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An effective risk score for patients undergoing coronary angioplasty is yet to be established. In this article we discuss the merits of using the EuroSCORE risk model for assessing these patients, and propose a potential modification to the system.
Magnetic Resonance Spectroscopy is a novel research tool used to noninvasively quantify myocardial triglyceride content. This method provides the opportunity to study myocardial steatosis in patients with diabetes.
Two or more drugs are needed to control blood pressure in the majority of patients with hypertension. The most commonly used combinations include a diuretic; however, results of two large, controlled trials show that better cardiovascular protection is provided by a combination of a renin-angiotensin inhibitor and a long-acting calcium-channel blocker than combinations that include a diuretic.
Poor responders to clopidogrel have low levels of circulating active metabolite. However, in vitro experiments have shown that blood platelets from poor responders are fully inhibited by the active metabolite of this prodrug. Impaired platelet inhibition reflects inadequate plasma levels of active metabolites, and not differences in platelet P2Y12 receptor function.
In the first section of this two-part Review, Dr Sweeny and colleagues explore the phenomenon of 'resistance' to antiplatelet drug therapy. They discuss the various factors influencing the patient's response to these drugs, and examine the link between laboratory-assessed nonresposiveness and clinical outcome.
Ventricular remodeling occurs over the weeks and months after myocardial infarction, and, therefore, provides a large temporal therapeutic window. In this Review, Dr Dorn examines recent developments in pharmacological treatment of ventricular remodeling in preclinical models of myocardial infarction.
Current treatment guidelines recommend exercise training in patients with heart failure classified as NYHA functional class II and III. This Review focuses on current knowledge of mechanisms by which progressive and moderate exercise training can have sustained beneficial effects on these patients.
Proteinuria often precedes any detectable decline in renal filtration function and is a strong and independent predictor of increased risk for all-cause and cardiovascular mortality. In this Review, Dr Agrawal and colleagues examine potential pathophysiologic mechanisms to explain simultaneous renal and cardiac disease, as well as therapeutic strategies for amelioration of proteinuria.
Dr Pasquale and colleagues demonstrate that dynamic left ventricular outflow tract obstruction was the cause of exertional chest pain and dyspnea in a patient with no evidence of hypertrophic cardiomyopathy or ischemic heart disease.
In this fascinating Perspective article, the authors propose a novel hypothesis for the developmental origin of the variable phenotypes seen in hypertrophic cardiomyopathy (HCM). They suggest that cross-talk between healthy epicardium-derived cells and abnormally contracting cardiomyocytes could account for the extramyocardial manifestations of HCM, by a putative mechanism of mechanotransduction leading to abnormal gene expression and cell differentiation.
