Volume 13 Issue 4, April 2016

The latest findings from the EMPA-REG OUTCOME trial show a 34% reduction in hospitalization for heart failure or cardiovascular death in patients receiving empagliflozin, a sodium/glucose cotransporter 2 (SGLT2) inhibitor, compared with placebo. These outstanding results call for discussion of the clinical implications, and in-depth studies of the mechanisms of action of SGLT2 inhibitors.

A major goal of precision medicine is to improve disease prevention and therapy by using big data provided by genomic technology and electronic health records. In a new study, assessment of a patient population without a history of cardiac disease revealed that genetic variants putatively associated with a risk of sudden death were not linked with arrhythmia phenotypes.

The long-term outcomes of operated and nonoperated patients with chronic thromboembolic pulmonary hypertension were reported in a large, prospective, multicentre, European and Canadian registry. The long-term prognosis of operated patients was superior to that of nonoperated patients, indicating that surgery should be the first-choice treatment in this patient cohort.

Rheumatic heart disease (RHD) key opinion leaders, health ministers, clinicians, and industry representatives gathered in Ethiopia in February 2015. The question: how to eradicate RHD in Africa. The response: the Addis Ababa communiqué, a practical document outlining seven major barriers to RHD control in Africa and seven strategies to address them.

Ischaemic conditioning is an endogenous cardioprotective strategy that involves the application of brief cycles of ischaemia and reperfusion either directly to the heart, or to a remote organ or tissue, and which has been shown to reduce infarct size. In this Review, Hausenloy and Yellon summarize the various forms of ischaemic conditioning and pharmacological cardioprotection, and highlight the challenges of translating these methods into the clinical setting.

In this Review, Brown et al. describe the role of biomechanical forces, including wall shear stress and plaque structural stress, in the development and progression of coronary atherosclerosis. The calculation and integration of biomechanical parameters might improve our ability to detect arterial regions at risk of atherosclerosis, enabling better identification of patients at high risk of adverse clinical events.

The leads of cardiovascular implantable electronic devices often need to be extracted because, for example, of infection or the lead has been recalled. In this Review, Wazni and Wilkoff summarize the common indications and techniques for lead extraction, and assess data on the safety, efficacy, and outcomes of these procedures.

To bridge the current gap between the known mechanisms of atrial fibrillation (AF) and the clinical management of patients with this arrhythmia, Fabritz and colleagues propose a roadmap to develop a set of clinical markers that reflect the major causes of AF in patients. A new, mechanism-based classification of AF can provide the basis for personalized prevention and management.

Renal denervation for the treatment of drug-resistant hypertension has been studied extensively in the past few years. Although early trials reported dramatic reductions in blood pressure after renal denervation, later trials testing denervation against a sham procedure showed neutral results. In this Perspectives article, Gulati and colleagues suggest potential reasons why results from these early trials could not be replicated, and summarize the current available trial data, newly designed devices, and recommendations for future trial design.