Volume 7 Issue 2, February 2010

Tibaldi et al. have addressed the feasibility of 'hospital-at-home' care as an alternative to hospitalization for elderly patients with chronic heart failure. Although this study addresses an important subject, and the results are intriguing, extrapolation to other settings may not be easy. The study should, therefore, be regarded as hypothesis-generating rather than definitive.

The ROOBY investigators found off-pump CABG surgery to be significantly inferior to on-pump surgery with regard to 1 year mortality, revascularization, or new myocardial infarction. This unexpected finding could be related to the fact that most of the participating surgeons were experienced in on-pump CABG surgery, but relatively inexperienced in the off-pump procedure.

Two large trials were conducted to evaluate the effects of an angiotensin-converting-enzyme inhibitor, an angiotensin-receptor blocker or a combination of both in high cardiovascular risk patients. A decrease in the prevalence of left ventricular hypertrophy (LVH) was reported, but this did not translate into a prognostic benefit. New-onset LVH was associated with an increase in cardiovascular events.

Despite angiographically successful primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction, microcirculatory failure is common and leads to an increased risk of morbidity and mortality. The administration of intracoronary streptokinase immediately after PCI may improve outcomes and provides a promising potential therapy for the future.

Defibrillators, with or without cardiac resynchronization therapy, can reduce the rate of sudden death. However, shocks are unpleasant, often unnecessary, and can damage myocardium or defibrillator leads, thereby increasing morbidity and mortality and detracting from the benefits of this therapy. Conservative programming of devices may reduce such risks.

In this Review, the authors discuss innovations in ventricular assist devices technology as an alternative therapeutic option for patients with advanced heart failure. In particular, they focus on the newer, third-generation VADs that are currently being developed for mechanical cardiac support.

Plaque macrophages account for the majority of leukocytes in atherosclerotic plaques, and are believed to differentiate from monocytes recruited from circulating blood. In this Review, Dr Woollard and Dr Geissmann discuss the heterogenous population of monocytes involved in the pathogenesis of atherosclerosis.

Cardiac rehabilitation can reduce cardiovascular risk factors and prevent cardiac morbidity and mortality as part of a comprehensive secondary-prevention strategy. However, evidence indicates that cardiac rehabilitation programs are currently underutilized, primarily because many patients are not referred to these programs by their health-care providers. The authors of this Review examine how novel referral strategies can help to improve cardiac rehabilitation referral and enrollment rates.

A major obstacle in cardiac stem cell investigations is the ability to monitor cell engraftment and survival following implantation within the myocardium. In this Review, Dr. Lau and colleagues examine cardiac cellular imaging modalities, including the combinatorial use of several probes in multimodality imaging. Their discussion focuses on data from the past 5 years.

Stable angina pectoris is a major contributor to disability in patients with coronary artery disease. Accurate identification of the extent and distribution of stable angina pectoris could vastly improve management and secondary prevention of underlying coronary artery disease. This Review assesses the strengths and limitations of contemporary methods for detection.