Challenges in heart failure
Interpretation and actionability of genetic variants in cardiomyopathies. Mendelian cardiomyopathies are used as a reference to show how detailed, systematic, and iterative evaluation of patients and relatives not only can establish the pathogenicity of genetic variants but can also provide a basis for personalized medicine in heritable cardiovascular (CV) conditions. Correct clinical interpretation of genetic variants will be one of the key contributors to precision cardiology of the future, but requires effective partnerships between clinicians, patients, scientists, and industry to maximize the benefits of genetic knowledge. Importantly, a genetic test supports and confirms, but does not substitute for, a clinical diagnosis. Electrical disturbances, such as atrial fibrillation (AF), dyssynchrony, tachycardia, and premature ventricular contractions (PVCs), are present in most patients with heart failure (HF). A substantial proportion of patients with HF with preserved ejection fraction (HFpEF) present with normal natriuretic peptide (NP) levels.

The authors conclude that bariatric surgery is associated with reduced all-cause and CV mortality, and lowered incidence of several CV diseases. Bariatric surgery should therefore be considered in these patients.