Volume 11 Issue 6, June 2014

The statement from the REACH investigators that angiotensin-converting-enzyme (ACE) inhibitors are not associated with improved outcome in stable coronary artery disease should be interpreted with caution to avoid generating confusion or depriving patients of preventative therapy. Such observational data do not enable definitive conclusions to be drawn on treatment efficacy.

The 2014 AHA/ACC guidelines on valvular heart disease are not an update of the previous 2008 version, but a completely new document. The guideline authors integrate the latest findings, in particular on novel transcatheter interventions, and also propose new strategies for risk assessment and shared decision-making through a multidisciplinary approach.

The medical literature contains a huge number of studies on the safety and performance of novel stent platforms, with primary outcomes usually assessed at 6 months or 1 year. The 5-year analysis from SORT OUT III demonstrates that, when assessing clinical outcomes in stent trials, 1-year follow-up is not enough.

Major controversy exists about whether to treat patients with ST-segment elevation myocardial infarction using fibrinolysis or percutaneous intervention. A study of 1,492 patients from approximately 60% of French hospitals demonstrates that similarly excellent 5-year outcomes can be achieved with either reperfusion strategy. Therefore, one size need not necessarily fit all.

Echocardiography can be used to diagnose congenital heart disease (CHD) in fetuses. Hunter and Simpson expertly review risk stratification and the detailed fetal echocardiography used to detect CHD. Next, the consequences of a diagnosis of CHD are summarized, including parental perceptions, fetal prognosis, and potential for intervention. Finally, the appropriate design of universal prenatal screening strategies is discussed.

Dengue is one of the most important emerging infectious viral diseases in the world. Cardiovascular complications of dengue, including myocardial impairment and arrhythmias, are increasingly recognized. Capillary leakage is frequently described, with a small proportion of patients developing hypovolaemic shock. In this Review, Yacoub et al. outline our current understanding of the pathophysiology of the cardiovascular manifestations of dengue, and discuss the available management options for this disease.

Left cardiac sympathetic denervation (LCSD) has antiarrhythmic and antifibrillatory effects that are beneficial for patients with channelopathies, such as long QT syndrome or catecholaminergic polymorphic ventricular tachycardia. In this Review, Peter Schwartz expertly summarizes the development and current indications for LCSD, including emerging evidence for a potential beneficial effect in patients with ischaemic cardiomyopathy or heart failure.

The number of heart transplantations performed each year is limited by a shortage of donor organs, and approximately 10% of patients on the waiting list die before a heart becomes available. In this Review, Longnus and colleagues explore the possibility of heart donation after circulatory determination of death (as opposed to after brain death). Before such as strategy can be adopted, problems such as the period of warm ischaemia before procurement, as well as various ethical considerations, must be resolved.

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition that affects women in the final stages of pregnancy or shortly after birth. The underlying pathophysiology of PPCM is incompletely understood. In this Review, Hilfiker-Kleiner and Sliwa summarize the epidemiology of this condition, the current understanding of its aetiology and risk factors, and propose novel biomarkers and treatment strategies for women with PPCM.