Best of heart failure

28 mortality and the combination of all-cause mortality with cardiovascular hos- pitalization [ 13 •• ]. Given the early mortality hazard associated with CABG, the advances made in PCI and mechanical circulatory support devices have led some to propose revascularization with PCI as an alternative to CABG for patients with ICM. Although numerous studies have compared surgical and percutaneous revas- cularization, most of these randomized trials focused on symptomatic coronary artery disease and excluded patients with congestive heart failure and/or re- duced LV function. Available data directly comparing PCI and surgical revas- cularization in the setting of LV dysfunction is limited to observational studies. A recent analysis of the New York state registries used propensity score matching to compare PCI and CABG in 1063 matched pairs with multivessel disease (excluding significant left main disease) and left ventricular ejection fraction (LVEF) of ≤ 35% over a period of 4 years. At a median follow-up of 2.9 years, there was no significant difference in all-cause mortality between the two groups (HR 1.01; 95% CI 0.81 – 1.28). PCI was associated with fewer strokes but more myocardial infarctions and repeat revascularizations [ 14 ]. The Ischemic Cardiomyopathy Percutaneous Revascularization for Ischemic Ventricular Dysfunction (the REVIVED-BCIS2) is an ongoing prospective mul- ticenter randomized controlled trial comparing percutaneous revascularization plus OMT with OMT alone in patients with LVEF of ≤ 35% and viable myo- cardium [ 9 ] (Fig. 2 ). Since August 2013, more than 400 patients have been randomized. Follow-up continues for at least 2 years following randomization. The primary outcome is a composite endpoint of all-cause death or Table 1. Updated HFA-ESC criteria for defining advanced heart failure Updated HFA-ESC criteria for defining advanced heart failure All the following criteria must be present despite optimal guideline directed treatment: Severe and persistent symptoms of heart failure [NYHA class III (advanced) or IV]. Severe cardiac dysfunction defined by a reduced LVEF ≤ 30%, isolated RV failure (e.g., ARVC) or non-operable severe valve abnormalities or congenital abnormalities or persistently high (or increasing) BNP or NT-proBNP values and data of severe diastolic dysfunction or LV structural abnormalities according to the ESC definition of HFpEF and HFmrEF [ 9 ]. Episodes of pulmonary or systemic congestion requiring high-dose intravenous diuretics (or diuretic combinations) or episodes of low output requiring inotropes or vasoactive drugs or malignant arrhythmias causing 9 1 unplanned visit or hospitalization in the last 12 months. Severe impairment of exercise capacity with inability to exercise or low 6MWTD ( G 300 m) or pVO 2 ( G 12 – 14 mL/kg/min), estimated to be of cardiac origin. In addition to the above, extracardiac organ dysfunction due to heart failure (e.g., cardiac cachexia, liver, or kidney dysfunction) or type 2 pulmonary hypertension may be present but are not required. Criteria 1 and 4 can be met in patients who have cardiac dysfunction (as described in criterion #2), but who also have substantial limitation due to other conditions (e.g., severe pulmonary disease, non-cardiac cirrhosis, or most commonly by renal disease with mixed etiology). These patients still have limited quality of life and survival due to advanced disease and warrant the same intensity of evaluation as someone in whom the only disease is cardiac, but the therapeutic options for these patients are usually more limited. ARVC , arrhythmogenic right ventricular cardiomyopathy; BNP , brain-type natriuretic peptide; ESC , European Society of Cardiology; HFA , Heart Failure Association; HFmrEF , heart failure with mid-range ejection fraction; HFpEF , heart failure with preserved ejection fraction; LV , left ventricular; LVEF , left ventricular ejection fraction; NT-proBNP , N-terminal pro-B-type natriuretic peptide; NYHA , New York Heart Association; pVO 2 , peak exercise oxygen consumption; RV , right ventricular, 6MWTD , 6-min walk test distance Curr Treat Options Cardio Med (2019) 21: 4 Page 3 of 12 4