The 2012 ESC Guidelines on Heart Failure.

The latest Guidelines feature new evidence on diagnosis, drugs, and devices The ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 were developed by the European Society of Cardiology (ESC) in collaboration with the Heart Failure Association (HFA) of the ESC. They were presented for the first time in May 2012 at the Heart Failure Congress in Belgrade, Serbia, and are published in full, in this EHJ issue and in European Journal of Heart Failure. There are a number of new features since the last ESC Guidelines on this topic were published in 2008. In the area of diagnostics, there is a new biomarker called mid-regional pro-A-type natriuretic peptide. In pharmacological treatments, two new drugs are discussed: ivab-radine and the mineralocorticoid receptor antagonist eplerenone. New evidence with the latter drug has extended the indication for mineralocorticoid receptor antagonists, meaning that for many patients, standard therapy should include three neurohumoral antagonists—an angiotensin-converting enzyme (ACE) inhibitor [or angiotensin receptor blocker (ARB)], a beta-blocker and, if symptoms persist, now a mineralocorticoid receptor antagonist as well. In devices, there is a new indication for cardiac resynchronization therapy (CRT) in patients with mild symptoms. There is also more clarity about the effects of CRT—it is clear that patients with left bundle branch block QRS morphology and those who are in sinus rhythm have the greatest benefit from CRT; conversely, those who have a non-left bundle branch block QRS morphology, and patients in atrial fibrillation have less certain benefit. 'This is because more evidence from new trials and further analysis of existing trials has emerged since the last Guidelines were published', says Prof. John McMurray (Glasgow, UK), chairperson of the Guidelines Task Force. Also in the device arena, new transcatheter valve interventions are discussed, offering the possibility of treatment for aortic sten-osis in patients unsuitable for surgery. In surgery, there is new information about the role of coronary artery bypass based on the long-awaited results of the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Also, Left Ven-tricular Assist Device (LVAD) technology has improved; the devices are more reliable and lead to fewer complications. 'Increas-ingly there is probably a place for these devices as a treatment in their own right, not just as a temporary support while awaiting transplantation', says McMurray. 'It is controversial and we had a lot of discussion about it'. The Task Force took a new approach to …