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Amiodarone effectively maintains sinus rhythm in patients with atrial fibrillation, and although dronedarone is less effective it has a better safety profile. The choice of antiarrhythmic drug (or nonpharmacological strategy) depends on the ultimate goal of therapy, which should be considered in the context of the patient's clinical presentation and the treatment tailored to the individual.
Clinical trial data, including those from MADIT-CRT, support the use of cardiac resynchronization therapy in patients with asymptomatic and mildly symptomatic heart failure and ventricular dyssynchrony. However, important questions remain about which of these patients benefit most from this therapy.
The Carillon system is a percutaneously delivered, coronary-sinus-based mitral annuloplasty device. A safety and feasibility trial now demonstrates low rates of major adverse events, with improvements in quality of life. Though promising, this report raises important questions related to relative efficacy and durability compared with other relevant therapies, and related to current clinical indications.
Stroke is the leading cause of morbidity and mortality in patients with atrial fibrillation. Whereas warfarin reduces the risk of stroke, its interactions with other drugs and food, individual differences in its efficacy and the need for frequent monitoring make its use inconvenient. Dabigatran etexilate might represent a step forward in the care of patients with atrial fibrillation.
The measurement of natriuretic peptides has emerged as an important tool for the diagnosis and risk stratification of patients with heart failure, but the use of these markers for monitoring treatment remains under question. In this Review, Drs. O'Donoghue and Braunwald explore the evolving role of natriuretic peptides in the guidance of heart failure therapy and appraise data from clinical trials in this field.
Leptin is thought to be intricately involved in pathophysiological mechanisms linking obesity and cardiovascular disease. In this Review, Dr. Sweeney highlights what is currently known about the cardiovascular effects of leptin and discusses how these effects may explain the so-called obesity paradox.
In this Review, Dr. van den Borne and colleagues examine the role of myofibroblasts in beneficial and adverse myocardial remodeling after myocardial infarction. The authors also briefly discuss strategies for imaging myofibroblasts, which might be useful for the early detection of adverse remodeling events and for predicting the risk of heart failure.
Continuing our series of Reviews on Molecular Imaging, Drs. Dobrucki and Sinusas discuss the applications of PET and single photon emission CT (SPECT) for the evaluation of cardiovascular disease, including myocardial metabolism, neurohumoral activity, atherosclerosis, ventricular remodeling, and angiogenesis.
Over the past two decades, there has been rapid progress in our understanding of the pleiotropic actions of relaxin in the cardiovascular system. In this Review, Dr. Du and colleagues discuss basic knowledge of relaxin signaling mechanisms, findings from experimental animal models of cardiovascular diseases, and findings from clinical trials on relaxin.
