Volume 5 Issue 11, November 2008

In this opinion piece, Hideo Mitamura presents some of the new strategies that are increasing the use of automated external defibrillators (AEDs) by lay persons in Japan. Professor Mitamura hopes that, if other countries follow in adopting initiatives such as internet-based maps showing the location of public-access AEDs, the lives of many who suffer an out-of-hospital cardiac arrest will be saved.

Patients with fulminant myocarditis present with acute-onset, severe heart failure and are often in cardiogenic shock. However, if patients are quickly diagnosed and given aggressive treatment, most will make a full recovery. Gupta et al. highlight the importance of early recognition of fulminant myocarditis and provide a comprehensive review of its epidemiology, pathophysiology, clinical presentation, methods of diagnosis, management, and prognosis.

Although optimum treatment for patients with acute ST-segment elevation myocardial infarction has been established through randomized clinical trials, the majority of patients do not receive all the guideline-recommended therapies promptly. In this Review, Keith Fox and Kurt Huber present a European perspective on the disparities between the evidence base and clinical practice in the treatment of ST-segment elevation myocardial infarction and propose that an integrated network of care, aimed at minimizing delays between symptom onset and treatment, is essential to improving outcomes among these patients.

The existence of diabetic cardiomyopathy has been debated; however, substantial data now demonstrate that diabetes impairs ventricular function independent of other risk factors. Here Lebeche et al. examine the hypothesis that impaired calcium regulation and insulin signaling contribute to the detrimental effect of diabetes on cardiomyocyte function. How these two abnormalities interact to induce cardiac dysfunction is also investigated.

Several chemotherapeutic agents, including newer drugs, can have toxic cardiac effects. In this month's Case Study, To and colleagues present their patient who had capecitabine-induced cardiogenic shock. They examine the best course of action for this serious complication of chemotherapy.

Several known candidate gene variants are useful markers for diagnosing hyperlipoproteinemia. In this paper the authors evaluate the association of two commonAPOA5 single-nucleotide polymorphisms across the range of classic hyperlipoproteinemia phenotypes. Their data shows that a high proportion of patients with four classic hyperlipoproteinemia phenotypes are carriers of either the APOA5S19W or −1131T>C variant or both. The authors conclude that these two variants are robust genetic biomarkers of a range of clinical hyperlipoproteinemia phenotypes linked by hypertriglyceridemia.

Because octogenarian patients have not been adequately represented in randomized trials comparing CABG and PCI, the most appropriate method of revascularization for this group of patients has not been determined. In this paper the authors performed a systematic review and a meta-analysis of 66 studies of coronary revascularization in patients aged over 80 years. Their data shows that revascularization can be performed in octogenarians with acceptable short-term and long-term outcomes. Furthermore, it is unclear whether octogenarians derive greater survival benefit from CABG or from PCI because preprocedural risk profiles differ between intervention types.