July 27, 2021
MIAMI, FL A debate at TVT 2021 last week was supposed to be about whether guideline-directed medical therapy should be tried at maximally tolerated doses before patients undergo transcatheter edge-to-edge repair (TEER) for functional mitral regurgitation (MR), but it ended up focusing on the difficulty of getting patients on foundational heart failure therapies in the first place.
JoAnn Lindenfeld, MD (Vanderbilt Heart and Vascular Institute, Nashville, TN), led off by arguing that drug therapy should be maxed out first, but her ostensible opponent didn’t disagree.
“I want to concede the debate to JoAnn. I think she made a convincing argument, and I really don’t have much to add to what she said,” Milton Packer, MD (Baylor Heart and Vascular Institute, Houston, TX), said.
SGLT2 Inhibitor Adds Years of Life to Patients With Heart Failure
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Schumer urges expedited dredging of Jones Beach Inlet
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One theory for why the medications tested in heart failure with preserved ejection fraction (HFpEF) trials have not shown efficacy: inclusion of too many unrecognized cases of cardiac amyloidosis (CA). The specific hemodynamic and pathophysiological features of CA result in poor tolerance of heart failure medications and in worse outcomes compared with other causes of heart failure, according to Silvia Oghina, MD, of Hôpital Henri-Mondor in Créteil, France, and colleagues. Studies have shown CA in up to 29% of patients with HFpEF. This finding is unsurprising, as criteria used to diagnose HFpEF include the presence by echocardiography of left ventricular hypertrophy with left atrial enlargement and/or diastolic dysfunction, which are typical features of CA, they wrote in a state-of-the-art paper published online in