Review Articles

Revascularization is currently recommended for patients with unprotected left main coronary artery disease. In this review, Chieffo and Colombo discuss the safety and effectiveness of percutaneous interventions involving drug-eluting stents as an alternative approach for treating this disease.

Shear stress plays an essential part in the maintenance of healthy vessels. If risk factors for atherosclerosis are present, low shear stress can lead to abnormalities, possibly creating predilection sites for eccentric plaque growth. The role of shear stress in the development of plaque prone to rupture is explored.

Patients who receive most types of modern prosthetic heart valve are currently also given long-term, low-intensity anticoagulation therapy to reduce the risk of thromboembolic complications. In this review, the authors discuss the current recommendations for anticoagulation therapy and the data on which these recommendations are based.

Multislice CT, with 16, 32 or 64 rows per image, can provide an image quality that has improved the noninvasive diagnosis of disorders such as atherosclerotic plaque or coronary anomalies. This review summarizes the main data available and, despite various remaining confounding factors to image quality, calls for guidelines.

Despite improvements in therapy, sudden cardiac death still poses a major problem for cardiovascular patients. In very high-risk patients, half of premature deaths are sudden. Certain inotropic drugs can increase the risk of death, but mechanical devices can provide prophylactic benefits. Winslowet al. sum up the major issues and challenges in this review.

Patients with long QT syndrome can experience life-threatening arrhythmias and related mortality is high among symptomatic, untreated people. Identification of several responsible genes and their effects on ion channels has advanced understanding of this disorder. Here, Peter Schwartz reviews how these discoveries have, or have not, modified management and changed the direction of research.

Cardiovascular complications, including cardiomyopathy and cardiac arrhythmias, are frequently seen in patients with muscular dystrophies. This review discusses the pathogenesis of the main forms of muscular dystrophy and focuses on how appropriate management of these disorders can improve the function, well being and longevity of patients.

Macrophage foam cells have important roles in physiological processes, including atherogenesis and lipoprotein metabolism, but they are also fundamental for the development and progression of atherosclerosis. As we understand more about the biology of these cells, therapeutic approaches for atherosclerosis that target macrophage foam cells are becoming a reality, as discussed in this review.

Cyclo-oxygenase 2 inhibitors, although offering gastrointestinal benefits, seem to have an adverse cardiovascular risk profile. The nature of this risk is still desperately underinvestigated. Given the recent withdrawals of certain agents from the US market, this review attempts to pull together the major data available so far and asks where studies should go next.

Coronary artery bypass grafting can now be performed without the use of the cardiopulmonary bypass pump, a technique known as “off-pump” coronary bypass. Despite data from nonrandomized retrospective trials showing a benefit to the off-pump technique, skepticism remains. This review discusses the evidence to date, focusing on data from prospectively randomized studies.

Stroke is an important complication of cardiac surgery. The degree of risk is significantly influenced by the presence, extent and location of atherosclerosis in the ascending aorta. Per Bergman and Jan van der Linden provide an overview of the current perioperative measures that can be taken to lessen this risk.

Patients with insulin resistance syndromes are at an increased risk of developing cardiovascular disease. This review discusses the relationship between insulin resistance and heart disease, and describes how aggressive risk factor management and multifactoral treatment approaches are being used to improve the clinical outcomes of these patients.

In children born with only one ventricle, the systemic and pulmonary venous blood mixes. The Fontan operation, by which the blood flows through the creation of a serial arrangement in which no ventricle interposes, has become the procedure of choice. The development of this therapy and the current issues associated with it are discussed here.

The importance of easy bedside investigations at an early stage is undeniable. Therefore, the introduction of hand-held ultrasound devices in settings such as the primary bedside diagnosis of patients is a welcome advance. The approaches to training, best use and reimbursement to aid this technology's introduction are discussed.

The roles of N-terminal proBNP, an inactive amino acid product of BNP prohormone cleavage, seem to be many-fold in heart disease. Here, Lisa C Costello-Boerrigter and John C Burnett Jr explore some of the ways in which this biomarker can aid diagnosis and prediction of prognosis in various cardiovascular diseases.

Structural remodeling of the heart is known to be related to various processes mediated by mechanical, neurohormonal and cytokine routes. Disruption in the production and breakdown of collagen fibers is a prominent mechanism in left-ventricular fibrosis. Javier Díez and colleagues discuss noninvasive diagnostic methods for such hypertrophy and possible therapeutic strategies to promote its reduction

Catheter ablation for atrial fibrillation has rapidly become used worldwide. This review provides an overview of the three main approaches currently used to perform ablation of the pulmonary veins. The efforts being made to raise efficacy from its current 70–80% and lower the risk of major complications from 5% are also discussed.

Atrial fibrillation and obesity share obstructive sleep apnea as a comorbidity. The data on the relationship between atrial fibrillation and obstructive sleep apnea have, however, generally been extrapolated from studies with other focuses. Gami et al. present the findings so far to summarize current understanding and identify avenues for future study.

In patients who require revascularization after myocardial infarction, noninvasive imaging tests can be useful to assess whether target areas of the myocardium are viable. Delayed-enhancement MRI allows direct visualization of potentially damaged regions, but it is still a new technique. This review explores its role in the routine evaluation of coronary artery disease patients.

The preclinical data for gene therapy's role in revascularization heralded much promise. In the phase II studies, though, little progress seems to have been made. Pislaru and Simari chart gene therapy's course to date and discuss whether and where research can continue, and conclude that all hope is not lost.