Survival and quality of life improved significantly with the dramatic changes of heart failure (HF) treatment in the last decades (1). An unanticipated consequence of this favorable development is the emergence of a patient population increasingly refractory to standard HF treatment. This paradox relates to the fact that none of the currently available drugs or devices completely silences HF disease or protects from the occurrence of new episodes of myocardial damage, the development of cardiorenal syndrom or right heart failure.