Review Articles

The management of atrial fibrillation, the most frequent sustained arrhythmia in humans, aims to reduce symptoms and to minimize the risk of thromboembolic events, such as strokes. This review compares and contrasts the rhythm-control and the rate-control approach for treating patients with this arrhythmia.

Risk factors identified by the Framingham Heart Study are useful for assessing a person's risk of cardiovascular disease; however, additional risk factors are needed. In this review, the potential role of lipoprotein-associated phospholipase A₂as a novel inflammatory marker for cardiovascular risk assessment is discussed.

Although excessive epicardial fat increases the work of pumping, this visceral fat depot is important source of free fatty acids and various bioactive molecules, and constitutes a metabolically active organ. Iacobelliset al. discuss its role, in the context of regional fat distribution, in cardiac pathology and the assessment of cardiac disease.

As defibrillator therapy is invasive and expensive, using a defibrillator as primary prevention therapy requires risk stratification to identify suitable patients at significant risk. In this review Antonis A Armoundaset alevaluate whether clinical data support the use of microvolt T-wave alternans testing to identify patients who are unlikely to benefit from primary prevention implantable cardioverter-defibrillator therapy.

Developments in the interpretation of blood pressure curves have enabled assessment of pressure-wave reflections and arterial stiffness in the vascular system. These measurements can be translated into assessment of cardiovascular risk, enabling new features of cardiovascular disease and new drug treatments to be investigated. Here, the structural and functional factors that influence arterial stiffness are discussed.

Alterations in β-adrenergic-receptor signal transduction play a major part in the development of heart failure. Although pharmacologic and device-based therapy can lessen morbidity and mortality, better understanding of these mechanisms should improve outcomes. Much of the current understanding of β-adrenergic signaling pathways and polymorphisms is summarized in this review.

Shear stress plays an essential part in the maintenance of healthy blood vessels, and locations of low shear stress can create predilection sites for eccentric plaque growth. This review discusses the mechanobiologic mechanisms related to shear stress that might have a role in plaque rupture.

Anticoagulation is a necessary part of interventional cardiology, despite the associated bleeding risks. In this review, Martin T Rothman presents an overview of how the various anticoagulant drugs weigh up against one another when used in combination with percutaneous coronary intervention.

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.

Patients with systemic lupus erythematosus are at a high risk of developing premature atherosclerosis and cardiovascular disease, but the mechanisms responsible for this are not fully understood. This review discusses traditional and lupus-specific risk factors that are likely to be involved, and outlines how risk assessments should be included in effective management of this disease.

Mutations inSCN5A, the gene encoding the α subunit of the cardiac sodium channel, are associated with a number of cardiac rhythm syndromes, including Brugada syndrome. This review discusses the genotypic and phenotypic characteristics, cellular mechanisms, diagnosis and management of Brugada syndrome.

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.

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.