Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials
Identifieur interne : 003796 ( Pmc/Checkpoint ); précédent : 003795; suivant : 003797Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials
Auteurs : Jonathan G. Howlett [Canada] ; Robert S. Mckelvie ; J Malcolm O. Arnold [Royaume-Uni] ; Jeannine Costigan ; Paul Dorian [Canada] ; Anique Ducharme ; Estrellita Estrella-Holder ; Justin A. Ezekowitz ; Nadia Giannetti [Canada] ; Haissam Haddad [Canada] ; George A. Heckman ; Anthony M. Herd [Canada] ; Debra Isaac [Canada] ; Philip Jong [Canada] ; Simon Kouz ; Peter Liu [Canada] ; Elizabeth Mann ; Gordon W. Moe [Canada] ; Ross T. Tsuyuki ; Heather J. Ross [Canada] ; Michel WhiteSource :
- The Canadian Journal of Cardiology [ 0828-282X ] ; 2009.
Abstract
The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.
Url:
PubMed: 19214293
PubMed Central: 2691911
Affiliations:
- Canada, Royaume-Uni
- Alberta, Angleterre, Grand Londres, Manitoba, Ontario, Québec
- Calgary, Londres, Montréal, Winnipeg
- Université McGill, Université de Calgary, Université du Manitoba
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PMC:2691911Le document en format XML
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Heckman</name><affiliation><nlm:aff id="af2-cjc25085">Hamilton Health Sciences and McMaster University, Hamilton;</nlm:aff><wicri:noCountry code="subfield">Hamilton</wicri:noCountry></affiliation></author><author><name sortKey="Herd, Anthony M" sort="Herd, Anthony M" uniqKey="Herd A" first="Anthony M" last="Herd">Anthony M. Herd</name><affiliation wicri:level="4"><nlm:aff id="af11-cjc25085">University of Manitoba, Winnipeg, Manitoba;</nlm:aff><orgName type="university">Université du Manitoba</orgName><country>Canada</country><placeName><settlement type="city">Winnipeg</settlement><region type="state">Manitoba</region></placeName></affiliation></author><author><name sortKey="Isaac, Debra" sort="Isaac, Debra" uniqKey="Isaac D" first="Debra" last="Isaac">Debra Isaac</name><affiliation wicri:level="4"><nlm:aff id="af1-cjc25085">University of Calgary, Calgary, Alberta;</nlm:aff><orgName type="university">Université de Calgary</orgName><country>Canada</country><placeName><settlement type="city">Calgary</settlement><region type="state">Alberta</region></placeName></affiliation></author><author><name sortKey="Jong, Philip" sort="Jong, Philip" uniqKey="Jong P" first="Philip" last="Jong">Philip Jong</name><affiliation wicri:level="2"><nlm:aff id="af5-cjc25085">University of Toronto, Toronto, Ontario;</nlm:aff><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>University of Toronto, Toronto</wicri:cityArea></affiliation></author><author><name sortKey="Kouz, Simon" sort="Kouz, Simon" uniqKey="Kouz S" first="Simon" last="Kouz">Simon Kouz</name><affiliation><nlm:aff id="af12-cjc25085">Centre Hospitalier Régional de Lanaudière, Joliette, Quebec;</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation></author><author><name sortKey="Liu, Peter" sort="Liu, Peter" uniqKey="Liu P" first="Peter" last="Liu">Peter Liu</name><affiliation wicri:level="2"><nlm:aff id="af5-cjc25085">University of Toronto, Toronto, Ontario;</nlm:aff><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>University of Toronto, Toronto</wicri:cityArea></affiliation></author><author><name sortKey="Mann, Elizabeth" sort="Mann, Elizabeth" uniqKey="Mann E" first="Elizabeth" last="Mann">Elizabeth Mann</name><affiliation><nlm:aff id="af13-cjc25085">Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia;</nlm:aff><wicri:noCountry code="subfield">Nova Scotia</wicri:noCountry></affiliation></author><author><name sortKey="Moe, Gordon W" sort="Moe, Gordon W" uniqKey="Moe G" first="Gordon W" last="Moe">Gordon W. 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Howlett</name><affiliation wicri:level="4"><nlm:aff id="af1-cjc25085">University of Calgary, Calgary, Alberta;</nlm:aff><orgName type="university">Université de Calgary</orgName><country>Canada</country><placeName><settlement type="city">Calgary</settlement><region type="state">Alberta</region></placeName></affiliation></author><author><name sortKey="Mckelvie, Robert S" sort="Mckelvie, Robert S" uniqKey="Mckelvie R" first="Robert S" last="Mckelvie">Robert S. Mckelvie</name><affiliation><nlm:aff id="af2-cjc25085">Hamilton Health Sciences and McMaster University, Hamilton;</nlm:aff><wicri:noCountry code="subfield">Hamilton</wicri:noCountry></affiliation></author><author><name sortKey="Arnold, J Malcolm O" sort="Arnold, J Malcolm O" uniqKey="Arnold J" first="J Malcolm O" last="Arnold">J Malcolm O. Arnold</name><affiliation wicri:level="3"><nlm:aff id="af3-cjc25085">University of Western Ontario, London;</nlm:aff><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><wicri:orgArea>University of Western Ontario</wicri:orgArea></affiliation></author><author><name sortKey="Costigan, Jeannine" sort="Costigan, Jeannine" uniqKey="Costigan J" first="Jeannine" last="Costigan">Jeannine Costigan</name><affiliation><nlm:aff id="af4-cjc25085">St Mary’s General Hospital, Kitchener;</nlm:aff><wicri:noCountry code="subfield">Kitchener</wicri:noCountry></affiliation></author><author><name sortKey="Dorian, Paul" sort="Dorian, Paul" uniqKey="Dorian P" first="Paul" last="Dorian">Paul Dorian</name><affiliation wicri:level="2"><nlm:aff id="af5-cjc25085">University of Toronto, Toronto, Ontario;</nlm:aff><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>University of Toronto, Toronto</wicri:cityArea></affiliation></author><author><name sortKey="Ducharme, Anique" sort="Ducharme, Anique" uniqKey="Ducharme A" first="Anique" last="Ducharme">Anique Ducharme</name><affiliation><nlm:aff id="af6-cjc25085">Institut de Cardiologie de Montréal, Montreal, Quebec;</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation></author><author><name sortKey="Estrella Holder, Estrellita" sort="Estrella Holder, Estrellita" uniqKey="Estrella Holder E" first="Estrellita" last="Estrella-Holder">Estrellita Estrella-Holder</name><affiliation><nlm:aff id="af7-cjc25085">St Boniface General Hospital, Cardiac Sciences Program, Winnipeg, Manitoba;</nlm:aff><wicri:noCountry code="subfield">Manitoba</wicri:noCountry></affiliation></author><author><name sortKey="Ezekowitz, Justin A" sort="Ezekowitz, Justin A" uniqKey="Ezekowitz J" first="Justin A" last="Ezekowitz">Justin A. Ezekowitz</name><affiliation><nlm:aff id="af8-cjc25085">University of Alberta, Edmonton, Alberta;</nlm:aff><wicri:noCountry code="subfield">Alberta</wicri:noCountry></affiliation></author><author><name sortKey="Giannetti, Nadia" sort="Giannetti, Nadia" uniqKey="Giannetti N" first="Nadia" last="Giannetti">Nadia Giannetti</name><affiliation wicri:level="4"><nlm:aff id="af9-cjc25085">McGill University, Montreal, Quebec;</nlm:aff><orgName type="university">Université McGill</orgName><country>Canada</country><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author><author><name sortKey="Haddad, Haissam" sort="Haddad, Haissam" uniqKey="Haddad H" first="Haissam" last="Haddad">Haissam Haddad</name><affiliation wicri:level="2"><nlm:aff id="af10-cjc25085">Ottawa Heart Institute, Ottawa, Ontario;</nlm:aff><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Ottawa Heart Institute, Ottawa</wicri:cityArea></affiliation></author><author><name sortKey="Heckman, George A" sort="Heckman, George A" uniqKey="Heckman G" first="George A" last="Heckman">George A. Heckman</name><affiliation><nlm:aff id="af2-cjc25085">Hamilton Health Sciences and McMaster University, Hamilton;</nlm:aff><wicri:noCountry code="subfield">Hamilton</wicri:noCountry></affiliation></author><author><name sortKey="Herd, Anthony M" sort="Herd, Anthony M" uniqKey="Herd A" first="Anthony M" last="Herd">Anthony M. Herd</name><affiliation wicri:level="4"><nlm:aff id="af11-cjc25085">University of Manitoba, Winnipeg, Manitoba;</nlm:aff><orgName type="university">Université du Manitoba</orgName><country>Canada</country><placeName><settlement type="city">Winnipeg</settlement><region type="state">Manitoba</region></placeName></affiliation></author><author><name sortKey="Isaac, Debra" sort="Isaac, Debra" uniqKey="Isaac D" first="Debra" last="Isaac">Debra Isaac</name><affiliation wicri:level="4"><nlm:aff id="af1-cjc25085">University of Calgary, Calgary, Alberta;</nlm:aff><orgName type="university">Université de Calgary</orgName><country>Canada</country><placeName><settlement type="city">Calgary</settlement><region type="state">Alberta</region></placeName></affiliation></author><author><name sortKey="Jong, Philip" sort="Jong, Philip" uniqKey="Jong P" first="Philip" last="Jong">Philip Jong</name><affiliation wicri:level="2"><nlm:aff id="af5-cjc25085">University of Toronto, Toronto, Ontario;</nlm:aff><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>University of Toronto, Toronto</wicri:cityArea></affiliation></author><author><name sortKey="Kouz, Simon" sort="Kouz, Simon" uniqKey="Kouz S" first="Simon" last="Kouz">Simon Kouz</name><affiliation><nlm:aff id="af12-cjc25085">Centre Hospitalier Régional de Lanaudière, Joliette, Quebec;</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation></author><author><name sortKey="Liu, Peter" sort="Liu, Peter" uniqKey="Liu P" first="Peter" last="Liu">Peter Liu</name><affiliation wicri:level="2"><nlm:aff id="af5-cjc25085">University of Toronto, Toronto, Ontario;</nlm:aff><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>University of Toronto, Toronto</wicri:cityArea></affiliation></author><author><name sortKey="Mann, Elizabeth" sort="Mann, Elizabeth" uniqKey="Mann E" first="Elizabeth" last="Mann">Elizabeth Mann</name><affiliation><nlm:aff id="af13-cjc25085">Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia;</nlm:aff><wicri:noCountry code="subfield">Nova Scotia</wicri:noCountry></affiliation></author><author><name sortKey="Moe, Gordon W" sort="Moe, Gordon W" uniqKey="Moe G" first="Gordon W" last="Moe">Gordon W. Moe</name><affiliation wicri:level="2"><nlm:aff id="af14-cjc25085">St Michael’s Hospital, Toronto, Ontario</nlm:aff><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>St Michael’s Hospital, Toronto</wicri:cityArea></affiliation></author><author><name sortKey="Tsuyuki, Ross T" sort="Tsuyuki, Ross T" uniqKey="Tsuyuki R" first="Ross T" last="Tsuyuki">Ross T. Tsuyuki</name><affiliation><nlm:aff id="af8-cjc25085">University of Alberta, Edmonton, Alberta;</nlm:aff><wicri:noCountry code="subfield">Alberta</wicri:noCountry></affiliation></author><author><name sortKey="Ross, Heather J" sort="Ross, Heather J" uniqKey="Ross H" first="Heather J" last="Ross">Heather J. Ross</name><affiliation wicri:level="2"><nlm:aff id="af5-cjc25085">University of Toronto, Toronto, Ontario;</nlm:aff><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>University of Toronto, Toronto</wicri:cityArea></affiliation></author><author><name sortKey="White, Michel" sort="White, Michel" uniqKey="White M" first="Michel" last="White">Michel White</name><affiliation><nlm:aff id="af6-cjc25085">Institut de Cardiologie de Montréal, Montreal, Quebec;</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation></author></analytic><series><title level="j">The Canadian Journal of Cardiology</title><idno type="ISSN">0828-282X</idno><idno type="eISSN">1916-7075</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.</p></div></front></TEI><pmc xml:lang="EN" article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Can J Cardiol</journal-id><journal-id journal-id-type="publisher-id">PGI</journal-id><journal-title>The Canadian Journal of Cardiology</journal-title><issn pub-type="ppub">0828-282X</issn><issn pub-type="epub">1916-7075</issn><publisher><publisher-name>Pulsus Group Inc</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">19214293</article-id><article-id pub-id-type="pmc">2691911</article-id><article-id pub-id-type="publisher-id">cjc25085</article-id><article-categories><subj-group subj-group-type="heading"><subject>Special Article</subject></subj-group></article-categories><title-group><article-title>Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Howlett</surname><given-names>Jonathan G</given-names></name><degrees>MD FRCPC (Chair)</degrees><xref ref-type="aff" rid="af1-cjc25085">1</xref><xref ref-type="corresp" rid="c1-cjc25085"></xref></contrib><contrib contrib-type="author"><name><surname>McKelvie</surname><given-names>Robert S</given-names></name><degrees>MD PhD FRCPC (Co-Chair)</degrees><xref ref-type="aff" rid="af2-cjc25085">2</xref></contrib><contrib contrib-type="author"><name><surname>Arnold</surname><given-names>J Malcolm O</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af3-cjc25085">3</xref></contrib><contrib contrib-type="author"><name><surname>Costigan</surname><given-names>Jeannine</given-names></name><degrees>RN MScN APN</degrees><xref ref-type="aff" rid="af4-cjc25085">4</xref></contrib><contrib contrib-type="author"><name><surname>Dorian</surname><given-names>Paul</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af5-cjc25085">5</xref></contrib><contrib contrib-type="author"><name><surname>Ducharme</surname><given-names>Anique</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af6-cjc25085">6</xref></contrib><contrib contrib-type="author"><name><surname>Estrella-Holder</surname><given-names>Estrellita</given-names></name><degrees>RN BN MScA CCNC</degrees><xref ref-type="aff" rid="af7-cjc25085">7</xref></contrib><contrib contrib-type="author"><name><surname>Ezekowitz</surname><given-names>Justin A</given-names></name><degrees>MB BCh MSc FRCPC</degrees><xref ref-type="aff" rid="af8-cjc25085">8</xref></contrib><contrib contrib-type="author"><name><surname>Giannetti</surname><given-names>Nadia</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af9-cjc25085">9</xref></contrib><contrib contrib-type="author"><name><surname>Haddad</surname><given-names>Haissam</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af10-cjc25085">10</xref></contrib><contrib contrib-type="author"><name><surname>Heckman</surname><given-names>George A</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af2-cjc25085">2</xref></contrib><contrib contrib-type="author"><name><surname>Herd</surname><given-names>Anthony M</given-names></name><degrees>MD CCFP CCFP(EM)</degrees><xref ref-type="aff" rid="af11-cjc25085">11</xref></contrib><contrib contrib-type="author"><name><surname>Isaac</surname><given-names>Debra</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af1-cjc25085">1</xref></contrib><contrib contrib-type="author"><name><surname>Jong</surname><given-names>Philip</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af5-cjc25085">5</xref></contrib><contrib contrib-type="author"><name><surname>Kouz</surname><given-names>Simon</given-names></name><degrees>MD FACC</degrees><xref ref-type="aff" rid="af12-cjc25085">12</xref></contrib><contrib contrib-type="author"><name><surname>Liu</surname><given-names>Peter</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af5-cjc25085">5</xref></contrib><contrib contrib-type="author"><name><surname>Mann</surname><given-names>Elizabeth</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af13-cjc25085">13</xref></contrib><contrib contrib-type="author"><name><surname>Moe</surname><given-names>Gordon W</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af14-cjc25085">14</xref></contrib><contrib contrib-type="author"><name><surname>Tsuyuki</surname><given-names>Ross T</given-names></name><degrees>PharmD FCSHP</degrees><xref ref-type="aff" rid="af8-cjc25085">8</xref></contrib><contrib contrib-type="author"><name><surname>Ross</surname><given-names>Heather J</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af5-cjc25085">5</xref></contrib><contrib contrib-type="author"><name><surname>White</surname><given-names>Michel</given-names></name><degrees>MD FRCPC</degrees><xref ref-type="aff" rid="af6-cjc25085">6</xref></contrib></contrib-group><aff id="af1-cjc25085"><label>1</label>University of Calgary, Calgary, Alberta;</aff><aff id="af2-cjc25085"><label>2</label>Hamilton Health Sciences and McMaster University, Hamilton;</aff><aff id="af3-cjc25085"><label>3</label>University of Western Ontario, London;</aff><aff id="af4-cjc25085"><label>4</label>St Mary’s General Hospital, Kitchener;</aff><aff id="af5-cjc25085"><label>5</label>University of Toronto, Toronto, Ontario;</aff><aff id="af6-cjc25085"><label>6</label>Institut de Cardiologie de Montréal, Montreal, Quebec;</aff><aff id="af7-cjc25085"><label>7</label>St Boniface General Hospital, Cardiac Sciences Program, Winnipeg, Manitoba;</aff><aff id="af8-cjc25085"><label>8</label>University of Alberta, Edmonton, Alberta;</aff><aff id="af9-cjc25085"><label>9</label>McGill University, Montreal, Quebec;</aff><aff id="af10-cjc25085"><label>10</label>Ottawa Heart Institute, Ottawa, Ontario;</aff><aff id="af11-cjc25085"><label>11</label>University of Manitoba, Winnipeg, Manitoba;</aff><aff id="af12-cjc25085"><label>12</label>Centre Hospitalier Régional de Lanaudière, Joliette, Quebec;</aff><aff id="af13-cjc25085"><label>13</label>Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia;</aff><aff id="af14-cjc25085"><label>14</label>St Michael’s Hospital, Toronto, Ontario</aff><author-notes><corresp id="c1-cjc25085">Correspondence: Dr Jonathan G Howlett, University of Calgary, Room 812 South Tower, 3031 Hospital Drive, Calgary, Alberta T2N 2T8. Telephone 403-457-4338, fax 403-944-3262, e-mail
<email>howlettjonathan@gmail.com</email>. Additionally, comments may be directed to <ext-link ext-link-type="uri" xlink:href="www.hfcc.ca">www.hfcc.ca</ext-link></corresp></author-notes><pub-date pub-type="ppub"><month>2</month><year>2009</year></pub-date><volume>25</volume><issue>2</issue><fpage>85</fpage><lpage>105</lpage><history><date date-type="received"><day>3</day><month>1</month><year>2009</year></date><date date-type="accepted"><day>4</day><month>1</month><year>2009</year></date></history><copyright-statement>© 2009, Pulsus Group Inc. All rights reserved</copyright-statement><copyright-year>2009</copyright-year><abstract><p>The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.</p></abstract><trans-abstract xml:lang="FR"><p>La Société canadienne de cardiologie avait publié un ensemble complet de recommandations sur le diagnostic et la prise en charge de l’insuffisance cardiaque en janvier 2006. Selon les commentaires obtenus par l’entremise d’un programme national d’ateliers sur l’insuffisance cardiaque et par une sollicitation active des principaux intéressés, plusieurs thèmes ont été jugés importants pour le praticien. Les thèmes retenus pour la présente mise à jour incluent : les pratiques optimales en matière de diagnostic et de prise en charge de l’insuffisance cardiaque droite, de la myocardite et des dispositifs thérapeutiques et une revue des récentes études cliniques importantes ou déterminantes. Ces recommandations ont été rédigées avec une approche structurée pour l’analyse et l’évaluation des preuves que la Société a adoptées et décrites précédemment. Cette mise à jour a été rédigée d’un point de vue clinique pour plus de convivialité et de commodité. Les questions cliniques spécifiquement abordées sont notamment : Qu’est-ce que l’insuffisance cardiaque droite et comment approche-t-on les épreuves diagnostiques? Quelles autres entités cliniques peuvent prendre l’aspect de cette maladie nébuleuse et comment les distinguer? Quand doit-on s’inquiéter de la présence de myocardite et avec quelle rapidité les patients atteints de cette maladie doivent-ils être adressés vers un centre spécialisé? Parmi la myriade d’essais cliniques déterminants publiés récemment, lesquels auront un impact sur nos normes de soins cliniques? Les objectifs sont d’aider les médecins et autres professionnels de la santé à traiter de manière optimale les patients atteints d’insuffisance cardiaque, de manière à exercer un impact mesurable sur leur santé et sur le pronostic clinique de la maladie au Canada.</p></trans-abstract><kwd-group><kwd>Congenital heart disease</kwd><kwd>Consensus statement</kwd><kwd>Device therapy</kwd><kwd>Diagnosis</kwd><kwd>Drug therapy</kwd><kwd>Etiology</kwd><kwd>Guidelines</kwd><kwd>Heart failure</kwd><kwd>Myocarditis</kwd><kwd>Prognosis</kwd><kwd>Pulmonary hypertension</kwd><kwd>Right-sided heart failure</kwd></kwd-group></article-meta></front><floats-wrap><table-wrap id="t1-cjc25085" position="float"><label>TABLE 1</label><caption><p>Causes of right-sided heart failure (RHF)</p></caption><table frame="hsides" rules="groups"><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Increased afterload, including left-sided heart failure and pulmonary arterial hypertension</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Right ventricular (RV) myopathic process, RV infarction and restrictive heart disease</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Right-sided valvular heart disease</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Congenital heart disease including surgical residua</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Pericardial disease (a mimic of RHF)</td></tr></tbody></table></table-wrap><table-wrap id="t2-cjc25085" position="float"><label>TABLE 2</label><caption><p>Comparison of right-sided heart failure (RHF) by etiology</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="bottom" align="left" rowspan="1" colspan="1"><bold>Cause</bold></th><th valign="bottom" align="left" rowspan="1" colspan="1"><bold>Clinical presentation</bold></th><th valign="bottom" align="left" rowspan="1" colspan="1"><bold>Differentiating features</bold></th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="3" colspan="1">Secondary to LV failure</td><td valign="top" align="left" rowspan="1" colspan="1">Typical heart failure presentation</td><td valign="top" align="left" rowspan="1" colspan="1">Abnormal LV valves with evidence of increased filling pressures</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Hypoxia in advanced stages</td><td valign="top" align="left" rowspan="1" colspan="1">Can confirm via left heart or transeptal catheterization</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">High BNP when decompensated</td></tr><tr><td valign="top" align="left" rowspan="5" colspan="1">Secondary to PAH</td><td valign="top" align="left" rowspan="1" colspan="1">RHF</td><td valign="top" align="left" rowspan="1" colspan="1">Evidence of pulmonary hypertension</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Hypoxia may occur earlier</td><td valign="top" align="left" rowspan="1" colspan="1">No evidence of increased LV filling pressures</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Evidence of significant lung disease may be present</td><td valign="top" align="left" rowspan="1" colspan="1">May require cardiac catheterization to determine LV filling pressures</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Findings of pulmonary hypertension may be present</td><td valign="top" align="left" rowspan="1" colspan="1">BNP may be modestly elevated</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Clinical findings may reflect the presence of conditions associated with PAH such as scleroderma</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Secondary to RV myopathic process</td><td valign="top" align="left" rowspan="1" colspan="1">RHF</td><td valign="top" align="left" rowspan="1" colspan="1">Diagnosis can usually be made on clinical grounds and with echocardiography or CMR</td></tr><tr><td valign="top" align="left" rowspan="3" colspan="1">RV infarction</td><td valign="top" align="left" rowspan="1" colspan="1">Acute or post-MI presentation</td><td valign="top" align="left" rowspan="1" colspan="1">May need urgent right heart catheterization to determine RV and LV filling pressures</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">May also have LV failure</td><td valign="top" align="left" rowspan="1" colspan="1">Low cardiac output despite elevated JVP following acute MI</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">May not tolerate vasodilator therapy due to systemic hypotension</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">ARVC</td><td valign="top" align="left" rowspan="1" colspan="1">Familial, uncommon (10%) LV involvement, may be asymptomatic</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Other rare cardiomyopathy<xref ref-type="table-fn" rid="tfn1-cjc25085">*</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Variable</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="3" colspan="1">Restrictive cardiomyopathy</td><td valign="top" align="left" rowspan="1" colspan="1">RHF</td><td valign="top" align="left" rowspan="1" colspan="1">Pulmonary hypertension may be present</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">May mimic constriction</td><td valign="top" align="left" rowspan="1" colspan="1">BNP may be very high</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Mixed RV/LV failure</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="4" colspan="1">Pericardial disease<xref ref-type="table-fn" rid="tfn2-cjc25085">†</xref></td><td valign="top" align="left" rowspan="1" colspan="1">RHF without evidence of pulmonary hypertension</td><td valign="top" align="left" rowspan="1" colspan="1">Pulmonary hypertension absent</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">May see abnormal pericardium</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">May differentiate from restrictive cardiomyopathy by tissue Doppler assessment</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Cardiac catheterization and/or RV biopsy may be required for differentiation</td></tr><tr><td valign="top" align="left" rowspan="4" colspan="1">Right-sided valvular heart disease</td><td valign="top" align="left" rowspan="2" colspan="1">Clinical findings of pulmonary or tricuspid valve disease</td><td valign="top" align="left" rowspan="1" colspan="1">Evidence of severe valvular structural and functional abnormality</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Usually observed by echocardiography</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Associated condition present (eg, endocarditis, carcinoid, diet pill ingestion)</td><td valign="top" align="left" rowspan="1" colspan="1">Evidence of interference of tricuspid closure by pacing wire, long history of RV pacing, with no other cause for ventricular dysfunction</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">History of RV pacing</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="2" colspan="1">Congenital heart disease</td><td valign="top" align="left" rowspan="2" colspan="1">Highly variable but, frequently, a history of congenital heart disease precedes RHF presentation</td><td valign="top" align="left" rowspan="1" colspan="1">Congenital heart disease noted by echocardiography or CMR</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Unexplained increase in RV volume warrants careful evaluation to rule out atrial septal defect or other intracardiac shunt; transesophageal echocardiography may be necessary</td></tr></tbody></table><table-wrap-foot><fn id="tfn1-cjc25085"><label>*</label><p>Uhl’s anomaly, Chagas’ disease (uncommon in North America, common elsewhere), right-sided involvement of hypertrophic cardiomyopathy;</p></fn><fn id="tfn2-cjc25085"><label><sup>†</sup></label><p>Mimic of RHF. ARVC Arrhythmogenic right ventricular cardiomyopathy; BNP B-type natriuretic peptide; CMR Cardiac magnetic resonance imaging; JVP Jugular venous pressure; LV Left ventricle; RV Right ventricle; MI Myocardial infarction; PAH Pulmonary arterial hypertension</p></fn></table-wrap-foot></table-wrap><table-wrap id="t3-cjc25085" position="float"><label>TABLE 3</label><caption><p>Classification of pulmonary hypertension as advanced at the World Symposium on Primary Pulmonary Hypertension</p></caption><table frame="below" rules="groups"><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1"><bold>Pulmonary arterial hypertension</bold><hr></hr></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Primary pulmonary hypertension</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Sporadic disorder</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Familial disorder</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Related conditions</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Collagen vascular disease</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Congenital systemic-to-pulmonary shunt</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Portal hypertension</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> HIV infection</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Drugs and toxins</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Anorectic agents (appetite suppressants)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Others</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Persistent pulmonary hypertension of the newborn</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Others</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"><bold>Pulmonary venous hypertension</bold><hr></hr></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Left-sided atrial or ventricular heart disease</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Left-sided valvular heart disease</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Extrinsic compression of central pulmonary veins</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Fibrosing mediastinitis</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Adenopathy and/or tumours</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Pulmonary veno-occlusive disease</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Others</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"><bold>Pulmonary hypertension associated with disorders of the respiratory system and/or hypoxemia</bold><hr></hr></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Chronic obstructive pulmonary disease</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Interstitial lung disease</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Sleep-disordered breathing</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Alveolar hypoventilation disorders</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Chronic exposure to high altitudes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Neonatal lung disease</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Alveolar-capillary dysplasia</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Others</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"><bold>Pulmonary hypertension resulting from chronic thrombotic and/or embolic disease</bold><hr></hr></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Thromboembolic obstruction of proximal pulmonary arteries</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Obstruction of distal pulmonary arteries</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Pulmonary embolism (thrombus, tumour, ova and/or parasites, foreign material)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> In situ thrombosis</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Sickle cell disease</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"><bold>Pulmonary hypertension resulting from disorders directly affecting the pulmonary vasculature</bold><hr></hr></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Inflammatory conditions</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Schistosomiasis</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Sarcoidosis</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Others</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Pulmonary capillary hemangiomatosis</td></tr></tbody></table><table-wrap-foot><fn id="tfn3-cjc25085"><p>Adapted with permission from reference <xref ref-type="bibr" rid="b139-cjc25085">139</xref></p></fn></table-wrap-foot></table-wrap><table-wrap id="t4-cjc25085" position="float"><label>TABLE 4</label><caption><p>Common symptoms, signs and test results in right-sided heart failure (RHF) without pulmonary hypertension and in cor pulmonale</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="bottom" align="left" rowspan="1" colspan="1"><bold>Common features</bold></th><th valign="bottom" align="left" rowspan="1" colspan="1"><bold>RHF without pulmonary hypertension</bold></th><th valign="bottom" align="left" rowspan="1" colspan="1"><bold>Cor pulmonale</bold></th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="9" colspan="1">Symptoms</td><td valign="top" align="left" rowspan="1" colspan="1">Fatigue</td><td valign="top" align="left" rowspan="1" colspan="1">Fatigue</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Hepatic congestion</td><td valign="top" align="left" rowspan="1" colspan="1"><italic>Hemoptysis</italic></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Right upper quadrant discomfort</td><td valign="top" align="left" rowspan="1" colspan="1"><italic>Hoarseness</italic></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Anorexia/early satiety</td><td valign="top" align="left" rowspan="1" colspan="1">Hepatic congestion</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Peripheral edema</td><td valign="top" align="left" rowspan="1" colspan="1">Right upper quadrant discomfort</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Cough</td><td valign="top" align="left" rowspan="1" colspan="1">Anorexia/early satiety</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Shortness of breath/orthopnea<xref ref-type="table-fn" rid="tfn5-cjc25085">*</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Peripheral edema</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Cough</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Shortness of breath/orthopnea<xref ref-type="table-fn" rid="tfn5-cjc25085">*</xref></td></tr><tr><td valign="top" align="left" rowspan="8" colspan="1">Physical signs</td><td valign="top" align="left" rowspan="1" colspan="1">Elevated jugular venous pulsation, positive hepatojugular reflux or Kussmaul’s sign</td><td valign="top" align="left" rowspan="1" colspan="1">Elevated jugular venous pulsation, positive hepatojugular reflux or Kussmaul’s sign</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Peripheral or sacral edema</td><td valign="top" align="left" rowspan="1" colspan="1">Peripheral or sacral edema</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Ascites</td><td valign="top" align="left" rowspan="1" colspan="1">Ascites</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Hepatomegaly or liver tenderness</td><td valign="top" align="left" rowspan="1" colspan="1">Hepatomegaly or liver tenderness</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Right-sided third heart sound</td><td valign="top" align="left" rowspan="1" colspan="1">Right-sided third heart sound, <italic>increased pulmonary closure sound, pulmonary ejection click</italic></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Murmur of tricuspid regurgitation</td><td valign="top" align="left" rowspan="1" colspan="1">Murmur of tricuspid regurgitation</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Signs of right ventricular enlargement</td><td valign="top" align="left" rowspan="1" colspan="1">Signs of right ventricular enlargement</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"><italic>Evidence of coexisting underlying pulmonary cause of cor pulmonale</italic></td></tr><tr><td valign="top" align="left" rowspan="3" colspan="1">Diagnostic testing</td><td valign="top" align="left" rowspan="1" colspan="1">ECG: Right axis deviation, right ventricular hypertrophy, p pulmonale pattern low-voltage QRS, incomplete or complete right bundle branch block</td><td valign="top" align="left" rowspan="1" colspan="1">ECG: Right axis deviation, right ventricular hypertrophy, p pulmonale pattern low-voltage QRS, incomplete or complete right bundle branch block</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Chest x-ray: Right-sided cardiac enlargement, enlargement of pulmonary arteries (uncommon), oligemic peripheral lung fields (rare), right-sided pleural effusion<xref ref-type="table-fn" rid="tfn5-cjc25085">*</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Chest x-ray: Right-sided cardiac enlargement, enlargement of pulmonary arteries, <italic>oligemic peripheral lung fields</italic>, right-sided pleural effusion<xref ref-type="table-fn" rid="tfn5-cjc25085">*</xref></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Echocardiography: Evidence of abnormal right ventricular structure and/or function. No evidence of increased pulmonary pressure. <italic>Septal flattening during diastole but not systole</italic></td><td valign="top" align="left" rowspan="1" colspan="1">Echocardiography: Evidence of abnormal right ventricular structure and/or function. <italic>Evidence of increased pulmonary pressure. Septal flattening during systole</italic></td></tr></tbody></table><table-wrap-foot><fn id="tfn4-cjc25085"><p>Items appearing in italics occur in the setting of cor pulmonale but are very uncommon in its absence.</p></fn><fn id="tfn5-cjc25085"><label>*</label><p>Less commonly found, but may occur. ECG Electrocardiogram</p></fn></table-wrap-foot></table-wrap><table-wrap id="t5-cjc25085" position="float"><label>TABLE 5</label><caption><p>Diagnostic criteria<xref ref-type="table-fn" rid="tfn6-cjc25085">*</xref> for arrhythmogenic right ventricular cardiomyopathy (ARVC)</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="bottom" align="left" rowspan="1" colspan="1"><bold>Major criteria</bold></th><th valign="bottom" align="left" rowspan="1" colspan="1"><bold>Minor criteria</bold></th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Severe dilation and reduction of right ventricular ejection fraction with no (or only mild) left ventricular impairment</td><td valign="top" align="left" rowspan="1" colspan="1">Mild global right ventricular dilation and/or ejection fraction reduction with normal left ventricle</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Localized right ventricular aneurysms (akinetic or dyskinetic areas with diastolic bulging)</td><td valign="top" align="left" rowspan="1" colspan="1">Mild segmental dilation of the right ventricle</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Severe segmental dilation of the right ventricle</td><td valign="top" align="left" rowspan="1" colspan="1">Regional right ventricular hypokinesia</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Fibrofatty replacement of myocardium on endomyocardial biopsy</td><td valign="top" align="left" rowspan="1" colspan="1">Inverted T waves in right precordial leads (V2 and V3) (people older than 12 years of age; in the absence of right bundle branch block)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Epsilon waves or localized prolongation (>110 ms) of the QRS complex in right precordial leads (V1–V3)</td><td valign="top" align="left" rowspan="1" colspan="1">Late potentials (signal averaged electrocardiogram)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Familial disease confirmed at necropsy or surgery</td><td valign="top" align="left" rowspan="1" colspan="1">Left bundle branch block type ventricular tachycardia (sustained and nonsustained) (electrocardiogram, Holter monitor, exercise testing)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Frequent ventricular extrasystoles (>1000/24 h) on Holter monitor</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Familial history of premature sudden death (<35 years of age) due to suspected ARVC</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Familial history (clinical diagnosis based on present criteria)</td></tr></tbody></table><table-wrap-foot><fn id="tfn6-cjc25085"><label>*</label><p>Diagnosis requires the presence of two major, one major and two minor, or four minor criteria. Modified and reprinted with permission from reference <xref ref-type="bibr" rid="b25-cjc25085">25</xref></p></fn></table-wrap-foot></table-wrap><table-wrap id="t6-cjc25085" position="float"><label>TABLE 6</label><caption><p>Summary of recently completed randomized studies of therapies: Acutely decompensated heart failure</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="bottom" align="left" rowspan="1" colspan="1"><bold>Study, sample size</bold></th><th valign="bottom" align="left" rowspan="1" colspan="1"><bold>Intervention</bold></th><th valign="bottom" align="left" rowspan="1" colspan="1"><bold>Results</bold></th><th valign="bottom" align="left" rowspan="1" colspan="1"><bold>Comments</bold></th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">SURVIVE (<xref ref-type="bibr" rid="b135-cjc25085">135</xref>), n=1327</td><td valign="top" align="left" rowspan="1" colspan="1">Intravenous levosimendan versus dobutamine</td><td valign="top" align="left" rowspan="1" colspan="1">No difference in 180-day total mortality (HR 0.91, 95% CI 0.74 to 1.13; P=0.40). No difference in dyspnea or other end point</td><td valign="top" align="left" rowspan="1" colspan="1">Early improvement in short-term BNP levels in levosimendan group not translated to mortality. Levosimendan is not available in Canada</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">VERITAS (<xref ref-type="bibr" rid="b134-cjc25085">134</xref>), n=1448</td><td valign="top" align="left" rowspan="1" colspan="1">24 h to 72 h of intravenous tezosentan</td><td valign="top" align="left" rowspan="1" colspan="1">No difference in death or worsening heart failure at seven days (26.4% versus 26.3%, P=0.92). No difference in dyspnea score measured by visual analogue scale</td><td valign="top" align="left" rowspan="1" colspan="1">Tezosentan is not available in Canada</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">EVEREST (<xref ref-type="bibr" rid="b136-cjc25085">136</xref>,<xref ref-type="bibr" rid="b137-cjc25085">137</xref>), n=4133</td><td valign="top" align="left" rowspan="1" colspan="1">Oral tolvaptan versus placebo in 4133 patients</td><td valign="top" align="left" rowspan="1" colspan="1">Improvement in primary composite end point of changes in global clinical status based on: visual analog scale and body weight at day seven or hospital discharge
<break></break>No improvement in dyspnea
<break></break>No difference in all-cause mortality (HR 0.98, 95% CI 0.87 to 1.11; P=0.68) or cardiovascular death or hospitalization for heart failure</td><td valign="top" align="left" rowspan="1" colspan="1">Greater weight loss in tolvaptan arm. Tolvaptan not is available in Canada</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">UNLOAD (<xref ref-type="bibr" rid="b138-cjc25085">138</xref>), n=200</td><td valign="top" align="left" rowspan="1" colspan="1">Venovenous ultrafiltration versus usual diuretic-based therapy in 200 patients</td><td valign="top" align="left" rowspan="1" colspan="1">5.0±3.5 kg versus 3.1±3.5 kg; P=0.001. Weight loss at 48 h
<break></break>No difference in dyspnea score improvement</td><td valign="top" align="left" rowspan="1" colspan="1">Secondary end point of 30-day repeat hospitalization reduced in intervention arm, although with few occurrences
<break></break>Significant increase in serum creatinine at all points of measurement</td></tr></tbody></table><table-wrap-foot><fn id="tfn7-cjc25085"><p><italic>BNP B-type natriuretic peptide; EVEREST</italic> Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan trial; <italic>HR Hazard ratio; SURVIVE</italic> Levosimendan vs Dobutamine for patients With Acute Decompensated Heart Failure study; UNLOAD Ultrafiltration versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure stduy; VERITAS Tezosentan on Symptoms and Clinical Outcomes in Patients With Acute Heart Failure study</p></fn></table-wrap-foot></table-wrap></floats-wrap></pmc><affiliations><list><country><li>Canada</li><li>Royaume-Uni</li></country><region><li>Alberta</li><li>Angleterre</li><li>Grand Londres</li><li>Manitoba</li><li>Ontario</li><li>Québec</li></region><settlement><li>Calgary</li><li>Londres</li><li>Montréal</li><li>Winnipeg</li></settlement><orgName><li>Université McGill</li><li>Université de Calgary</li><li>Université du Manitoba</li></orgName></list><tree><noCountry><name sortKey="Costigan, Jeannine" sort="Costigan, Jeannine" uniqKey="Costigan J" first="Jeannine" last="Costigan">Jeannine Costigan</name><name sortKey="Ducharme, Anique" sort="Ducharme, Anique" uniqKey="Ducharme A" first="Anique" last="Ducharme">Anique Ducharme</name><name sortKey="Estrella Holder, Estrellita" sort="Estrella Holder, Estrellita" uniqKey="Estrella Holder E" first="Estrellita" last="Estrella-Holder">Estrellita Estrella-Holder</name><name sortKey="Ezekowitz, Justin A" sort="Ezekowitz, Justin A" uniqKey="Ezekowitz J" first="Justin A" last="Ezekowitz">Justin A. Ezekowitz</name><name sortKey="Heckman, George A" sort="Heckman, George A" uniqKey="Heckman G" first="George A" last="Heckman">George A. Heckman</name><name sortKey="Kouz, Simon" sort="Kouz, Simon" uniqKey="Kouz S" first="Simon" last="Kouz">Simon Kouz</name><name sortKey="Mann, Elizabeth" sort="Mann, Elizabeth" uniqKey="Mann E" first="Elizabeth" last="Mann">Elizabeth Mann</name><name sortKey="Mckelvie, Robert S" sort="Mckelvie, Robert S" uniqKey="Mckelvie R" first="Robert S" last="Mckelvie">Robert S. Mckelvie</name><name sortKey="Tsuyuki, Ross T" sort="Tsuyuki, Ross T" uniqKey="Tsuyuki R" first="Ross T" last="Tsuyuki">Ross T. Tsuyuki</name><name sortKey="White, Michel" sort="White, Michel" uniqKey="White M" first="Michel" last="White">Michel White</name></noCountry><country name="Canada"><region name="Alberta"><name sortKey="Howlett, Jonathan G" sort="Howlett, Jonathan G" uniqKey="Howlett J" first="Jonathan G" last="Howlett">Jonathan G. Howlett</name></region><name sortKey="Dorian, Paul" sort="Dorian, Paul" uniqKey="Dorian P" first="Paul" last="Dorian">Paul Dorian</name><name sortKey="Giannetti, Nadia" sort="Giannetti, Nadia" uniqKey="Giannetti N" first="Nadia" last="Giannetti">Nadia Giannetti</name><name sortKey="Haddad, Haissam" sort="Haddad, Haissam" uniqKey="Haddad H" first="Haissam" last="Haddad">Haissam Haddad</name><name sortKey="Herd, Anthony M" sort="Herd, Anthony M" uniqKey="Herd A" first="Anthony M" last="Herd">Anthony M. Herd</name><name sortKey="Isaac, Debra" sort="Isaac, Debra" uniqKey="Isaac D" first="Debra" last="Isaac">Debra Isaac</name><name sortKey="Jong, Philip" sort="Jong, Philip" uniqKey="Jong P" first="Philip" last="Jong">Philip Jong</name><name sortKey="Liu, Peter" sort="Liu, Peter" uniqKey="Liu P" first="Peter" last="Liu">Peter Liu</name><name sortKey="Moe, Gordon W" sort="Moe, Gordon W" uniqKey="Moe G" first="Gordon W" last="Moe">Gordon W. Moe</name><name sortKey="Ross, Heather J" sort="Ross, Heather J" uniqKey="Ross H" first="Heather J" last="Ross">Heather J. Ross</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Arnold, J Malcolm O" sort="Arnold, J Malcolm O" uniqKey="Arnold J" first="J Malcolm O" last="Arnold">J Malcolm O. Arnold</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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