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Cover image supplied by James C. Weaver, Catherine S. Spina, James J. Collins, and Donald E. Ingber, from the Wyss Institute, Harvard University, Cambridge, MA, USA. The image shows a polychromatic scanning electron micrograph of a bisected heart of an E15.5 mouse. Using a radial array of electron detectors, the electron scatter field can be deconstructed from the surface of a sample. The signals from each detector can then be recombined to create a colour-coded topographic reconstruction of the sample surface, with the resulting image shown here clearly illustrating the 3D external and internal architecture of the heart.
Among patients with diabetes mellitus and ischaemic heart disease, high-sensitivity testing effectively identified 39.3% of patients with elevated troponin levels who were at high 5-year risk of cardiovascular death, myocardial infarction, or stroke. Compared with optimal medical therapy, revascularization did not reduce ischaemic events among patients with elevated troponin levels.
Exposure to air pollution and to metals in the environment contributes to the development and severity of cardiovascular disease. Cosselman et al. review the pathophysiological processes associated with long-term and short-term exposure to these pollutants, at levels above and below current regulatory standards, and discuss the need for further reductions in levels of environmental pollutants.
Mast cells have many roles in the pathogenesis of cardiometabolic diseases. In this Review, Shi et al. explore the mechanistic role of mast cells in atherogenesis and its atherothrombotic complications, as well as in aortic aneurysm, valvular disease, obesity, and diabetes mellitus. Pharmacological inhibition of mast-cell activation or their targeted effector functions offers potential novel therapeutic strategies for patients with cardiometabolic disorders.
Iron deficiency is very common worldwide, and has detrimental effects in individuals with cardiovascular disease. Correction of iron deficiency via intravenous iron supplementation results in symptomatic improvement in patients with heart failure, and improved exercise capacity in patients with pulmonary hypertension, but iron administration after cardiac transplantation surgery is contraindicated.
This Review explores the pathophysiology and natural history of viral myocarditis—a common cause of dilated cardiomyopathy and sudden cardiac death. Despite established standards, heterogeneity exists in the evaluation, diagnosis, and treatment of patients with myocarditis, and these aspects are also covered in detail by Pollack and colleagues. Investigational treatment options are highlighted.