Nature Reviews Cardiology Nature Reviews Cardiology provides physicians and academics with authoritative and topical discussions of key developments in the field. http://www.nature.com/nrcardio/current_issue/ Nature Publishing Group en © 2009 Nature Publishing Group Nature Reviews Cardiology 1759-5002 1759-5010 © 2009 Nature Publishing Group permissions@nature.com Nature Reviews Cardiology http://www.nature.com/includes/rj_globnavimages/nrcardio_logo.gif http://www.nature.com/nrcardio/ Interventional cardiology: Drug-eluting stents are superior to bare-metal stents in elderly patients http://dx.doi.org/10.1038/nrcardio.2009.82 Interventional cardiology: Drug-eluting stents are superior to bare-metal stents in elderly patients

Nature Reviews Cardiology 6, 439 (2009). doi:10.1038/nrcardio.2009.82

Author: Alexandra King

]]> Interventional cardiology: Drug-eluting stents are superior to bare-metal stents in elderly patients Alexandra King doi:10.1038/nrcardio.2009.82 Nature Reviews Cardiology 6, 439 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.82 http://dx.doi.org/10.1038/nrcardio.2009.82 6 7 Research Highlight 439 439 Heart Failure: HF potentially preventable in the elderly http://dx.doi.org/10.1038/nrcardio.2009.90 Heart Failure: HF potentially preventable in the elderly

Nature Reviews Cardiology 6, 440 (2009). doi:10.1038/nrcardio.2009.90

Author: Alexandra King

]]> Heart Failure: HF potentially preventable in the elderly Alexandra King doi:10.1038/nrcardio.2009.90 Nature Reviews Cardiology 6, 440 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.90 http://dx.doi.org/10.1038/nrcardio.2009.90 6 7 Research Highlight 440 440 Hypertension: ECG strain predicts cardiovascular risk http://dx.doi.org/10.1038/nrcardio.2009.91 Hypertension: ECG strain predicts cardiovascular risk

Nature Reviews Cardiology 6, 440 (2009). doi:10.1038/nrcardio.2009.91

Author: Sharmini Rajanayagam

]]> Hypertension: ECG strain predicts cardiovascular risk Sharmini Rajanayagam doi:10.1038/nrcardio.2009.91 Nature Reviews Cardiology 6, 440 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.91 http://dx.doi.org/10.1038/nrcardio.2009.91 6 7 Research Highlight 440 440 Intramyocardial injections are safe http://dx.doi.org/10.1038/nrcardio.2009.87 Intramyocardial injections are safe

Nature Reviews Cardiology 6, 441 (2009). doi:10.1038/nrcardio.2009.87

Author: Bryony M. Mearns

]]> Intramyocardial injections are safe Bryony M. Mearns doi:10.1038/nrcardio.2009.87 Nature Reviews Cardiology 6, 441 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.87 http://dx.doi.org/10.1038/nrcardio.2009.87 6 7 Research Highlight 441 441 Interventional cardiology: Guidance for carotid stenting http://dx.doi.org/10.1038/nrcardio.2009.84 Interventional cardiology: Guidance for carotid stenting

Nature Reviews Cardiology 6, 442 (2009). doi:10.1038/nrcardio.2009.84

Author: Sharmini Rajanayagam

]]> Interventional cardiology: Guidance for carotid stenting Sharmini Rajanayagam doi:10.1038/nrcardio.2009.84 Nature Reviews Cardiology 6, 442 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.84 http://dx.doi.org/10.1038/nrcardio.2009.84 6 7 Research Highlight 442 442 Blood pressure predicts AF in women http://dx.doi.org/10.1038/nrcardio.2009.86 Blood pressure predicts AF in women

Nature Reviews Cardiology 6, 442 (2009). doi:10.1038/nrcardio.2009.86

Author: Lisa Richards

]]> Blood pressure predicts AF in women Lisa Richards doi:10.1038/nrcardio.2009.86 Nature Reviews Cardiology 6, 442 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.86 http://dx.doi.org/10.1038/nrcardio.2009.86 6 7 Research Highlight 442 442 Cardiomyopathies: Syncope is a risk factor for death in HCM http://dx.doi.org/10.1038/nrcardio.2009.83 Cardiomyopathies: Syncope is a risk factor for death in HCM

Nature Reviews Cardiology 6, 443 (2009). doi:10.1038/nrcardio.2009.83

Author: Alexandra King

]]> Cardiomyopathies: Syncope is a risk factor for death in HCM Alexandra King doi:10.1038/nrcardio.2009.83 Nature Reviews Cardiology 6, 443 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.83 http://dx.doi.org/10.1038/nrcardio.2009.83 6 7 Research Highlight 443 443 Atrial fibrillation: Physician specialty and ICD implant outcome http://dx.doi.org/10.1038/nrcardio.2009.85 Atrial fibrillation: Physician specialty and ICD implant outcome

Nature Reviews Cardiology 6, 443 (2009). doi:10.1038/nrcardio.2009.85

Author: Lisa Richards

]]> Atrial fibrillation: Physician specialty and ICD implant outcome Lisa Richards doi:10.1038/nrcardio.2009.85 Nature Reviews Cardiology 6, 443 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.85 http://dx.doi.org/10.1038/nrcardio.2009.85 6 7 Research Highlight 443 443 Drug therapy does not match guidelines http://dx.doi.org/10.1038/nrcardio.2009.92 Drug therapy does not match guidelines

Nature Reviews Cardiology 6, 443 (2009). doi:10.1038/nrcardio.2009.92

Author: Bryony M. Mearns

]]> Drug therapy does not match guidelines Bryony M. Mearns doi:10.1038/nrcardio.2009.92 Nature Reviews Cardiology 6, 443 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.92 http://dx.doi.org/10.1038/nrcardio.2009.92 6 7 Research Highlight 443 443 Infection: Infections related to outpatient health care cause native endocarditis http://dx.doi.org/10.1038/nrcardio.2009.100 Infection: Infections related to outpatient health care cause native endocarditis

Nature Reviews Cardiology 6, 444 (2009). doi:10.1038/nrcardio.2009.100

Author: Alexandra King

]]> Infection: Infections related to outpatient health care cause native endocarditis Alexandra King doi:10.1038/nrcardio.2009.100 Nature Reviews Cardiology 6, 444 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.100 http://dx.doi.org/10.1038/nrcardio.2009.100 6 7 Research Highlight 444 444 Acute coronary syndromes: Early versus late intervention in NSTEMI http://dx.doi.org/10.1038/nrcardio.2009.101 Acute coronary syndromes: Early versus late intervention in NSTEMI

Nature Reviews Cardiology 6, 444 (2009). doi:10.1038/nrcardio.2009.101

Author: Bryony M. Mearns

]]> Acute coronary syndromes: Early versus late intervention in NSTEMI Bryony M. Mearns doi:10.1038/nrcardio.2009.101 Nature Reviews Cardiology 6, 444 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.101 http://dx.doi.org/10.1038/nrcardio.2009.101 6 7 Research Highlight 444 444 Echo versus ECG for suspected CAD http://dx.doi.org/10.1038/nrcardio.2009.93 Echo versus ECG for suspected CAD

Nature Reviews Cardiology 6, 445 (2009). doi:10.1038/nrcardio.2009.93

Author: Sharmini Rajanayagam

]]> Echo versus ECG for suspected CAD Sharmini Rajanayagam doi:10.1038/nrcardio.2009.93 Nature Reviews Cardiology 6, 445 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.93 http://dx.doi.org/10.1038/nrcardio.2009.93 6 7 Research Highlight 445 445 Interventional cardiology: New polymer-free dual-drug-eluting stent http://dx.doi.org/10.1038/nrcardio.2009.88 Interventional cardiology: New polymer-free dual-drug-eluting stent

Nature Reviews Cardiology 6, 446 (2009). doi:10.1038/nrcardio.2009.88

Author: Lisa Richards

]]> Interventional cardiology: New polymer-free dual-drug-eluting stent Lisa Richards doi:10.1038/nrcardio.2009.88 Nature Reviews Cardiology 6, 446 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.88 http://dx.doi.org/10.1038/nrcardio.2009.88 6 7 Research Highlight 446 446 Genetics: Identification of genes associated with stroke risk http://dx.doi.org/10.1038/nrcardio.2009.89 Genetics: Identification of genes associated with stroke risk

Nature Reviews Cardiology 6, 446 (2009). doi:10.1038/nrcardio.2009.89

Author: Sharmini Rajanayagam

]]> Genetics: Identification of genes associated with stroke risk Sharmini Rajanayagam doi:10.1038/nrcardio.2009.89 Nature Reviews Cardiology 6, 446 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.89 http://dx.doi.org/10.1038/nrcardio.2009.89 6 7 Research Highlight 446 446 Heart failure: Support for exercise training in CHF http://dx.doi.org/10.1038/nrcardio.2009.96 The results of HF-ACTION—the largest ever intervention trial of a nonpharmacological treatment for chronic heart failure—have been reported. The investigators randomly allocated participants to either a structured exercise program or to usual care. Although the primary end point was not reached at the prespecified significance level, the background evidence and data from previous trials and other prespecified analyses compel me to conclude that exercise training should be recommended for patients with stable chronic heart failure. Heart failure: Support for exercise training in CHF

Nature Reviews Cardiology 6, 447 (2009). doi:10.1038/nrcardio.2009.96

Author: Andrew J. S. Coats

The results of HF-ACTION—the largest ever intervention trial of a nonpharmacological treatment for chronic heart failure—have been reported. The investigators randomly allocated participants to either a structured exercise program or to usual care. Although the primary end point was not reached at the prespecified significance level, the background evidence and data from previous trials and other prespecified analyses compel me to conclude that exercise training should be recommended for patients with stable chronic heart failure.

]]> Heart failure: Support for exercise training in CHF Andrew J. S. Coats doi:10.1038/nrcardio.2009.96 Nature Reviews Cardiology 6, 447 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.96 http://dx.doi.org/10.1038/nrcardio.2009.96 6 7 News and Views 447 448 Stroke: Atrial fibrillation, stroke prevention therapy and aging http://dx.doi.org/10.1038/nrcardio.2009.98 Stroke risk in patients with nonvalvular atrial fibrillation increases markedly with age. Although anticoagulation is more effective than antiplatelet therapy in atrial fibrillation, it tends to be underutilized in the elderly. A study by van Walraven et al. examines the influence of age on stroke prevention therapy in atrial fibrillation. Stroke: Atrial fibrillation, stroke prevention therapy and aging

Nature Reviews Cardiology 6, 448 (2009). doi:10.1038/nrcardio.2009.98

Author: J. David Spence

Stroke risk in patients with nonvalvular atrial fibrillation increases markedly with age. Although anticoagulation is more effective than antiplatelet therapy in atrial fibrillation, it tends to be underutilized in the elderly. A study by van Walraven et al. examines the influence of age on stroke prevention therapy in atrial fibrillation.

]]> Stroke: Atrial fibrillation, stroke prevention therapy and aging J. David Spence doi:10.1038/nrcardio.2009.98 Nature Reviews Cardiology 6, 448 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.98 http://dx.doi.org/10.1038/nrcardio.2009.98 6 7 News and Views 448 450 Cardiomyopathies: New test for arrhythmogenic right ventricular cardiomyopathy http://dx.doi.org/10.1038/nrcardio.2009.97 Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is challenging to diagnose because of nonspecific findings, particularly in the early phases of the disease. Clinical diagnosis is made on the basis of several criteria, but these lack sensitivity. Asimaki et al. suggest that immunohistochemical analysis of myocardial desmosomal proteins is a highly sensitive and specific diagnostic test for ARVD/C. Cardiomyopathies: New test for arrhythmogenic right ventricular cardiomyopathy

Nature Reviews Cardiology 6, 450 (2009). doi:10.1038/nrcardio.2009.97

Authors: J. Peter van Tintelen & Richard N. W. Hauer

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is challenging to diagnose because of nonspecific findings, particularly in the early phases of the disease. Clinical diagnosis is made on the basis of several criteria, but these lack sensitivity. Asimaki et al. suggest that immunohistochemical analysis of myocardial desmosomal proteins is a highly sensitive and specific diagnostic test for ARVD/C.

]]> Cardiomyopathies: New test for arrhythmogenic right ventricular cardiomyopathy J. Peter van Tintelen Richard N. W. Hauer doi:10.1038/nrcardio.2009.97 Nature Reviews Cardiology 6, 450 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.97 http://dx.doi.org/10.1038/nrcardio.2009.97 6 7 News and Views 450 451 Diabetes: Does screening for inducible ischemia improve outcomes? http://dx.doi.org/10.1038/nrcardio.2009.95 The DIAD trial investigators have demonstrated that screening for inducible myocardial ischemia did not improve overall clinical outcome in a contemporary cohort of patients with asymptomatic type 2 diabetes, most of whom were receiving excellent medical management and few of whom underwent revascularization. Future studies should be designed to evaluate the clinical value and cost effectiveness of unconditional treatment versus screening using techniques to detect atherosclerotic and ischemic burden, coupled with therapeutic interventions, risk-factor management, and selective use of revascularization in high-risk patients. Diabetes: Does screening for inducible ischemia improve outcomes?

Nature Reviews Cardiology 6, 452 (2009). doi:10.1038/nrcardio.2009.95

Author: Prediman K. Shah

The DIAD trial investigators have demonstrated that screening for inducible myocardial ischemia did not improve overall clinical outcome in a contemporary cohort of patients with asymptomatic type 2 diabetes, most of whom were receiving excellent medical management and few of whom underwent revascularization. Future studies should be designed to evaluate the clinical value and cost effectiveness of unconditional treatment versus screening using techniques to detect atherosclerotic and ischemic burden, coupled with therapeutic interventions, risk-factor management, and selective use of revascularization in high-risk patients.

]]> Diabetes: Does screening for inducible ischemia improve outcomes? Prediman K. Shah doi:10.1038/nrcardio.2009.95 Nature Reviews Cardiology 6, 452 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.95 http://dx.doi.org/10.1038/nrcardio.2009.95 6 7 News and Views 452 453 Atrial Fibrillation: Predicting the efficacy of pulmonary vein isolation with CMR http://dx.doi.org/10.1038/nrcardio.2009.99 Pulmonary vein antrum isolation is an accepted alternative to antiarrhythmic therapy for restoring normal sinus rhythm in patients with atrial fibrillation. The procedure has a high initial success rate, but many patients subsequently experience recurrence of the arrhythmia. Cardiac magnetic resonance might offer a means of identifying patients who are more likely to experience successful long-term results from pulmonary vein antrum isolation. Atrial Fibrillation: Predicting the efficacy of pulmonary vein isolation with CMR

Nature Reviews Cardiology 6, 453 (2009). doi:10.1038/nrcardio.2009.99

Author: Mario J. Garcia

Pulmonary vein antrum isolation is an accepted alternative to antiarrhythmic therapy for restoring normal sinus rhythm in patients with atrial fibrillation. The procedure has a high initial success rate, but many patients subsequently experience recurrence of the arrhythmia. Cardiac magnetic resonance might offer a means of identifying patients who are more likely to experience successful long-term results from pulmonary vein antrum isolation.

]]> Atrial Fibrillation: Predicting the efficacy of pulmonary vein isolation with CMR Mario J. Garcia doi:10.1038/nrcardio.2009.99 Nature Reviews Cardiology 6, 453 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.99 http://dx.doi.org/10.1038/nrcardio.2009.99 6 7 News and Views 453 454 Update on strategies to increase HDL quantity and function http://dx.doi.org/10.1038/nrcardio.2009.94 Low levels of HDL cholesterol are a significant predictor of atherosclerotic cardiovascular events. HDL is believed to protect against atherosclerosis by promoting reverse cholesterol transport, and potentially through anti-inflammatory, antioxidative, antithrombotic and nitric oxide effects. The multiple mechanisms of action, as well as a limited Update on strategies to increase HDL quantity and function

Nature Reviews Cardiology 6, 455 (2009). doi:10.1038/nrcardio.2009.94

Authors: Danielle Duffy & Daniel J. Rader

Low levels of HDL cholesterol are a significant predictor of atherosclerotic cardiovascular events. HDL is believed to protect against atherosclerosis by promoting reverse cholesterol transport, and potentially through anti-inflammatory, antioxidative, antithrombotic and nitric oxide effects. The multiple mechanisms of action, as well as a limited

]]> Update on strategies to increase HDL quantity and function Danielle Duffy Daniel J. Rader doi:10.1038/nrcardio.2009.94 Nature Reviews Cardiology 6, 455 (2009) 2009-06-02 Nature Reviews Cardiology 2009-06-02 10.1038/nrcardio.2009.94 http://dx.doi.org/10.1038/nrcardio.2009.94 6 7 Review 455 463 Biomarkers of AAA progression. Part 1: extracellular matrix degeneration http://dx.doi.org/10.1038/nrcardio.2009.80 Abdominal aortic aneurysm (AAA) is an important health problem. Elective surgical treatment is recommended on the basis of an individual's risk of rupture, which is predicted by AAA diameter. However, the natural history of AAA differs between patients and a reliable and individual predictor of Biomarkers of AAA progression. Part 1: extracellular matrix degeneration

Nature Reviews Cardiology 6, 464 (2009). doi:10.1038/nrcardio.2009.80

Authors: Femke A. M. V. I. Hellenthal, Willem A. Buurman, Will K. W. H. Wodzig & Geert Willem H. Schurink

Abdominal aortic aneurysm (AAA) is an important health problem. Elective surgical treatment is recommended on the basis of an individual's risk of rupture, which is predicted by AAA diameter. However, the natural history of AAA differs between patients and a reliable and individual predictor of

]]> Biomarkers of AAA progression. Part 1: extracellular matrix degeneration Femke A. M. V. I. Hellenthal Willem A. Buurman Will K. W. H. Wodzig Geert Willem H. Schurink doi:10.1038/nrcardio.2009.80 Nature Reviews Cardiology 6, 464 (2009) 2009-05-26 Nature Reviews Cardiology 2009-05-26 10.1038/nrcardio.2009.80 http://dx.doi.org/10.1038/nrcardio.2009.80 6 7 Review 464 474 Molecular imaging of cardiovascular disease with contrast-enhanced ultrasonography http://dx.doi.org/10.1038/nrcardio.2009.77 Techniques for noninvasive imaging of specific disease-related molecular changes are being developed to enhance diagnosis and therapeutic decision making in the clinical setting, and to facilitate research efforts. Molecular imaging with contrast-enhanced ultrasonography relies on the detection of the acoustic signal produced by microbubble or Molecular imaging of cardiovascular disease with contrast-enhanced ultrasonography

Nature Reviews Cardiology 6, 475 (2009). doi:10.1038/nrcardio.2009.77

Author: Jonathan R. Lindner

Techniques for noninvasive imaging of specific disease-related molecular changes are being developed to enhance diagnosis and therapeutic decision making in the clinical setting, and to facilitate research efforts. Molecular imaging with contrast-enhanced ultrasonography relies on the detection of the acoustic signal produced by microbubble or

]]> Molecular imaging of cardiovascular disease with contrast-enhanced ultrasonography Jonathan R. Lindner doi:10.1038/nrcardio.2009.77 Nature Reviews Cardiology 6, 475 (2009) 2009-06-09 Nature Reviews Cardiology 2009-06-09 10.1038/nrcardio.2009.77 http://dx.doi.org/10.1038/nrcardio.2009.77 6 7 Review 475 481 Mechanical bridge to recovery in pheochromocytoma myocarditis http://dx.doi.org/10.1038/nrcardio.2009.58 Background. A 27-year-old male presented with exercise-related symptoms of chest tightness, palpitations, breathlessness and severe headache, with occasional nausea, dizziness, and blurred vision. Apart from a family history of coronary artery disease there was no other medical history of note.Investigations. Clinical examination, Mechanical bridge to recovery in pheochromocytoma myocarditis

Nature Reviews Cardiology 6, 482 (2009). doi:10.1038/nrcardio.2009.58

Authors: Stephen Westaby, Ashwin Shahir, Gregory Sadler, Fidelma Flynn & Oliver Ormerod

Background. A 27-year-old male presented with exercise-related symptoms of chest tightness, palpitations, breathlessness and severe headache, with occasional nausea, dizziness, and blurred vision. Apart from a family history of coronary artery disease there was no other medical history of note.Investigations. Clinical examination,

]]> Mechanical bridge to recovery in pheochromocytoma myocarditis Stephen Westaby Ashwin Shahir Gregory Sadler Fidelma Flynn Oliver Ormerod doi:10.1038/nrcardio.2009.58 Nature Reviews Cardiology 6, 482 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.58 http://dx.doi.org/10.1038/nrcardio.2009.58 6 7 Case Study 482 487 Preventing CVD in resource-poor areas: perspectives from the 'real-world' http://dx.doi.org/10.1038/nrcardio.2009.79 An evolving epidemic of cardiovascular disease (CVD) is having a profound effect on the health of vulnerable populations in low-to-middle income countries with limited resources. Despite some encouraging signs (particularly initiatives from the WHO), global and regional apathy towards noncommunicable forms of CVD adds to Preventing CVD in resource-poor areas: perspectives from the 'real-world'

Nature Reviews Cardiology 6, 489 (2009). doi:10.1038/nrcardio.2009.79

Authors: Simon Stewart & Karen Sliwa

An evolving epidemic of cardiovascular disease (CVD) is having a profound effect on the health of vulnerable populations in low-to-middle income countries with limited resources. Despite some encouraging signs (particularly initiatives from the WHO), global and regional apathy towards noncommunicable forms of CVD adds to

]]> Preventing CVD in resource-poor areas: perspectives from the 'real-world' Simon Stewart Karen Sliwa doi:10.1038/nrcardio.2009.79 Nature Reviews Cardiology 6, 489 (2009) Nature Reviews Cardiology 10.1038/nrcardio.2009.79 http://dx.doi.org/10.1038/nrcardio.2009.79 6 7 Perspectives 489 492