Review Articles

Improvement is still needed in the diagnosis of renal artery stenosis, which is the most common treatable cause of secondary hypertension. An accurate functional and morphological characterization of the disease might assist in management of patients. The value of magnetic resonance angiography in this setting is discussed.

More than 80% of the US elderly population dies from coronary heart disease, but the benefits of statin therapy are not realized. These drugs are frequently underprescribed to elderly patients because few relevant age-specific data are available. This Review draws together the findings from major studies and assesses the value of statin use in the elderly.

Many changes are taking place in terms of the devices and techniques available to perform heart valve repair and replacement. Advances have meant that interest has been raised in percutaneous and minimally invasive valvular interventions. This review outlines the evolution of and possible future for this subspecialty.

Atrial fibrillation is the most common cause of arrhythmia, but the reason it occurs is not always apparent. Despite many efforts, the molecular basis for atrial fibrillation is still unclear. Genetic features of the disorder are, however, being elucidated. Robert Roberts provides here an overview of the major mutation findings so far.

An accurate, noninvasive method of imaging the heart and coronary arteries has long been elusive. Multidetector row CT, however, seems a likely candidate to fill this gap. This modality can be safely used to obtain high-quality images in seconds. Michael Poon provides an update on the advances in the development of this technology.

Left ventricular dyssynchrony can lead to adverse cardiac effects, particularly if left untreated. Dyssynchrony can be improved by cardiac resynchronization therapy, but accurate diagnosis of the disorder is essential to obtain good results. Here, Bleeker et al. present an overview of the causes, diagnostic techniques and management in heart failure patients.

Angiotensin-converting-enzyme blockade therapy is useful in many cardiovascular disorders. Since atrial fibrillation is frequently associated with such disorders, these drugs might also be beneficial in its primary and secondary prevention. The available data for these indications are, however, supportive rather than definitive. This review summarizes the major findings and calls for randomized, placebo-controlled trials.

Despite major advances in immunosuppressive regimens, which have greatly improved heart-transplant outcomes, drugs are still being developed and tested. In this review, data for the various available drugs and combined regimens are discussed, as well as those for novel drugs, in terms of efficacy and safety and cardiac allograft vasculopathy.

Major sex-based differences for coronary heart disease remain inadequately appreciated by physicians. Nanette Wenger draws together information on some of the major issues that have arisen in 2 years since the coronary prevention guidelines for women were published and highlights that their application is likely to improve outcomes for women.

The main surveillance method for allograft rejection after heart transplantation is endomyocardial biopsy, but this method's invasive nature and poor uniformity of results pose problems. Noninvasive, reliable monitoring methods are, therefore, sought. In this review, protein-based and gene-based targets for the testing of allograft function to fulfill this role are discussed.

Although coronary angiography is an established technique in the assessment of atherosclerosis, it is limited by 2-dimensional imaging and poor differentiation between plaque types. Optical coherence tomography enables visualization of plaque architecture at the microscopic level, and in this review the possibilities of its use as an alternative modality are discussed.

Small, dense HDL possesses potent antioxidative activity but this is compromised under conditions of atherogenic dyslipidemia. The raising of HDL cholesterol levels might, however, improve functionality. In this review, Kontush and Chapman explore the mechanisms behind the antiatherogenic effects of small HDL, and the possible roles of these particles as therapeutic targets.

The implementation of guidelines into everyday practice does not always seem straightforward. In this primer article, Eagle and colleagues provide a summary of efforts to improve care for acute coronary syndromes in the Guidelines Applied in Practice program in Michigan, highlighting particularly methods that could be transferable to other cardiovascular subspecialties.

The integrity of the endothelium can be damaged in various ways, making the formation of atherosclerotic lesions possible. The source of cells involved in endothelial repair and smooth-muscle accumulation in lesions has been debated, but data suggest progenitor cells as a likely origin. Their role in the pathogenesis of atherosclerosis is discussed here.

The need for improved prevention of sudden cardiac death has led physicians to increase the use of implantable cardioverter-defibrillators. Despite data now being available from a variety of studies, how to identify patients who will benefit most from this invasive and expensive therapy is still unclear. Here, the impact of findings on clinical decision-making is explored.

Cardiovascular disease is a major concern in elderly adults, particularly in those with age-related reductions in renal function. Physicians are often cautious when prescribing therapy because of the perceived frailty of older patients and limited understanding of adverse effects. This review tackles the issue of prescribing considerations in elderly patients with concomitant renal and cardiovascular disease.

The role of the rennin–angiotensin system was previously thought to be restricted to the cardiovascular system, but important roles in other tissues are coming to light. This review concentrates on this system's effects on hematopoiesis and presents a discussion of the clinical relevance and possible therapeutic applications in this context.

The relationship between cardiovascular disease and the metabolic syndrome is now well known but is not yet fully elucidated. In this review, Yuji Matsuzawa discusses the role of intra-abdominal visceral fat accumulation and the release of bioactive substances termed adipocytokines in the development of disorders contributing to the metabolic syndrome.

Disease markers for cardiovascular disease have radically altered thinking about diagnosis and monitoring of disease course. Although a substantial amount of information seems available already, new data are emerging all the time. This review provides a snapshot of the current status of biomarkers in heart failure and acute coronary syndromes.

Several gene mutations in ryanodine receptors, affecting channel gating, have been associated with certain arrhythmias and cardiomyopathy. In this review, the authors highlight the role of the ryanodine receptor, a Ca2+-release channel, in the pathogenesis of fatal arrhythmia and heart failure. They discuss also the possibility of this receptor as a new therapeutic target.