Systolic heart failure: diagnosis and therapy

The present review highlights recent findings on perioperative systolic heart failure. It briefly summarizes the pathophysiology of heart failure and provides the reader with new insight in diagnosis and treatment of systolic heart failure. In addition, we review new therapeutic strategies with pharmacologic agents and mechanical assist devices to treat systolic heart failure.

Left ventricular systolic heart failure is a high-risk disease for patients undergoing cardiac and noncardiac surgery and poses a high burden on the anesthesiologist in charge. Perioperative echocardiography is well established for urgent diagnosis in the operating room and is superior to biomarker-based diagnosis. Although cardiovascular disease associated mortality decreases, systolic heart failure related mortality remains at a high of 50% after 5 years. As a consequence, left ventricular assist device implantation rates grow rapidly and include approximately 30-40% patients with desperate clinical situation and destination therapy. Extracorporeal life support for acute heart failure needs further investigation to document possible indications and side-effects.

Recent advances in the field of cardiovascular anesthesiology comprise advanced use of perioperative echocardiography, mechanical circulatory assist devices, and customized pharmacologic management.