Volume 14 Issue 4, April 2017

The optimal blood-pressure (BP) goals for elderly patients remain inconclusive, despite the recent publication of meta-analyses comparing intensive BP control with standard BP control. In searching for therapeutic approaches in these patients, researchers should change the focus from optimal BP values to a more holistic, individual approach.

Inflammation is a recognized component of many diseases, including atherosclerosis and its complications. IL-1β is a crucial cytokine promoting the inflammatory cascade. In the February 2017 issue of Nature Medicine, Furman et al. show that metabolites can trigger inflammation via inflammasome-dependent IL-1β production in elderly individuals. Intriguingly, caffeine is protective by offsetting this activation.

In this Review, the authors discuss the pathological mechanisms involved in thoracic aortic aneurysms (TAAs), including extracellular matrix homeostasis, transforming growth factor-β signalling, and vascular smooth muscle cell contractility. The understanding of TAA genetics might not only help to characterize the aetiology of more complex forms of this disease, but can also lead to the development of new therapeutic strategies and patient management.

Innovations in noninvasive imaging have provided new insights in the pathophysiology and quantification of valvular heart disease. In this Review, Bax and Delgado discuss the novel imaging modalities used to assess the pathophysiology, dysfunction, and prognosis of aortic stenosis, mitral regurgitation, and aortic regurgitation.

Left ventricular hypertrabeculation or noncompaction is a myocardial abnormality frequently associated with monogenic disorders, particularly neuromuscular disorders, or with chromosomal defects. The pathogenesis of this cardiomyopathy remains unknown, and the diagnostic criteria, prognosis, and optimal treatment are under debate. In this Review, Finsterer et al. provide an update on the aetiology, pathophysiology, diagnosis, treatment, and prognosis of left ventricular hypertrabeculation.

The pathophysiology of heart failure is complex, but mitochondrial dysfunction is an emerging therapeutic target to improve cardiac function. In this Consensus Statement, insights into the mechanisms of mitochondrial dysfunction in heart failure are presented, along with an overview of emerging treatments with the potential to improve the function of the failing heart by targeting mitochondria.