Volume 11 Issue 9, September 2014

In an analysis of electronic health records, 1.25 million patients aged ≥30 years without diagnosed cardiovascular disease experienced 83,098 cardiovascular events during follow-up (median 5.2 years). Associations between incident cardiovascular disease and blood pressure differed for systolic and diastolic blood pressures and between the 12 cardiovascular end points examined.

A meta-analysis by investigators from FDA of three major trials of cardiac resynchronization therapy (CRT) demonstrated that women have a reduced rate of heart failure (HF) and death with CRT at a shorter QRS duration than men. Recognizing these sex-specific differences is important to improve outcomes for women with HF.

Uncertainty surrounds the benefit of β-blocker treatment in various clinical settings. The researchers in a new retrospective analysis of preoperative β-blocker use in CABG surgery now add to the debate, and suggest that these drugs might not improve perioperative outcomes.

Cryptogenic stroke is an apology for ignorance about the cause of ischaemic stroke. Now, in two new studies involving long-term electrocardiogram monitoring, investigators from the EMBRACE and CRYSTAL-AF trials suggest that many instances of cryptogenic stroke might be caused by undetected atrial fibrillation.

The 2014 revision of the 2005 AHA consensus statement on the evaluation of women with suspected ischaemic heart disease is a major update. The authors discuss the spectrum of ischaemic heart disease and review new data on the diagnostic and prognostic performance of the various diagnostic testing modalities now available.

Approximately half of all patients with heart failure have preserved ejection fraction (HFpEF), a syndrome for which no treatment has proven to be effective in clinical trials. The pathophysiology of HFpEF is heterogeneous, with multiple individual mechanisms frequently coexisting within the same patient to cause symptomatic heart failure. In this Review, Barry Borlaug discusses the current understanding of the pathophysiological mechanisms underlying HFpEF, and how they might be mechanistically related to typical risk factors for HFpEF, including ageing, obesity, and hypertension.

Atherosclerosis is a chronic, multifactorial disease in which inflammatory processes have long been known to be involved. Heat shock proteins (HSPs) are a group of proteins whose expression is increased when cells are exposed to elevated temperatures or other stressors, including classic risk factors for atherosclerosis. In this Review, Georg Wick and colleagues describe the role of HSPs in the initiation and potentiation of atherosclerosis, summarize the data supporting their theory of concept of atherosclerosis as an autoimmune disease in terms of the HSPs, specifically HSP60, and outline possible future developments in this field.

Constrictive pericarditis arises from a stiffening of the pericardium, which prevents complete or satisfactory diastolic filling of the heart. In this Review, Syed and colleagues discuss the pathophysiology of constrictive pericarditis and how to differentiate the disease from other causes of heart failure with preserved ejection fraction that have a similar presentation. Finally, the authors detail how best to treat patients with pericardial constriction, including by complete pericardiectomy.

Blood motion in the heart features vortices, the stability of which is vital to the dynamic balance between rotating blood and myocardial tissue and to the development of cardiac dysfunction. In this Perspectives article, Pedrizzetti et al. examine cardiac vortex flow as a sensitive pathogenetic indicator and modulator of left ventricular remodelling towards heart failure, and the role of cardiac vortices for risk stratification of patients following cardiac surgery or device therapy.