Volume 10 Issue 9, September 2013

In a study conducted in selected US hospitals, bypassing the emergency department with direct transport to the cardiac catheterization laboratory resulted in a reduced time to reperfusion for patients with ST-segment elevation myocardial infarction. However, this strategy was used infrequently—mostly during working hours—and varied significantly between hospitals.

The selection of end points for clinical trials of heart failure is challenging, with important implications for patients, the medical community, and regulatory agencies. The standards used in clinical research on patients with heart failure influence the effectiveness and value of future clinical trials, and the extent to which they can be translated into clinical practice.

Exercise is associated with reduced long-term morbidity and mortality but, in some individuals, can transiently increase the risk of fatal or nonfatal cardiac events. In this Review, Dangardt and colleagues discuss the benefits and risks of physical activity and exercise in the general population and in patients with various forms of cardiovascular disease. Strategies to promote physical activity and improve public health are proposed.

Important differences exist between women and men in clinical presentation, recognition of symptoms, response to treatment, and outcomes in ischaemic heart disease (IHD). In this Review, Vaccarino et al. discuss the current evidence for sex-related differences in the manifestation of IHD, diagnostic strategy, and approaches to treatment, and identify gaps in the literature that need to be addressed in future research.

Dysfunctional blood vessel regulation is a key component in the pathophysiology of heart failure. Vascular endothelial growth factor (VEGF) has an essential role in the formation of new vessels. In this Review, Taimeh et al. outline the biological characterization of VEGF, and examine the evidence for its potential therapeutic application, including the novel concept of VEGF as adjuvant therapy to stem cell transplantation, in patients with heart failure.

The underlying genetics of dilated cardiomyopathy are complex, and the condition can be caused by mutations in any one of more than 30 genes. In this Review, Hershberger and colleagues assess the diverse genomics of this condition and how they might intersect with those of the hypertrophic and arrhythmogenic right ventricular forms of cardiomyopathy.