JACC Heart Failure Editor's Update, June 2019
June 2019 JACC: Heart Failure—Focus Issue: Heart Failure Etiology and Outcomes
"Like Fire and Fury"—in a state-of-the-art review, Jon Piccini and colleagues examine alternate approaches to rate and rhythm control in patients with heart failure and atrial fibrillation. The authors discuss the epidemiology and pathophysiological link between heart failure and atrial fibrillation, with a focus on clinically relevant factors including the role of inflammation. They summarize the results of recent clinical trials that studied medical therapy, catheter ablation and cardiac resynchronization therapy for the treatment of heart failure patients with atrial fibrillation and identify questions to be answered through further research. Read their in-depth analysis of this interaction.
Heart Failure and Atrial Fibrillation, Like Fire and Fury
Matthew A. Carlisle, Jonathan P. Piccini, et al.
Do women have different outcomes than men following mitral valve surgery for severe ischemic mitral regurgitation (SIMR)? Gennaro Giustino and colleagues analyzed data from the Cardiothoracic Surgical Trials Network (CTSN) SIMR study, which compared the effectiveness of replacing versus repairing the mitral valve for SIMR patients, to determine if there were sex-based differences in baseline characteristics and outcomes, including survival, major adverse cardiovascular and cerebrovascular events (MACCE) and quality of life following surgery.
Ischemic vs. non-ischemic heart failure: what is the significance? Juarez Braga and colleagues examined the role and prognostic value of non-obstructive coronary artery disease in heart failure. Heart failure patients for whom the underlying etiology is coronary artery disease are classified as ischemic, at higher risk, and, therefore, treated more aggressively. The established practice of categorizing heart failure patients as ischemic versus non-ischemic combines those with non-obstructive coronary artery disease with those with normal coronary arteries. This study looks at the relative risk of death, MI, stroke or hospitalization for heart failure patients with non-obstructive coronary artery disease versus those with normal coronary arteries.
Importance of Nonobstructive Coronary Artery Disease in the Prognosis of Patients With Heart Failure
Juarez R. Braga, Douglas S. Lee, 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 what we know from their publications and extensive work. This month we feature Dr. Jay Cohn, who has made enormous contributions to our understanding of pathophysiology of cardiovascular disease through his innovative research in the areas of hypertension, shock, acute myocardial infarction, and heart failure. His recent efforts have focused on a new approach to recognize the functional and structural markers of early cardiovascular disease to allow the introduction of effective therapy to slow its progression. He is the “Founding Father” of HFSA and was the first Editor of the Journal of Cardiac Failure.
We asked Dr. Cohn how he became interested in heart failure, what he sees as his major achievements and his sources of inspiration. Here is his response:
I became interested in heart failure because it was a common and always terminal disease process for which in the 1960s and 1970s we had no effective treatment. I was convinced that if we understood the disease process and the mechanisms of its progression, we could develop effective treatments. We began studying patients with heart failure to document the abnormalities of cardiac and vascular function and the neurohormonal mechanisms that appeared to be activated.
I am most proud of our demonstration of the unexpectedly favorable effects of vasodilator drugs that reduce impedance to left ventricular ejection and of our documentation of the contributory role of neurohormonal activation on the pathophysiologic process in the left ventricle. In recent years I have focused on my goal of preventing heart failure and other cardiovascular illnesses by understanding the long-term vascular and cardiac processes that precipitate these symptomatic diseases, and by developing interventions that can slow disease progression and delay the appearance of symptoms and morbid events.
What inspires me every day is the belief that all endeavors—whether scientific, societal, or athletic—are best based on understanding the fundamental mechanisms of the problem one confronts. Developing tools to address these perceived mechanisms and testing the effectiveness of these interventions should underpin all our efforts to improve welfare of people and of society. I have taken this approach to improving my golf swing (with mixed results) as well as to improving the management of hypertension and cardiovascular disease. Societal problems, however, are currently too steeped in political conflict to make this mechanistic approach viable. I share the hope of many that the search for practical solutions based on mechanistic insight can be restored.
3 Things People May Not Know About Me
- I have in recent years published two trade books which are available on Amazon: (Saving Sam: Drugs, Race, and Discovering the Secrets of Heart Disease and Cardiovascular Health: How Conventional Wisdom Is Failing Us). These have allowed me to express my opinions more openly than is possible in the medical literature.
- I will be retiring from the University of Minnesota next year, shortly after my 90th birthday.
- My wife Syma and I still live in the same house we bought when we arrived in Minneapolis in 1974. We also have a condo on Longboat Key, FL, where we spend the cooler months and enjoy the culture, arts, music, golf, tennis and beaches of Sarasota.
Dr. Cohn is internationally recognized for his seminal contributions to our understanding of pathophysiology of cardiovascular disease and for his innovative research into modernization of the treatment of hypertension, shock, acute myocardial infarction and heart failure. His recent efforts have focused on a new approach to recognize the functional and structural markers of early cardiovascular disease in order to introduce effective therapy aimed at slowing its progression. He is a Master of the American College of Physicians and a Fellow of the American Heart Association, the American College of Cardiology, and the American Association for the Advancement of Science. He has received awards for his pioneering research from the American Heart Association, the American College of Cardiology, the High Blood Pressure Research Council, the American Society of Hypertension, the Heart Failure Society of America, the International Academy of Cardiovascular Sciences, the Arrigo Recordati International Foundation, Cornell University Medical School, and the University of Minnesota Academic Health Center. He founded and served as the first president of the Heart Failure Society of America and has served as president of the American Society of Hypertension, the International Society of Hypertension, and the International Society of Cardiovascular Pharmacotherapy. He is the author of over 750 peer-reviewed publications, is the co-editor of the major medical textbook, Cardiovascular Medicine, and is the author of two trade books: Saving Sam: Drugs, Race, and Discovering the Secrets of Heart Disease and Cardiovascular Health: How Conventional Wisdom Is Harming Us. He holds numerous patents on diagnostic and therapeutic discoveries in cardiovascular medicine.
Call for Papers: Heart Failure in the Elderly
Heart failure is a significant global epidemic; however, in the elderly, there may be differences in treatment effects, treatment options, epidemiology, pathophysiology, risk factors, and outcomes. JACC: Heart Failure is focusing on the growing body of literature with a special issue on this topic. In line with our commitment to advance scientific understanding and patient care, we will publish a uniquely themed issue to highlight this emerging theme.
Topics spanning this theme will be considered, including epidemiology, diagnosis and prognosis, short- and long-term outcomes, clinical management, phenotyping, emerging therapies, comorbidities, the role of biomarkers, and other relevant issues.
How will this process work?
- We welcome papers addressing the broad topic of "Heart Failure in the Elderly" – these can be in the form of original research, clinical trials, meta-analysis, or position statements from societies or advocacy groups. Other formats will be considered if sufficiently rigorous and impactful.
- Interested authors should submit their papers via http://www.jaccsubmit-heartfailure.org on or before August 1, 2019. When entering manuscript information, please select "Heart Failure in the Elderly" from the "Special Issues" pull-down menu in the Keywords, Categories, Special Sections tab.
- We plan for the final publication to appear in the December 2019 issue of JACC: Heart Failure. Please see instructions to authors on the Journal webpage (http://heartfailure.onlinejacc.org).
- Accepted papers will also be displayed on the JACC: Heart Failure website in an “online before print” format.