Review Articles in 2014

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.

Cardiac rehabilitation participation reduces mortality and rehospitalization of patients with cardiovascular disease, but this cost-effective treatment programme is still underused worldwide. In this Review, Turk-Adawi and colleagues describe the global availability of cardiac rehabilitation and highlight strategies that might increase its use, particularly in low and middle-income countries.

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.

Statins and other drugs are widely used to lower the LDL-cholesterol level, which has been shown to prevent cardiovascular events. In this Review, Dadu and Ballantyne review the latest evidence on a novel class of LDL-lowering agents: proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. In particular, monoclonal antibodies against PCSK9 have proven efficacious and safe in phase I–III clinical trials.

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.

The left atrial appendage (LAA) is the main location of thrombus formation in patients with atrial fibrillation. This Review by Romero et al. is focused on the pathophysiology, assessment, and clinical implications of stasis and thrombus formation in the LAA. The advantages and disadvantages of the available imaging modalities for LAA assessment are discussed, and the authors explore the role of cardiac imaging in the therapeutic use of LAA closure devices.

¹⁸F-FDG is the most-commonly used tracer in PET imaging of atherosclerosis.¹⁸F-FDG uptake can be used to identify patients at the highest risk of clinical events and as a surrogate end point in clinical trials of antiatherosclerotic therapies. However, background myocardial uptake of ¹⁸F-FDG can make identifying high-risk coronary artery plaque difficult. Several novel PET tracers have, therefore, also been tested in atherosclerosis imaging. Here, Tarkin et al. review the role of state-of-the-art PET imaging of inflammation in atherosclerosis, including the rationale for this modality, and its current and future uses.

Percutaneous coronary intervention (PCI) for a chronic total occlusion (CTO) is currently infrequently performed due to technical difficulty or perceived risk of complication. In this Review, Hoebers et al, provide a comprehensive overview of CTO–PCI and the selection criteria for those patients who might benefit from the procedure, which the authors believe should be performed more frequently to treat CTOs. The authors also discuss emerging technologies that might improve CTO–PCI.

Cardiac resynchronization can be a useful therapy for patients with heart failure and abnormal ventricular contraction. However, up to half of patients do not respond to therapy. In this Review, Vernooy and colleagues discuss the selection of patients, positioning of pacing leads, timing of pacing, and management of patients after device implantation to improve the outcomes from cardiac resynchronization therapy.

Dysregulation of the natriuretic peptide system has been associated with several life-style related metabolic and cardiovascular disorders, including obesity, type 2 diabetes mellitus, hypertension, atherosclerosis, thrombosis, and myocardial ischaemia, implying biological effects beyond pressure–volume homeostasis. In this Review, Zois et al. discuss the role of the various natriuretic peptides in the pathophysiology of these cardiometabolic conditions.

Angiotensin-converting enzyme 2, and its product angiotensin 1–7, are thought to have counteracting effects against the adverse actions of the better-known members of the renin–angiotensin system and might, therefore, be useful therapeutic targets in patients with cardiovascular disease. Professor Jiang and colleagues review the evidence for the potential roles of these proteins in various cardiovascular conditions, including hypertension, atherosclerosis, myocardial remodelling, heart failure, ischaemic stroke, and diabetes.

In this Review, Otsuka et al. describe how optical coherence tomography (OCT)—an intravascular imaging modality with high resolution—can be used to define various stages of plaque progression. The authors also highlight how OCT might be used in the identification of high-risk plaques vulnerable to rupture in patients with coronary disease, to enable pre-emptive interventional treatment, and how OCT might be used in the management of acute coronary syndromes.

Catastrophic acute coronary events are often the result of ruptured atherosclerotic plaques and subsequent luminal thrombosis. Preventing such an event seems to be the only effective strategy to reduce mortality and morbidity of coronary artery disease. This Review highlights how computed tomography angiography might be combined with fluid dynamic assessment to identify rupture-prone plaques in patients with coronary artery disease.

The number of heart transplantations performed each year is limited by a shortage of donor organs, and approximately 10% of patients on the waiting list die before a heart becomes available. In this Review, Longnus and colleagues explore the possibility of heart donation after circulatory determination of death (as opposed to after brain death). Before such as strategy can be adopted, problems such as the period of warm ischaemia before procurement, as well as various ethical considerations, must be resolved.

Dengue is one of the most important emerging infectious viral diseases in the world. Cardiovascular complications of dengue, including myocardial impairment and arrhythmias, are increasingly recognized. Capillary leakage is frequently described, with a small proportion of patients developing hypovolaemic shock. In this Review, Yacoub et al. outline our current understanding of the pathophysiology of the cardiovascular manifestations of dengue, and discuss the available management options for this disease.

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition that affects women in the final stages of pregnancy or shortly after birth. The underlying pathophysiology of PPCM is incompletely understood. In this Review, Hilfiker-Kleiner and Sliwa summarize the epidemiology of this condition, the current understanding of its aetiology and risk factors, and propose novel biomarkers and treatment strategies for women with PPCM.

Epidemiological studies of cardiovascular disease generally, and coronary heart disease specifically, have provided the basis for clinical trials that document the efficacy of risk-factor interventions, and are the basis of preventive cardiology. In this Review, Nathan Wong discusses the evolution of CHD epidemiology from the 1940s to the present, and examines the contributions of large population studies to the field.

Myocardial infarction initiates an inflammatory response that is required for repair of, but also contributes to, heart failure. In this Review, Nikolaos Frangogiannis, outlines our current understanding of the inflammatory response in the infarcted heart, and highlights potential therapies that might counterbalance the destructive effects of this immune response.

Echocardiography can be used to diagnose congenital heart disease (CHD) in fetuses. Hunter and Simpson expertly review risk stratification and the detailed fetal echocardiography used to detect CHD. Next, the consequences of a diagnosis of CHD are summarized, including parental perceptions, fetal prognosis, and potential for intervention. Finally, the appropriate design of universal prenatal screening strategies is discussed.

Robotically assisted techniques have been used in cardiovascular medicine since the late 1990s. The benefits of these approaches include increased procedural speed and accuracy, and reduced surgical trauma and exposure to radiation and contrast agents. However, learning curves and high costs have limited the widespread use of this technology. In this Review, Bonatti and colleagues outline the fields of application of robotic technology in cardiovascular medicine, the systems currently in use, and future directions in the field.