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Advanced Heart Failure — EECC MCQ

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HardHeart FailureAdvanced Heart FailureEECC

A 52-year-old man with non-ischaemic DCM (LVEF 18%) has been on maximal GDMT for 6 months. Despite CRT-D implantation 4 months ago, he remains NYHA class IIIb-IV with recurrent hospitalisations. His peak VO2 is 10 mL/kg/min. He has persistently elevated filling pressures (PCWP 28 mmHg). His BMI is 30 kg/m2, eGFR 48 mL/min/1.73 m2, and PVR 3.2 Wood units. What is the most appropriate next management step?

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Correct answer: A — Referral for cardiac transplantation assessment

Explanation lettering: E = shown as B · B = shown as C · C = shown as E

This patient has advanced heart failure (Stage D) refractory to optimal medical and device therapy. With a peak VO2 of 10 mL/kg/min, recurrent hospitalisations, and persistently elevated filling pressures, he meets criteria for advanced HF therapies. The 2021 ESC HF Guidelines recommend assessment for cardiac transplantation as the gold-standard treatment for end-stage HF (Class I). His PVR of 3.2 WU is within acceptable limits. LVAD (C) may be considered if transplant is not feasible. Long-term inotropes (B) and intermittent levosimendan (D) lack strong evidence. Palliative care (E) should be considered alongside active treatment.

Reference: ESC (2021): Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure