The year in cardiovascular medicine 2021: heart failure and cardiomyopathies

Area of Science:

• Cardiology
• Pharmacology

Background:

• The 2021 universal definition classifies heart failure (HF) based on clinical signs and cardiac abnormalities, aligning with the 2021 ESC Guidelines.
• The classification includes HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).

Purpose of the Study:

• To review recent advancements in HF diagnosis, classification, and treatment based on 2021 publications.
• To highlight the role of SGLT2 inhibitors and other novel therapies in managing HF patients.

Main Methods:

• Review of the 2021 universal definition and classification of HF.
• Analysis of the 2021 ESC Guidelines on HF, focusing on new recommendations.
• Examination of clinical trial data, including the EMPEROR-Preserved trial for empagliflozin in HFpEF.
• Synthesis of reports on various medical therapies and device treatments for HF.

Main Results:

• SGLT2 inhibitors (dapagliflozin, empagliflozin) are now indicated for HFrEF.
• Empagliflozin demonstrated efficacy in the EMPEROR-Preserved trial, reducing cardiovascular death and HF hospitalizations in HFpEF patients.
• Novel analyses of sacubitril/valsartan, SGLT2 inhibitors, and other therapies offer detailed insights.
• Acute HF and myocardial injury are common in COVID-19 patients, but myocarditis and long-term damage are rare.

Conclusions:

• The 2021 guidelines and definitions provide a framework for modern HF management.
• SGLT2 inhibitors represent a significant therapeutic advancement for both HFrEF and HFpEF.
• Ongoing research continues to refine understanding and treatment strategies for various HF phenotypes.