Review Articles in 2012

Arterial injury is an inevitable consequence of all interventional coronary procedures. In this Review, the authors explain the importance of a competent, functional endothelium for vascular health and describe the processes that are required for full endothelial recovery after arterial injury.

Oral anticoagulation therapy is the most effective strategy for preventing thromboembolic complications in pregnant women with prosthetic heart valves. However, this therapy is associated with increased fetal morbidity and mortality. The authors discuss the controversies surrounding the choice of prosthetic heart valve in women of childbearing age and the advantages and disadvantages of various anticoagulation strategies during pregnancy.

The role of biomarkers in the management of patients with acute heart failure (HF) has evolved rapidly in the past several years to meet the need for earlier diagnosis, better risk stratification, and cost-effective treatment. In this state-of-the-art Review, Drs Maisel and Choudhary provide an update on biomarkers used for the diagnosis and management of patients with acute HF, as well as non-HF markers indicative of damage to the organs and systems most-commonly affected by HF.

Transcatheter aortic valve implantation is increasingly being used to treat aortic valve disease in patients at high surgical risk, but data indicate an emerging association between the procedure and incident conduction abnormalities. The authors review the frequency, potential anatomical and procedural causes, and clinical consequences of these adverse effects.

Direct inhibitors of thrombin are a novel class of anticoagulant. The authors critically review the data from clinical trials on the use of the parenteral and oral forms of these drugs for primary or secondary prevention or treatment in patients with acute coronary syndrome, atrial fibrillation, or venous thromboembolism, or those undergoing percutaneous coronary intervention or orthopedic surgery.

Cardiovascular disease (CVD) is an under-recognized major health problem among women in South-East Asia, which is compounded by psychological, social, and cultural issues as well as by misconceptions about the disease. In this Review, leading female cardiologists from South-East Asia discuss the changing prevalence of CVD and cardiovascular risk factors among women in the region. The 'heart health awareness' strategies implemented by governments and national heart associations are reviewed, together with the barriers and challenges to improving women's cardiovascular health in South-East Asia.

Psychological stress is thought to contribute to the cardiovascular disease process at several stages, including the long-term development of coronary heart disease and acute triggering of cardiac events. In this Review, Steptoe and Kivimäki summarize the evidence for the association between stress and cardiovascular disease, with a focus on external work-related and social stressors. They also discuss the effects of stress-management strategies on cardiovascular health.

Molecular biomarkers could provide a window into the pathophysiology of chronic heart failure, potentially improving our ability to predict adverse outcomes, provide novel drug targets, and even help gauge therapeutic efficacy. In this Review, Ahmad et al. examine some emerging biomarkers of the biomechanical stretch, inflammation, ventricular remodeling, myocardial injury, and renal dysfunction that occur in chronic heart failure, and discuss their potential role within a multimarker-based strategy.

Hypertension is the most prevalent controllable disease in the adult population of the developed world. Although various effective treatments are available, the development of novel therapies is still required. The authors review key advances in pharmacological and nonpharmacological therapies for hypertension in 2010–2011 and comment on possible future developments.

Hypertension is a highly prevalent modifiable risk factor for cardiovascular disease, which is particularly common among older adults. The elderly represent an important, although often overlooked, group of patients for whom assessment and treatment of hypertension requires special consideration. Comorbidities, multiple drug regimens, and potential causes of secondary hypertension can all affect the management of these individuals. Drs Pimenta and Oparil review the pathophysiology of hypertension in the elderly and how best to assess and treat these patients.

Echocardiographic screening for rheumatic heart disease (RHD) over the past 5 years has revealed a higher RHD disease burden than previously imagined and, globally, at least 15 million people are estimated to be affected by this disease. In this article, an international advisory group of experts in RHD screening and echocardiographic manifestations of RHD present the 2012 World Heart Federation criteria for echocardiographic diagnosis of RHD.

Oral direct factor Xa inhibitors, particularly apixaban and rivaroxaban, are novel and promising alternatives to warfarin for stroke prevention in patients with atrial fibrillation. Drs Cabral and Ansell review the data from clinical trials of these drugs, and also discuss the challenges of reversing their anticoagulant effects, interactions with other medications, patient compliance, and therapeutic monitoring.

Novel, oral, direct inhibitors of factor Xa are valuable additions to anticoagulation therapy in patients with various thrombotic disorders, but have shown mixed results in trials for secondary prevention in patients with an acute coronary syndrome. Drs Wisler and Becker review the available data, with particular emphasis on the phase III APPRAISE 2 and ATLAS ACS 2–TIMI 51 trials of apixaban and rivaroxaban.

Dr. Moss and colleagues review data from randomized clinical trials which suggest that important sex-specific differences in the epidemiology and clinical characteristics of patients with heart failure can affect their response to both medical and device therapies.

Multimodality and hybrid imaging combine various imaging modalities to enhance diagnostic accuracy and improve clinical outcomes. Dr. Delgado and colleagues review the use of multiple novel imaging techniques to evaluate plaque burden and stability in patients with coronary artery disease, target cardiac resynchronization therapy in patients with heart failure, and guide transcatheter procedures in patients with valvular heart disease.

Glucagon-like peptide 1 (GLP)-based therapies reduce blood glucose levels in patients with type 2 diabetes mellitus. Interestingly, GLP 1 receptor agonists can also have beneficial effects on cardiovascular risk. Dr. Sivertsen and colleagues provide an overview of the cardiovascular mechanisms targeted by GLP 1-based therapies and discuss clinical data for long-term management of cardiovascular risk in patients treated with these agents.

Particular mutations in cardiac potassium channels are known to be arrhythmogenic. In this Review, the authors discuss the genetic basis, diagnosis, risk stratification, and management of patients with various potassium channelopathies, including long and short QT syndromes, Brugada syndrome, and familial atrial fibrillation.

Systems biology harnesses experimental and computational high-throughput techniques to unravel complex biological interactions, such as those between genetic and environmental factors. Drs MacLellan, Wang, and Lusis provide an overview of system-based approaches to cardiovascular diseases and discuss the translational implications of such studies.

The second of the two Reviews on cardiogenic shock in acute coronary syndromes focuses by Westaby et al. focuses on the use of mechanical circulatory support systems, from intra-aortic balloon pumps, extracorporeal membrane oxygenation, and ventricular assist devices, to the total artificial heart. The authors highlight the importance of multidisciplinary care teams, and discuss some of the ethical and economic issues that impact the use of these devices.