Advanced Heart Failure and Transplant&nbsp;&nbsp;&nbsp;

In patients with moderate calcific mitral stenosis, possible HFpEF and dyspnea on exertion, how would you differentiate the etiology of the symptoms?

Among patients with recovered LVEF on GDMT with a reversible cause for heart failure (i.e., tachycardia-mediated or alcohol-mediated cardiomyopathy), would you consider de-escalation of GDMT?

How should clinicians balance the use of finerenone with other heart failure treatments like SGLT2 inhibitors, considering their glycemic benefits?

Butt et al., PMID 39818225

What are some immunosuppression regimens to consider in a patient with refractory cardiac sarcoidosis?

Would you consider opting for beta blocker withdrawal to improve exercise capacity in patients with heart failure with preserved ejection fraction and chronotropic incompetence?

In patients who are on 3 of the 4 pillars of HF therapy for HFrEF, would you add the 4th pillar if they are no longer in symptomatic HF and LVEF normalizes?

The basis of the question is that HFrEF trials enroll patients who have Class II-IV symptoms. If their LV systolic function recovers and they become a...

4 Answers available

When would you consider referring a patient with suspected cardiac sarcoidosis based on PET and MRI for endomyocardial biopsy given degree of patchy involvement, as opposed to initiating empiric immunosuppressive therapies?

Is there any utility in ACE levels and/or IL-2 levels in the diagnostic work-up of cardiac sarcoidosis?

Do you routinely check digoxin levels, and if so, when would you consider using Digibind in chronic digoxin use patients?

Is your pattern for drug monitoring different if digoxin is being given for afib vs HFrEF?

What are reasonable alternatives to invasive angiography for CAV surveillance in patients who are a few years out from cardiac transplant with impaired renal function?

With the FDA recently approving acoramidis for ATTR cardiac amyloidosis, how should should we decide on optimal drug therapy and options for our patients?

What are reasonable next steps in the work-up of suspected ATTR amyloidosis if the PYP scan is equivocal, in light of the potential risks of endomyocardial biopsy?

Especially if cMRI is not possible in the presence of non-MRI conditional devices and abandoned leads.

How many days prior to surgery do you recommend stopping SGLT2 inhibitors and when is it safe to resume therapy?

Would it be reasonable to begin considering GLP1 RAs or finerenone for patients with heart failure with recovered LVEF in light of recent trials such as SELECT and FINEARTS-HF showing some success in HFpEF and HFmrEF populations?

Or should they be continued on maximally tolerated GDMT?

How soon would you repeat PET/CT in a patient with cardiac sarcoid after starting treatment with infliximab?

Pre-treatment troponin was mildly elevated, while ILR2 receptor, ACE, CRP, ESR were normal.

Does the presence of diastolic dysfunction guide subsequent pharmacological, pacing and ablative therapies for atrial fibrillation?

If so, what diastolic parameters do you look at?

What is your approach to GDMT uptitration (particularly dosing for ARBs/ARNIs/MRA) if there is further evidence of renal dysfunction, especially in situations with worsening AKI on CKD?

Would a decrease in eGFR by more than 30% prompt you to consider decreasing or discontinuing these medications?

How do you manage patients with central sleep apnea due to heart failure with reduced ejection fraction?

Are there specific scenarios in which you employ BPAP with a back up rate?

How do you choose between finerenone and traditional steroidal MRAs for patients with heart failure and mildly reduced or preserved EF, considering recent results showing finerenone's efficacy in reducing heart failure events?

Soloman, et al., PMID 39225278

When would be your threshold to consider obtaining an exercise RHC for undifferentiated dyspnea to help diagnose HFpEF?

What is your approach to initiating spironolactone in patients with end stage kidney disease and heart failure?

4 Answers available

How do you identify the subset of heart failure patients who are likely to benefit from cardiac resynchronization therapy in the setting of an RBBB pattern?

What patient characteristics prompt you to prescribe vericiguat for patients with heart failure with reduced ejection fraction who are already on standard therapy?

Should there be a role for sacubitril-valsartan in the management of patients with heart failure with preserved ejection fraction?

PARAGON HF trial, PMID: 31475794

What is your approach to anticoagulation in patients with hypertrophic cardiomyopathy and an apical aneurysm?

What is a reasonable class of antihypertensive to start in patients with HCM who remain hypertensive and symptomatic in spite of maximal doses of beta blockade or calcium channel blockers?

What is the right approach in terms of GDMT and device consideration for patients with intermittent LBBB (QRS duration exceeding 150ms) and HFrEF?

Besides HR variability how can we explain resolution of the intermittent LBBB with HF GDMT (especially with ARNI use)?

How would you lead a goals of care discussion in terms of prognosis/survival likelihood for patients with inotropic dependent HFrEF with CRT-D on maximally tolerated GDMT?

How do you risk stratify patients with different WHO groups of pulmonary hypertension prior to non-cardiac surgeries?

And who would you not recommend to undergo surgeries?

How do you decide when to refer patients with obstructive hypertrophic cardiomyopathy for alcohol septal ablation versus septal myectomy?

How reliable is an exercise stress echo in the diagnosis of exercise-induced heart failure with preserved ejection fraction?

Do you have a specific protocol you follow during the stress echo, and if so, what echo parameters are you using to evaluate for exercised-induced hea...

How can hepatic venous pressure gradients in patients with cirrhosis be used to differentiate between cardiac cirrhosis and portopulmonary hypertension?

In which clinical scenario(s) would you consider checking HVPG?

Is it reasonable to consider the use of DOACs for LV thrombus management instead of coumadin?

Would testing for ATTR cardiac amyloidosis be considered in an older patient with bilateral carpal tunnel surgeries and multiple spinal stenosis surgeries, but no obvious cardiac symptoms?

What would be your index of suspicion for AL amyloidosis with cardiac involvement in a patient with MGUS to prompt further imaging (and which modality would be preferred)?

How do you re-stratify patients with a primary prevention ICD in need of a generator change if their LVEF has improved to >40% and they have not previously required any device therapies?