Skip to main content
Top
Published in: Immunity & Ageing 1/2020

Open Access 01-12-2020 | SARS-CoV-2 | Commentary

“The ancient and the new”: is there an interaction between cytomegalovirus and SARS-CoV-2 infection?

Author: Paul Moss

Published in: Immunity & Ageing | Issue 1/2020

Login to get access

Summary

The SARS-CoV-2 pandemic represents one of the greatest infectious challenges to humanity in recent history. One of the striking features of infection is the heterogeneous clinical response with worse outcomes observed in older patients and those with underlying health conditions. To date the potential impact of previous infection history has been poorly investigated as a potential determinant of risk. Cytomegalovirus (CMV), a persistent herpesvirus infection whose prevalence increases with age, is a major modulator of immune function and several observations suggest that infection might act to influence clinical outcome following SARS-CoV-2 infection. In particular, CMV is associated with the acceleration of immune senescence and has been linked to a range of cardiovascular and metabolic disorders. This review addresses mechanisms by which cytomegalovirus infection may act to worsen the clinical outcome of SARS-CoV-2 infection, discusses how these potential links could be investigated, and assesses the potential significance of any findings that emerge.
Literature
1.
go back to reference Zhu N, Zhang D, Wang W, Li X, Yang B, Song J. Et al; China novel coronavirus investigating and research team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33.PubMedPubMedCentralCrossRef Zhu N, Zhang D, Wang W, Li X, Yang B, Song J. Et al; China novel coronavirus investigating and research team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33.PubMedPubMedCentralCrossRef
2.
go back to reference Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.PubMedPubMedCentralCrossRef Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.PubMedPubMedCentralCrossRef
5.
go back to reference Reddehase, MJ. Cytomegaloviruses: molecular biology and immunology. 2006. Caister Academic Press. Reddehase, MJ. Cytomegaloviruses: molecular biology and immunology. 2006. Caister Academic Press.
6.
go back to reference Zuhair M, Smit GSA, Wallis G, Jabbar F, Smith C, Devleesschauwer B, et al. Estimation of the worldwide seroprevalence of cytomegalovirus: a systematic review and meta-analysis. Rev Med Virol. 2019;29(3):e2034.PubMedCrossRef Zuhair M, Smit GSA, Wallis G, Jabbar F, Smith C, Devleesschauwer B, et al. Estimation of the worldwide seroprevalence of cytomegalovirus: a systematic review and meta-analysis. Rev Med Virol. 2019;29(3):e2034.PubMedCrossRef
7.
go back to reference Dowd JB, Aiello AE, Alley DE. Socioeconomic disparities in the seroprevalence of cytomegalovirus infection in the US population: NHANES III. Epidemiol Infect. 2009;137(1):58–65.PubMedCrossRef Dowd JB, Aiello AE, Alley DE. Socioeconomic disparities in the seroprevalence of cytomegalovirus infection in the US population: NHANES III. Epidemiol Infect. 2009;137(1):58–65.PubMedCrossRef
8.
go back to reference Adriaensen W, Pawelec G, Vaes B, Hamprecht K, Derhovanessian E, van Pottelbergh G, et al. CD4:8 ratio above 5 is associated with all-cause mortality in CMV-Seronegative very old women: results from the BELFRAIL study. J Gerontol A Biol Sci Med Sci. 2017;72(9):1155–62.PubMed Adriaensen W, Pawelec G, Vaes B, Hamprecht K, Derhovanessian E, van Pottelbergh G, et al. CD4:8 ratio above 5 is associated with all-cause mortality in CMV-Seronegative very old women: results from the BELFRAIL study. J Gerontol A Biol Sci Med Sci. 2017;72(9):1155–62.PubMed
9.
go back to reference Chidrawar S, Khan N, Wei W, McLarnon A, Smith N, Nayak L, et al. Cytomegalovirus-seropositivity has a profound influence on the magnitude of major lymphoid subsets within healthy individuals. Clin Exp Immunol. 2009;155(3):423–32.PubMedPubMedCentralCrossRef Chidrawar S, Khan N, Wei W, McLarnon A, Smith N, Nayak L, et al. Cytomegalovirus-seropositivity has a profound influence on the magnitude of major lymphoid subsets within healthy individuals. Clin Exp Immunol. 2009;155(3):423–32.PubMedPubMedCentralCrossRef
10.
go back to reference Gillespie GM, Wills MR, Appay V, O’Callaghan C, Murphy M, Smith N, et al. Functional heterogeneity and high frequencies of cytomegalovirus-specific CD8(+) T lymphocytes in healthy seropositive donors. J Virol. 2000;74(17):8140–50.PubMedPubMedCentralCrossRef Gillespie GM, Wills MR, Appay V, O’Callaghan C, Murphy M, Smith N, et al. Functional heterogeneity and high frequencies of cytomegalovirus-specific CD8(+) T lymphocytes in healthy seropositive donors. J Virol. 2000;74(17):8140–50.PubMedPubMedCentralCrossRef
11.
go back to reference Weinberger B, Lazuardi L, Weiskirchner I, Keller M, Neuner C, Fischer KH, et al. Healthy aging and latent infection with CMV lead to distinct changes in CD8+ and CD4+ T-cell subsets in the elderly. Hum Immunol. 2007;68(2):86–90.PubMedCrossRef Weinberger B, Lazuardi L, Weiskirchner I, Keller M, Neuner C, Fischer KH, et al. Healthy aging and latent infection with CMV lead to distinct changes in CD8+ and CD4+ T-cell subsets in the elderly. Hum Immunol. 2007;68(2):86–90.PubMedCrossRef
12.
go back to reference Ouyang Q, Wagner WM, Wikby A, Walter S, Aubert G, Dodi AI, et al. Large numbers of dysfunctional CD8+ T lymphocytes bearing receptors for a single dominant CMV epitope in the very old. J Clin Immunol. 2003;23(4):247–57.PubMedCrossRef Ouyang Q, Wagner WM, Wikby A, Walter S, Aubert G, Dodi AI, et al. Large numbers of dysfunctional CD8+ T lymphocytes bearing receptors for a single dominant CMV epitope in the very old. J Clin Immunol. 2003;23(4):247–57.PubMedCrossRef
13.
go back to reference Costa-Garcia M, Vera A, Moraru M, Vilches C, López-Botet M, Muntasell A. Antibody-mediated response of NKG2Cbright NK cells against human cytomegalovirus. J Immunol. 2015;194(6):2715–24.PubMedCrossRef Costa-Garcia M, Vera A, Moraru M, Vilches C, López-Botet M, Muntasell A. Antibody-mediated response of NKG2Cbright NK cells against human cytomegalovirus. J Immunol. 2015;194(6):2715–24.PubMedCrossRef
14.
go back to reference Wikby A, Johansson B, Olsson J, Lofgren S, Nilsson BO, Ferguson F. Expansions of peripheral blood CD8 T-lymphocyte subpopulations and an association with cytomegalovirus seropositivity in the elderly: the Swedish NONA immune study. Exp Gerontol. 2002;37(2–3):445–53.PubMedCrossRef Wikby A, Johansson B, Olsson J, Lofgren S, Nilsson BO, Ferguson F. Expansions of peripheral blood CD8 T-lymphocyte subpopulations and an association with cytomegalovirus seropositivity in the elderly: the Swedish NONA immune study. Exp Gerontol. 2002;37(2–3):445–53.PubMedCrossRef
15.
go back to reference Roberts ET, Haan MN, Dowd JB, Aiello AE. (2010) Cytomegalovirus antibody levels, inflammation, and mortality among elderly Latinos over 9 years of follow-up. Am J Epidemiol. Aug 15;172(4):363-371.PubMedPubMedCentralCrossRef Roberts ET, Haan MN, Dowd JB, Aiello AE. (2010) Cytomegalovirus antibody levels, inflammation, and mortality among elderly Latinos over 9 years of follow-up. Am J Epidemiol. Aug 15;172(4):363-371.PubMedPubMedCentralCrossRef
16.
go back to reference Wang GC, Kao WH, Murakami P, Xue QL, Chiou RB, Detrick B et al. (2010) Cytomegalovirus infection and the risk of mortality and frailty in older women: a prospective observational cohort study. Am J Epidemiol. May 15;171(10):1144-1152.PubMedPubMedCentralCrossRef Wang GC, Kao WH, Murakami P, Xue QL, Chiou RB, Detrick B et al. (2010) Cytomegalovirus infection and the risk of mortality and frailty in older women: a prospective observational cohort study. Am J Epidemiol. May 15;171(10):1144-1152.PubMedPubMedCentralCrossRef
17.
go back to reference Matheï C, Adriaensen W, Vaes B, Van Pottelbergh G, Wallemacq P, Degryse J. (2015) No relation between CMV infection and mortality in the oldest old: results from the Belfrailstudy.. Age Ageing. Jan;44(1):130-135.PubMedCrossRef Matheï C, Adriaensen W, Vaes B, Van Pottelbergh G, Wallemacq P, Degryse J. (2015) No relation between CMV infection and mortality in the oldest old: results from the Belfrailstudy.. Age Ageing. Jan;44(1):130-135.PubMedCrossRef
18.
go back to reference Trzonkowski P, Mysliwska J, Szmit E, Wieckiewicz J, Lukaszuk K, Brydak LB, et al. Association between cytomegalovirus infection, enhanced proinflammatory response and low level of antihemagglutinins during the anti-influenza vaccination--an impact of immunosenescence. Vaccine. 2003;21:3826–36.PubMedCrossRef Trzonkowski P, Mysliwska J, Szmit E, Wieckiewicz J, Lukaszuk K, Brydak LB, et al. Association between cytomegalovirus infection, enhanced proinflammatory response and low level of antihemagglutinins during the anti-influenza vaccination--an impact of immunosenescence. Vaccine. 2003;21:3826–36.PubMedCrossRef
19.
go back to reference van den Berg SPH, Warmink K, Borghans JAM, Knol MJ, van Baarle D. Effect of latent cytomegalovirus infection on the antibody response to influenza vaccination: a systematic review and meta-analysis. Med Microbiol Immunol. 2019;208(3–4):305–21.PubMedPubMedCentralCrossRef van den Berg SPH, Warmink K, Borghans JAM, Knol MJ, van Baarle D. Effect of latent cytomegalovirus infection on the antibody response to influenza vaccination: a systematic review and meta-analysis. Med Microbiol Immunol. 2019;208(3–4):305–21.PubMedPubMedCentralCrossRef
20.
go back to reference Furman D, Jojic V, Sharma S, Shen-Orr SS, Angel CJ, Onengut-Gumuscu S, et al. Cytomegalovirus infection enhances the immune response to influenza. Sci Transl Med. 2015;7(281):281ra43.PubMedPubMedCentralCrossRef Furman D, Jojic V, Sharma S, Shen-Orr SS, Angel CJ, Onengut-Gumuscu S, et al. Cytomegalovirus infection enhances the immune response to influenza. Sci Transl Med. 2015;7(281):281ra43.PubMedPubMedCentralCrossRef
21.
go back to reference Miles DJ, van der Sande M, Jeffries D, Kaye S, Ismaili J, Ojuola O, et al. Cytomegalovirus infection in Gambian infants leads to profound CD8 T-cell differentiation. J Virol. 2007;81(11):5766–76.PubMedPubMedCentralCrossRef Miles DJ, van der Sande M, Jeffries D, Kaye S, Ismaili J, Ojuola O, et al. Cytomegalovirus infection in Gambian infants leads to profound CD8 T-cell differentiation. J Virol. 2007;81(11):5766–76.PubMedPubMedCentralCrossRef
22.
go back to reference Moss,P. ‘From immunosenescence to immune modulation': a re-appraisal of the role of cytomegalovirus as major regulator of human immune function. Med Microbiol Immunol 2019;208(3–4):271–280.PubMedCrossRef Moss,P. ‘From immunosenescence to immune modulation': a re-appraisal of the role of cytomegalovirus as major regulator of human immune function. Med Microbiol Immunol 2019;208(3–4):271–280.PubMedCrossRef
23.
go back to reference Karrer U, Sierro S, Wagner M, Oxenius A, Hengel H, Koszinowski UH, et al. Memory inflation: continuous accumulation of antiviral CD8+ T cells over time. J Immunol. 2003;170(4):2022–9.PubMedCrossRef Karrer U, Sierro S, Wagner M, Oxenius A, Hengel H, Koszinowski UH, et al. Memory inflation: continuous accumulation of antiviral CD8+ T cells over time. J Immunol. 2003;170(4):2022–9.PubMedCrossRef
24.
go back to reference Fletcher JM, Vukmanovic-Stejic M, Dunne PJ, Birch KE, Cook JE, Jackson SE, et al. Cytomegalovirus-specific CD4+ T cells in healthy carriers are continuously driven to replicative exhaustion. J Immunol. 2005;175(12):8218–25.PubMedCrossRef Fletcher JM, Vukmanovic-Stejic M, Dunne PJ, Birch KE, Cook JE, Jackson SE, et al. Cytomegalovirus-specific CD4+ T cells in healthy carriers are continuously driven to replicative exhaustion. J Immunol. 2005;175(12):8218–25.PubMedCrossRef
26.
go back to reference Bolovan-Fritts CA, Spector SA. Endothelial damage from cytomegalovirus-specific host immune response can be prevented by targeted disruption of fractalkine-CX3CR1 interaction. Blood. 2008;111:175–82.PubMedPubMedCentralCrossRef Bolovan-Fritts CA, Spector SA. Endothelial damage from cytomegalovirus-specific host immune response can be prevented by targeted disruption of fractalkine-CX3CR1 interaction. Blood. 2008;111:175–82.PubMedPubMedCentralCrossRef
28.
go back to reference Pachnio A, Ciaurriz M, Begum J, Lal N, Zuo J, Beggs A, et al. Cytomegalovirus infection leads to development of high frequencies of cytotoxic virus-specific CD4+ T cells targeted to vascular endothelium. PLoS Pathog. 2016;12(9):e1005832.PubMedPubMedCentralCrossRef Pachnio A, Ciaurriz M, Begum J, Lal N, Zuo J, Beggs A, et al. Cytomegalovirus infection leads to development of high frequencies of cytotoxic virus-specific CD4+ T cells targeted to vascular endothelium. PLoS Pathog. 2016;12(9):e1005832.PubMedPubMedCentralCrossRef
29.
go back to reference Strandberg TE, Pitkala KH, Tilvis RS. Cytomegalovirus antibody level and mortality among community-dwelling older adults with stable cardiovascular disease. JAMA. 2009;301(4):380–2.PubMedCrossRef Strandberg TE, Pitkala KH, Tilvis RS. Cytomegalovirus antibody level and mortality among community-dwelling older adults with stable cardiovascular disease. JAMA. 2009;301(4):380–2.PubMedCrossRef
30.
go back to reference Simanek AM, Dowd JB, Pawelec G, Melzer D, Dutta A, Aiello AE. (2011) Seropositivity to cytomegalovirus, inflammation, all-cause and cardiovascular disease-related mortality in the United States. PLoS one. Feb 17;6(2):e16103.PubMedPubMedCentralCrossRef Simanek AM, Dowd JB, Pawelec G, Melzer D, Dutta A, Aiello AE. (2011) Seropositivity to cytomegalovirus, inflammation, all-cause and cardiovascular disease-related mortality in the United States. PLoS one. Feb 17;6(2):e16103.PubMedPubMedCentralCrossRef
31.
go back to reference Savva GM, Pachnio A, Kaul B, Morgan K, Huppert FA, Brayne C, Moss PA; Medical Research Council Cognitive Function and Ageing Study. Cytomegalovirus infection is associated with increased mortality in the older population. (2013) Aging Cell. Jun;12(3):381–387.PubMedCrossRef Savva GM, Pachnio A, Kaul B, Morgan K, Huppert FA, Brayne C, Moss PA; Medical Research Council Cognitive Function and Ageing Study. Cytomegalovirus infection is associated with increased mortality in the older population. (2013) Aging Cell. Jun;12(3):381–387.PubMedCrossRef
32.
go back to reference Wall NA, Chue CD, Edwards NC, Pankhurst T, Harper L, Steeds RP, et al. Cytomegalovirus seropositivity is associated with increased arterial stiffness in patients with chronic kidney disease. PLoS One. 2013;8(2):e55686.PubMedPubMedCentralCrossRef Wall NA, Chue CD, Edwards NC, Pankhurst T, Harper L, Steeds RP, et al. Cytomegalovirus seropositivity is associated with increased arterial stiffness in patients with chronic kidney disease. PLoS One. 2013;8(2):e55686.PubMedPubMedCentralCrossRef
33.
go back to reference Yu HT, Youn JC, Kim JH, Seong YJ, Park SH, Kim HC et al. Arterial Stiffness Is Associated With Cytomegalovirus-Specific Senescent CD8+ T Cells. J Am Heart Assoc. 2017;6(9). Yu HT, Youn JC, Kim JH, Seong YJ, Park SH, Kim HC et al. Arterial Stiffness Is Associated With Cytomegalovirus-Specific Senescent CD8+ T Cells. J Am Heart Assoc. 2017;6(9).
34.
go back to reference Cheng J, Ke Q, Jin Z, Wang H, Kocher O, Morgan JP, Zhang J, Crumpacker CS. Cytomegalovirus infection causes an increase of arterial blood pressure. PLoS Pathog. 2009;5:e1000427.PubMedPubMedCentralCrossRef Cheng J, Ke Q, Jin Z, Wang H, Kocher O, Morgan JP, Zhang J, Crumpacker CS. Cytomegalovirus infection causes an increase of arterial blood pressure. PLoS Pathog. 2009;5:e1000427.PubMedPubMedCentralCrossRef
35.
go back to reference Firth C, Harrison R, Ritchie S, Wardlaw J, Ferro CJ, Starr JM, et al. Cytomegalovirus infection is associated with an increase in systolic blood pressure in older individuals. QJM. 2016;109(9):595–600.PubMedPubMedCentralCrossRef Firth C, Harrison R, Ritchie S, Wardlaw J, Ferro CJ, Starr JM, et al. Cytomegalovirus infection is associated with an increase in systolic blood pressure in older individuals. QJM. 2016;109(9):595–600.PubMedPubMedCentralCrossRef
37.
go back to reference Rector JL, Thomas GN, Burns VE, Dowd JB, Herr RM, Moss PA, et al. Elevated HbA (1c) levels and the accumulation of differentiated T cells in CMV(+) individuals. Diabetologia. 2015;58(11):2596–605.PubMedPubMedCentralCrossRef Rector JL, Thomas GN, Burns VE, Dowd JB, Herr RM, Moss PA, et al. Elevated HbA (1c) levels and the accumulation of differentiated T cells in CMV(+) individuals. Diabetologia. 2015;58(11):2596–605.PubMedPubMedCentralCrossRef
38.
go back to reference Contreras NA, Sitnik KM, Jeftic I, Coplen CP, Čičin-Šain L, Nikolich-Žugich J. Life-long control of cytomegalovirus (CMV) by T resident memory cells in the adipose tissue results in inflammation and hyperglycemia. PLoS Pathog. 2019;15(6):e1007890.PubMedPubMedCentralCrossRef Contreras NA, Sitnik KM, Jeftic I, Coplen CP, Čičin-Šain L, Nikolich-Žugich J. Life-long control of cytomegalovirus (CMV) by T resident memory cells in the adipose tissue results in inflammation and hyperglycemia. PLoS Pathog. 2019;15(6):e1007890.PubMedPubMedCentralCrossRef
39.
go back to reference Yang FJ, Shu KH, Chen HY, Chen IY, Lay FY, Chuang YF et al. Immun Ageing. Anti-cytomegalovirus IgG antibody titer is positively associated with advanced T cell differentiation and coronary artery disease in end-stage renal disease 2018;15:15. Yang FJ, Shu KH, Chen HY, Chen IY, Lay FY, Chuang YF et al. Immun Ageing. Anti-cytomegalovirus IgG antibody titer is positively associated with advanced T cell differentiation and coronary artery disease in end-stage renal disease 2018;15:15.
40.
go back to reference Bennett JM, Glaser R, Malarkey WB, Beversdorf DQ, Peng J, Kiecolt-Glaser JK. Inflammation and reactivation of latent herpesviruses in older adults. Brain Behav Immun. 2012;26(5):739–46.PubMedCrossRef Bennett JM, Glaser R, Malarkey WB, Beversdorf DQ, Peng J, Kiecolt-Glaser JK. Inflammation and reactivation of latent herpesviruses in older adults. Brain Behav Immun. 2012;26(5):739–46.PubMedCrossRef
41.
go back to reference Jackson SE, Sedikides GX, Okecha G, Poole EL, Sinclair JH, Wills MR. Latent Cytomegalovirus (CMV) infection does not detrimentally Alter T cell responses in the healthy old, But Increased Latent CMV Carriage Is Related to Expanded CMV-Specific T Cells. Front Immunol. 2017;8:733.PubMedPubMedCentralCrossRef Jackson SE, Sedikides GX, Okecha G, Poole EL, Sinclair JH, Wills MR. Latent Cytomegalovirus (CMV) infection does not detrimentally Alter T cell responses in the healthy old, But Increased Latent CMV Carriage Is Related to Expanded CMV-Specific T Cells. Front Immunol. 2017;8:733.PubMedPubMedCentralCrossRef
42.
go back to reference Wallace DL, Masters JE, De Lara CM, Henson SM, Worth A, Zhang Y, et al. Human cytomegalovirus-specific CD8(+) T-cell expansions contain long-lived cells that retain functional capacity in both young and elderly subjects. Immunology. 2011;132(1):27–38.PubMedPubMedCentralCrossRef Wallace DL, Masters JE, De Lara CM, Henson SM, Worth A, Zhang Y, et al. Human cytomegalovirus-specific CD8(+) T-cell expansions contain long-lived cells that retain functional capacity in both young and elderly subjects. Immunology. 2011;132(1):27–38.PubMedPubMedCentralCrossRef
43.
go back to reference Beswick M, Pachnio A, Lauder SN, Sweet C, Moss PA. Antiviral therapy can reverse the development of immune senescence in elderly mice with latent cytomegalovirus infection. J Virol. 2013;87(2):779–89.PubMedPubMedCentralCrossRef Beswick M, Pachnio A, Lauder SN, Sweet C, Moss PA. Antiviral therapy can reverse the development of immune senescence in elderly mice with latent cytomegalovirus infection. J Virol. 2013;87(2):779–89.PubMedPubMedCentralCrossRef
Metadata
Title
“The ancient and the new”: is there an interaction between cytomegalovirus and SARS-CoV-2 infection?
Author
Paul Moss
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
SARS-CoV-2
Published in
Immunity & Ageing / Issue 1/2020
Electronic ISSN: 1742-4933
DOI
https://doi.org/10.1186/s12979-020-00185-x

Other articles of this Issue 1/2020

Immunity & Ageing 1/2020 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.