Can Bridge to Recovery Help to Reveal the Secrets of the Failing Heart?

Despite several decades of research and clinical experience, the basic mechanisms of the failing heart remain largely a secret. While pharmacological therapy can induce limited reverse remodeling, left ventricular assist device (LVAD) therapy offers the opportunity to induce significant improvements to the structure and function of the heart, with major clinical implications. LVAD therapy also provides significant insight into which changes have an impact on function and which do not, and could therefore reveal some of the secrets of the failing heart. In addition, LVAD-induced mechanical unloading may unlock further myocardial properties hitherto unknown such as the proliferation of the stem cell compartment. It may also serve as an important platform for emerging therapies such as gene and cell therapies. In this review, we highlight the most recent novel discoveries related to LVAD therapy and bridge to recovery (BTR). Discovering the integrated network of events that underlies BTR could unravel the secrets of the failing heart.     

Is prophylaxis the best use of the ICD? Response to the letter to the editor (Sharma et al.).

We thank Dr. Sharma and his colleagues for their interest inour article and wish to respond to the issues they have raised.¹ Regarding ß-blocker use in the MADIT study,² Mosshas shown that the ICD benefit "...remained significant after adjustment for ß-blocker use".³The Multicenter UnSustained Tachycardia Trial (MUSTT)—withpatients nearly identical in profile to     

Smoking during pregnancy: a way to transfer the addiction to the next generation?

Many epidemiological studies support a relationship between maternal smoking during pregnancy and adverse neurobehavioral effects later in life. Prenatal exposure to tobacco seems to increase the risks for cognitive deficits, attention deficit/hyperactivity disorder, conduct disorder, criminality in adulthood and a predisposition in the offspring to start smoking and alcohol abuse. Nicotine readily crosses the placenta and the fetuses of mothers who smoke are exposed to relatively higher nicotine concentrations than their mothers. In the fetal brain nicotine can activate nicotinic receptors which play an important role during development of the brain. A direct specific action on the developing human brain is plausible during the major part of the prenatal life, since the nicotinic receptors are already present in the brain during the first trimester.     

Is the insulin resistance syndrome the price to be paid to achieve body weight stability?

The insulin resistance syndrome represents a metabolic state in which hyperinsulinemia and/or insulin resistance constitute the platform underlying the development of metabolic complications and related diseases such as diabetes and coronary heart disease. As described in this paper, these insulin-related changes are also involved in the regulation of energy balance and contribute to the recovery of body weight stability in a context of long-term positive energy balance. Under conditions of negative energy balance such as obesity treatment, this connection has a high clinical relevance. In this regard, relevant literature as well as the reanalysis of previously published data suggest that the beneficial effect of weight loss on insulin-related changes in glycemia cannot be disassociated from the relationship between changes in plasma insulin and those in resting energy expenditure. In clinical terms, this suggests that the beneficial effect of weight loss on components of the insulin resistance syndrome could be related to the development of a state of physiological vulnerability that complicates the control of body weight. This poses a major challenge to health professionals who then have to manage obesity treatment as the search for a compromise between the beneficial and potentially detrimental effects of weight loss on insulinemia and insulin sensitivity. This also reinforces the relevance to adhere to healthy diet and physical activity habits in order to maintain body weight stability rather than relying on the overuse of regulatory systems soliciting the effects of hyperinsulinemia on the control of energy intake and expenditure.