Volume 6 Issue 7, July 2009

The results of HF-ACTION—the largest ever intervention trial of a nonpharmacological treatment for chronic heart failure—have been reported. The investigators randomly allocated participants to either a structured exercise program or to usual care. Although the primary end point was not reached at the prespecified significance level, the background evidence and data from previous trials and other prespecified analyses compel me to conclude that exercise training should be recommended for patients with stable chronic heart failure.

Stroke risk in patients with nonvalvular atrial fibrillation increases markedly with age. Although anticoagulation is more effective than antiplatelet therapy in atrial fibrillation, it tends to be underutilized in the elderly. A study by van Walraven et al. examines the influence of age on stroke prevention therapy in atrial fibrillation.

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is challenging to diagnose because of nonspecific findings, particularly in the early phases of the disease. Clinical diagnosis is made on the basis of several criteria, but these lack sensitivity. Asimaki et al. suggest that immunohistochemical analysis of myocardial desmosomal proteins is a highly sensitive and specific diagnostic test for ARVD/C.

The DIAD trial investigators have demonstrated that screening for inducible myocardial ischemia did not improve overall clinical outcome in a contemporary cohort of patients with asymptomatic type 2 diabetes, most of whom were receiving excellent medical management and few of whom underwent revascularization. Future studies should be designed to evaluate the clinical value and cost effectiveness of unconditional treatment versus screening using techniques to detect atherosclerotic and ischemic burden, coupled with therapeutic interventions, risk-factor management, and selective use of revascularization in high-risk patients.

Pulmonary vein antrum isolation is an accepted alternative to antiarrhythmic therapy for restoring normal sinus rhythm in patients with atrial fibrillation. The procedure has a high initial success rate, but many patients subsequently experience recurrence of the arrhythmia. Cardiac magnetic resonance might offer a means of identifying patients who are more likely to experience successful long-term results from pulmonary vein antrum isolation.

Low levels of HDL-cholesterol are associated with an increased risk of coronary heart disease. Rader and Duffy discuss new strategies that are currently in development to improve HDL levels and/or function.

In the first part of their Review on circulating biomarkers of abdominal aortic aneurysm, Hellenthal et al. focus on the constituents and active enzymes of the extracellular matrix and their possible roles in the development and progression of this disease.

In the second article of our Molecular Imaging series, Dr. Lindner focuses on molecular imaging of cardiovascular diseases using contrast-enhanced ultrasound. The basics of targeted ultrasound contrast agents, the progress that has been made in imaging key events in cardiovascular medicine, and other potential clinical applications of targeted microbubbles are discussed.

Professor Stephen Westaby and colleagues describe the case of a patient who presented with cardiogenic shock that swiftly deteriorated to severe heart failure. CT revealed a large adrenal tumor that was subsequently indentified as pheochromocytoma. After the tumor was removed, the patient underwent left ventricular assist device implantation as a bridge to left ventricular recovery.