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Transcatheter aortic valve implantation (TAVI) is an established therapeutic option for high-risk patients with a tricuspid aortic valve, but patients with a bicuspid aortic valve (BAV) are contraindicated. In this Perspectives article, Zhao and colleagues summarize the available evidence for the use of TAVI in patients with a BAV and propose that this procedure might be appropriate in high-risk or inoperable individuals, but that more evidence is required before indications for TAVI can be extended to other patients with a BAV.
The global epidemic of cardiovascular disease is being fuelled by the spread of a Western lifestyle characterized by a high prevalence of cardiovascular risk factors. In this Perspectives article, Valentin Fuster highlights 10 therapies and interventions that, in his opinion, will be most useful in combating cardiovascular disease and promoting cardiovascular health over the next decade.
Cardiovascular and renal disease often have similar origins and shared risk factors. With the progression of chronic kidney disease, additional risk factors develop, contributing to the evolution of both diseases. In this Perspectives article, Ruiz-Hurtado and Ruilope postulate that that simultaneous protection for both cardiovascular and renal disease can be achieved with the same therapy. They review the evidence from clinical trials supporting this theory, and discuss strategies to prevent both cardiovascular and chronic kidney disease.
Mutations in theSCN5A gene, which encodes the cardiac sodium channel, are well known to cause gain or loss of channel function and, consequently, various cardiac arrhythmias. However, greater phenotypic variability exists than can be ascribed directly to mutation-dependent changes in channel biophysical properties. In this Perspectives article, Liu et al. propose that additional intrinsic and extrinsic modifiers of channel behaviour might help to explain this variability and to improve genotype–phenotype correlations.
Blood motion in the heart features vortices, the stability of which is vital to the dynamic balance between rotating blood and myocardial tissue and to the development of cardiac dysfunction. In this Perspectives article, Pedrizzetti et al. examine cardiac vortex flow as a sensitive pathogenetic indicator and modulator of left ventricular remodelling towards heart failure, and the role of cardiac vortices for risk stratification of patients following cardiac surgery or device therapy.
Coronary 'no-reflow' is a substantial clinical problem, even after successful percutaneous coronary intervention for myocardial infarction. In this Perspectives, article, O'Farrell and Attwell describe the similarities between this phenomenon and no-reflow in the brain after ischaemic stroke, and propose that pericytes contribute to the underlying pathophysiology in both situations. Cardiac pericytes might, therefore, be a novel therapeutic target for coronary no-reflow.
