Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Advanced and Acute Heart Failure

Abstract

The Korean Society of Heart Failure (KSHF) Guidelines provide evidence-based recommendations based on Korean and international data to guide adequate diagnosis and management of heart failure (HF). Since introduction of 2017 edition of the guidelines, management of advanced HF has considerably improved, especially with advances in mechanical circulatory support and devices. The current guidelines addressed these improvements. In addition, we have included recently updated evidence-based recommendations regarding acute HF in these guidelines. In summary, Part IV of the KSHF Guidelines covers the appropriate diagnosis and optimized management of advanced and acute HF.

Keywords: Cardiogenic shock; Heart failure; Heart transplantation; Heart-assist devices.

Figure 1. Stages of cardiogenic shock. Adapted from Baran et al. with the permission of the Society for Cardiovascular Angiography & Interventions.

CPR = cardiopulmonary resuscitation; ECMO = extracorporeal membrane oxygenation.

Figure 2. Treatment algorithm for cardiogenic shock.

ACS = acute coronary syndrome; MCS = mechanical circulatory support; PCI = percutaneous coronary intervention; RRT = renal replacement therapy.

Figure 3. Temporary circulatory support for drug-refractory cardiogenic shock.

ECMO = extracorporeal membrane oxygenation; IABP = intra-aortic balloon counterpulsation; MI = myocardial infarction; MR = mitral regurgitation; VSD = ventricular septal defect.

Figure 4. Weaning of percutaneous ECMO.

CVP = central venous pressure; ECMO = extracorporeal membrane oxygenation; LVEF = left ventricular ejection fraction; LVOT = left ventricular outflow tract; MAP = mean arterial pressure; MCS = mechanical circulatory support; SFA = superficial femoral artery; SvO₂ = mixed venous oxygen saturation; S’ = tissue Doppler tricuspid lateral peak systolic velocity; PAOD = peripheral arterial occlusive disease; RV = right ventricular; VTI = velocity time integral. *Low level of vasopressor/inotropes refers to norepinephrine ≤0.03 μg/min/kg and dobutamine ≤5 μg/min/kg.

Figure 5. Treatment strategy according to the INTERMACS profile.

ECMO = extracorporeal membrane oxygenation; INTERMACS = Interagency Registry for Mechanically Assisted Circulatory Support; LVAD = left ventricular assist device; NYHA = New York Heart Association; MCS = mechanical circulatory support.

Figure 6. Diagnostic approach to suspected acute HF.

BNP = brain natriuretic peptide; CAG = coronary angiography; CT = computed tomography; HF = heart failure; NT-pro-BNP = N-terminal pro-B-type natriuretic peptide; US = ultrasound. *Blood tests include troponin, serum creatinine, electrolytes, blood urea nitrogen, thyroid stimulating hormone, liver function test, d-dimer, procalcitonin, arterial blood gas analysis, lactate. ^†Coronary angiography can be performed if acute coronary syndrome is suspected, and chest CT if pulmonary embolism is suspected.

Figure 7. Therapeutic algorithm of acute HF.

HF = heart failure; MCS = mechanical circulatory support; RRT = renal replacement therapy; SBP = systolic blood pressure.