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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article addresses several topics, including classifications of advanced heart failure, hemodynamic monitoring, implantable devices, and heart transplantation.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eheart failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EIssues in Advanced Heart Failure\u003C\/h2\u003E\n         \u003Cp id=\u0022p-2\u0022\u003EThe AHA\/European Society of Cardiology Joint Session, \u201cAdvanced Heart Failure,\u201d addressed several topics, including classifications of advanced heart failure (HF), hemodynamic monitoring, implantable devices, and heart transplantation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EMariell Jessup, MD, University of Pennsylvania, Philadelphia, PA, first described the staging system for HF. Dr. Jessup said that the New York Heart Association (NYHA) classification of advanced (or severe) HF is based primarily on the presence of symptoms. In contrast, the American College of Cardiology\/American Heart Association (ACC\/AHA) classification guidelines, updated in 2005, focus more on underlying disease and the need to treat early in the disease process, before overt symptoms of HF are present [Hunt et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2005].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EChristopher M. O\u0027Connor, MD, Duke University, Durham, NC, noted the importance of clinical and hemodynamic monitoring, emphasizing that serial clinical assessment remains an important cornerstone of surveillance. Dr. O\u0027Connor said that the use of implantable hemodynamic monitoring systems have significantly reduced HF-related events. He also discussed several studies that have shown that biomarker-guided therapy is a less-invasive approach that may add significantly to the management of patients with advanced HF. Specifically, HF therapy that is guided by brain natriuretic protein (BNP) levels has reduced cardiovascular events and mortality in small studies. Dr. O\u0027Connor added that a definitive large-scale, multicenter, randomized, controlled trial of BNP-guided HF therapy is needed.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003ESeveral guidelines have established criteria for the use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices in patients with advanced HF [Zipes et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2006; Dickstein et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2008; Epstein et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2008]. However, the overall use of these devices is low, especially among female and black populations, said Angelo Auricchio, MD, PhD, Fondazione Cardiocentro Ticino, Lugano, Switzerland. Dr. Auricchio noted that all national and international scientific societies recommend CRT for patients with advanced HF, reduced left ventricular ejection fraction, sinus rhythm, and QRS duration of at least 120 ms who remain symptomatic despite the use of optimal tailored drug therapy. Additional patient groups may now be considered for CRT, added Dr. Auricchio, including HF patients in whom permanent pacing or frequent dependence on ventricular pacing is expected and patients with chronic atrial fibrillation who eventually undergo atrioventricular junction ablation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EVentricular assist devices (VADs) and heart transplantation are therapeutic options for patients with severe HF, and there are several important factors to note when considering either of these approaches. James Young, MD, Cleveland Clinic, Cleveland, OH, described several contraindications for VADs, which he classified into categories of technical, hemodynamic, pulmonary, peripheral vascular, active systemic infection, irreversible endorgan dysfunction, and psychosocial issues that may affect compliance.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EUnlike the case with implantable devices, there are no comprehensive guidelines for the care of heart transplantation candidates, said Mandeep R. Mehra, MD, University of Maryland School of Medicine, Baltimore, MD. Dr. Mehra discussed several important questions to ask when deciding to perform heart transplantation:\u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n               \u003Cp id=\u0022p-8\u0022\u003EIs the patient sick enough?\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n               \u003Cp id=\u0022p-9\u0022\u003EWill the patient tolerate a heart transplant?\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n               \u003Cp id=\u0022p-10\u0022\u003EAre there comorbidities that will influence outcome?\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n               \u003Cp id=\u0022p-11\u0022\u003EAre absolute contraindications really relative contraindications?\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EDr. Mehra also noted that transplant listing should be dynamic; patients who are listed for transplantation must be re-evaluated at 3-month intervals to determine response to therapy and should be removed from the list if they have improved.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/8\/31.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmmi1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}