EDITED AND REVIEWED BY
Syamal K. Bhattacharya,
University of Tennessee Health Science Center
(UTHSC), United States
*
CORRESPONDENCE
Matteo Cameli
Federico Landra
RECEIVED 23 August 2023
ACCEPTED 01 September 2023
PUBLISHED 11 September 2023
CITATION
Cameli M and Landra F (2023) Editorial: Case
reports in heart failure and transplantation:
2022.
Front. Cardiovasc. Med. 10:1282064.
doi: 10.3389/fcvm.2023.1282064
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Editorial: Case reports in heart
failure and transplantation: 2022
Matteo Cameli
*
and Federico Landra
*
Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
In this editorial we summarize the most viewed and downloaded contributing
articles to the Research Topic “Case Reports in Heart Failure and
Transplantation: 2022” of the journal Frontiers in Cardiovascular Medicine.
KEYWORDS
heart failure, heart transplant, takotsubo, genetic, devices, advanced heart failure
Editorial on the Research Topic
Case reports in heart failure and transplantation: 2022
The adjunctive value of genetic testing
Even though it may be difficult to glean interpretable results i n the absence of a
specific clinical suspicion, nowadays genetic testing has largely est abli shed as a
fundamental tool both in the diagnostic workflow and risk st rat i fication of a great
variety of cardiac diseases. A similarrevolutioninthecardiovascularfield has be en
recognized with the introduction of cardiac magnetic resonance, which brought the
possibility to unveil structural abnormalities with out th e need of a histological
specimen. However, tissue alterations are only the epiphenomenon of an unde rlying
pathological process and we sometimes fail to g o beyond the ultrastructural
understanding. In this context, genetic testing may help identifying the missing link
piece, finally le ading to a comprehensive characterization o f the pathological
process. This is the c ase of the patient reported by Liu X et al. which eventually
appeared to be affected by a rare desmin myopathy. Diagnosis was only possible
with the aid of genetic testing, which identified a missense mutation (c.1366G > A)
in the desmin gene, and immunohistochemical staining confirmed desmin
deficiency. Clearly, we are still far from tailored therapies for each genetic disease,
so one could argue what is the adjunctive value o f such pathological understanding.
Heart failure and arrhythmia treatments would have been initiated irrespective of
the diagnosis of desmin myopathy. However, being able to call a pathological entity
by its name and its genetic underpinning give us the chance not only to focus
more specifically on its peculiar characteristics, such as, for instance, conduction
disturbances occurrence in the c ase of desmin myopathy, but also to diagnose the
disease in a preclinical form in patient’s relatives. In addition, the well-known
advent of the precision medicine can cast the light of hope on the future of these
progressive diseases.
TYPE Editorial
PUBLISHED 11 September 2023
|
DOI 10.3389/fcvm.2023.1282064
Frontiers in Cardiovascular Medicine 01 frontiersin.org
Increasing knowledge in Takotsubo
cardiomyopathy pathophysiology
Recently, growing evidence is forming around the mysterious
pathophysiology of Takotsubo stress cardiomyopathy. As a proof of
that, only in this Resear ch Topic as much as three articles out of
seventeen take into account this specific nosological entity.
Takotsubo is known to be triggered by emotional or physical stress,
and acute cathecolamine release is considered to be the causativ e
event leading to cardiac dysfunction. Wei et al.presentedan
interesting case of an iatrogenic Takotsubo cardiomyopathy,
occurred after injection of high doses of epinephrine infusion for
cardiopulmonary resuscitation. This case confirms the central role
of cathecolamines and poses the problem of treating those patients
presenting with cardiogenic shock, since the much needed
cathecolamines may paradoxically deteriorate the hemodynamic
status. In contras t, beta blockers are usually beneficial, but overt
heart failure is a clear contraindication, and levosimendan may be a
reasonable option. Lastly, a potential common pathological
substrate has been reported between cancer and Takotsubo
cardiomyopa thy , namely an individually high catecholaminergic
state, underlying the need for careful inves tigation in that sense.
In addition to ca techolami ne excess, the pa thogenesis could be
linked also to other factors such as inflammatory responses and
endothelial dysfunctions. Gudenkauf et al. nicely described a case of
cytokine storm triggering Takotsubo cardiomyopa thy. Cytokine
storm is a clinically diagnosed condition presenting with fever,
absence of signs of infections and eleva ted inflamma tory
biomarkers. In this case, cytokine storm was also associated with
rapid development of lactic acidosis and hemodynamic
compromise. Even though treatment of cytokine storm has not
been clearly defined so far, and much interest is directed towards
molecules specifically targeting single cytokines, the Authors
showed the beneficial role of pulse dose s ter oids for the treatment
of inflammation associated with Tak otsubo syndrome. Further
research will clarify in more detail an integra ted pathophysiological
process and better characterize treatment rationale and
implementation depending on the specific phenotype of the disease.
New device options for advanced heart
failure
We are now familiar with the implementation of devices in the
treatment of heart failure, ranging from cardiac resynchronization
therapy to mechanical circulatory support systems such as left
ventricular assist devices. The improvements in medical and device
therapy for chronic heart failure are dramatically increasing the
number of patients worldwide living with this disease. A significant
portion of these patients face a progressiv e decline in heart function
and functional capacity , moving towards an advanced stage of the
disease. At this point of the natural history of heart failure, patients
may no longer tolerate full dose of medical treatments, therefore
prognosis consequently worsen as witnessed by the higher number of
heart failure-related hospitalizations. Heart transplant is the most
effective treatment for these patients, but strict contraindications and
the reduced number of organ availability limit the feasibility for most
of the patients with advanced heart failure. Fortunately, many device
therapies are available and play a major role at this s tage, bringing
progno st ic benefit and improving quality of life. Cardiac contractility
modulat ion is a novel device-based therapy for patient s with heart
failure with reduced ejection fraction and may be considered a
valuable treatment option also for those patients in advanced stage in
whom no other therapeutic strategies may be pursued. Cardiac
contractility modulation has been shown to improve functional class,
reverse left ventricular remodeling and reduce hospitalization in
patients with reduced ejection fraction. In the case presented by
Masarone et al. cardiac contractility modulation has been successfully
used as a bridge to transplant strategy for an obese patient in whom
no other viable options were available. In the follow-up, patient’s
quality of life improv ed, along with reduction of left ventricular filling
pressure and level of N-terminal prohormone of brain natriuretic
peptide. In another case by Visco et al. the hemodynamic
improv ement achieved by cardiac contractility modulation was
elegantly demonstrated by data collected from the CardioMEMS
device. CardioMEMS is another device which may be used for
symptomatic patients with heart failure and recent hospitalization,
placed at pulmonary artery level with the purpose of monitoring
cardiac filling pressure. Having an invasive hemodynamic monitoring
system allows prompt identification of congestion and treatment. In
this case, for the first time the usefulness of cardia c contr actil ity
modulation was objectively proven by continuous invasive
monitoring of pulmonary arterial pressures.
Final considerations
Generally speaking, research has the role to improve both diseases
understanding and diseases treatment. This Research topic
homogeneously included case reports which brought additional
insights into these two directions. Aside from the papers highlighted
herein, many other high-quality works ha ve been published in this
topic w hich well deserve a lecture. From heart t ransplant-
related infections to rare cardiomyopathies, from mechanical
circulatory support to cardiac rehabilitation, this series of clinical
cases spans over a wide range of subjects concerning heart failure.
Author contributions
MC: Writing – original draft, Writing – review & editing. FL:
Writing – original draft, Writing – review & editing.
Conflict of interest
The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
The author(s) declared that they were an editorial board
member of Frontiers, at the time of submission. This had no
impact on the peer review process and the final decision.
Cameli and Landra 10.3389/fcvm.2023.1282064
Frontiers in Cardiovascular Medicine 02 frontiersin.org
Publisher’s note
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Cameli and Landra 10.3389/fcvm.2023.1282064
Frontiers in Cardiovascular Medicine 03 frontiersin.org
