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The ROMICAT-II trial shows that CT coronary angiography is safe and fast for the exclusion of clinically significant obstructive coronary artery disease in low-risk patients with acute chest pain. Several issues and questions relating to the low prevalence of disease and the actual benefit to patients remain to be answered.
A 3-h algorithm using high-sensitivity assays for cardiac troponin to rule out myocardial infarction (MI) is recommended in current ESC guidelines. Whether faster rule-out algorithms can discriminate between MI and other conditions that elevate the troponin level, or be safely implemented across the whole spectrum of patient risk, is unclear.
Defibrillation testing during implantation of cardioverter–defibrillators is controversial because of potential safety concerns and a lack of evidence for the effectiveness of the procedure. New data from the SAFE-ICD study is helpful, but does not completely resolve the issue.
Myocardial infarction is a major cause of morbidity and mortality worldwide. In this consensus document, experts from the ESC, ACCF, AHA, and WHF update the universal definition and classification of myocardial infarction to integrate the latest evidence on the detection of myocardial injury and necrosis using biomarker assays and imaging techniques.
Preliminary evidence suggests that therapies focused on nutrition and weight loss might reduce the incidence of peripheral arterial disease (PAD), as well as ameliorate functional impairment and improve ischemic outcomes in patients with PAD. The authors summarize the available data on the effects of nutrition and anthropometric factors on PAD incidence and risk, and discuss potential nutritional strategies for the prevention and treatment of the disease.
Echocardiography is a useful imaging modality for the evaluation of heart failure and its response to treatment. In the past 5 years, the application of speckle tracking technology to 3D echocardiographic datasets (3D wall motion tracking) has enabled comprehensive evaluation of cardiac mechanics in three dimensions. Here, Yiu-fai Cheung discusses the principles of 3D wall motion tracking, the assessment of myocardial deformation using this novel imaging modality, its clinical applications and limitations, as well as the future of this technology.
In this Review, the authors present evidence for a causal relationship between the presence of large, dense, reactive platelets in the circulation and the onset of acute coronary syndromes (ACS). The increase in mean platelet volume in the pathogenesis of ACS can potentially overwhelm current therapeutics. Therefore, the control system for the production of these large platelets should be further researched to facilitate the development of new therapeutics that comprehensively prevent ACS.
