Review Articles in 2016

The mechanisms of thromboembolism in patients with atrial fibrillation are complex and not well understood, and existing stroke risk scores are limited in their predictive capacity. In this Review, Calenda et al. discuss stroke risk assessment in atrial fibrillation and explain how the atrial myopathy concept might help to refine stroke risk prediction.

Nutraceuticals are natural compounds that are beneficial for the prevention or treatment of disease. In their Review, Moss and Ramji summarize the preclinical and clinical studies to evaluate the efficacy of various nutraceuticals, such as polyunsaturated fatty acids, flavanols, and vitamins C and E, for the prevention of atherosclerosis.

Both the cardiovascular research and clinical communities are ideally positioned to develop and implement precision medicine to achieve more effective prevention and treatment. This Review highlights the advances in modern biomedicine that make possible the precision medicine era, provides current examples of the use of this approach in the cardiovascular field, and defines the goals and barriers to implementation of a precision medicine system.

Refractory cardiogenic shock carries a poor prognosis, with an inhospital mortality of ∼50%. In this Review, Reyentovich and colleagues discuss the current therapeutic and management options available for patients with refractory cardiogenic shock.

The underlying mechanisms for the continued sex-based disparities in acute coronary syndromes (ACS) remain unclear. In this Review, Pagidipati and Peterson discuss the current evidence for sex-related differences in the clinical presentation, pathophysiology, evaluation, management, and outcomes of ACS, and identify urgent research questions that need to be addressed in areas that range from clinical evaluation and management, to representation of women in clinical research.

Elevated heart rate can induce myocardial ischaemia in patients with coronary artery disease, and is a risk factor for cardiovascular events in those with heart failure. In this Review, Ferrari and Fox discuss the evidence for therapeutic heart rate reduction, drawing particularly on data from the BEAUTIFUL, SHIFT, and SIGNIFY trials.

A range of established and emerging invasive and noninvasive imaging modalities can be used to evaluate various parameters of coronary atherosclerosis, including functional severity, plaque burden, and high-risk characteristics. In this Review, Dweck et al. assess the relative strengths and weaknesses of these techniques, how they might be complementary when used in combination, and barriers that exist to their translation into clinical practice.

Veins are the most commonly used conduits for surgical revascularization; however, they are associated with a high failure rate. In this Review, de Vries and colleagues discuss the pathophysiological mechanisms underlying the development of vein graft failure, and summarize the current and developing therapies used to prevent graft failure.

In this Review, Parati et al. outline the complex interactions between heart failure and sleep alterations, with a focus on sleep-disordered breathing, and describe the pathophysiology, diagnosis, and treatment of these sleep disorders. In the context of increasing evidence from clinical trials, the authors aim to raise awareness among clinicians of the importance of sleep-disordered breathing in heart failure management.

This Review summarizes the existing knowledge on the effects of vitamin D on cardiovascular diseases and the associated risk factors. Pilz and colleagues provide an update on clinical studies on vitamin D and cardiovascular risk, discuss ongoing vitamin D research, and consider the management of vitamin D deficiency from the perspective of cardiovascular health.

Multivalvular disease is common among patients with valvular disease, and has a complex pathophysiology. In this Review, Unger et al. discuss the mechanisms, diagnosis, and percutaneous and surgical treatment of multivalvular disease, focusing on the combinations of valve pathologies that are most often encountered in clinical practice.

Although patients with chronic kidney disease (CKD) are at high risk of developing cardiovascular disease, therapies proven to protect both the cardiovascular and renal systems are used only at low doses or not at all. Ruiz-Hurtado et al. describe available and emerging treatments that can provide adequate cardiorenal protection without adverse effects in patients with CKD.

Transcatheter aortic valve implantation (TAVI) is increasingly being used in patients with intermediate-risk and lower-risk profiles, but little is known about the durability of TAVI devices beyond 5 years. In this Review, Arsalan and Walther summarize the existing data on TAVI durability, highlight differences between surgical and transcatheter treatment of aortic stenosis that might influence durability, and discuss clinical solutions for failed prostheses.

Differences between women and men with atrial fibrillation have received far less attention in recent years than sex-specific differences in coronary heart disease and stroke. In this Review, Ko et al. discuss sex-specific differences in the incidence, prevalence, risk factors, and pathophysiology of atrial fibrillation, and the clinical presentation and prognosis of patients with this prevalent arrhythmia.

Human induced pluripotent stem cells (hiPSCs) can be differentiated into many cardiovascular cell types, including cardiomyocytes and endothelial cells. hiPSC-derived cardiovascular cells can recapitulate patient-specific and disease-specific phenotypes. In this Review, Chen et al. discuss how hiPSCs can be used as a platform for cardiovascular drug development and disease modelling, and can facilitate individualized therapy in the era of precision medicine.

Big data analytics have tremendous potential to improve cardiovascular quality of care and patient outcomes. In this Review, Rumsfeld and colleagues provide an overview of the data sources and methods that comprise big data analytics, describe the potential applications of these analyses in cardiovascular care and research, and delineate the principal challenges to implementing big data applications in cardiovascular practice.

Distal embolization of thrombus resulting in microvascular obstruction can result in incomplete myocardial reperfusion after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. In this Review, Mahmoud and Zijlstra discuss the use of thrombus aspiration to enhance myocardial reperfusion, and how this technique has improved our understanding of the pathophysiology of acute myocardial infarction.

Heart failure (HF) is a global epidemic affecting >37.7 million individuals globally. HF is associated with increased morbidity and mortality, and confers a substantial burden on the health-care system. In this Review, Ziaeian and Fonarow summarize the latest epidemiological data on HF in both developed and developing countries, and provide an overview of associated risk factors and aetiologies contributing to the disease burden.

A large number of acute coronary syndrome (ACS) events originate from plaques with an intact fibrous cap (IFC). In this Review, Kanwar et al. provide an overview of the latest advances in our understanding of plaque morphology in ACS with IFC, reviewing contemporary data from multimodality imaging. They also discuss whether the use of such imaging might result in more effective management of patients with ACS.

Advanced noninvasive imaging techniques add diagnostic and prognostic value in patients with suspected acute coronary syndrome, complementing patient history, electrocardiogram, and cardiac biomarkers for timely identification or ruling out of acute coronary syndrome. In this Review, Garg and colleagues summarize the current guidelines and clinical use of the most common noninvasive imaging techniques, and provide an update on developments in noninvasive imaging.