Review Articles in 2011

This Review outlines the main ethical and legal issues surrounding informed consent for the insertion, removal, and deactivation of implantable cardioverter-defibrillators (ICDs). The authors also provide an overview of current guidelines for communication with and involvement of patients and next of kin throughout the decision-making process.

Pulmonary arterial hypertension (PAH) is a rare, but devastating, disease characterized by progressive obliteration of the pulmonary microvasculature. Over the past decade, an increasing number of therapies targeting the prostacyclin, endothelin, and nitric oxide pathways have been shown to improve the symptoms of PAH and even slow disease progression. O'Callaghan and colleagues review the pharmacological agents currently available for the treatment of PAH and discuss potential novel therapeutic targets in this disease.

Dual and triple antiplatelet therapies prevent ischemic events in high-risk patients with coronary artery disease or during percutaneous coronary interventions, but can cause bleeding complications. In this Review, Dr. Tantry and Dr. Gurbel discuss the utility of platelet function assays for the assessment of ischemic and bleeding risk to personalize antithrombotic combination therapies.

Heart failure is a chronic condition that requires a substantial amount of self care by patients. Dr. Riegel and colleagues review heart failure self care in terms of predictors and outcomes, and discuss their implications on clinical practice, public health and policy.

In this state-of-the-art Review, Drs Yousuf and Bhatt appraise landmark trials of various existing, new, and investigational antiplatelet agents. They also discuss the optimal dosing and timing of antiplatelet medications in relation to percutaneous and surgical intervention, and the challenges associated with high platelet reactivity in patients receiving dual antiplatelet therapy.

Several dietary components contribute to the development and progression of hypertension. Dong Zhao and colleagues review the available evidence for the association of various dietary factors with blood pressure and hypertension, the dietary recommendations of national and international guidelines on hypertension prevention and management, and the outcomes of diet-based public policy plans on hypertension control.

Pathological arterial thrombosis represents the most-frequent cause of death worldwide. Dr. Lippi and colleagues explain the molecular and cellular mechanisms involved in atherothrombosis, and discuss genetic and acquired risk factors associated with this condition.

Translation of ischemic conditioning into clinical practice has been remarkably slow, but important advances have occurred in the past 5–6 years. This Review provides an update on the use of ischemic conditioning, and describes the results of successful proof-of-concept clinical trials.

In the past decade or so, our understanding of pulmonary arterial hypertension has undergone a paradigm shift. In this article, Dr Schermuly and colleagues discuss the known molecular mechanisms of the pathogenesis of this disease, and highlight the molecular technologies that are currently being used to further our understanding of these disease processes.

In the absence of symptoms, the presence of left ventricular systolic dysfunction is pivotal in making treatment decisions for patients with aortic stenosis. Dr. Alper and colleagues explain the pathophysiological mechanisms underlying left ventricular dysfunction in patients with aortic stenosis and discuss the role of echocardiographic deformation parameters in monitoring disease progression and determining when aortic valve replacement should be performed.

The prevalence and severity of obesity among children has increased dramatically over the past 30 years. Strong evidence supports the concept that precursors of adult cardiovascular disease (CVD) begin in childhood, and that pediatric obesity has an important influence on overall CVD risk. In this Review, Nadeau and colleagues examine the evidence supporting the impact of childhood obesity on adult obesity, surrogate markers of CVD, and the development of CVD as well as the effects of obesity treatment strategies on risk factors and clinical outcomes.

The treatment of patients with peripheral artery disease (PAD) has two important goals; firstly, to reduce the extremely high morbidity and mortality associated with this condition and, secondly, to prevent amputation, improve symptoms of claudication, and improve overall quality of life. In the second part of their Review on, Weinberg et al. discuss risk factor modification, medical therapy, and approaches to revascularization in PAD, with a focus on endovascular techniques.

Peripheral artery disease is underdiagnosed and undertreated because many patients are asymptomatic. In Part 1 of this Review, Lauet al. discuss epidemiology and risk factors of peripheral artery disease and give advice on the diagnostic evaluation of patients with this condition.

Anemia and iron deficiency are common in patients with heart failure, and negatively impact on symptoms and outcomes in this patient population. In this Review, Dr. van Veldhuisen and colleagues discuss the impact of anemia and iron deficiency in patients with heart failure, mechanisms of iron metabolism, and treatment strategies for these patients.

Three-dimensional electromechanical mapping with the NOGA^® system is a promising strategy to evaluate myocardial viability and identify motion disturbances in the ventricular wall. The authors of this Review discuss the NOGA^® procedure, the validation of this novel technique, and the current and future applications of NOGA^®in patients with ischemia.

Clarifying the underlying cause of prosthetic heart valve dysfunction is important for initiating appropriate treatment. Dr. Habets et al. describe the complementary roles of noninvasive imaging techniques in the diagnosis of left-sided mechanical and biological prosthetic heart valve dysfunction.

The volume of literature attesting to the clinical benefits of exercise training in patients with stable chronic systolic heart failure is substantial. Exercise training can improve symptoms and exercise capacity, as well as reducing morbidity, mortality, and rates of emergency hospitalization associated with this condition. In this article, Dr. Coats reviews the modes and intensity of exercise training, selection of patients, duration of training effects, and discusses other clinical guidance for using this treatment option in patients with stable chronic systolic heart failure.

Elevated resting heart rate is an independent, modifiable risk factor for cardiovascular events and mortality in patients with coronary artery disease (CAD). Several mechanisms by which elevated heart rate adversely affects the cardiovascular system are now known. Rates of adequate heart rate control appear to be low in current clinical practice, potentially representing a missed therapeutic opportunity. Drs. Fox and Ferrari discuss the mechanisms that might underlie the involvement of heart rate in CAD and other conditions and review the results of randomized trials that have emphasized its clinical importance.

Chronic inflammation of the vascular wall is a hallmark of atherosclerosis. The authors of this Review discuss the role of various T and B cell subsets in the development of atherosclerotic lesions and summarize potential treatment strategies that are based on the modulation of the adaptive immune response.

In this Review, Dr. Que and Dr. Moreillon discuss the epidemiology, pathogenesis, prophylaxis, diagnosis, and management of infective endocarditis. They particularly highlight the importance of making every effort to prevent this disease, as when established, infective endocarditis is a severe condition that requires aggressive antibiotic and, often, surgical therapy.