

Atrial Fibrillation (Management of) 2010 and Focused Update (2012)

http://www.escardio.org/guidelines-surv ... fib-FT.pdf

Acute Myocardial Infarction in patients presenting with ST-segment elevation

http://www.escardio.org/guidelines-surv ... _STEMI.pdf
Пьянков Василий Алексеевич
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Сообщение AOkhotin »

В новые рекомендации вошло понятие "очень тяжелого аортального стеноза" и "парадоксального" тяжелого стеноза с низким градиентом, но нормальной сократимостью левого желудочка.
с уважением, Артемий Охотин

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Pyankov Vasily
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Сообщение Pyankov Vasily »

What’s new in the 2012 heart failure guidelines

1. An expansion of the indication for mineralo-corticoid (aldosterone) receptor antagonists (MRA).

MRA such as spironolactone or eplerenone are now recommended for all heart failure patients with persisting symptoms (NYHA Class II-IV) and an ejection fraction ≤35% despite treatment with an ACE inhibitor and a beta-blocker to reduce the risk of heart failure hospitalisation and the risk of premature death (I-A recommendation).

2. A new indication for the sinus node inhibitor ivabradine.

Based on the results of the SHIFT trial, ivabradine should now be considered to reduce the risk of heart failure hospitalisation in patients in sinus rhythm with an ejection fraction ≤35%, a heart rate remaining ≥70 bpm, and persisting symptoms (NYHA Class II-IV) despite treatment with an evidence-based dose of beta-blocker, ACE-inhibitor and a MRA (IIa-B recommendation).

3. An expanded indication for cardiac resynchronisation therapy (CRT).

CRT (preferably CRT-D) is now recommended in NYHA class II heart failure patients if they are in sinus rhythm with a QRS duration of ≥130 ms, LBBB QRS morphology and an ejection fraction ≤30% and if expected to survive with good functional status for more than one year, to reduce the risk of heart failure hospitalisation and the risk of premature death. In contrast, in patients who do not have a LBBB QRS morphology, a QRS duration of ≥150 ms is required and the level of recommendation is only IIa-A. The guideline also indicates that the evidence for CRT is uncertain in two commonly encountered clinical situations, in patients with atrial fibrillation and when a patient with a reduced ejection fraction has an indication for conventional pacing and no other indication for CRT.

4.New information on the role of coronary revascularisation in heart failure.

The STICH trial led to a I-B recommendation to use CABG in patients with angina and two or three-vessel coronary disease (including a left anterior descending stenosis) who have an LVEF ≤35% and who are otherwise suitable for surgery and expected to survive ≥1 year with good functional status.

5. Recognition of the growing use of ventricular assist devices.

Left ventricular or biventricular assist devices are recommended in selected patients with endstage heart failure despite optimal pharmacological and device treatment and who are otherwise suitable for heart transplantation to improve symptoms and reduce the risk of heart failure hospitalisation and to reduce the risk of premature death while awaiting transplantation (I-B recommendation). However, this recommendation is restricted to patients who have severe heart failure symptoms for more than two months despite optimal medical and device therapy and additional clearly defined conditions.

6. The emergence of transcatheter valve interventions.

Transcatheter aortic valve replacement should be considered in patients with heart failure and severe aortic stenosis if patients are not medically fit for surgery (in general because of severe pulmonary disease). In patients with secondary mitral regurgitation and judged inoperable or at unacceptably high surgical risk, percutaneous edge-to-edge repair (mitral clip) may be considered in order to improve symptoms.
Пьянков Василий Алексеевич
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