Volume 12 Issue 1, January 2015

The results of the Q-SYMBIO trial showing a reduction in mortality in patients with heart failure treated with coenzyme Q₁₀ have substantial limitations. Nevertheless, they highlight the need to identify effective new therapies targeted at mitochondrial dysfunction and oxidative stress in heart failure.

Biomarkers are needed to accurately represent or predict clinical outcomes for optimal management of patients with atrial fibrillation (AF) in clinical practice. Growth differentiation factor-15, a member of the transforming growth factor-β family, has an independent prognostic role for major bleeding and death in patients with AF receiving oral anticoagulation.

Atherosclerosis is characterized by increased accumulation of macrophages within the vessel wall. In response to stimuli such as modified lipids, cytokines, and senescent erythrocytes present in the atherosclerotic lesion, these macrophages can alter their functional phenotypes. Different macrophage subsets can influence the growth and composition of the atherosclerotic plaque in distinct ways. In this Review, Chinetti-Gbaguidi et al. highlight the diverse range of macrophage phenotypes present in atherosclerotic lesions, and their roles in both plaque progression and stability.

Cardiac MRI is a noninvasive phenotyping tool that allows for accurate and easy detection and quantification of myocardial fibrosis in myocardial tissue. In this Review, Ambale-Venkatesh and Lima focus on late-gadolinium enhancement and T1 mapping strategies, and explore the different prognostic applications of this technique.

Dual antiplatelet therapy (DAPT) with aspirin and the P2Y purinoceptor 12 (P2Y₁₂)-receptor inhibitor clopidogrel has been considered the gold standard of care in patients with acute coronary syndrome (ACS). The FDA approval of the novel P2Y₁₂-receptor antagonists prasugrel and ticagrelor, which are faster-acting and more potent than clopidogrel, in the past 5 years have improved clinical outcomes in patients with ACS. Even with these newer compounds, many patients continue to experience adverse ischaemic events. This Review will provide an overview of the antiplatelet agents currently used to treat patients with ACS. Furthermore, emerging antiplatelet therapies, including intravenous P2Y₁₂antagonists, oral PAR-1 antagonists and thromboxane-receptor inhibitors will be discussed.

The coronary microvasculature cannot be directly imagedin vivo, but parameters that depend directly on coronary microvascular function are routinely assessed by a number of invasive and noninvasive procedures. In this Review, Camici and colleagues explore available imaging techniques that allow novel insights into the pathophysiological role of coronary microvascular dysfunction.