With Liemena Harold Adrian, Syarifah Ambami Rato Ebu General Academic Hospital, Surabaya - Indonesia and Shelley Zieroth, St. Boniface Hospital, Winnipeg - Canada.

In this episode, Liemena Harold Adrian and Shelley Zieroth discuss heart failure in post–myocardial infarction patients, covering how myocardial infarction leads to the development of heart failure despite advances in reperfusion and acute care. The conversation addresses the epidemiology and underlying pathophysiology, approaches to early prevention and screening, diagnostic tools, as well as key interventions in the acute and early post-MI phases that may alter heart failure trajectories. They outline management with guideline-directed medical therapy, review current studies on heart failure–modifying therapies (such as the DAPA-MI and EMPACT-MI trials), and address indications for advanced therapies in post-MI populations. The episode also highlights the importance of early diagnosis, prompt recognition, and key evidence gaps in the field.

Recommended readings:

• Akhtar KH, Khan MS, Baron SJ, et al. The Spectrum of Post-Myocardial Infarction Care: From Acute Ischemia to Heart Failurehttps://doi.org/10.1016/j.pcad.2024.01.017. Prog Cardiovasc Dis. (2024); 82: 15-25. DOI: 10.1016/j.pcad.2024.01.017.
• Butler J, Hammonds K, Talha KM, et al. Incident Heart Failure and Recurrent Coronary Events Following Acute Myocardial Infarctionhttps://doi.org/10.1093/eurheartj/ehae885. Eur Heart J (2025); 46: 1540-50. DOI: 10.1093/eurheartj/ehae885.
• Butler J, Jones WS, Udell JA. Empagliflozin after Acute Myocardial Infarction. N Engl J Med (2024); 390: 1455-66. DOI: 10.1056/NEJMoa2314051.
• Fioretti F, Butler J, Udell JA, et al. Empagliflozin after myocardial infarction with or without diabetes and chronic kidney disease: Insights from EMPACT-MI. ESC Heart Failure (2025); 12: 3940-3952. DOI: 10.1002/ehf2.15393.
• Hernandez AF, Udell JA, Jones WS. Effect of Empagliflozin on Heart Failure Outcomes After Acute Myocardial Infarction: Insights From the EMPACT-MI Trial. Circulation (2024); 149: 1627–1638. DOI: 10.1161/CIRCULATIONAHA.124.069217.
• Jenca D, Melenovsky V, Stehlik J, et al. Heart Failure after Myocardial Infarction: Incidence and Predictors. ESC Heart Failure (2021): 8: 222-237. DOI: 10.1002/ehf2.13144.
• Lala A, Beavers C, Blumer V, et al. The Continuum of Prevention and Heart Failure in Cardiovascular Medicine: A Joint Scientific Statement from the Heart Failure Society of America and The American Society for Preventive Cardiology. Journal of Cardiac Failure (2026); 32: 75-105.
• Petrie MC, Udell JA, Anker SD, et al. Empagliflozin in Acute Myocardial Infarction in Patients with and without Type 2 Diabetes: A Pre-specified Analysis of the EMPACT-MI Trial. Eur J of Heart Fail. (2025): 27: 577-588. DOI: 10.1002/ejhf.3548.
• Zieroth S, Rizi SS. Time Is of the Essence. JACC: Heart Failure (2023): 11(6): 713-714. DOI: 10.1016/j.jchf.2023.03.022

"This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsors."

With Felix Lindberg, Karolinska Institutet & Södersjukhuset Hospital, Stockholm – Sweden and Marianna Fontana, National Amyloidosis Center, University College London, London – UK.

In this episode, Felix Lindberg and Marianna Fontana discuss the evolving landscape in the treatment of cardiac amyloidosis. After exploring the pathophysiology of cardiac AL and ATTR amyloidosis and recent years' insights about the epidemiology of these conditions, they focus on the transformation that has occurred in the therapeutic options for cardiac ATTR amyloidosis. The conversation addresses the key mechanistic differences and trial data on stabilizers and silencers, how to approach patient selection for these therapies, as well as emerging therapies including anti-amyloid antibodies. The discussion also highlights the importance of early diagnosis and key red flags that should elicit suspicion of cardiac amyloidosis.

• Vutisiran in patients with transthyretin amyloidosis with cardiomyopathy. Fontana M, et al. N Engl J Med. 2025.
• Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. Maurer M, et al. N Engl J Med. 2018.
• Efficacy and safety of acoramidis in tranthyretin amyloid cardiomyopathy. Gillmore JD, et al. N Engl J Med. 2024.
• CRISPR-Cas9 gene editing with nexiguran ziclumeran for ATTR cardiomyopathy. Fontana M, et al. N Engl J Med. 2024.
• Conventional heart failure therapy in cardiac ATTR amyloidosis. Ioannou A, et al. Eur Heart J. 2023.
• Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Gillmore JD, et al. Circulation. 2016.
• Current landscape of therapies for transthyretin amyloid cardiomyopathy. Griffin JM, et al. JACC Heart Fail. 2025.
• Transthyretin amyloid cardiomyopathy: from cause to novel treatments. Fontana M, et al. Eur Heart J. 2026.
• Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC Working Group on Myocardial and Pericardial Diseases. Garcia-Pavia P, et al. Eur Heart J. 2021.

This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsor.

With Maria Tereza Sampaio de Sousa Lira, Federal University of Pernambuco - Brazil and Anja Zupan Meznar, University Medical Centre Ljubljana - Slovenia.

This episode will discuss when conduction system pacing (CSP) may be the appropriate pacing strategy for heart failure patients, particularly those with pacing-induced dyssynchrony or suspected pacing-induced cardiomyopathy (PICM).

Key talking points include:

• Clinical clues and diagnostic approach to PICM

• Differentiating PICM from other causes of LV dysfunction

• When to consider CRT upgrade in pacemaker patients

• Insights from the BUDAPEST-CRT upgrade trial

• Advantages and limitations of CSP (His-bundle and left bundle branch pacing)

• Practical take-home message for clinicians managing HF patients with pacemaker

This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsors.