Volume 11 Issue 3, March 2014

The VISTA-16 trial of varespladib, a secretory phospholipase A₂ (sPLA₂) inhibitor, in patients with an acute coronary syndrome was terminated prematurely owing to futility and a signal towards harm. Despite these discouraging results, therapies that target inflammation to modify pathways in atherogenesis remain an area of active investigation.

A scientific statement on the prevention and treatment of thrombosis in children with congenital heart disease has been published by Giglia et al. on behalf of the AHA. This paper adds substantially to the current literature, and yet highlights the major limitations in our current understanding and knowledge in this field.

Cardiomyopathy classification has been subject to revisions for >60 years. The new MOGE(S) classification system, which incorporates information on structural and functional abnormalities, organ involvement, genetics, aetiology, and disease severity, is a step towards a globally accepted nomenclature, but needs to be applicable in all health-care systems around the world.

The new ACC/AHA cardiovascular-risk guidelines feature updated equations for women, distinct equations for African–American individuals, and include stroke prediction. However, the equations rely on the same traditional risk factors as previous versions, are driven predominantly by age, and curtail the intermediate-risk group, in which personalized risk assessment is recommended.

Currently, numerous tests are available for the assessment and triage of patients with stable ischaemic heart disease. National societies in the USA have collaborated to develop appropriate use criteria to give guidance to clinicians about the evidence-based use of these tests.

A number of gene variants that cause hypercoagulability, and can lead to venous thromboembolism, have been identified. The two main mechanisms are loss-of-function of anticoagulant proteins and gain-of-function of procoagulants. In this Review, Ida Martinelli and colleagues discuss the main causes of inherited thrombophilia, the associated clinical manifestations, and the implications for screening and antithrombotic prophylaxis in affected individuals and their families.

Transcatheter aortic valve implantation (TAVI) is increasingly used to treat patients with aortic stenosis for whom the risks associated with surgery are very high. In this Review, the new generation of TAVI devices are discussed, many of which have features that allow repositioning of the device and reduce paravalvular leakage.

Dystrophinopathies, such as Duchenne muscular dystrophy, Becker muscular dystrophy, and X linked dilated cardiomyopathy, can have cardiac sequelae. In this Review, Finsterer and Cripe discuss how the onset of cardiac involvement should be delayed in these patients, and then how it should be treated. The use of both pharmacological and nonpharmacological tools is described.

Chelation therapy with ethylenediamine tetra acetic acid is increasingly being used in patients with cardiovascular disease, without definitive evidence for its efficacy. In this Perspectives article, Sidhu et al. discuss data from major studies of chelation therapy in this field, with particular emphasis on TACT. They opine that the findings from this trial are not robust and do not marshal evidence in support of the potential clinical use of chelation therapy for cardiovascular disease.