JACC: Heart Failure Editor's Update, August 2018
AUGUST 2018 SPECIAL ISSUE: HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFpEF)
The issue begins with an Expert Scientific Panel that brought together stakeholders from industry, academia, FDA, and other agencies to review existing understanding, controversies, and gaps in evidence related to HFpEF. This paper highlights the issues faced in designing much-needed clinical trials in this space. The summary of their discussion illustrates the importance of the insights and unique perspectives of each of these stakeholders when designing studies to lead to optimal care. This is an excellent initial step to add to our understanding of a condition with no known specific therapy. Let’s keep the conversation going #DCRIThinkTank #HFpEF #JACCHF.
Heart Failure With Preserved Ejection Fraction Expert Panel Report: Current Controversies and Implications for Clinical Trials
Kishan S. Parikh, Kavita Sharma, et al
Does the specific location of adipose tissue in older obese HFpEF patients matter? Mark Haykowsky and his colleagues analyzed the impact of body composition on exercise intolerance to identify areas of fat to target as a means of improving quality of life for these patients. Prior studies have focused on the mechanical burdens on the heart caused by HFpEF and obesity, but cardio-centric therapies have not been successful. The novel approach of targeting regional adipose deposits advances our knowledge of the complex interactions of body composition, aging and cardiovascular disease.
Regional Adipose Distribution and its Relationship to Exercise Intolerance in Older Obese Patients Who Have Heart Failure With Preserved Ejection Fraction
Mark J. Haykowsky, Barbara J. Nicklas, et al
In a State-of-the-Art Review, Milton Packer and Dalane Kitzman outline the mechanistic framework for a potential role for novel pharmacotherapy and combination therapy in the treatment of obesity-related heart failure with HFpEF as a distinct phenotype. Large-scale clinical trials are pointing to the potential for using mineralocorticoid receptor antagonists, neprilysin inhibitors, and SGLT2 inhibitors (alone or in combination) in the management of obesity-related HFpEF. This paper explores the underlying mechanisms of this disease and provides insight to help guide research aimed at treating this particular subset of HFpEF patients.
Obesity-Related Heart Failure With a Preserved Ejection Fraction: The Mechanistic Rationale for Combining Inhibitors of Aldosterone, Neprilysin, and Sodium-Glucose Cotransporter-2
Milton Packer, Dalane W. Kitzman
Sudden death accounts for a high percentage of deaths in global trials of HFpEF patients, according to this analysis from TOPCAT by Muthiah Vaduganathan, Scott Solomon and others. Can information about the profile of these patients be useful in predicting and attenuating the risk of sudden death? The authors look at data from TOPCAT to determine the potential for developing risk stratification models. Peter Carson provides a highly informative analysis.
Sudden Death in Heart Failure With Preserved Ejection Fraction: A Competing Risks Analysis From the TOPCAT Trial
Muthiah Vaduganathan, Brian L. Claggett, et al
What is the incidence of HFpEF versus HFrEF associated with obesity and cardiometabolic traits? These data provide additional information for use in creating strategies to identify, target, and prevent these disease progression.
The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF
Nazir Savji, Wouter C. Meijers, et al
MEET ASSOCIATE EDITOR Hector Ventura
I previously shared some information about our Deputy Editors. It is now my pleasure to focus on Associate Editor Hector Ventura. Dr. Ventura’s expertise in comorbidities, such as obesity and hypertension, and his knowledge of the history of heart failure are invaluable to our discussions and deliberations. We can always count on Hector to bring humor and a lot of commentary (sometimes in Spanish) to our deliberations.
He attended medical school at National University of Buenos Aires School of Medicine and did his Internal Medicine training and Cardiovascular Disease Fellowship at Ochsner. He is currently Section Head, Advanced Heart Failure/Heart Transplant at the Ochsner Heart and Vascular Institute, and Professor of Medicine, Ochsner Clinical School--The University of Queensland School of Medicine in New Orleans.
He is active in national and international medical societies, serves on 21 editorial boards and is Editor-in-Chief of the journal, Current Problems in Cardiology.
3 Things People May Not Know about Me:
- I love soccer but wasn’t good at it; so, at the age of 20, I played division 1 basketball. My Dennis Rodman–type antics on the court were not appreciated however, and resulted in my being expelled from games several times.
- During medical school I had a band that played folklore music from Argentina. If being a doctor hadn’t worked out, I would have become an actor, dancer, or performer specializing in that very special type of Argentinian music.
- I have written some historical novels and becoming a novelist would have been another possible alternate career choice.
Those of you who know Hector personally know that, with a little encouragement, he will sing Broadway, Bocelli, or Sinatra favorites, and I am happy to say that he always honors my personal request for “Somewhere Over the Rainbow”.