Clinical Research
Heart Failure
Acute Heart Failure Syndromes in Patients With Coronary Artery Disease: Early Assessment and Treatment

https://doi.org/10.1016/j.jacc.2008.08.072Get rights and content
Under an Elsevier user license
open archive

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

Cited by (0)

Dr. Bax has received research grants from St. Jude, Medtronic, Boston Scientific, GE Healthcare, and Bristol-Myers Squibb Medical Imaging. Dr. Filippatos has received research support from the University of Athens, the American Heart Association, Sigma-Tau, Brahms, Roche, Medtronic, and Otsuka. Dr. Konstam receives research support and is a consultant for Otsuka, Merck, Sanofi, PDL Biopharma, Astra-Zeneca, Novartis, Biogen, Nitromed, Cardiokine, Boehringer Ingelheim, and Wyeth, and receives salary support and stock options from Orqis Medical. Dr. Greenberg has been a Speakers' Bureau member and received honoraria from Merck, GlaxoSmithKline, Novartis, and Medtronic, and is a consultant for GlaxoSmithKline, Sanofi-Aventis, and Otsuka. Dr. Young is a consultant for Abbott, Acorn, Amgen, AstraZeneca, Aresion Therapeutics, Biomax Canada, Biosite, Boehringer Ingelheim, Cotherix, GlaxoSmithKline, Guidant, Medtronic, Protemix, Savacor, Scios, Sunshine, Transworld Medical Corporation, Vasogen, and World Heart, and has received research support from Abbott, Amgen, Zeneca, GlaxoSmithKline, Guidant, Medtronic, the National Institutes of Health, Vasogen, and World Heart. Dr. Fonarow reports research, consultant fees, and/or honorarium from GlaxoSmithKline, Scios, Medtronic, Pfizer, and Merck-Schering-Plough. Dr. Pang is a consultant for Astellas, Otsuka, and PDL BioPharma; has received honoraria from Solvay Pharmaceuticals and Corthera; and has received research support from Corthera and PDL BioPharma. Dr. Gheorghiade has received honoraria from Medtronic, Otsuka, Protein Design Labs, Scios, and Sigma Tau; has received research grants from the National Institutes of Health, Otsuka, Sigma Tau, Merck, and Scios; and is a consultant for Debio Pharm, Errekappa Terapeutici, GlaxoSmithKline, Protein Design Lab, Medtronic, Solvay, and Johnson & Johnson. Jay Cohn, MD, served as Guest Editor for this article.