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Transvenous leads are the most common source of complications associated with the use of implantable cardioverter-defibrillators (ICDs). A preliminary experience with an entirely subcutaneous ICD system, which avoids the need for transvenous leads, has been reported. We discuss these results and the importance of investigations in this new field.
The best strategy for management of patients with non-ST-segment elevation acute coronary syndrome is still a matter of debate. A meta-analysis, in which results from three large-scale studies were pooled, shows that a routine invasive approach is associated with better 5-year outcomes than a selectively invasive approach.
T2-weighted cardiovascular magnetic resonance imaging (T2W-CMR) has been championed as the best noninvasive method to determine the myocardial area at risk and to quantify myocardial salvage in patients with acute coronary syndromes. However, several unresolved issues warrant discussion and we urge caution when utilizing T2W-CMR for this purpose.
Determining the appropriate dose of warfarin that should be used in each patient is challenging, and the rate of adverse events at the beginning of therapy remains high. Testing for genetic variability related to warfarin sensitivity at the start of treatment is a promising strategy to guide dosing in clinical practice.
The morphology, structure and position of the right ventricle differ substantially from those of the left ventricle and have posed difficulties in the assessment of right ventricular function. Imaging techniques, notably echocardiography and MRI, have enabled a better understanding of right ventricular performance. Mertens and Friedberg discuss the advantages and disadvantages of established and new methods of right ventricular imaging and their potential in the clinical setting.
Cancer therapies can have a profound, and often permanent, effect on the cardiovascular system. Patients at high risk of cardiotoxicity should be identified before treatment, closely monitored, and given cardioprotective agents to reduce adverse events. The authors of this Review discuss the complications that can occur as a result of cancer therapy, and emphasize the importance of assessing both the cardiotoxicity and benefits of cancer treatment.
Excess dietary salt is associated with insulin resistance and hypertension, and may lead to type 2 diabetes, cardiovascular disease and chronic kidney disease. The mechanisms underlying the pathogenic effects of salt on the cardiovascular system include impaired glucose homeostasis and activation of the sympathetic nervous system and renin–angiotensin–aldosterone system. Mineralocorticoid receptor blockers are promising therapies to counteract the adverse metabolic and cardiovascular effects of salt.
Pulmonary embolism (PE) is a frequently occurring, acute, and potentially fatal condition. Numerous risk factors for PE have been identified. The diagnostic work-up for PE should comprise safe, efficient and noninvasive methods. In this Review, Renée Douma and colleagues discuss the epidemiology of PE, its risk factors and clinical presentation, together with the latest advances in the diagnostic approach to this condition.
