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CARDIOVASCULAR GENOMIC MEDICINE

Redefining Heart Failure

The Utility of Genomics

Mark P. Donahue, MD, MHS^_*,,_*, Douglas A. Marchuk, PhD and Howard A. Rockman, MD^_*,

^_* Division of Cardiovascular Medicine
Duke Clinical Research Institute
Department of Molecular Genetics and Microbiology, Durham, North Carolina

Manuscript received February 9, 2006; accepted May 29, 2006.

^_* Reprint requests and correspondence: Dr. Mark Donahue, Duke University Medical Center, Box 3298 DUMC, Durham, North Carolina 27710 (Email: mark.donahue{at}duke.edu).

In this era of genomics, new technologies and the information that they generate have a wide range of potential applications to heart failure. Though there has not been widespread practical use of genomic information in everyday practice, there are many examples of how this information is beginning to transform the way we look at disease states in terms of diagnosis, prognosis, and treatment. The experience of oncology and other fields helps inform the heart failure field of not only the use of this information in investigating diagnosis, prognosis, and treatment response, but the reciprocal nature of this information. This information can be clinically useful (for instance, predicting treatment response) as well as further drive laboratory investigation (teasing out the biological pathways in non-responders to treatment can be a focus of new drug discovery); this is the essence of translational medicine. We believe that this is a good time to review where new technologies and information they generate can be placed into our classic understanding of heart failure: that is how we might redefine cardiomyopathy given our new information. Here we will review genomic evidence to date and how it can and may be considered in the evaluation and management of cardiomyopathies.

Abbreviations and Acronyms   ACC/AHA = American College of Cardiology/American Heart Association   ACE = angiotensin-converting enzyme   BNP = brain natriuretic peptide   DCM = dilated cardiomyopathy   HCM = hypertrophic cardiomyopathy   ICM = ischemic cardiomyopathy   LVAD = left ventricular assist device

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