Volume 12 Issue 3, March 2015

The perioperative management of patients with atrial fibrillation who require an elective surgical or other invasive procedure is an area of ongoing uncertainty. Accumulating evidence from observational studies suggests that the use of bridging anticoagulation with heparin, although well-intentioned, might not reduce perioperative thromboembolism and can increase bleeding.

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.

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.

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.

Resistance to diuretic therapy to achieve decongestion is common in patients with acute heart failure. In this Review, ter Maaten and colleagues describe the pathophysiology and mechanisms of diuretic resistance, how to evaluate diuretic response, and propose a treatment strategy for patients with acute heart failure who are diuretic resistant.