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HFA honours outstanding cardiologists

This afternoon, delegates will be given the opportunity to see two exceprional figures in cardiology receive the HFA Lifetime Achievement Award and to listen to them talk about their research, whiwh has changed thinking about heart failure and its treatment.

Heart Failure


Intervening in high-risk myocardial infarction to improve prognosis

Marc Pfeffer.jpg

Prof. Marc Pfeffer 

It is fitting that this year’s Eugene Braunwald Lecture will be delivered by Professor Marc Pfeffer (Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA), a former mentee of Professor Braunwald. “I feel hugely privileged to be giving the lecture named in honour of the man who has had such a big impact on my career and my life,” says Prof. Pfeffer. “It is no exaggeration to say that as a fellow in 1976, I would have travelled anywhere in the world to join his team. Luckily for me, he was in Boston.” Prof. Pfeffer will talk about the interface between high-risk myocardial infarction and prognosis. “This is something that interested me even as a student,” he says. “The heart is unique in the way it is able to adapt over time to an increased pathological load. Basic studies I conducted together with my wife, the late Doctor Janice Pfeffer, in Prof. Braunwald’s laboratory demonstrated that we could avoid adverse ventricular remodelling by the use of long-term drug intervention.” He considers this to be one of his greatest research achievements.

“Forty years on, our animal work in ventricular remodelling has still not been bettered.”

And at the time, the findings from the research led directly to the initiation of the SAVE trial.1 “SAVE showed that prolonged angiotensin-converting enzyme (ACE) inhibitor administration to asymptomatic patients following a myocardial infarction could attenuate remodelling and improve prognosis. This was what Prof. Braunwald would call ‘a home run’,” says Prof. Pfeffer.

Dzau Professor of Medicine at Harvard Medical School and Senior Physician in the Cardiovascular Division at the Brigham and Women’s Hospital, his work on ventricular remodelling alone is enough to justify his HFA Lifetime Achievement Award, even without his extensive publication list. Prof. Pfeffer is the recipient of the James B. Herrick Award and Clinical Research Prize from the American Heart Association (AHA) and Distinguished Scientist Awards from both the AHA and the American College of Cardiology, as well as the Lifetime Achievement Award from the Heart Failure Society of America. He believes firmly that collaboration is what makes cardiovascular research second to none. “Each time we start a new project, we get the opportunity to develop a different team and to meet new colleagues and friends,” he says. “The continual exchange of fresh ideas helps to drive research standards ever higher in the search to bring new treatments to patients.” As one who considers his colleagues to be the global cardiovascular research community, Prof. Pfeffer is “particularly honoured to be recognised by the HFA.”

Four decades on from their first meeting, Prof. Pfeffer is delighted to be working again with Prof. Braunwald on a clinical trial similar to SAVE. “This is a head-to-head trial comparing the efficacy of sacubitril/valsartan with ramipril in a patient population comparable to that in the original study,” he says, adding wryly, “If your mentor doesn’t stop, how can you?”

  1. Pfeffer MA, et al. N Engl J Med 1992;327:669–677.

 

The war against diastolic heart failure

 Walter Paulus.jpg

 

 

 

Prof. Walter Paulus 

Once the ‘little brother’ of heart failure with reduced ejection fraction (HFrEF), diastolic heart failure (heart failure with preserved ejection fraction [HFpEF]) has grown up and now accounts for over 50% of cases. In his Philip Poole Wilson Lecture—‘Fighting heart failure with preserved ejection fraction: the battle lines are shifting’—Professor Walter Paulus (VU University Medical Center [VUmc] Amsterdam, Amsterdam, The Netherlands) will talk about the challenges of treating this type of heart failure and the sorts of strategies that are being explored. “The shift in the balance of heart failure types, such that HFpEF now predominates, is due to the rising elderly population—it has essentially been a disease of the older individual—and also to the obesity epidemic and associated morbidities of metabolic syndrome and diabetes,” says Prof. Paulus. “Treatment is frustrating because much of the neuro-humoral inhibitor therapy developed for HFrEF doesn’t work in patients with preserved ejection fraction. Currently no single medication improves the prognosis of these patients.” The shifting of the battle lines refers to the novel paradigm suggested by Prof. Paulus and his colleague Professor Carsten Tschöpe for the development of HFpEF, a paradigm that will drive the exploration of new treatment strategies.1 The war against HFpEF will be staged on four fronts, explains Prof. Paulus. “We need to tackle obesity and comorbidities, reappraise the use of systemic anti-inflammatory therapy, correct cardiomyocyte elasticity and target cardiac fibrosis.”

Professor of Physiology at the VUmc’s Institute for Cardiovascular Research, Prof. Paulus is also Chairman of the Scientific Committee of the Netherlands Heart Institute and coordinated the European Commission FP7 Health Large Collaborative Project on Diastolic Heart Failure (MEDIA). His HFA Lifetime Achievement Award is well deserved. Under his keen eye, the group at VUmc has been instrumental in furthering understanding of the pathophysiology of diastolic heart failure. “This has been my main area of research ever since my early days as a cardiology fellow at the Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. My mentor, Professor Bill Grossman, was one of only a few at that time to recognise the importance of diastolic function to the global performance of the heart,” Prof. Paulus explains. “I am incredibly proud of the contributions we have made in this area,” he continues.

“I think that our work in being the first to propose a global framework for HFpEF development is a great achievement.”

“By studying biopsy material from diastolic heart failure patients we discovered a cascade of physiological derangements that led us to construct a novel, integrated view of the processes involved in diastolic heart failure,” he says, concluding, “This definitely represents my most notable research achievement.”

  1. Paulus WJ, Tschöpe C. J Am Coll Cardiol 2013;62:263–271.