Volume 13 Issue 2, February 2016

In the first multicentre, randomized trial to compare undersized annuloplasty versus mitral replacement in severe ischaemic mitral regurgitation (MR), higher recurrence of clinically significant MR and increased rehospitalization occurred after repair. With the rapid development of transcatheter mitral valve interventions, valve replacement might be the preferable transcatheter mitral valve therapy.

Cardiac arrhythmias produce considerable morbidity and mortality, and are challenging to treat. Advances reported in 2015 will help to guide physicians in the use of therapeutic approaches ranging from established pharmaceutical agents through ablation of arrhythmic sources to novel uses of implanted devices for life-threatening bradyarrhythmias and tachyarrhythmias.

Third-generation drug-eluting stents (DES) have emerged as first-line devices for percutaneous coronary intervention, even in patients with high bleeding risk. Studies published in 2015 report that bioabsorbable vascular scaffolds are equally effective and safe as DES in low-risk populations and, with the addition of extended dual antiplatelet therapy, might improve long-term outcomes.

The proportion of the lay population that is trained in cardiopulmonary resuscitation is closely linked to the probability of an individual surviving cardiac arrest. New mobile-assisted technologies might increase the benefit of population-based training. Furthermore, admission of patients to specialized hospitals can increase the likelihood of survival.

Cardiovascular genomics has evolved substantially in the past 2 decades. Numerous papers published in 2015 demonstrate that new genomic approaches, often used synergistically, can yield noteworthy findings. A range of laboratory, analytical, and bioinformatic techniques to uncover genetic contributors to coronary artery disease, myocardial infarction, and dilated cardiomyopathy are described.

Statins remain the first-line therapy for dyslipidaemia. In 2015, however, effectiveness in reducing serum cholesterol levels and decreasing rates of cardiovascular disease in combination with statins has been demonstrated for two new classes of drugs: cholesterol-absorption inhibitors and PCSK9 inhibitors. The latter rival statins in their capacity to lower cholesterol levels.

In 2015, success in clinical trials in heart failure was obtained mainly from prevention, whereas treatments showed neutral or even adverse effects. A new glucose-lowering medication prevents development of heart failure. Treating central sleep apnoea might be harmful. In Chagas cardiomyopathy, benznidazole treatment did not affect long-term clinical outcomes.

The structural and temporal characteristics of atherosclerotic plaques differ between native coronary artery disease, vein-graft atherosclerosis, and in-stent neoatherosclerosis. In this Review, Yahagi et al. compare the shared and divergent morphological features, giving insight into the pathogenesis of atheroma formation, and provide an updated classification scheme for atherosclerotic lesions.

Many patients with pericarditis experience recurrent episodes. In this Review, Imazio et al. emphasize the importance of identifying the aetiology of the disease, and summarize the available evidence for the various treatment options. First-line anti-inflammatory therapy involves aspirin, NSAIDs, and colchicine; additional and alternative options include corticosteroids, anakinra, azathioprine, and intravenous immunoglobulins.

Bone morphogenetic proteins (BMPs) and their receptors are important for the development and modulation of cardiovascular structure and function. Morrell and colleagues discuss physiological roles and regulation of BMP signalling in cardiovascular health and disease, and based on this advancing knowledge, they suggest opportunities for therapeutic intervention for a range of cardiovascular diseases, such as atherosclerosis and pulmonary arterial hypertension.