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The prospect of nonsurgical replacement of cardiac valves by percutaneous valve replacement holds immense promise for both patients and clinicians. In this Viewpoint, Younes Boudjemline and Philipp Bonhoeffer discuss the achievements so far and the future this new technique has in interventional cardiology.
Brief episodes of ischemia before total coronary occlusion can protect the heart in animals; a similar preconditioning effect might be seen in humans. Preinfarction angina, already an important part of cardiac assessment, might be a corollary of preconditioning before myocardial infarction. Rezkalla and Kloner discuss the impact of preinfarction angina in the clinical setting.
Heart failure is increasingly thought to be a myocyte deficiency disease. Therapeutic strategies to increase the number of cardiac muscle cells by direct transplantation are being met with a mixture of enthusiasm and caution. While conceptually attractive, however, the success of this approach remains unproven. The evidence to date is discussed.
An inverse correlation exists between the plasma concentration of HDLs and the incidence of cardiovascular disease. The harnessing of this beneficial effect has been explored as a new approach for treatment. In this review, the range of beneficial effects and the methods being developed for the delivery of therapy are explored.
Chronic delayed cerebral vasospasm has a major impact on morbidity and mortality related to aneurysmal subarachnoid hemorrhage. Reduced concentrations of endothelium-derived NO, an important vasodilator, and increased levels of endothelin-1, one of the most potent vasoconstrictors, are important contributory factors. This review discusses the relevant mechanisms in cerebral vasospasm.
Despite treatment being available for angina in the form of β-blockers and calcium-channel blockers, these drugs are contraindicated in some patients. PharmacologicalIfinhibition could prove a promising alternative for protection from angina through heart-rate slowing. This review discusses the early mechanisms and early clinical use of ivabradine as a specific bradycardic agent.