Review Articles in 2004

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.

An inverse correlation exists between the plasma concentration of HDLs and the incidence of cardiovascular disease. The harnessing of this beneficial effect has been explored as a new approach for treatment. In this review, the range of beneficial effects and the methods being developed for the delivery of therapy are explored.

Chronic delayed cerebral vasospasm has a major impact on morbidity and mortality related to aneurysmal subarachnoid hemorrhage. Reduced concentrations of endothelium-derived NO, an important vasodilator, and increased levels of endothelin-1, one of the most potent vasoconstrictors, are important contributory factors. This review discusses the relevant mechanisms in cerebral vasospasm.

Despite treatment being available for angina in the form of β-blockers and calcium-channel blockers, these drugs are contraindicated in some patients. PharmacologicalI_finhibition could prove a promising alternative for protection from angina through heart-rate slowing. This review discusses the early mechanisms and early clinical use of ivabradine as a specific bradycardic agent.

Interruption or blocking of renin-angiotensin-aldosterone systems can reverse cardiac fibrosis and hypertensive vascular remodeling, and improve hypertensive left-ventricular hypertrophy. Local, possibly cellular, renin-angiotensin-aldosterone systems are thought to participate in the pathogenesis of vascular disease, but their roles are not yet fully explained. This review explores the evidence of such actions.

In Marfan's syndrome, connective-tissue alterations promote aortic aneurysm and dissection. Despite advances in understanding the causes, treatments are still based on old protocols. The pathophysiology of aneurysm formation and progression is, however, being elucidated by new genetic data, discussed here, which might aid the advancement of therapy for Marfan-related aneurysm.

The underlying electrophysiological mechanisms of cardiac arrhythmias remain unclear. Consequently, therapy is difficult, and for the worst arrhythmias is frequently ineffective. This review looks at the accumulating evidence for various emerging mechanisms of cardiac arrhythmias, with focus on selected ionic currents, stretch-activated phenomena and connexins.

Given the high risk of sudden death or myocardial infarction associated with atherosclerosis, frequently with no previous symptoms, techniques to better identify high-risk plaques might help lower morbidity and mortality. In this review, various biological markers are suggested as targets for imaging to aid risk assessment.

A positive relationship between salt and hypertension is well documented. Salt seems also to adversely affect cardiac structure and function independently from its influence on arterial pressure. This review discusses clinical and experimental evidence for an association between increased sodium consumption and cardiac structural and functional changes and raised cardiovascular risk.