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CLINICAL RESEARCH: HEART FAILURE

Acute Heart Failure Syndromes in Patients With Coronary Artery Disease

Early Assessment and Treatment

James D. Flaherty, MD, FACC^_*, Jeroen J. Bax, MD, PhD, FACC, Leonardo De Luca, MD, Joseph S. Rossi, MD^_*, Charles J. Davidson, MD, FACC^_*, Gerasimos Filippatos, MD, FACC, Peter P. Liu, MD, FACC^||, Marvin A. Konstam, MD, FACC^¶, Barry Greenberg, MD, FACC^#, Mandeep R. Mehra, MD, FACC^_**, Günter Breithardt, MD, FACC, Peter S. Pang, MD, James B. Young, MD, FACC, Gregg C. Fonarow, MD, FACC^||||, Robert O. Bonow, MD, MACC^_*, Mihai Gheorghiade, MD, FACC^_*,_* for the Acute Heart Failure Syndromes International Working Group

^_* Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Department of Cardiology, University Hospital, Leiden University Medical Center, Leiden, the Netherlands
Department of Cardiology, European Hospital, Rome, Italy
Department of Cardiology, Attikon University Hospital, Athens, Greece
^|| Department of Cardiology, Toronto General Hospital/UHN, Toronto, Ontario, Canada
^¶ Division of Cardiology Tufts University School of Medicine, Boston, Massachusetts
^# Department of Cardiology, University of California–San Diego, San Diego, California
^_** Division of Cardiology, University of Maryland School of Medicine, Baltimore, Maryland
Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Department of Cardiovascular Medicine, Heart Failure Section, Cleveland Clinic Foundation, Cleveland, Ohio
^|||| Department of Medicine, University of California, Los Angeles, Medical Center, Los Angeles, California

Manuscript received May 21, 2008; revised manuscript received August 8, 2008, accepted August 27, 2008.

^_* Reprint requests and correspondence: Dr. Mihai Gheorghiade, Professor of Medicine and Surgery, Associate Chief, Division of Cardiology, Northwestern University, Feinberg School of Medicine, 676 North St. Clair, Suite 600, Chicago, Illinois 60611 (Email: m-gheorghiade{at}northwestern.edu).

Acute heart failure syndromes (AHFS) have emerged as a leading public health problem worldwide, accounting for a substantial number of hospitalizations and a high utilization of resources. Although in-hospital mortality rates are relatively low, patients with AHFS have very high early after-discharge mortality and rehospitalization rates. The majority of patients admitted with AHFS have coronary artery disease (CAD), which independently has an adverse impact on prognosis. The initial in-hospital and after-discharge management of AHFS may be dependent on clinical presentation: AHFS in patients with underlying CAD or acute coronary syndromes (ACS) complicated by heart failure. In addition, the extent and severity of CAD and the presence of ischemia and/or stunned/hibernating myocardium should be assessed for optimal management. Although the overall management of AHFS with CAD may be similar to that in patients with ACS complicated by heart failure, for which specific guidelines exist, management of the former is less well defined. Prospective studies of the assessment and treatment of CAD in patients with AHFS are urgently needed.

Key Words: acute heart failure • coronary artery disease • assessment

Abbreviations and Acronyms   ACS = acute coronary syndrome(s)   AHFS = acute heart failure syndrome(s)   CABG = coronary artery bypass graft   CAD = coronary artery disease   CTA = computed tomography angiography   HF = heart failure   LV = left ventricular   MI = myocardial infarction   MRI = magnetic resonance imaging

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