Disentangling the Impact of Adiposity From Insulin Resistance in HFpEF | JACC Deep Dive

Hosts Mitsuaki Sawano, MD, and co-host Satoshi Shoji, MD, welcome regional associate editor Kentaro Ejiri, MD, for his debut appearance on the JACC: Baran Journal Club. Dr. Ejiri presents insights on the Altshock-2 trial, a pivotal randomized controlled trial evaluating early intra-aortic balloon pump (IABP) support in heart failure-related cardiogenic shock (HF-CS). The discussion covers the trial’s clinical relevance, key challenges, and the implications of its findings within the Japanese healthcare context. The episode also delves into evolving definitions of cardiogenic shock, trial methodology, and the potential for Altshock-2 to inform more individualized treatment approaches in Japan.

In a Deep Dive in our May 13 issue, Editor-in-Chief Harlan Krumholz, MD, SM, FACC, discusses a study led by Barry Borlaug that investigates whether excess weight or metabolic dysfunction has a greater impact on heart failure with preserved ejection fraction (HFpEF). The findings showed that obesity—more than insulin resistance—was strongly associated with worse hemodynamic and functional outcomes. Reviewers praised the study's nuanced approach and use of invasive measures, while editorialists emphasized the ongoing importance of addressing both adiposity and metabolic health in HFpEF management.

This JACC Deep Dive in our May 13 issue highlights new findings from the SUMMIT CKD study, showing that terzepatide improves symptoms, function, and weight in patients with HFpEF and obesity—regardless of kidney function. The analysis also underscores the importance of using both creatinine and cystatin C to better assess kidney health. Reviewers praised the study’s methodological rigor and dual focus, while noting the need for larger, long-term trials to confirm renal outcomes.

In a time of rising global tensions, JACC reaffirms its commitment to science as a unifying, borderless force—advocating for truth, equity, and collaboration to improve health worldwide. By fostering inclusive research, promoting open dialogue, and resisting politicization, JACC aims to build a global medical community working together to overcome disease and conflict.

In this podcast, Dr. Valentin Fuster discusses a groundbreaking study from the Orbiter 2 trial, which explores how dobutamine stress echocardiography (DSE) can predict the efficacy of percutaneous coronary intervention (PCI) in relieving angina in patients with stable coronary artery disease. The study reveals that the degree of ischemia, as measured by DSE, is strongly correlated with improvement in symptoms, offering new insights into patient selection for PCI treatment.

In this episode, Dr. Valentin Fuster, provides a concise summary of the May 13, 2025 issue. He discusses four original studies on key cardiovascular topics, including the impact of chronic kidney disease and obesity on heart failure, the role of dobutamine stress echocardiography in predicting PCI outcomes, the effects of empagliflozin on erythropoiesis in heart failure, and the influence of adiposity, insulin resistance, and diabetes in heart failure with preserved ejection fraction. He highlights emerging insights into treatment strategies and ongoing challenges in understanding these complex cardiovascular conditions. Concluding with a separate review on anthracycline cardiotoxicity in cancer patients.

In this podcast, Dr. Valentin Fuster reviews findings from the SUMMIT trial, which examined how tirzepatide impacts patients with obesity-related heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD). The study revealed that while tirzepatide improved cardiovascular outcomes and slightly boosted kidney function, the benefits in CKD patients may stem from mechanisms beyond glomerular filtration alone.

In this podcast, Dr. Valentin Fuster explores a study on the effects of SGLT2 inhibitors, like empagliflozin, on erythropoiesis and iron mobilization in heart failure patients. The research reveals how these drugs activate key metabolic pathways, potentially enhancing iron utilization and improving clinical outcomes, with significant implications for treatment in heart failure and chronic kidney disease.

In this podcast, Dr. Valentin Fuster discusses a study published in the JACC examining the impact of obesity, insulin resistance, and diabetes on patients with heart failure and preserved ejection fraction. The findings suggest that while obesity is closely linked to heart abnormalities, insulin resistance and diabetes have a less direct impact, urging further research into cardiometabolic therapies and the role of body fat in managing heart failure.

In this podcast, Dr. Valentin Fuster dives into the crucial review of anthracycline-induced cardiotoxicity in adult cancer patients, exploring the molecular mechanisms, treatment regimens, and long-term cardiovascular risks associated with this widely used chemotherapy. The podcast highlights the importance of early detection, collaborative care between oncologists and cardiologists, and the development of proactive strategies to manage and mitigate the heart-related side effects of anthracyclines for cancer survivors.