New research shows that the pyruvate–lactate axis is an important regulatory node for cardiac homeostasis and function and that alteration of this axis is an early event in cardiomyocyte hypertrophy and heart failure.

A new study shows that hydralazine, a drug used for the treatment of resistant hypertension and heart failure, can inhibit mitochondrial fission, thereby reducing cardiomyocyte death and myocardial infarct size after ischaemia–reperfusion injury in mice.

Antihypertensive therapy, particularly with the use of an angiotensin-converting enzyme inhibitor, improves outcomes in patients with hypertension and SARS-CoV-2 infection, who are susceptible to hyperinflammation and severe outcomes with COVID-19.

Alarmins released by infarcted myocardium stimulate B cells to differentiate into antibody-producing plasma cells, which then remotely drive the progression of atherosclerosis by producing autoantibodies that accumulate in pre-existing atherosclerotic plaques, increasing local inflammation and accelerating the progression towards a vulnerable plaque phenotype.

A new study identifies a protective function for eosinophils after myocardial infarction.

Impairment of drainage by the lymphatic system is involved in the accumulation of interstitial fluid in patients with heart failure with preserved ejection fraction and the development and progression of atherosclerotic plaque.

A new study identifies microRNAs that are enriched in exosomes secreted from cardiosphere-derived cells and which are associated with cardiac repair in pigs and humans with dilated cardiomyopathy.

A new study identifies the mitochondrial protein ALDH4A1 as a potential biomarker of atherosclerosis and as a target antigen of protective autoantibody A12, which might have therapeutic potential.

In the AFFIRM-AHF trial, the use of intravenous ferric carboxymaltose in patients with acute heart failure and iron deficiency was associated with a reduction in hospitalization for heart failure and cardiovascular death.

In patients with recurrent pericarditis, treatment with rilonacept, an engineered fusion protein that acts as an IL-1 trap, leads to a rapid resolution of recurrent pericarditis episodes and reduces the risk of pericarditis recurrence.

Omecamtiv mecarbil (a myosin activator) and mavacamten (a myosin inhibitor) have beneficial effects in patients with heart failure with reduced ejection fraction or obstructive hypertrophic cardiomyopathy, respectively.

Findings from two clinical trials indicate that cryoablation as first-line treatment is superior to drug therapy for the prevention of atrial arrhythmia recurrence in patients with paroxysmal atrial fibrillation.

In the TIPS-3 trial, a single polypill comprising blood-pressure-lowering and cholesterol-lowering drugs, together with a daily dose of aspirin, reduced cardiovascular events in people at risk of cardiovascular disease.

Sotagliflozin reduces the risk of adverse cardiovascular events in patients with type 2 diabetes mellitus and chronic kidney disease or worsening heart failure according to the SCORED and SOLOIST-WHF trials.

In patients with heart failure who are carriers of a clonal haematopoiesis driver mutation in DNMT3A, circulating monocytes have a pro-inflammatory transcriptome, which might worsen disease progression.

A new study identifies a previously unknown paracrine signalling system in the human atrium that is mediated by calcitonin produced by atrial cardiomyocytes and is involved in controlling atrial fibrogenesis and arrhythmia.

A metabolomics approach to assess heart energy metabolism in humans provides new insights into what fuels are used by both the failing and non-failing heart.

After myocardial infarction in mice, cardiac macrophages produce matrix metalloproteinase 14, which promotes endothelial-to-mesenchymal transition, cardiac fibrosis and myocardial dysfunction.

A new study shows that crosstalk between the ERBB2 and Hippo–YAP pathways is required for robust cardiac regeneration after myocardial infarction. ERBB2–ERK–YAP mechanotransduction signalling and epithelial–mesenchymal transition-like processes in cardiomyocytes can trigger regeneration even after functional deterioration and scarring.

A newly identified mechanism of piRNA-mediated post-transcriptional regulation of gene expression is associated with pathological hypertrophy, cardiac remodelling and heart failure.

Higher levels of angiotensin-converting enzyme 2 in plasma are associated with a greater risk of major cardiovascular disease events, according to a global, population-based study.

A new single-cell data set defines the immune response to myocardial infarction, from origins in the bone marrow and its translational potential in the blood to diversification and regulation within the heart.

The cellular composition of the heart is highly heterogeneous, plastic and sex-specific. These findings have important implications for understanding the functional specialization of the heart and also highlight the importance of considering biological sex in preclinical studies.

A new study shows that exosomes secreted by cardiac cells derived from human induced pluripotent stem cells improve myocardial recovery without arrhythmogenic complications and might provide an acellular therapeutic option for myocardial infarction.

A network of macrophages in the heart supports cardiac health and function by removing dysfunctional mitochondria and waste material released from cardiomyocytes in subcellular particles called exophers.

A study in an in vitro model of RBM20-deficient dilated cardiomyopathy suggests that pharmacological upregulation of RBM20 with all-trans retinoic acid is a potential therapeutic strategy in patients with a heterozygous RBM20 mutation.

Mavacamten, a first-in-class cardiac myosin inhibitor, reduces symptoms and improves health status in patients with obstructive hypertrophic cardiomyopathy, according to findings from the EXPLORER-HCM trial.

Anti-inflammatory therapy with low-dose colchicine reduces the risk of cardiovascular events by 31% compared with placebo in patients with chronic coronary artery disease, according to findings from the LoDoCo2 trial presented at the ESC Congress 2020.

A strategy of early rhythm control for patients with recently diagnosed atrial fibrillation reduces the risk of cardiovascular events compared with usual care, according to findings from the EAST-AFNET 4 trial.

Empagliflozin, an SGLT2 inhibitor, reduces the risk of cardiovascular death or hospitalization for heart failure in patients with heart failure with reduced ejection fraction with or without diabetes mellitus, according to findings from the EMPEROR-Reduced trial.

Findings from the ATPCI trial show that trimetazidine is safe but not protective against angina and cardiac events in the long term after percutaneous coronary intervention.

According to findings from the POPular TAVI trial, in patients without an indication for oral anticoagulation, the use of aspirin alone compared with aspirin plus clopidogrel after transcatheter aortic valve implantation significantly reduced bleeding rates and did not increase thromboembolic events.

A novel sequencing technique reveals ROS-induced position-specific oxidation of microRNAs provides a mechanism whereby elevated oxidative stress within the heart leads to hypertrophy.

Gene therapy with H19, a highly conserved long non-coding RNA H19, prevents and reverses pathological cardiac hypertrophy in animal models, according to a study by Thomas Thum and colleagues.

A new clinical trial in a dish study sheds light on a new mechanism that restores endothelial dysfunction with lovastatin in induced pluripotent stem cells that are derived from patients with dilated cardiomyopathy.

Visceral adipose tissue-resident macrophages can sense remote organ injury, such as myocardial infarction. In response, they undergo apoptosis, which can initiate de novo insulin resistance.

In atherosclerosis-prone mice, administration of small interfering RNA (siRNA)–nanoparticle system targeted to lesional macrophages to silence Camk2g improves plaque stability compared with control nanoparticles.

Myocardial infarction can accelerate tumour growth in a mouse model of breast cancer by promoting the reprogramming of myelopoietic progenitors to alter long-term immune responses that contribute to a protumoural environment.

In a prespecified secondary analysis of the ACCELERATE trial, Puri and colleagues report a stepwise relationship between lipoprotein(a) levels and risk of major adverse cardiac events in patients with high-sensitivity C-reactive protein levels ≥2 mg/l.

SS-31, an inhibitor of mitochondrial reactive oxygen species production, can rescue age-related cardiac dysfunction and normalize mitochondrial proton leak in old mice.

Type V collagen, a minor constituent of the myocardial scar that forms after ischaemic injury, is an important regulator of scar size via a previously unrecognized role in limiting integrin-dependent fibrosis.

Maternal exercise during pregnancy confers benefits to offspring, including improvements in glucose metabolism, adiposity and cardiac function, via an oligosaccharide present in breast milk.

Non-coding de novo variants (DNVs) contribute to congenital heart disease (CHD) through transcriptional and post-transcriptional regulatory effects during cardiac development. The proportion of individuals with CHD ascribed to non-coding DNVs might be at least as high as that with CHD attributed to coding DNVs

A new study involving theoretical and experimental assays provides proof of concept of a fully biological self-restoring system that automatically detects and terminates cardiac arrhythmias.

A decline in the number of hospital admissions for acute coronary syndrome was observed across Italy and USA during the peak of the COVID-19 pandemic.

In patients with COVID-19, myocardial injury is prevalent and is associated with an adverse prognosis and increased mortality, according to two retrospective cohort studies from China and the USA.

In a new cross-trial analysis of patients with heart failure with reduced ejection fraction, researchers predict that a comprehensive strategy combining several pharmacological approaches reduces hospitalization and mortality compared with conventional therapy.

A new biomimetic drug delivery system consisting of nanoparticles that are coated with macrophage membrane and responsive to reactive oxygen species enables targeted pharmacotherapy for atherosclerosis in mice while also suppressing local inflammation by sequestering inflammatory factors.

Similar rates of infection and device-related deaths were observed between patients who received a recycled cardiac device and patients who received a new device.

According to five new studies, therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) is not associated with an increased risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or with an increased risk of severe disease or in-hospital death among patients with COVID-19.