JACC Heart Failure Editor's Update, August 2019
August 2019 JACC: Heart Failure—Mini-Focus Issue: Prevention and Lifestyle Intervention
Is there a simple way to prevent heart failure? A favorable AHA Life’s Simple 7 (LS7) lifestyle score reduces the risk but is not so simple to achieve. Will minor lifestyle improvements bring better results? Alicia Uijl et al looked at the prevalence and association of the LS7 score with Heart Failure in the EPIC-NL (European Prospective Investigation into Cancer and Nutrition—Netherlands) database to determine if modest lifestyle improvements, such as reducing one or two LS7 components could decrease risk of heart failure.
Risk for Heart Failure: The Opportunity for Prevention With the American Heart Association's Life's Simple 7
Alicia Uijl, Ivonne Sluijs, et al.
Does malnutrition predict adverse events in HFpEF patients? Masatoshi Minamisawa and colleagues analyzed the relationship between malnutrition and adverse outcomes among the American enrollees in the TOPCAT trial. This study contributes to our understanding of HFpEF and provides additional and welcome insight relative to this patient population.
Impact of Malnutrition Using Geriatric Nutritional Risk Index in Heart Failure With Preserved Ejection Fraction
Masatoshi Minamisawa, Scott D. Solomon, et al.
Obesity in HFpEF patients is associated with more severe symptoms, and hemodynamics play a major direct role in the pathophysiology of HFpEF, but the effect of weight loss on directly measured hemodynamics has not been studied. Yogesh N.V. Reddy et al conducted a systematic review and meta-analysis of invasive hemodynamic changes as a result of therapeutic weight loss interventions in obese patients without HF and point the way to studies of weight loss strategies as treatment options for obese patients with HFpEF.
Hemodynamic Effects of Weight Loss in Obesity: A Systematic Review and Meta-Analysis
Yogesh N.V. Reddy, Barry A. Borlaug, et al.
The impact of exercise-based cardiac rehabilitation (ExCR) on hospitalization, quality of life, and other outcomes for heart failure patients is examined through an update of the 2014 Cochrane Review of ExCR for Heart Failure. This updated analysis by Rod S. Taylor and colleagues includes 11 additional trials that encompass a broader base of types of heart failure and heart failure patient characteristics. The effectiveness of home based versus center-based programs was also reviewed.
Exercise-Based Rehabilitation for Heart Failure: Cochrane Systematic Review, Meta-Analysis, and Trial Sequential Analysis
Rod S. Taylor, Ann-Dorthe Zwisler, et al.
Heart Failure Hall of Fame—Getting to Know the Pioneers Who Inspire Us
Our Heart Failure Hall of Fame series brings information about leaders in the field of heart failure beyond their publications and extensive work. This month we feature Dr. Michel Komajda. He is a Past President of the European Society of Cardiology (ESC) and has served in several key positions for ESC and the French Society of Cardiology and is a member of the editorial boards of the European Heart Journal, European Journal of Heart Failure, and Circulation. His main fields of interest are pharmacology of heart failure, neuro-hormones in heart failure, and genetics of dilated and hypertrophic cardiomyopathy
What first made you interested in a career in heart failure?
When I was resident, I saw many young patients with idiopathic dilated cardiomyopathy. Some of them could benefit from a heart transplant but many died in end-stage heart failure and I was very frustrated by this situation. Then we started to test captopril, the first-in-class ACE inhibitor in the early 80s, and this changed dramatically the outcome of some of these patients. This is how I got more and more interested in the diagnosis and the management of heart failure. And I have to say that I lived at an exciting period of time with the development of ACE I then beta blockers—which reverted entirely the paradigm of what we were taught as students, i.e., never use beta blockers in heart failure. Subsequently we saw the benefit of other classes including ARBs, mineralocorticoid receptor antagonists, ivabradine, and recently sacubitril valsartan. So, we have been very fortunate to use all these agents in heart failure with reduced ejection fraction. However, there are two areas of frustration since we made no or little progress: HF with preserved ejection fraction and acute heart failure
Which of your many accomplishments are you most proud of?
I am proud to have developed in my institution the first structure on cardiogenetics in France dedicated to diagnosis, management, and genetic counselling of patients who have familial cardiomyopathies (either hypertrophic or dilated). Also, to have been part of the largest national center for heart transplant.
Who inspires you, in your career or otherwise?
My mentor, Prof. Yves Grosgogeat, who advised me to get interested in cardiomyopathies and always supported me in my career with benevolence and friendship; Eugene Braunwald because he is the symbol of modern cardiology and watching him participating in meetings is a source of inspiration; Christian Cabrol, the pioneer of heart transplantation in Europe, because he had the courage to continue although early results were appalling because of the lack of immunosuppressive drugs.
What is your favorite, or last book you read?
The Plague by Albert Camus because it resonates very much with the troubled world that we are living nowadays.
3 Things People May Not Know About Me
- Classical music
More about Dr. Komajda
Michel Komajda was Professor of Cardiology at the University Pierre et Marie Curie–Paris VI/Hospital Pitié Salpétrière, Paris, France from 1990 to 2017 and was Head of the Department of Cardiology, Pitié Salpêtrière Hospital (Paris) and of the cardio-metabolic division (2006-2014).
He is consultant in the Department of Cardiology Saint Joseph Hospital in Paris, and a member of the research Unit INSERM UMRS 1166, of the Institut Hospitalo-Universitaire ICAN.
He is member of the Académie Nationale de Médecine since 2012 and chair of the Board of the Fondation Coeur et Recherche since 2014.
His main fields of interest are pharmacology of heart failure, neuro-hormones in heart failure, and genetics of dilated and hypertrophic cardiomyopathy.
He was President of the European Society of Cardiology in 2010–2012 and occupied several key positions including Vice President of the ESC Working Groups, Association and Councils (2006-2008), and Chairman of the ESC Programme Committee in 2005–2006 in the ESC. He was also Co-Chairman on the “Euro Heart Failure Survey I” and Member of the Executive Committee of “Euro Heart Failure Survey II” Programmes.
He also served as Treasurer and General Secretary of the French Society of Cardiology and President of that Society in 2002-2003. He is member of the editorial boards of European Heart Journal, European Journal of Heart Failure, and Circulation.
Michel Komajda is the author of over 300 peer-reviewed papers, mostly in heart failure, and has collaborated in several steering, executive committees, adjudication committees, or DSMBs of international trials on heart failure and cardiovascular diseases (CARMEN, COMET, I-PRESERVE, HEAAL, RECORD, CORONA, SHIFT, PARADIGM HF, PARAGON, PARALLEL, RELAX AHF 2, PARADISE, COLCOT).