Articles in 2010

A continuous-flow left ventricular assist device (LVAD) improved survival free from disabling stroke compared with a pulsatile LVAD, when used as destination therapy over a 2-year period in patients with advanced heart failure. Both devices improved patient quality of life. Continuous-flow devices are smaller, lighter, and more simple than pulsatile LVADs and have the potential to fulfill all the requirements of a permanently implanted blood pump.

Klersy et al. have performed a meta-analysis of remote monitoring of patients with heart failure. Programs using structured telephone support (telephone-monitoring approach) were combined with those using transmission of physiological data (technology-assisted approach) in combination with telephone communication. Results from this study may inform policy makers regarding a potential solution to reducing hospital readmissions.

Patients with structural heart disease are at risk for life-threatening ventricular tachycardias (VTs). Implantable cardioverter-defibrillators (ICDs) can terminate VT, but often at the cost of traumatic shocks, syncope, or even exacerbation of underlying heart disease. Catheter ablation for VT can reduce the need for ICD therapies and is an increasingly important adjunct to the treatment of these patients.

The cardiovascular manifestations of Marfan syndrome are the main cause of morbidity and mortality in patients with this disease. In Part 1 of a 2-part Review on Marfan syndrome, Dr Cañadas and colleagues discuss the pathogenesis of Marfan syndrome, our idea of which has dramatically changed in the past decade, as well as the current strategy for diagnosis.

Over the past 30 years, we have witnessed a steady improvement in life expectancy of patients with Marfan syndrome, owing to advances in various treatments. In Part 2 of a 2-part Review on Marfan syndrome, Dr. Cañadas and colleagues discuss the present the state of the art in the management of patients with this disease.

Controversy exists as to whether the detection of myocardial edema, to quantify myocardial damage and assess myocardial salvage, is ready for clinical use or is still only practical as a research tool. In this Perspectives article, Matthias Friedrich explains his point of view on this issue—that myocardial edema imaging using magnetic resonance technology should be seen as the essential diagnostic modality of choice for patients with suspected myocardial injury by virtue of its safety, versatility, and cost-efficiency.

Statin therapy has been associated with improved outcomes in patients with heart failure. However, two large prospective, controlled trials showed neutral effects with rosuvastatin. The authors of this Review highlight data from observational studies that have showed positive outcomes, and discuss how the design of the two large trials may have contributed to the neutral effects of statin therapy on the survival of patients with heart failure.

Imaging techniques that assess myocardial perfusion and coronary anatomy obtain complementary information. Simultaneous dual-modality or sequential multimodal imaging techniques facilitate integration of this information, and thus have the potential to improve diagnostic and prognostic evaluations, as well as care of patients. This Review discusses the clinical utility and future directions of hybrid imaging.

Stress cardiomyopathy, or Takotsubo syndrome, is a transient and reversible disorder that occurs suddenly after emotional or physical stress. It displays symptoms similar to acute myocardial infarction and is found predominantly in postmenopausal women. The underlying cause is still unknown. In this Review, the authors describe the published data relating to stress cardiomyopathy and discuss the possible mechanisms of this cardiac entity.

The introduction of drug-eluting stents (DES) has greatly reduced in-stent restenosis. Improvements to this technology are required, however, as safety and efficacy are still a problem. This Review describes current DES and the methods that are being used to optimize the performance of these stents. The author also suggests the direction of DES in the future, including tailored therapy to improve patient outcomes.

Aldosterone antagonists decrease the mortality of patients with heart failure, but an observational study by Albert and colleagues has found that a surprisingly low number of patients receive aldosterone antagonists before discharge from hospital. This article highlights potential reasons for why there is such an underuse of efficient drugs in heart failure.

A novel three-catheter radiofrequency ablation system has been reported to reduce procedure time, but maintain ablation success rates, in patients with persistent atrial fibrillation. The findings are promising; however, important limitations and concerns must be overcome before use of this system can be considered the standard-of-care for catheter treatment of persistent atrial fibrillation.

Inflammation might be involved in the pathophysiology of atrial fibrillation. Glucocorticoid use can attenuate inflammation and might be an effective therapy for atrial fibrillation. However, some population-based studies have reported an increased risk of atrial fibrillation associated with glucocorticoid use. Whether this link results from a direct effect of glucocorticoids or from the underlying inflammatory disease remains to be elucidated.