Review Articles in 2012

Medical devices are often life-saving therapies in patients with advanced heart failure whose condition worsens despite optimal medical therapy. Drs Abraham and Smith expertly review the development of cardiac resynchronization therapy and left ventricular assist devices, describe the current challenges associated with these treatment strategies, and speculate on future advances in this fast-moving field.

In the diseased heart, cardiomyocytes undergo necrotic cell death. A healing response results in myofibroblast production of collagen and other matrix molecules, which initially serve to preserve the structural integrity of the myocardium. However, myofibroblast dispersion fails to occur in many cardiac diseases, and perpetual matrix formation leads to adverse remodelling of the heart. In this Review, Weber et al. discuss relevant mechanisms of cardiac fibrosis and consequent remodelling, and highlight potential strategies for cardioprotection.

The success of transcatheter therapeutics relies heavily on the choice of vascular access site and on adequate arteriotomy closure. In this article, Byrne and colleagues review the state-of-the-art and future developments in vascular closure devices. They also compare the safety and efficacy of radial artery and femoral artery access for diagnostic and interventional procedures.

Timeliness of reperfusion is paramount in the management of patients with ST segment elevation myocardial infarction. Both fibrinolysis and primary percutaneous coronary intervention are inherently associated with patient and health-care system delays. In this Review, Jens F. Lassen and colleagues describe the types of delay to reperfusion and their effects on outcome, and discuss strategies to optimize reperfusion therapy in these patients.

In dilated cardiomyopathy (DCM), the function of the heart is altered by the change in the shape of the left ventricle. Restoring the natural 'ellipse' of the heart from the dilated, spherical form using surgical ventricular restoration (SVR) can correct the relationship between structure and function. This technique is often combined with other interventions to simultaneously treat the vessels, valves, and ventricle. Buckberg and colleagues discuss the role and reported benefits of this procedure in patients with ischemic DCM with systolic dysfunction, and consider future uses for SVR.

Rheumatic heart disease (RHD) is preventable, yet continues to be a leading cause of morbidity and mortality in children in developing countries. In this Review, Kathryn Roberts and colleagues examine whether RHD fulfils the 1994 Council of Europe criteria for a disease suitable for screening, assess cardiac auscultation and echocardiography as methods of screening for RHD, and discuss areas of controversy that require further research in order to make recommendations about screening for this disease.

An epidemic of obesity and related cardiovascular comorbidities is occurring worldwide. In this comprehensive Review, the authors describe the various forms of adipose tissue and the complex roles of adipokines in cardiac health and disease. They also discuss the contribution of adipose tissue to inflammatory processes, and finally review the potential use of stem cells derived from adipose tissue in cardiac tissue engineering.

Ca²⁺ cycling defects in cardiac myocytes are a hallmark of heart failure. Roger Hajjar and colleagues discuss the association between abnormalities in sarcoplasmic reticulum Ca²⁺handling proteins and heart failure as well as the potential therapeutic benefits of novel treatment strategies that target these proteins.

The association between obstructive sleep apnea (OSA) and cardiovascular morbidity and mortality is largely the result of myocardial anomalies. In this Review, the authors discuss the mechanisms that lead to myocardial damage and cardiac dysfunction in patients with OSA, and the potential beneficial effects of nasal continuous positive airway pressure on cardiac symptoms and hemodynamic parameters in these patients.

In this Review, the authors present evidence for a causal relationship between the presence of large, dense, reactive platelets in the circulation and the onset of acute coronary syndromes (ACS). The increase in mean platelet volume in the pathogenesis of ACS can potentially overwhelm current therapeutics. Therefore, the control system for the production of these large platelets should be further researched to facilitate the development of new therapeutics that comprehensively prevent ACS.

Echocardiography is a useful imaging modality for the evaluation of heart failure and its response to treatment. In the past 5 years, the application of speckle tracking technology to 3D echocardiographic datasets (3D wall motion tracking) has enabled comprehensive evaluation of cardiac mechanics in three dimensions. Here, Yiu-fai Cheung discusses the principles of 3D wall motion tracking, the assessment of myocardial deformation using this novel imaging modality, its clinical applications and limitations, as well as the future of this technology.

Preliminary evidence suggests that therapies focused on nutrition and weight loss might reduce the incidence of peripheral arterial disease (PAD), as well as ameliorate functional impairment and improve ischemic outcomes in patients with PAD. The authors summarize the available data on the effects of nutrition and anthropometric factors on PAD incidence and risk, and discuss potential nutritional strategies for the prevention and treatment of the disease.

Myocardial infarction is a major cause of morbidity and mortality worldwide. In this consensus document, experts from the ESC, ACCF, AHA, and WHF update the universal definition and classification of myocardial infarction to integrate the latest evidence on the detection of myocardial injury and necrosis using biomarker assays and imaging techniques.

Chagas disease is endemic in Latin America, but the migration of infected individuals makes the condition an increasingly global problem. The authors review the epidemiology, pathogenesis, diagnosis, and treatment of the disease, focusing particularly on the risk stratification and management of patients with Chagas cardiomyopathy.

Syncope is a transient, self-terminating period of cerebral hypoperfusion that usually results from systemic hypotension. Many patients with this condition are successfully treated according to current guidelines. However, the authors identify and expertly review the current understanding of four key challenges in the characterization, diagnosis, risk stratification, and treatment of patients with suspected syncope.

Dr Javier Escaned discusses the increasing problem of time-dependent failure of coronary artery bypass grafts, and the subsequent need for secondary revascularization. Issues such as the substrate and epidemiology of graft failure, the choice of secondary revascularization modality, the specific problems inherent in repeat CABG surgery and percutaneous coronary intervention, and the importance of secondary prevention are reviewed.

Depression increases the risk of cardiovascular disease and is a predictor of poor cardiovascular outcomes. The authors outline these epidemiological findings, describe the pathophysiological mechanisms that might underlie the risk of cardiovascular disease in patients with depression, and describe new data on the effects of successful treatment of depression on biological risk factors for coronary artery disease.

Abnormalities in the control of intracellular calcium are involved in several forms of inherited arrhythmias. The genetic mutations that cause these abnormalities have generated much research interest in the past decade. Here, Venetucci et al. provide an overview of the structural organization and the function of calcium-handling proteins and describe the mechanisms by which mutations determine the various clinical phenotypes of calcium channelopathies.

High-quality cardiopulmonary resuscitation started as soon as possible after cardiac arrest increases the rate of return of spontaneous circulation and improves long-term neurologically intact outcome. The authors discuss the latest evidence for successful resuscitation and subsequent patient care.

In the past decade, improvements in procedural techniques and the understanding of electrophysiological mechanisms have led to the establishment of effective ablation strategies for almost all types of ventricular tachycardia. The underlying cardiac disease, the site of origin, and the electrophysiological mechanism of the arrhythmia should all be considered when choosing the optimal ablation strategy for an individual patient.