Kanu Chatterjee Receives 2009 HFSA Lifetime Achievement Award ...

Heart Failure Society News December 2009
Highlights from the 13th Annual Scientific Meeting
Opening Session – Personalized Medicine: The Dawn of a New Era
The Opening Plenary session presented
three different perspectives on the
application of genetic information and
testing to better understand complex
human disease and personalize
medicine. David A. Schwartz (Denver,
CO), an expert on pulmonary disease,
addressed the role of the epigenome
in the development of disease. One
important aspect of personalized
medicine is how the environment is
altering biology and therefore affecting
the risk of developing disease. Schwartz
explained that the field of epigenetics
concerns the mechanisms that control
gene regulation and transcription. These
epigenetic mechanisms can be altered by the
environment or inherited from one generation
to the next. The goal is to measure these
epigenetic marks in patients and use them
to identify individuals who may respond to
certain medications.
Atul J. Butte (Palo Alto, CA) discussed
translational bioinformatics. There are now
approximately 350,000 publicly available
microarrays, a number that should double or
triple each year. This easily-searched data is
leading to a new taxonomy of disease based
on genomics.
David E. Duncan, a journalist, (Berkley,
CA) anchored the session by recounting
his experiences in the “Experimental
Man” project in a talk, “One Man’s Quest
for Personalized Medicine.” The project
involved taking 320 tests, including
genetic and gene expression tests that
required having 2 liters of blood drawn
and undergoing 22 hours of MRI scans.
Baseline testing showed that Duncan was
a healthy 51-year-old male. However,
a battery of genetic tests indicated that
Duncan was at a lifetime risk for several
illnesses or events, including myocardial
infarction and addiction. He learned
he had a greater tolerance for caffeine,
had a greater propensity for risk taking, and
showed a high exposure to DDT. Duncan
said his experiences underscored the need
to standardize and organize the information
better, since different companies showed
different results.
Oliver Smithies, PhD receiving 3rd Distinguished
Lecture in Basic Science
Excellence in Basic Science
Oliver Smithies, PhD, co-recipient of the
2007 Nobel Prize in Physiology or Medicine
for work on gene modifications in mice
through the use of embryonic stem cells,
delivered the 3rd Distinguished Lecture in
Basic Science. Following Smithies’ lecture
were presentations on the current role of
mouse models in cardiovascular research,
current research in cardiac transgenesis, and
the implications of biased signaling by G
protein-coupled receptors for the treatment
of patients with heart failure. The Special
Sunday Session is the kick off for the basic
science component of the annual meeting, and
always features excellent speakers that attract
a large audience.
Insights from Recent Trials and Registries
Key data and new insights from 4 recent
trials and registries of heart failure therapies
were discussed in a session focusing on
implications for patient care. James K.
Kirklin (Birmingham, AL) presented on the
INTERMACS registry; David J. Whellan
(Philadelphia, PA) presented HF-ACTION;
Peter E. Carson (Washington, DC) discussed
the I-PRESERVE trial; and Eric J. Velazquez
(Durham, NC) presented the STICH trial.
INTERMACS is a U.S. national registry for
patients receiving mechanical circulatory
support therapy for advanced heart failure.
Registry data indicates that the strategy is
increasingly to implant a temporary device
before the patient is in cardiogenic shock
and to do it as an elective procedure. Patients
with an isolated LVAD have the best survival.
However, there are still issues with long-term
survival, and destination therapy currently does
not look favorable. There is a clear movement
from pulsatile to axial flow pumps.
Most patients enrolled in ACTION-HF did not
meet the exercise goal, but approximately 30%
achieved or surpassed the target. When the
results were adjusted for baseline prognostic
factors such as EF, atrial fibrillation, and
depression, there was a significant benefit, with
greater exercise resulting in a greater benefit
in terms of the primary end point. The study
clearly demonstrated that exercise training for
heart failure patients is safe.
Approximately 50% of patients with heart
failure have an ejection fraction of at least
45%, but no pharmacological therapies have
been shown to improve outcomes. Irbesartan
did not improve outcomes in patients in
the I-PRESERVE trial. Although mortality
in the study was substantial, the change in
Minnesota Living with Heart Failure scores
was favorable.
One of the objectives of the STICH trial was
to compare surgical ventricular reconstruction
(SVR) in addition to a coronary artery
bypass graft (CABG) procedure to CABG
alone. Results of the randomized study of
1,000 patients found no differences between
the 2 groups in death or cardiovascular
hospitalization.
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