The year in cardiovascular medicine 2021: heart failure and cardiomyopathies
█ Current opinion
Johann Bauersachs1*, Rudolf A. de Boer2, JoAnn Lindenfeld3 and Biykem Bozkurt4
1Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany;
2Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands;
3Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA; and
4Winters Center for Heart Failure, Cardiology, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston TX, USA
In the year 2021, the universal deﬁnition and classiﬁcation of heart failure (HF) was published that deﬁnes HF as a clinical syndrome with symptoms and/or signs caused by a cardiac abnormality and corroborated by elevated natriuretic peptide levels or objective evidence of cardiogenic congestion. This deﬁnition and the classiﬁcation of HF with reduced ejection fraction (HFrEF), mildly reduced, and HF with pre-served ejection fraction (HFpEF) is consistent with the 2021 ESC Guidelines on HF. Among several other new recommendations, these guidelines give a Class I indication for the use of the sodium-glucose co-transporter 2 (SGLT2) inhibitors dapagliﬂozin and empagliﬂozin in HFrEF patients. As the ﬁrst evidence-based treatment for HFpEF, in the EMPEROR-Preserved trial, empagliﬂozin reduced the composite endpoint of cardiovascular death and HF hospitalizations. Several reports in 2021 have provided novel and detailed analyses of device and medical therapy in HF, especially regarding sacubitril/valsartan, SGLT2 inhibitors, mineralocorticoid receptor antagonists, ferric carboxymal-tose, soluble guanylate cyclase activators, and cardiac myosin activators. In patients hospitalized with COVID-19, acute HF and myocardial injury is quite frequent, whereas myocarditis and long-term damage to the heart are rather uncommon.