The 24th Annual Scientific Meeting of the Japanese Heart Failure Society

Keiichi Fukuda, MD, PhD
President, the 24th Annual Scientific Meeting of
the Japanese Heart Failure Society
Professor, Department of Cardiology, Keio University School of Medicine

The 24th Annual Scientific Meeting of the Japanese Heart Failure Society will be held at PACIFICO Yokohama over the three-day period from Thursday, October 15 to Saturday, October 17, 2020.

Drug development and advances in devices have dramatically improved the treatment of conditions such as hypertension, hyperlipidemia, ischemic heart disease, arrhythmia, valvulopathy, congenital heart disease, and metabolic heart disease, for which effective, non-invasive treatments are now available. At this point, however, a curative treatment for heart failure has yet to be devised. This is because heart failure is the end point of a wide variety of underlying diseases. To date, attempts to treat heart failure have regarded it as a single pathophysiological condition to be treated with a single drug. Despite the discovery of beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and aldosterone antagonists as effective drugs, and the advent of cardiac resynchronization therapy (CRT) devices and other devices, the subsequent development of further new treatment methods is becoming more and more difficult.

I believe this is because it is basically impossible to understand the pathophysiology of heart failure by simplifying it into reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) on the basis of hyposystole (ejection fraction), and that its pathophysiology must rather be elucidated and treatment methods developed based on each different underlying condition. The causes of heart failure may be classified as: (1) quantitative insufficiency of cardiomyocytes for reasons such as myocardial infarction or myocarditis; (2) qualitative myocardial abnormalities for reasons such as hypertrophic cardiomyopathy or inherited arrhythmia; (3) abnormal protein accumulation in the myocardium or interstitial tissue, in conditions such as cardiac Fabry disease and cardiac amyloidosis; and (4) fibrosis and similar disorders, typified by restrictive cardiomyopathy and endomyocardial fibroelastosis. I believe that these must be further subcategorized according to their different components, and that they should be accurately diagnosed and treatment methods adopted in line with each different component. In cancer research, cancers that were formerly classified according to their location and histopathology are now being reclassified according to the genes responsible for carcinogenesis, opening the way for personalized treatment. We are coming to the turning point at which heart failure should similarly be reclassified according to its etiology, and methods of treatment developed on this basis.

In heart failure, too, the concept that diagnosis and treatment should depend on individual pathophysiology has slowly been gaining ground in recent years. With the establishment of diagnostic methods for cardiac Fabry disease and cardiac amyloidosis, methods of treatment have also been developed. Although a wide range of causative genes have been implicated in hypertrophic cardiomyopathy, the similarity of their phenotypes has given rise to new therapeutic concepts, and methods of treatment are currently under development. My own life’s work, the treatment of heart failure by the transplantation of iPS-derived regenerated cardiomyocytes, is now well advanced, and we have reached the stage at which first-in-human trials are now poised to start. Myocardial regenerative therapies may be used to treat conditions caused by the quantitative insufficiency of the myocardium, such as following myocardial infarction, myocarditis and dilated cardiomyopathy.

For this reason, as the theme of this Annual Scientific Meeting we have chosen “The Challenge of Personalized Medicine for Heart Failure.” Jean-Henri Fabre, famous for his Souvenirs Entomologiques, succeeded in understanding the ecology of insects on the basis of careful observation. Following his example, I hope that at this Annual Scientific Meeting we will elucidate the components (genetic and environmental) of heart failure by careful observation, and take the first step on the road toward personalized treatment depending on its pathophysiology.