Abstract
Supplement Aims and Scope
The supplement aims to provide readers with an exploration of recent advances in research on and treatment of heart failure. This includes but is not limited to the following topics
Pathophysiology Evaluation Management Diagnosis Prognosis Treatment Screening Prevention Epidemiology Risk factor modification Systematic reviews Observational studies Commentary on clinical trials Risk and safety of medical interventions Epidemiology and statistical methods Evidence-based medicine Evaluation of guidelines Translational medicine
Article types include original clinical and basic research articles, case reports, commentaries, meeting reports, methodology, perspective, research proposal, reviews, software/database reviews, and technical advance.
Common etiological mechanisms of heart failure include coronary ischemia, valvular disease, hypertension, and diastolic dysfunction. Yet, other causes include: post-partum cardiomyopathy, post-infectious, chronic tachycardia, metabolic dysregulation, adverse medication side effects (particularly adriamycin chemotherapy), orphan disease Duchenne's Muscular Dystrophy, infiltrative diseases (such as amyloidosis), and inflammatory/connective tissue diseases (such as systemic lupus erythematosus). When known causes of heart failure are excluded then heart failure is classified as idiopathic. Less often studied versus chronic heart failure, is acute decompensated heart failure associated with abrupt-onset symptoms associated with hospitalization. Nearly half of admitted patients with heart failure have preserved ejection fraction.2,3
Survival among heart failure patients long-term may be improved with β-blockers, 4 angiotensin converting enzyme inhibitors, 5 aldosterone antagonists, 6 electrophysiology devices such as automatic implantable cardiovascular defibrillators, and vasodilators. Other drugs such as digoxin and diuretics do not alter death rates–digoxin reduces hospitalizations, while diuretics (furosemide or lasix) improve symptoms.
Another aspect of heart failure is diastolic dysfunction with preserved left ventricular ejection fraction, accounting for half of hospitalizations. Pathophysiologically, there is concentric remodeling and increased left ventricular end diastolic pressure from a stiff left ventricle, thereby preventing relaxation. Medications for diastolic dysfunction are similar to systolic dysfunction: ACE inhibitors, ARBs, diuretics, and β-blockers. 7
Left ventricular assist devices (LVADs) as both a bridge to heart transplantation or as a destination unto itself have been developed. Limitations to LVADs entail gastrointestinal bleeding, pump thrombosis, driveline infection, and late right heart failure and aortic insufficiency. Cardiac transplantations are limited by a relatively small annual donor pool (<4000) 8 and 60% five-year survival. 9
Notable manuscripts in this supplement to
Dr. David Bejar and colleagues review sundry abnormal substances which may infiltrate the heart to lead to “Infiltrative Cardiomyopathies” as a prelude to heart failure. While Fabry Disease necessitates enzyme replacement with α-galactosidase A, other diseases like hemochromatosis warrant phlebotomy and deferoxamine, and AL cardiac amyloid may respond to bortezomib, yet other etiologic mechanisms are incurable, leading to heart transplantation. 11
An overlooked topic relates to geriatrics, so in regard to heart failure, Drs. Deena Goldwater and Sean Pinney bring up for discussion “Frailty in Advanced Heart Failure: A Consequence of Aging or a Separate Entity?” With the prevalence of frailty higher at 20% of the heart failure population versus 10% in a matched aged cohort, the molecular mechanisms underpinning these differences warrant investigation. 12
As a complementary article to the mechanical support reviews noted
Finally, I would like to comment on “Reversible Cardiomyopathies” by Dr. Harsh Patel and co-authors, which reminds us to search the treatable, such as Sympathoexcitation-Induced Takotsubo Cardiomyopathy due to excess catecholamines from autonomic dysfunction. Despite spontaneous reversibility aided with beta-blockers and angiotensin converting enzyme inhibitors, heart recidivism rates are 11.4% at 4 years. 14
We are fortunate to be practicing at an exciting time for the profession of medicine–an era of rapid evolution in technology and knowledge-base in basic science. What this may hold for the short-term treatment of heart failure remains to be seen, but ultimately the goal will be to help us improve upon current practice. Bioinformatics, computational biology, genomics, proteomics, metabolomics, pharmacology, and quantitative epidemiology may be part-and-parcel of the next issue of “Heart Failure: An Exploration of Recent Advances in Research and Treatment.”
Footnotes
Lead Guest Editor
Guest Editors: ALLISON MCLARTY: Dr Allison McLarty is an Associate Professor, Department of Surgery, and Co-director of the Ventricular Assist Device Program at Stony Brook Medicine. She completed her MD at Columbia University and has previously worked at the Mayo Clinic and Columbia-Presbyterian Medical Center. She now works primarily in cardiac diseases, cardiac surgery, esophageal diseases and lung cancer. Dr McLarty is the author or co-author of 20 published papers.
Dr Hal Skopicki is an Assistant Professor, Department of Internal Medicine, Director, Heart Failure and Cardiomyopathy Program, and Co-director, Ventricular Assist Device Program at Stony Brook Medicine. He completed his MD at The Chicago Medical School and has previously worked at Yale-New Haven Hospital and Massachusetts General Hospital. He now works primarily in treatment of cardiovascular diseases. Dr Skopicki is the author or co-author of 27 published papers.
Dr Michelle Bloom is an Assistant Professor at the Department of Internal Medicine at Stony Brook Medicine. She completed her MD at the University of Medicine and Dentistry of New Jersey and has previously worked at Albert Einstein College of Medicine and Mt. Sinai Medical Center. She now works primarily in cardiovascular disease, heart failure and transplant cardiology. Dr Bloom is the author or co-author of 4 published papers.
Dr Rita Jermyn is an Assistant Professor at Hofstra North Shore-LIJ School of Medicine. She completed her MD at SUNY Upstate Medical University and has completed her training at Baylor College of Medicine, SUNY Stony Brook, and Montefiore Medical Center. She now practices as a cardiologist specifically within heart failure and transplant. Dr Jermyn is the author or co-author of 5 published papers and has presented at 3 conferences in the 2014-2015 academic year, including HFSA and ACC.