Review Articles in 2013

Patients with chronic coronary artery disease can develop angina that is refractory to standard medical treatment. Henry and colleagues review the novel treatment strategies being developed for those individuals who are not suitable candidates for traditional revascularization, including pharmacological metabolic modulation, therapeutic angiogenesis, neuromodulation, and other invasive and noninvasive techniques.

Endovascular aneurysm repair has become the standard of care in many hospitals for patients with abdominal aortic aneurysms (AAAs) who have anatomy deemed suitable for the procedure. In this Review, Dominique Buck and colleagues discuss evidence-based practice and evaluate promising new strategies for endovascular repair of AAAs. The role of imaging in the management of AAAs is also highlighted.

Ventricular tachyarrhythmias are a leading cause of sudden cardiac death (SCD). In this Review, Bezzina et al. discuss the genetics of SCD, and how gene discovery programmes will contribute to the identification of novel genes involved in SCD in the coming years.

Infection of the endocardium or prosthetic surfaces in the heart, if ineffectively treated, is associated with severe complications and a high mortality. In this Review, Karl Werdan and colleagues summarize the pathogen–host interactions and mechanisms of increased risk in patients with infective endocarditis, including immunosenescence in elderly patients, and the transition from local infection to systemic sepsis and shock.

As patients with paediatric cardiological conditions become adults, they should be transitioned to adult care. In this Review, McCrindle and Kovacs discuss how this transition should occur, and what should be done to avoid lapses in care during and after this process.

The aim of minimally invasive surgery for congenital heart disease in paediatric patients is to reduce the trauma of the operation at each stage of management. In this Review, paediatric cardiac surgeons Emile Bacha and David Kalfa discuss various techniques for minimally invasive surgery, including sternal-sparing incisions, video-assisted thoracoscopic and robotically assisted surgery, hybrid procedures, and other trauma-sparing strategies. They also highlight the importance of multidisciplinary care, and emotional support for the patient and their family after hospital discharge.

Cardiologists and intensivists often regard death as failure, continuing to pursue active treatment while potentially denying patients access to alternatives such as symptom control and end-of-life care. In this Review, Price and Haxby describe how decision-making should be shared between the patient, their family, and the physician, to ensure that high-quality, patient-centred care is provided to critically ill patients with cardiac disease.

De novostenosis of coronary or peripheral arteries as well as restenosis of previously stented vessels are increasingly prevalent clinical problems. In this Review, Byrne and colleagues summarize the evidence for the use of novel balloon catheters covered with antiproliferative drug both to restore vessel patency and to provide long-lasting inhibition of cell regrowth.

Silent cerebral infarcts frequently occur in association with cardiovascular disease and cardiac interventional procedures, but their prognostic importance is unknown. In this Review, Hassell and colleagues assess the incidence and detection of silent cerebral infarcts, and their possible association with adverse neurological outcomes, such as stroke, depression, cognitive decline, and dementia.

Percutaneous transcatheter mechanical occlusion of the left atrial appendage (LAA) is a nonpharmacological treatment option for stroke prevention in patients with atrial fibrillation who cannot receive anticoagulant drugs. In this Review, Cheuk-Man Yu and colleagues present the rationale for LAA occlusion in patients with AF, the available occlusion devices and the clinical evidence for their use, and discuss the role of imaging techniques in device implantation and the management of procedural complications.

Transcatheter aortic valve replacement (TAVR) is an effective treatment for patients with severe aortic stenosis who are not suitable candidates for surgery. However, serious complications such as myocardial infarction, cerebrovascular events, vascular complications, bleeding, acute kidney injury, valve regurgitation, valve malpositioning, coronary obstruction, and conduction disturbances and arrhythmias, can occur. In this Review, Alec Vahanian and colleagues describe TAVR-related complications, the mechanisms that cause these events, and methods of preventing them.

Hypertriglyceridaemia is heterogeneous in aetiology, involving interactions between genetic and nongenetic factors. Although the importance of elevated triglyceride concentrations in the primary and secondary prevention of cardiovascular disease is uncertain, hypertriglyceridaemia is known to be an indicator of other risk factors for cardiometabolic diseases and atherosclerosis. In this Review, Watts and colleagues present contemporary knowledge in the field of hypertriglyceridaemia, and provide practical guidance on managing this condition.

Patients with coronary artery disease, who do not respond to optimal medical therapy, are candidates for revascularization. In this Review, Javaid Iqbal and colleagues discuss the evidence for CABG surgery versus percutaneous coronary intervention as the optimal revascularization method in patients with complex coronary artery disease. The choice of technique is dependent on the patient's overall medical state, and the authors highlight the most appropriate surgery in specific patient groups.

The techniques and indications for percutaneous intervention in adults with congenital heart disease can vary considerably from those of paediatric populations. Here, the most common percutaneous techniques applied in adults with structural congenital lesions are described. Singh et al. also discuss the additional requirements of specialized catheterization laboratories, the integration of imaging modalities, and the need for a collaborative multidisciplinary model for improved patient care.

Cardiac troponins (cTn) are the preferred biomarkers for the noninvasive detection of myocardial injury. However, cTn are not exclusively released as a result of ischaemic myocardial cell necrosis, but also with acute and chronic nonischaemic conditions. In this Review, Giannitsis and Katus describe the causes and the prognostic importance of the release of cTn not related to acute coronary syndromes, and recommend strategies to discriminate between ischaemic and nonischaemic cTn elevation.

Atrial fibrillation is one of the most common heart arrhythmias. In this Review, Dewire and Calkins discuss the development and role of catheter ablation to electrically isolate the pulmonary veins in patients with paroxysmal, persistent, or longstanding persistent atrial fibrillation. They go on to highlight novel tools that improve the safety, efficacy, and precision of ablation techniques.

Statins are the first-line therapy for the prevention and treatment of atherosclerotic vascular disease; however, various other lipid-lowering agents can provide additional beneficial effects when to statin therapy or alternatives for patients who are intolerant to statins. In this Review, Antonio Gotto Jr and Jennifer Moon discuss the mechanisms of action, indications, and clinical data for existing pharmacotherapies for lipid modification, as well as trials of investigational agents that are being developed for cardiovascular risk reduction.

Cardiac contractility modulation has positive inotropic effects in the failing heart, without increasing oxygen consumption. Here, Lyon and colleagues review the preclinical data, mode of action, and clinical evidence for the use of this therapy in patients with chronic heart failure. Long-term application of cardiac contractility modulation seems to improve exercise tolerance and quality of life, and have an acceptable safety profile.

Cardiomyopathies and cardiac channelopathies can predispose individuals to sudden cardiac death. The genetics that underlie these phenotypes are complex and incompletely understood. In this Review, Wilde and Behr discuss the indications for genetic testing of index patients, and its use in cascade testing of family members, to guide diagnosis, management, and assessment of prognosis.

The underlying genetics of dilated cardiomyopathy are complex, and the condition can be caused by mutations in any one of more than 30 genes. In this Review, Hershberger and colleagues assess the diverse genomics of this condition and how they might intersect with those of the hypertrophic and arrhythmogenic right ventricular forms of cardiomyopathy.