Volume 20 Issue 11, November 2023

Unloading left atrial hypertension by catheter-based, transvenous creation of atrial shunts is being explored to treat heart failure. So far, trials including sham control have demonstrated safety and efficacy in lowering left-sided cardiac filling pressures. Ongoing trials will determine the effect on clinical outcomes.

In patients with heart failure (HF) with preserved ejection fraction and obesity, treatment with the glucagon-like peptide 1 receptor agonist semaglutide (2.4 mg) leads to large reductions in HF-related symptoms and physical limitations, improves exercise function and decreases body weight compared with placebo, according to the STEP-HFpEF trial.

According to data from the COP-AF trial, anti-inflammatory therapy with colchicine does not reduce the risk of perioperative atrial fibrillation or myocardial injury in patients undergoing major non-cardiac thoracic surgery.

New data from the ECLS-SHOCK trial and a meta-analysis indicate that the routine use of venoarterial extracorporeal membrane oxygenation does not increase survival in patients with myocardial infarction-related cardiogenic shock.

Two clinical trials presented at the ESC Congress 2023 provide conflicting evidence on the use of optical coherence tomography to guide percutaneous coronary intervention.

The FIRE trial showed that complete revascularization improves outcomes in older patients with myocardial infarction (MI) and multivessel disease compared with culprit-lesion-only revascularization, whereas the MULTISTARS AMI trial reported that immediate multivessel revascularization is non-inferior to staged revascularization in patients with ST-segment elevation MI.

An interaction between blood vessels and nerve fibres in the heart contributes to the decline in nerve density in the ageing left ventricle, potentially increasing susceptibility to arrhythmias.

In the CASTLE HTx trial, patients with symptomatic atrial fibrillation and end-stage heart failure who underwent catheter ablation and received medical therapy had improved outcomes compared with patients who received medical therapy only.

Two studies now report that TET2-driven clonal haematopoiesis of indeterminate potential (CHIP) is associated with poor prognosis in patients with heart failure (HF) and preserved ejection fraction and that DNMT3A CHIP driver mutations promote dysregulated gene expression profiles that are associated with inflammation in monocytes in the setting of HF.

The benefits of oxygen therapy for the treatment of cardiovascular disease are unclear, and findings from preclinical studies have suggested potential adverse effects associated with its excessive use. In this Review, Eltzschig and colleagues provide an overview of studies on oxygen therapy for various cardiovascular conditions and describe alternative therapeutic strategies that target oxygen-sensing pathways.

In this Review, Jo and colleagues discuss blood flow-induced mechanisms involved in endothelial cell dysfunction and atherosclerosis, including the emerging concept of disturbed-flow-induced reprogramming of endothelial cells as a pro-atherogenic mechanism, and highlight the therapeutic potential of targeting of flow-sensitive genes, proteins and pathways.

In this Review, Kroemer and colleagues describe eight molecular hallmarks of cardiovascular ageing: disabled macroautophagy, loss of proteostasis, genomic instability, epigenetic alterations, mitochondrial dysfunction, cell senescence, dysregulated neurohormonal signalling and inflammation. Therapeutically targeting these hallmarks might attenuate residual cardiovascular risk in older individuals.

Acute coronary syndromes (ACS) are a major contributor to death from cardiovascular disease. In this Review, Timmis and colleagues present data on mortality from ACS for 122 countries and examine the regional and temporal changes in the epidemiology of ACS over the past 20 years.