Volume 12 Issue 10, October 2015

A new systematic review and meta-analysis by Lee and colleagues confirms the safety of nonprimary percutaneous coronary intervention (PCI) at centres without onsite surgical backup. In daily clinical practice at PCI centres without onsite surgical facilities, quality assurance and improvement programmes are important to ensure high-quality care.

Familial hypercholesterolaemia (FH) is a common genetic disorder that remains mostly undetected, and even high-intensity statin therapy—the standard treatment for FH—often fails to lower LDL-cholesterol levels below those recommended by guidelines. In this Review, Reiner describes the different therapeutic strategies available for patients with FH that have been used with some success, including statin combination therapy, bile acid sequestrants, ezetimibe, apheresis, repression of apolipoprotein B-100 expression, and PCSK9 inhibition.

Although the harmful cardiovascular effects of alcoholism are well-known, the potentially beneficial effects of low-to-moderate alcohol intake are still debated. In this Review, Fernández-Solà considers the evidence for and against the cardioprotective properties of alcohol, and makes the case for the overall health benefits of reductions in alcohol consumption.

Measurement of biomarkers is a critical component of cardiovascular care, but sex-specific differences in these markers have not been fully integrated into clinical practice. In this Review, Daniels and Maisel assess the utility of sex-specific cut-off points when measuring cardiac troponins or natriuretic peptides in the diagnosis and prognosis of acute coronary syndrome and heart failure, respectively. They also discuss sex-specific differences in novel cardiovascular biomarkers, such as galectin-3, soluble ST2, and proneurotensin.

Most idiopathic ventricular arrhythmias (including forms of premature ventricular contraction and ventricular tachycardia) originate from the right or left ventricular outflow tracts. In this Review, Lerman summarizes how these arrhythmias are triggered by cAMP-mediated mechanisms, addresses the differential diagnosis between these and other arrhythmias, and discusses optimal treatment strategies, usually involving catheter-based radiofrequency ablation.

The quest for a practical total artificial heart (TAH) stems from the large number of patients with advanced heart failure, and the limited number of donor hearts available for transplantation. In this Perspectives article, Cohn et al. give their expert insight into the development of TAHs over the past 50 years. They describe the evolution from positive-displacement, pulsatile pumps to continuous-flow devices, and give their opinion on the most promising avenues for future innovation.