LAUSR

Any update in advanced heart failure must be scrutinized with the question of purpose in light of the progress which has been achieved in our field. What are the significant advances which have been realized, and how are they relevant in the war on progressive heart failure? We have selected topics across the spectrum of therapeutic interventions which are affecting our patients with cardiomyopathy and heart failure. First, Dr. Reza and co-authors have written an important summary of the therapeutic potential that is being leveraged in patients with hypertrophic and familial cardiomyopathies. Next, our world of advanced heart failure has been redefined in the past 10 years with the compilation of longitudinal data from important registries, i nc lud ing In t e rmacs [ In t e r agency Reg i s t ry fo r Mechanical ly Assisted Circulatory Support] and MedaMACS [Medical Arm of Mechanically Assisted Circulatory Support], which to date are illuminating the phenotype of advanced, end-stage heart failure—the work put together by Dr. Cascino and colleagues for this section provides input on these data co-authored by the architects of these registries. Pulmonary hypertension (PH) and right ventricular failure may be the sine qua non of advancing congestive heart failure, and the review by Dr. Sri Rao and his colleagues provides insight into the mechanisms and management of pulmonary vascular disease in patients with WHO Group II PH. We are witnessing an important transition in heart transplantation with the realization of timely transplantation of critically ill, Intermacs Category I patients across the world. Dr. Shah and his colleagues have put together a timely update on the most current progress in the now half-century-old practice of cardiac replacement with heart transplantation. Last but not least, the field of mechanical circulatory support has revolutionized our management of and approach to advanced heart failure, and we have the important contributions of Dr. Michaels and Dr. Cowger, along with Dr. Hanff and Dr. Birati, who detail patient selection and device-specific management of our patients on long-term continuous flow support. Although one figure cannot capture the spectrum of what our esteemed authors have written for the journal, the figure below provides a perspective of the lifeconsuming syndrome of advancing heart failure, with the hope of reversal to a healthier state with the innovation—in this case left ventricular assist device (LVAD) therapy— that marks the spirit and future of our field.