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HEART FAILURE IN 2011

Heart failure therapytechnologyto the foreJohn J. V. McMurray

Studies published in 2011 in the feld o heart ailure have reinorced

the beneft o cardiac resynchronization therapy in patients with mild

symptoms and confrmed the value o let ventricular assist devices and

CABG surgery in selected patients. Conversely, the efcacy o nesiritide

in acute heart ailure has been questioned.

McMurray, J. J. V. Nat. Rev. Cardiol.9, 7374 (2012); doi:10.1038/nrcardio.2011.212

Although many interesting studies onepidemiology, pathophysiology, and bio-markers in heart failure (HF) were pub-lished in 2011, my focus in this article is ontreatments that are available for use and canmake an impact in everyday practice. Fiveimportant studies, covering device and drugtherapy, and surgery in patients with HF willbe discussed.

In August 2011, a follow-up report fromMADIT-CRT1 reinforced the impressiveeffect of cardiac resynchronization therapy(CRT) on outcomes among patients with

HF, even in those with mild symptoms. Theinvestigators showed that CRT plus a defi-brillator, compared with a defibrillator alone,reduced the risk of a first episode of worsen-ing HF by 46% (P

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6 months in the intervention group, meaningthat eight patients needed to be treated toprevent one hospitalization.4 Althoughthese results are impressive, the trial hasbeen criticized because of the active involve-ment of the sponsor in encouraging treat-ment changes in the intervention group, andwhether the benefit would be as substantial

when used in ordinary practice has beenquestioned. Nevertheless, the positive find-ings of the CHAMPION trial4 contrastedstrikingly with those of other studies, suchas the negative study DOT-HF5 in whichan implantable intrathoracic impedancedetection device was used.

Another study that raised as many ques-tions as answers was the STICH trial.6 In thisstudy, 1,212 patients with a left ventricularejection fraction