Review Articles

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.

As yet, 22 cases of short QT syndrome have been confirmed but other cases have probably been overlooked. This syndrome is a heritable primary electrical disease of the heart that can lead to atrial fibrillation and sudden cardiac death. The knowledge to date on this little recognized disorder is presented.

Congestive heart failure and chronic kidney disease are severe diseases, but a frequently complicated individually by anemia. If all three disorders are present, a vicious circle ensues, in which each component causes or worsens the other two. This review discusses the inter-relationships and how to approach correction or alleviation of this syndrome.

Although a number of therapies have been able to reduce infarct size as part of reperfusion therapy in experimental studies, the clinical results after acute myocardial infarction have not been as satisfactory. Current understanding of the mechanisms and consequences of reperfusion injury and the pharmacologic options are discussed here.

Sinus tachycardia is frequently encountered in clinical practice but is often overlooked. It comprises four distinct rhythm disturbances namely normal sinus tachycardia, inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome and sinus node re-entry tachycardia. The important differences in clinical features, basic underlying etiologic mechanisms and treatment strategies of these arrhythmias are discussed here.

Despite the various available methods of detection and risk assessment, an unsatisfactory proportion of cardiovascular disease cases are still missed. New approaches are, therefore, constantly being sought. This review discusses the potential applications of C-reactive protein, which has emerged as a powerful predictor of heart disease risk.

Many patients who die from coronary heart disease have ST-segment-elevation myocardial infarction. The optimum timing and method of reperfusion therapy, however, still need clarification. This review discusses the use of fibrinolytic drugs and primary coronary angioplasty and how to achieve the goals of door-to-balloon or door-to-needle times purported in the AHA/ACC guidelines.

Cells derived from bone marrow, blood, skeletal muscle and other tissues could have regenerative capacity in the human heart and vasculature. Should clinical practice become a reality, however, the indications for which cells, which disease, and which patients are less clear. Noel Caplice and colleagues discuss how such decisions might be made.

Brief episodes of ischemia before total coronary occlusion can protect the heart in animals; a similar preconditioning effect might be seen in humans. Preinfarction angina, already an important part of cardiac assessment, might be a corollary of preconditioning before myocardial infarction. Rezkalla and Kloner discuss the impact of preinfarction angina in the clinical setting.

Heart failure is increasingly thought to be a myocyte deficiency disease. Therapeutic strategies to increase the number of cardiac muscle cells by direct transplantation are being met with a mixture of enthusiasm and caution. While conceptually attractive, however, the success of this approach remains unproven. The evidence to date is discussed.