Volume 6 Issue 5, May 2009

The cardiovascular community has witnessed an important transition over the past two decades—from awareness of the global nature of the cardiovascular disease epidemic, to identification of interventions to control it, and now to a resolution that global action is urgently required.

The ASSOCIATE study investigators have reported that the I_f current inhibitor, ivabradine, is safe, improves exercise performance, and delays the development of ischemia in patients with chronic stable angina being treated with atenolol. Ivabradine should be considered in the medical management of symptom-limited patients with angina, when heart rate is suboptimally controlled.

Management of asymptomatic patients with severe mitral valve regurgitation is controversial—conservative surveillance and early mitral valve repair have both been advocated as reasonable approaches on the basis of divergent data. A new study by Kang et al. fuels this debate. However, careful assessment of the existing literature can provide insight into the optimal care of this population of patients.

The A4 and other similar (small) studies strongly support the launch of major trials of left atrial catheter ablation for the maintenance of sinus rhythm, reduction of cardiovascular hospitalizations and improved survival in patients with symptomatic recurrent atrial fibrillation. Will pharmacological therapies continue to have an important place in the management of atrial fibrillation?

The benefits of clopidogrel in the treatment and prevention of coronary artery disease vary among patients. Studies have identified predictive markers of poor response to clopidogrel that might allow risk stratification of patients. Are we ready to enter the age of personalized medicine?

This Review describes the current understanding of the molecular mechanism of inherited arrhythmias. Focus is placed on arrhythmia-causing mutations in the genes encoding the α subunit of the cardiac sodium channel (SCN5A) but arrhythmia-causing mutations in the genes encoding the β subunit and other proteins in the associated macromolecular complex are also discussed.

The use of phosphodiesterase 5 (PDE5) inhibitors for the treatment of heart failure is an emerging field of research. The authors of this timely Review examine the available basic and clinical data on PDE5 inhibition in the context of heart failure, providing a mechanistic overview and discussing the potential clinical implications of this therapy.

In this comprehensive Review, Drs Stashenko and Tapson examine the literature on the use of venous thromboembolism prophylaxis in hospitalized medical patients, and evaluate the available data for the outpatient setting. The authors also discuss the potential strategies for improving venous thromboembolism prophylaxis rates in these groups of patients.

In the second part of their Review on resistance to antiplatelet medication, the authors discuss the various laboratory tests of platelet function and highlight the limitations of these methods for determining the true thrombotic status of the patient.

Ramcharitar et al. describe the first case treated in the SECRITT I trial. The 63-year-old man presented with class II anginal symptoms and was diagnosed as having a culprit lesion in the left circumflex artery and a vulnerable plaque in the left anterior descending artery. The vulnerable plaque was treated with a self-expanding stent tailored to shield this type of plaque.

Lindsay et al. present an interesting case of a patient with a ruptured sinus of Valsalva aneurysm. The authors recommend the early use of imaging modalities for prompt diagnosis, as anticoagulation therapy might have detrimental effects on patient outcome. Reparative surgery is safe and successful in almost all noninfective cases.