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In this Review, Daniel Mark examines the use of health-related quality of life (QOL) as an outcome measure in clinical cardiovascular research. The main concepts, assumptions, tools, and methods used to assess QOL are discussed. Applied research into QOL outcomes in coronary artery disease, heart failure, and atrial fibrillation are also summarized, with an emphasis on experience from large, randomized clinical trials.
Glutathione is considered the major natural antioxidant, protecting cells from oxidative stress. Patel and colleagues used plasma levels of the aminothiols cystine and glutathione to quantify oxidative stress in patients with coronary artery disease, and show that the cystine/glutathione ratio is associated with increased mortality. Is this a new approach for clinical risk stratification?
Coronary artery disease (CAD) is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), but its clinical relevance is controversial. In this Review, Danson et al. summarize the methods of assessing CAD in TAVI populations, and the data on the safety and efficacy of percutaneous coronary intervention in patients undergoing TAVI.
A new meta-analysis by Ettehad and colleagues, which included >613,000 patients with hypertension from randomized, controlled trials, clearly demonstrates that antihypertensive medication reduces cardiovascular events and death in all patients, including those with systolic blood pressure <130 mmHg and regardless of concomitant diseases. The risks of stroke and heart failure were particularly reduced.
Successful application of spinal cord stimulation (SCS) is dependent on the location of bioelectric stimuli, the stimulation protocol employed, and the substrate being targeted (neural and cardiac). Safety concerns for bioelectrical treatment of heart failure with reduced ejection fraction have been addressed, but optimization of SCS delivery remains a concern.
Renal denervation for the treatment of drug-resistant hypertension has been studied extensively in the past few years. Although early trials reported dramatic reductions in blood pressure after renal denervation, later trials testing denervation against a sham procedure showed neutral results. In this Perspectives article, Gulati and colleagues suggest potential reasons why results from these early trials could not be replicated, and summarize the current available trial data, newly designed devices, and recommendations for future trial design.
Ischaemic conditioning is an endogenous cardioprotective strategy that involves the application of brief cycles of ischaemia and reperfusion either directly to the heart, or to a remote organ or tissue, and which has been shown to reduce infarct size. In this Review, Hausenloy and Yellon summarize the various forms of ischaemic conditioning and pharmacological cardioprotection, and highlight the challenges of translating these methods into the clinical setting.
In this Review, Brown et al. describe the role of biomechanical forces, including wall shear stress and plaque structural stress, in the development and progression of coronary atherosclerosis. The calculation and integration of biomechanical parameters might improve our ability to detect arterial regions at risk of atherosclerosis, enabling better identification of patients at high risk of adverse clinical events.
The leads of cardiovascular implantable electronic devices often need to be extracted because, for example, of infection or the lead has been recalled. In this Review, Wazni and Wilkoff summarize the common indications and techniques for lead extraction, and assess data on the safety, efficacy, and outcomes of these procedures.
