SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

The year in cardiovascular medicine 2020: heart failure and cardiomyopathies

█ Current opinion

Héctor Bueno1,2,3,4,*, Brenda Moura5,6, Patrizio Lancellotti7,8, and
Johann Bauersachs9
Corresponding Author:
1Multidisciplinary Translational Cardiovascular Research Group. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, Madrid 28029, Spain; 2Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain; 3Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain; 4Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040 Madrid, Spain; 5Cardiology Department, Military Hospital, Av. da Boavista S/N, 4050-115 Porto, Portugal; 6CINTESIS – Center for Health Technology and Services Research, R. Dr. Plácido da Costa, 4200-450 Porto, Portugal 7Department of Cardiology, CHU SartTilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Avenue de L’Hôpital 1, 4000 Liège, Belgium; 8Cardiology Departments, Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola Bari, Italy and Via Corriera, 1, 48033 Cotignola RA, Italy and Anthea Hospital, Via Camillo Rosalba, 35/37, 70124 Bari BA, Italy; and 9Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany


Heart failure (HF) prevalence remains high worldwide with significant sex-related and regional differences in its presentation, management, and outcomes. In 2020, advances in biomarkers and imaging techniques were reported for the diagnosis and prognosis of diastolic dysfunction, HF with preserved ejection fraction or monitoring cardiotoxicity; a new definition of HF with recovered left ventricular ejection fraction (LVEF) was released.

Benefits of renin–angiotensin–aldosterone system inhibitors and β-blockers may extend to patients with an LVEF up to 55%. Sacubitril–valsartan improved LV remodeling, biomarker levels, and rates of sudden cardiac death.
Two studies investigating the sodium-glucose cotransporter 2 inhibitors empagliflozin and sotagliflozin in patients with HF were reported: the EMPEROR-Reduced trial in patients with HF with reduced EF with or without type 2 diabetes (T2DM) demonstrated a significant reduction in cardiovascular (CV) death and HF hospitalisations (HFH). In patients with T2DM and HF across the whole EF spectrum after a recent HFH, the SOLOIST trial showed a reduction in the primary endpoint of CV deaths, total HFH, and urgent visits for HF. In addition, in patients with kidney disease with or without diabetes mellitus (DAPA-CKD), dapagliflozin prevented the deterioration of renal function. Two novel drugs, the activator of soluble guanylate cyclase vericiguat and the myosin activator omecamtiv-mecarbil, in the large outcome trials VICTORIA and GALACTIC-HF predominantly reduced HFH in high-risk patients with worsening HF. In the AFFIRM-AHF trial, intravenous ferric carboxymaltose reduced HFH in patients with iron deficiency after an HF decompensation.

Year 2020 will be remembered as the year of coronavirus disease of 2019 (COVID-19). The pandemia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a massive impact on global health and economy. When this article is published, >80 million people will have been infected and >1.75 million will have died of the disease. Many others will have died or worsen of their diseases, many with cardiovascular (CV) disease, as an indirect effect of the fear to seek assistance or the collapse of healthcare systems. Yet, advances in science and medical care continued developing during the year. This article reviews important advances in the field of heart failure (HF) presented in 2020.


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