Acute coronary syndromes and acute heart failure: a diagnostic dilemma and high-risk combination. A statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology

Veli Pekka Harjola*, John Parissis, Johann Bauersachs, Hans Peter Brunner-La Rocca, Hector Bueno, Jelena Čelutkienė, Ovidiu Chioncel, Andrew J.S. Coats, Sean P. Collins, Rudolf A. de Boer, Gerasimos Filippatos, Etienne Gayat, Loreena Hill, Mika Laine, Johan Lassus, Jyri Lommi, Josep Masip, Alexandre Mebazaa, Marco Metra, Òscar MiróAndrea Mortara, Christian Mueller, Wilfried Mullens, W. Frank Peacock, Markku Pentikäinen, Massimo F. Piepoli, Effie Polyzogopoulou, Alain Rudiger, Frank Ruschitzka, Petar Seferovic, Alessandro Sionis, John R. Teerlink, Thomas Thum, Marjut Varpula, Jean Marc Weinstein, Mehmet B. Yilmaz

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

51 Citations (Scopus)

Abstract

Acute coronary syndrome is a precipitant of acute heart failure in a substantial proportion of cases, and the presence of both conditions is associated with a higher risk of short-term mortality compared to acute coronary syndrome alone. The diagnosis of acute coronary syndrome in the setting of acute heart failure can be challenging. Patients may present with atypical or absent chest pain, electrocardiograms can be confounded by pre-existing abnormalities, and cardiac biomarkers are frequently elevated in patients with chronic or acute heart failure, independently of acute coronary syndrome. It is important to distinguish transient or limited myocardial injury from primary myocardial infarction due to vascular events in patients presenting with acute heart failure. This paper outlines various clinical scenarios to help differentiate between these conditions and aims to provide clinicians with tools to aid in the recognition of acute coronary syndrome as a cause of acute heart failure. Interpretation of electrocardiogram and biomarker findings, and imaging techniques that may be helpful in the diagnostic work-up are described. Guidelines recommend an immediate invasive strategy for patients with acute heart failure and acute coronary syndrome, regardless of electrocardiographic or biomarker findings. Pharmacological management of patients with acute coronary syndrome and acute heart failure should follow guidelines for each of these syndromes, with priority given to time-sensitive therapies for both. Studies conducted specifically in patients with the combination of acute coronary syndrome and acute heart failure are needed to better define the management of these patients.

Original languageEnglish
Pages (from-to)1298-1314
Number of pages17
JournalEuropean Journal of Heart Failure
Volume22
Issue number8
DOIs
Publication statusPublished - 1 Aug 2020
Externally publishedYes

Bibliographical note

Funding Information:
The authors acknowledge the Heart Failure Association of the European Society of Cardiology for organizing the meeting during which this topic was discussed. The authors acknowledge T.J. for her expert review of the manuscript, and W.G. S., PharmD (Campbell University College of Pharmacy and Health Sciences), supported by the Heart Failure Association of the European Society of Cardiology for contributions to content development, writing, and editing the manuscript. J.M., C.M. and F.P. performed their expert review of the paper on behalf of Acute Cardiovascular Care Association of the European Society of Cardiology. J.B. and T.T. were supported by the Deutsche Forschungsgemeinschaft, Clinical Research Group 311 (KFO 311) ‘(Pre‐)terminal heart and lung failure: unloading and repair’ (DFG; TP1 and TP11).

Funding Information:
The authors acknowledge the Heart Failure Association of the European Society of Cardiology for organizing the meeting during which this topic was discussed. The authors acknowledge T.J. for her expert review of the manuscript, and W.G. S., PharmD (Campbell University College of Pharmacy and Health Sciences), supported by the Heart Failure Association of the European Society of Cardiology for contributions to content development, writing, and editing the manuscript. J.M., C.M. and F.P. performed their expert review of the paper on behalf of Acute Cardiovascular Care Association of the European Society of Cardiology. J.B. and T.T. were supported by the Deutsche Forschungsgemeinschaft, Clinical Research Group 311 (KFO 311) ‘(Pre-)terminal heart and lung failure: unloading and repair’ (DFG; TP1 and TP11).

Funding Information:
V.P.H. reports personal fees from Bayer, Boehringer Ingelheim, BMS, Orion Pharma, Novartis, and Roche Diagnostics, research grant from Abbott Laboratories. J.P. reports personal fees for lectures and advisory boards from Orion Pharma, Novartis, Servier, and Roche Diagnostics. J.B. reports personal fees from Novartis, Vifor, Bayer, Servier, Orion, CVRx, Abiomed, Abbott, Medtronic, Boehringer Ingelheim; research support from Zoll, CVRx, Bayer, Vifor, Abiomed, Medtronic. H.P.B.L.R. reports research grants from Roche Diagnostics, Novartis Pharma, Vifor Pharma; personal fees from Roche Diagnostics, Novartis Pharma, Vifor Pharma. J.C. reports personal fees from Amgen, Novartis, Orivas, Servier, Berlin‐Chemie. O.C. reports research grants from Servier, Novartis, Vifor Pharma. A.J.S.C. reports personal fees from Actimed, AstraZeneca, Faraday, Gore, Impulse Dynamics, Menarini, Novartis, Nutricia, Resmed, Respicardia, Servier, Stealth Peptides, Verona, Vifor. S.P.C. reports research grants from NIH, PCORI, AHRQ, AHA, Ortho Clinical; personal fees from Novartis, Medtronic, Vixiar. G.F. reports to br clinical trial/registry committee member for Bayer, Novartis, Servier, Medtronic, Vifor. J.L. reports personal fees from Bayer, Boehringer Ingelheim, Novartis, Pfizer, Roche Diagnostics, Orion Pharma, Servier, and Vifor Pharma. A.M. reports personal fees from Cardiorentis, Novartis, Orion, Roche, Servier, Adrenomed, Abbott, Neuro Tronik, Sphyngotec; research grants from Adrenomed, Abbott, Sphyngotec. M.M. reports personal fees (advisory boards) from Novartis and Bayer. W.F.P. reports research grants from Abbott, Boehringer Ingelheim, Braincheck, CSL Behring, Daiichi‐Sankyo, Immunarray, Janssen, Ortho Clinical Diagnostics, Portola, Relypsa, Roche; consultant for Abbott, AstraZeneca, Bayer, Beckman, Boehrhinger‐Ingelheim, Ischemia Care, Dx, Immunarray, Instrument Labs, Janssen, Nabriva, Ortho Clinical Diagnostics, Relypsa, Roche, Quidel, Siemens; expert testimony for Johnson and Johnson; stock/ownership interests: AseptiScope Inc, Brainbox Inc, Comprehensive Research Associates LLC, Emergencies in Medicine LLC, Ischemia DX LLC. M.P. reports personal fees from Novartis, Vifor Pharma, Roche Diagnostics (lectures); stock ownership in Orion. F.R. reports research grants from St. Jude Medical/Abbott, Servier, Novartis, Bayer, Mars; personal fees (for lectures, advisory board meetings, steering committee) from St. Jude Medical/Abbott, Servier, Zoll, AstraZeneca, Sanofi, Novartis, Amgen, BMS, Pfizer, Fresenius, Vifor, Roche, Bayer, Cardiorentis, Boehringer Ingelheim, Heartware. A.S. reports research grants and personal fees from Singulex Inc. J.R.T. reports research support/personal (consulting) fees from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol‐Myers Squibb, Cytokinetics, Janssen, Medtronic, Novartis, Relypsa. T.T. reports personal fees from Novartis, Sanofi/Genzyme, Beiersdorf, Shire, Amicus; grant/research support from Novartis, Sanofi/Genzyme, Beiersdorf.; he is founder and holds shares of Cardior Pharmaceuticals GmbH. J.M.W. reports personal fees from Novartis (lectures). M.B.Y. reports research grants from Amgen, Novartis, Bayer, Dalcor Pharmaceuticals; institutional consultancy fees from Servier. The other authors have nothing to disclose. Conflict of interest:

Publisher Copyright:
© 2020 European Society of Cardiology

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