Review Articles in 2008

Transposition of the great arteries is a common but serious congenital heart malformation. It is estimated that approximately 9,000 patients in the US live with an atrial-level repair. Barry Love and colleagues discuss the anatomy, potential late complications, and appropriate therapies in this patient group—everything needed to properly care for these patients.

Here, Stephen Westaby highlights the promise of new blood pumps in severely symptomatic patients with heart failure, a patient population with very limited treatment options.

Considerable controversy continues to surround diastolic heart failure—is diastolic heart failure even a separate entity from systolic heart failure? In this Review, Maral Ouzounian, Douglas Lee and Peter Liu examine the evolving understanding of this important, albeit controversial, condition from molecular mechanisms to how the population is affected.

There is considerable semantic confusion when it comes to differentiating between the array of chemically and functionally distinct progestins used therapeutically. Hermsmeyer et al. consider the research reported to date, clearly distinguishing between the cardiovascular actions of estrogen, medroxyprogesterone acetate (a synthetic progestin) and progesterone (the naturally occurring progestin).

Noninvasivein vivoimaging to monitor the trafficking or homing of hematopoietic progenitor cells to vascular lesions is essential for both basic research and clinical practice. Here Qiu and Yang examine molecular MRI of stem-progenitor cells in atherosclerosis. They discuss advanced techniques for magnetic labeling of stem-progenitor cells, and how this modality could be used to monitor stem-progenitor cells migrating to injured arteries and vascular gene therapy mediated by stem-progenitor cells.

Förstermann reviews oxidative stress—the enzymes responsible for generating reactive oxygen species and the enzymatic and nonprotein systems designed to protect from vascular disease. He discusses how oxidative stress is involved in endothelial dysfunction, how it contributes to vascular disease, and by what therapeutic approaches it could be prevented.

The premature termination of the torcetrapib trial in December 2006 was widely publicized. A year on, Anatol Kontush, Maryse Guérin and M John Chapman revisit cholesteryl ester transfer protein inhibition as a potential therapeutic target and review recent developments in HDL-raising therapy with a focus on torcetrapib trials.

In light of the recent furore over late stent thrombosis and drug-eluting stents, Drs Stephan Windecker and Peter Jüni present their thorough review of the benefits and risks of first-generation sirolimus-eluting and paclitaxel-eluting stents, providing practical advice on the use of these devices in different patient groups.

Here, Mark Awad, Hugh Calkins and Daniel Judge tackle the known genetic mutations associated with arrhythmogenic right ventricular dysplasia/cardiomyopathy, and examine the complex issues surrounding genetic analysis in the clinical assessment of individuals with this condition.

The development of aortic regurgitation is often insidious and rate of disease progression varies between individuals. As such, symptoms do not necessarily correlate with objective evidence of ventricular dysfunction and the most appropriate criteria for risk stratification and optimum medical therapy remain controversial. Here the epidemiology of AR and evolution of practice guidelines regarding diagnosis and treatment are examined.

Atherosclerosis can remain below the clinical horizon for a long time. Acute vascular disease, however, can manifest clinically at almost any stage. Brightness ultrasonographic imaging of the carotid arterial walls can depict all stages of atherosclerotic arterial wall changes as a continuous variable. Here de Grootet al. describe the role of carotid IMT measurements as a tool in risk evaluation of individuals and explore how this technique could advance atherosclerosis research.

Elucidating arrhythmia mechanisms in heart failure at the basic ionic level will facilitate the design of novel therapeutic approaches. In this Review, Nass and colleagues examine some of the important changes in ventricular ion channels and calcium-handling proteins that underlie electrical remodeling.

Quantitative assessment of plaque composition has not been possible with grayscale IVUS analysis—until now. Here König and coworkers examine intravascular ultrasonography-derived virtual histology, a method which can provide detailed analysis of plaque morphology, providing more information on the vulnerability of coronary plaques and, in turn, the risk of acute clinical events.

Little is known about the basic pathologic mechanisms in acute decompensated heart failure (ADHF), despite ADHF being a large clinical problem. Here, David Feldman, Terry Elton, Benjamin Sun, Mickey Martin and Mark Ziolo focus on β-adrenergic receptor signaling as one of the final common pathways that could directly contribute to ADHF.

Magnetically guided navigation of a wire or devicein vivocould increase the accuracy of angiographic intervention significantly, especially in tortuous or chronic occluded arteries. In this Technology Insight, Ramcharitar and colleagues examine this novel technology and provide an up-to-date analysis of what is currently possible and an insight to what the future holds.

In this update on the cardiac manifestations of hypertension and the aging process, Susic and Frohlich discuss the distinct pathophysiological mechanisms behind these two closely related entities, examine the clinical correlates, and outline future hypertension therapies.

The percutaneous repair of mitral regurgitation is a new and rapidly evolving field, offering a less-invasive alternative to surgery. Written by two leaders in percutaneous, nonsurgical repair of heart valves, this Review examines the elements influencing patient selection for percutaneous valve repair, such as underlying valve pathology and the characteristics of the various percutaneous devices.

Rapid stabilization and regression of atherosclerosis, even for advanced complex plaques, has been achieved experimentally in both animals and humans. In this insightful Review, Kevin Williams, Jonathan Feig and Edward Fisher examine the successes and failures of many established and experimental interventions to induce plaque regression, and discuss how regression of atheromata could become a realistic therapeutic goal.

Hypertrophic cardiomyopathy is the most common inherited cardiac disorder. In this Review the authors summarize current knowledge on the genetics, disease mechanisms, and correlations between phenotype and genotype in patients with hypertrophic cardiomyopathy, and discuss the implications of genetic testing in routine clinical practice.

Surgical valve repair or replacement is currently the 'gold standard' treatment for prosthetic paravalvular leaks, despite the fact that the risks of reoperation frequently prohibit surgery in elderly patients with comorbidities. Bhindi and colleagues review the emerging field of percutaneous leak closure—an attractive, less-invasive alternative for the treatment of paravalvular leaks in high-risk patients.