Articles in 2009

In the past 5 years, technological advances in multidetector CT imaging have enabled the development of complementary myocardial applications beyond coronary imaging. In this Review, the authors describe these advances and discuss the clinical potential of such imaging for a broad range of applications.

Consumption of omega-3 fatty acids is recommended by many international cardiology associations on the basis of abundant evidence for their cardioprotective nature. In this Review, Lee et al. discuss whether fish or fish-oil supplements are the best source of omega-3 fatty acids, and whether recommendations for omega-3 supplementation are warranted in view of the rapid depletion of world fish stocks.

Randomized trial data on pericardial diseases are scarce, but a number of new studies are moving the management of these conditions from empirically-based to evidence-based medicine. Massimo Imazio and colleagues show how the emerging data and the first guidelines for pericardial disease can be used to tailor management to the individual patient.

Factor Xa inhibitors, a new class of oral anticoagulants, have been evaluated in the phase II ATLAS ACS-TIMI 46 and APPRAISE trials. Addition of these agents to standard therapy has tended to reduce the incidence of adverse cardiovascular events at the expense of a dose-dependent increase in the risk of bleeding complications.

Cell therapy for myocardial infarction has received widespread attention. Although short-term effects have been encouraging, Yousef et al. now report substantial benefit of bone marrow mononuclear cells over 5 years of follow-up in an open-label series of 62 patients. Long-term follow-up of randomized trials is eagerly awaited and novel approaches of cell therapy are currently under investigation.

Ultrasonographic screening of older men to detect abdominal aortic aneurysms has been added to the list of programs supported by the National Health Service in England and Scotland, and by Medicare in the US. Two articles in the British Medical Journal addressing the cost-effectiveness of this practice have provided markedly discordant results.

Transcatheter aortic valve implantation has evolved as a viable therapeutic option for high-risk, elderly patients with symptomatic aortic stenosis in select cardiac centers with experience of the procedure. In this article we consider the findings reported by Webb et al. and discuss current criteria for selection of patients, technical features, clinical results, and future developments in this rapidly advancing area.

The extent of coronary calcification is thought to reflect the total coronary atherosclerotic burden. In this Review, Drs. Alexopoulos and Raggi discuss the current uncertainty about the role of coronary artery calcium in various disease states, the utility of calcium screening and current recommendations on its use.

Patients of low socioeconomic status (SES) with cardiovascular disease are a highly vulnerable, but often under-served, population. In high income countries in particular, these individuals develop cardiovascular disease younger, have more risk factors, and are less likely to benefit from treatment than are patients of higher socioeconomic status. In this Review, Clark et al. examine how socioeconomic status is linked to adverse cardiovascular outcomes and what clinicians can do to address inequalities.

Rheumatic heart disease is a substantial global health problem that particularly affects developing countries. In this article, Andrew Steer and Jonathan Carapetis review the pathophysiology and epidemiology of this disease and discuss strategies for diagnosis, prevention, and treatment. They also emphasize the importance of secondary prophylaxis programs and highlight the potential for vaccine development.

Myocardial angiogenesis occurs in response to hypoxia in ischemic tissues. This Review discusses imaging techniques that can be used to assess the effectiveness of exogenous angiogenic agents in promoting the growth of collateral vessels in ischemic myocardium.