Review Articles in 2014

Rheumatological diseases can have a broad spectrum of cardiovascular manifestations that, whilst sometimes mild or clinically silent, can often increase morbidity and mortality. In this Review, Prasad et al. explore the underlying pathophysiology and available management strategies of cardiovascular complications in patients with autoimmune rheumatic diseases, and focus on the vascular aspects of the emerging field of 'cardiorheumatology'.

In elderly patients with degenerative mitral regurgitation who are not ideal candidates for conventional surgical valve repair or replacement, percutaneous valve repair is emerging as an alternative therapeutic option. While percutaneous valve repair is associated with clinical improvement, faster recovery, and reduced perioperative mortality, it should only be considered in patients who will gain the most benefit from it. In this Review, Taramasso and colleagues discuss the treatment options and indications for degenerative mitral regurgitation in elderly patients.

Acute aortic syndrome (AAS) encompasses acute aortic dissection, intramural haematoma, and penetrating aortic ulcer, a group of conditions that carry a risk of imminent aortic rupture. The development of these disorders has been linked to a number of pathologies, including untreated hypertension and connective tissue disorders. In this Review, Clough and Nienaber discuss the epidemiology, diagnostic strategies, and treatment options for each condition.

MicroRNAs regulate the processes that underlie cardiac remodelling after myocardial infarction, including angiogenesis and cardiomyocyte apoptosis and proliferation. In this Review, Boon and Dimmeler summarize the microRNAs that are involved with these postischaemic pathways, and discuss potential therapeutic interventions to enhance cardiac regeneration in patients with acute myocardial infarction.

Available treatments for atrial fibrillation (AF) often lack sufficient efficacy or have considerable complications, but novel therapies based on the underlying molecular mechanisms of AF can provide useful alternatives. MicroRNAs (miRNAs) regulate gene transcription, and constitute a promising therapeutic approach for the treatment of AF. In this Review article, Luo et al. provide a comprehensive overview of the mechanisms of miRNA action, and explore the available experimental evidence supporting a role for miRNAs as novel therapeutic targets for AF.

Pulmonary arterial hypertension (PAH) is an incurable disease associated with high mortality, but early detection of PAH improves long-term survival. In this Review, Lau and colleagues discuss which individuals warrant screening for PAH, such as those with systemic sclerosis, and summarize the variety of diagnostic tests that could be combined into a multimodal approach to optimize the performance of screening algorithms.

Although PCI can restore epicardial patency, microvascular blockage can occur in up to 50% of patients with acute myocardial infacrtion and lead to intramyocardial haemorrhage. In this Review, Betgem and colleagues discuss the pathophysiology, diagnostic options, and clinical relevance of intramyocardial haemorrhage, as well as potential future therapies to treat this condition.

Traditional Chinese medicine (TCM) has been used in China for >2000 years, and become increasingly popular in Western countries. In this Review, Hao and colleagues describe and assess the randomized controlled trials that have compared TCM with no intervention or modern western medicines for the treatment of cardiovascular diseases.

Atherosclerosis is characterized by increased accumulation of macrophages within the vessel wall. In response to stimuli such as modified lipids, cytokines, and senescent erythrocytes present in the atherosclerotic lesion, these macrophages can alter their functional phenotypes. Different macrophage subsets can influence the growth and composition of the atherosclerotic plaque in distinct ways. In this Review, Chinetti-Gbaguidi et al. highlight the diverse range of macrophage phenotypes present in atherosclerotic lesions, and their roles in both plaque progression and stability.

Novel oral anticoagulants (direct thrombin or factor Xa inhibitors) have become alternative options to vitamin K antagonists owing to their predictable and safe pharmacological profiles. In this Review, Baber and colleagues discuss the overall clinical effect of these drugs, which is a balance between ischaemic benefit and bleeding risk, in patients with atrial fibrillation, venous thromboembolism, or acute coronary syndrome.

Cardiac MRI is a noninvasive phenotyping tool that allows for accurate and easy detection and quantification of myocardial fibrosis in myocardial tissue. In this Review, Ambale-Venkatesh and Lima focus on late-gadolinium enhancement and T1 mapping strategies, and explore the different prognostic applications of this technique.

Combination antiretroviral therapy (cART) has substantially prolonged the lives of patients with HIV infection, but these individuals have an increased risk of coronary heart disease and myocardial infarction compared with uninfected individuals. In this Review, Reiss and colleagues discuss the control of both traditional and immune risk factors, and the appropriate selection of cART regimens, to reduce the risk of cardiovascular complications in patients with HIV.

Amyloidosis is caused by the aggregation of insoluble fibrous deposits of misfolded proteins. Cardiac deposition can lead to diastolic dysfunction, arrhythmias, and ischaemia. In this Review, Gertz et al. summarize the pathophysiology of the condition, and how best to achieve early diagnosis and treatment, before advanced heart failure occurs.

The coronary microvasculature cannot be directly imagedin vivo, but parameters that depend directly on coronary microvascular function are routinely assessed by a number of invasive and noninvasive procedures. In this Review, Camici and colleagues explore available imaging techniques that allow novel insights into the pathophysiological role of coronary microvascular dysfunction.

In conditions of prolonged stress valvular cells can contribute to valve disease progression. In this Review, Wang and colleagues describe how the biophysical and biochemical properties of the extracellular matrix can regulate valve cell function in the context of calcific valvular diseases. The authors also describe how new cell culture approaches can be employed to better understand the pathophysiology of valve diseases.

Dual antiplatelet therapy (DAPT) with aspirin and the P2Y purinoceptor 12 (P2Y₁₂)-receptor inhibitor clopidogrel has been considered the gold standard of care in patients with acute coronary syndrome (ACS). The FDA approval of the novel P2Y₁₂-receptor antagonists prasugrel and ticagrelor, which are faster-acting and more potent than clopidogrel, in the past 5 years have improved clinical outcomes in patients with ACS. Even with these newer compounds, many patients continue to experience adverse ischaemic events. This Review will provide an overview of the antiplatelet agents currently used to treat patients with ACS. Furthermore, emerging antiplatelet therapies, including intravenous P2Y₁₂antagonists, oral PAR-1 antagonists and thromboxane-receptor inhibitors will be discussed.

Risk models to predict outcomes in cardiac surgery are increasingly being used to identify patients who might be better treated using percutaneous techniques than by surgical intervention. In this Review, Thalji and colleagues critically evaluate how the databases from which these models are derived might influence risk prediction in clinical practice, particularly for selecting patients to undergo transcatheter aortic valve implantation.

During stress or injury-induced cardiac remodelling, fibroblasts increase production of extracellular matrix proteins, which leads to fibrosis formation, and consequently, heart failure. In this Review, Thomas Thum describes the contribution of noncoding RNAs to this process, with a specific focus on microRNAs that might be used as future therapeutic targets or biomarkers for cardiac fibrosis.

Early detection of signs of heart failure can allow fast therapeutic intervention, potentially improving a patient's prognosis and avoiding unnecessary hospitalizations. Implantable monitoring devices have been suggested as useful tools in detecting early changes in cardiac parameters, but clinical trials aimed at studying their efficacy and safety have unique problems. In this Review, Abraham et al. identify the major hurdles in trials of implantable monitoring devices, and discuss the approaches used to overcome the challenges arising during trial design.

The prevalence of atrial fibrillation (AF) is estimated to increase worldwide, mainly as a consequence of generalized population ageing. Even though the rise in AF prevalence is a global trend, data from Africa, Asia, and South America are limited and might underestimate the true frequency of AF. In this Review, the authors discuss the available epidemiological data on AF and highlight the widespread inadequacy of its treatment.