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

Cameli M.

Landra F.

English

Archivio della Ricerca - Università degli Studi di Siena

TYPE EditorialPUBLISHED 11 September 2023| DOI 10.3389/fcvm.2023.1282064EDITED AND REVIEWED BYSyamal K. Bhattacharya,University of Tennessee Health Science Center(UTHSC), United States*CORRESPONDENCEMatteo Camelimatteo.cameli@yahoo.comFederico Landraf.landra@student.unisi.itRECEIVED 23 August 2023ACCEPTED 01 September 2023PUBLISHED 11 September 2023CITATIONCameli M and Landra F (2023) Editorial: Casereports in heart failure and transplantation:2022.Front. Cardiovasc. Med. 10:1282064.doi: 10.3389/fcvm.2023.1282064COPYRIGHT© 2023 Cameli and Landra. This is an open-access article distributed under the terms of theCreative Commons Attribution License (CC BY).The use, distribution or reproduction in otherforums is permitted, provided the originalauthor(s) and the copyright owner(s) arecredited and that the original publication in thisjournal is cited, in accordance with acceptedacademic practice. No use, distribution orreproduction is permitted which does notcomply with these terms.Frontiers in Cardiovascular MedicineEditorial: Case reports in heartfailure and transplantation: 2022Matteo Cameli* and Federico Landra*Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, ItalyIn this editorial we summarize the most viewed and downloaded contributingarticles to the Research Topic “Case Reports in Heart Failure andTransplantation: 2022” of the journal Frontiers in Cardiovascular Medicine.KEYWORDSheart failure, heart transplant, takotsubo, genetic, devices, advanced heart failureEditorial on the Research TopicCase reports in heart failure and transplantation: 2022The adjunctive value of genetic testingEven though it may be difficult to glean interpretable results in the absence of aspecific clinical suspicion, nowadays genetic testing has largely established as afundamental tool both in the diagnostic workflow and risk stratification of a greatvariety of cardiac diseases. A similar revolution in the cardiovascular field has beenrecognized with the introduction of cardiac magnetic resonance, which brought thepossibility to unveil structural abnormalities without the need of a histologicalspecimen. However, tissue alterations are only the epiphenomenon of an underlyingpathological process and we sometimes fail to go beyond the ultrastructuralunderstanding. In this context, genetic testing may help identifying the missing linkpiece, finally leading to a comprehensive characterization of the pathologicalprocess. This is the case of the patient reported by Liu X et al. which eventuallyappeared to be affected by a rare desmin myopathy. Diagnosis was only possiblewith the aid of genetic testing, which identified a missense mutation (c.1366G > A)in the desmin gene, and immunohistochemical staining confirmed desmindeficiency. Clearly, we are still far from tailored therapies for each genetic disease,so one could argue what is the adjunctive value of such pathological understanding.Heart failure and arrhythmia treatments would have been initiated irrespective ofthe diagnosis of desmin myopathy. However, being able to call a pathological entityby its name and its genetic underpinning give us the chance not only to focusmore specifically on its peculiar characteristics, such as, for instance, conductiondisturbances occurrence in the case of desmin myopathy, but also to diagnose thedisease in a preclinical form in patient’s relatives. In addition, the well-knownadvent of the precision medicine can cast the light of hope on the future of theseprogressive diseases.01 frontiersin.orgCameli and Landra 10.3389/fcvm.2023.1282064Increasing knowledge in Takotsubocardiomyopathy pathophysiologyRecently, growing evidence is forming around the mysteriouspathophysiology of Takotsubo stress cardiomyopathy. As a proof ofthat, only in this Research Topic as much as three articles out ofseventeen 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 causativeevent leading to cardiac dysfunction. Wei et al. presented aninteresting case of an iatrogenic Takotsubo cardiomyopathy,occurred after injection of high doses of epinephrine infusion forcardiopulmonary resuscitation. This case confirms the central roleof cathecolamines and poses the problem of treating those patientspresenting with cardiogenic shock, since the much neededcathecolamines may paradoxically deteriorate the hemodynamicstatus. In contrast, beta blockers are usually beneficial, but overtheart failure is a clear contraindication, and levosimendan may be areasonable option. Lastly, a potential common pathologicalsubstrate has been reported between cancer and Takotsubocardiomyopathy, namely an individually high catecholaminergicstate, underlying the need for careful investigation in that sense.In addition to catecholamine excess, the pathogenesis could belinked also to other factors such as inflammatory responses andendothelial dysfunctions. Gudenkauf et al. nicely described a case ofcytokine storm triggering Takotsubo cardiomyopathy. Cytokinestorm is a clinically diagnosed condition presenting with fever,absence of signs of infections and elevated inflammatorybiomarkers. In this case, cytokine storm was also associated withrapid development of lactic acidosis and hemodynamiccompromise. Even though treatment of cytokine storm has notbeen clearly defined so far, and much interest is directed towardsmolecules specifically targeting single cytokines, the Authorsshowed the beneficial role of pulse dose steroids for the treatmentof inflammation associated with Takotsubo syndrome. Furtherresearch will clarify in more detail an integrated pathophysiologicalprocess and better characterize treatment rationale andimplementation depending on the specific phenotype of the disease.New device options for advanced heartfailureWe are now familiar with the implementation of devices in thetreatment of heart failure, ranging from cardiac resynchronizationtherapy to mechanical circulatory support systems such as leftventricular assist devices. The improvements in medical and devicetherapy for chronic heart failure are dramatically increasing thenumber of patients worldwide living with this disease. A significantportion of these patients face a progressive decline in heart functionand functional capacity, moving towards an advanced stage of thedisease. At this point of the natural history of heart failure, patientsmay no longer tolerate full dose of medical treatments, thereforeprognosis consequently worsen as witnessed by the higher number ofheart failure-related hospitalizations. Heart transplant is the mostFrontiers in Cardiovascular Medicine 02effective treatment for these patients, but strict contraindications andthe reduced number of organ availability limit the feasibility for mostof the patients with advanced heart failure. Fortunately, many devicetherapies are available and play a major role at this stage, bringingprognostic benefit and improving quality of life. Cardiac contractilitymodulation is a novel device-based therapy for patients with heartfailure with reduced ejection fraction and may be considered avaluable treatment option also for those patients in advanced stage inwhom no other therapeutic strategies may be pursued. Cardiaccontractility modulation has been shown to improve functional class,reverse left ventricular remodeling and reduce hospitalization inpatients with reduced ejection fraction. In the case presented byMasarone et al. cardiac contractility modulation has been successfullyused as a bridge to transplant strategy for an obese patient in whomno other viable options were available. In the follow-up, patient’squality of life improved, along with reduction of left ventricular fillingpressure and level of N-terminal prohormone of brain natriureticpeptide. In another case by Visco et al. the hemodynamicimprovement achieved by cardiac contractility modulation waselegantly demonstrated by data collected from the CardioMEMSdevice. CardioMEMS is another device which may be used forsymptomatic patients with heart failure and recent hospitalization,placed at pulmonary artery level with the purpose of monitoringcardiac filling pressure. Having an invasive hemodynamic monitoringsystem allows prompt identification of congestion and treatment. Inthis case, for the first time the usefulness of cardiac contractilitymodulation was objectively proven by continuous invasivemonitoring of pulmonary arterial pressures.Final considerationsGenerally speaking, research has the role to improve both diseasesunderstanding and diseases treatment. This Research topichomogeneously included case reports which brought additionalinsights into these two directions. Aside from the papers highlightedherein, many other high-quality works have been published in thistopic which well deserve a lecture. From heart transplant-related infections to rare cardiomyopathies, from mechanicalcirculatory support to cardiac rehabilitation, this series of clinicalcases spans over a wide range of subjects concerning heart failure.Author contributionsMC: Writing – original draft, Writing – review & editing. FL:Writing – original draft, Writing – review & editing.Conflict of interestThe authors declare that the research was conducted in theabsence of any commercial or financial relationships that couldbe construed as a potential conflict of interest.The author(s) declared that they were an editorial boardmember of Frontiers, at the time of submission. This had noimpact on the peer review process and the final decision.frontiersin.orgCameli and Landra 10.3389/fcvm.2023.1282064Publisher’s noteAll claims expressed in this article are solely those of theauthors and do not necessarily represent those of their affiliatedFrontiers in Cardiovascular Medicine 03organizations, or those of the publisher, the editors and thereviewers. Any product that may be evaluated in this article, orclaim that may be made by its manufacturer, is not guaranteedor endorsed by the publisher.frontiersin.org

Editorial: Case reports in heart failure and transplantation: 2022

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Editorial: Case reports in heart failure and transplantation: 2022

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