Review Articles in 2017

The optimal reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease is still uncertain. In this Review, Mehran and colleagues discuss the available evidence on the different treatment options for patients with STEMI and multivessel disease, highlighting current guideline recommendations and providing future directions on reperfusion strategies in these patients.

The epidemiology of pulmonary arterial hypertension (PAH) has evolved considerably in the past 2 decades. In this Review, Lau and colleagues describe how this evolving epidemiology has influenced the treatment and management of PAH.

Mendelian randomization (MR) is an increasingly common tool that involves the use of genetic variants to evaluate causal relationships between exposures and outcomes. In this Review, Holmes et al. describe some of the scenarios in which findings from MR analyses can be challenging to evaluate, using examples from studies on cardiometabolic diseases.

Physical activity and exercise training are important for improving outcomes in patients with heart failure (HF), especially elderly patients, but uptake remains poor. In this Review, Stewart Coats and colleagues discuss the importance of exercise training among the older patient population with HF, and provide potential strategies to improve uptake and adherence rates.

Cardiovascular disease (CVD) follows a seasonal pattern in many populations, often peaking after 'cold snaps'. In this Review, Stewart and colleagues identify the physiological and environmental factors that contribute to seasonality in nearly all forms of CVD, and describe the potential strategies that might attenuate peaks in cardiovascular events during cold and hot periods of the year.

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome associated with poor quality of life, substantial health-care resource utilization, and premature mortality. Dunlay and colleagues summarize the epidemiological data on HFpEF, with a focus on the prevalence and incidence of HFpEF in the community as well as associated conditions and risk factors, morbidity and mortality after diagnosis, and quality of life.

The identification of mutations in ion channels has been crucial to understanding the pathogenesis of cardiac arrhythmias, but the aetiology of a considerable number of arrhythmogenic disorders remains unknown. In this Review, Lazzerini and colleagues discuss the role of autoimmunity in the pathogenesis of cardiac arrhythmias, describing how different autoantibodies against ion channels in the heart participate in the development of these conditions.

Cardiac tumours include a wide array of both neoplastic and non-neoplastic entities. Cardiac tumours are often found incidentally during imaging by ultrasonography, CT, or MRI. In this Review, Maleszewiski and colleagues discuss the clinical presentation, imaging characteristics, pathological characteristics, and treatment of these lesions.

Muscle wasting (sarcopenia) and loss of weight (cachexia) can occur in patients with heart failure. In this Review, von Haehling and colleagues provide an overview of the prevalence and pathophysiological mechanisms of these processes in heart failure, and discuss potential therapeutic strategies, including exercise training, nutritional supplements, and drug treatments.

Activated cardiac fibroblasts in adult hearts participate in the healing response after acute myocardial infarction and during chronic disease states. In this Review, Tallquist and Molkentin discuss insights gained from the use of genetically engineered mice that allow a systematic evaluation of fibroblast identity, origins, and response during cardiac disease and ventricular remodelling.

Inflammatory processes have a crucial role in abdominal aortic aneurysm and aortic wall remodelling. This Review focuses on the involvement of monocytes and macrophages, summarizing current knowledge on their origin and the roles of distinct monocyte and macrophage subsets in AAA development and complications, and highlighting potential translational applications targeting monocytes and macrophages.

Troponin is a widely used biomarker in patients with cardiac disease. In this Review, Westermann et al. describe the development of high-sensitivity assays for troponin, and their practical use in clinical diagnosis of acute myocardial infarction. Elevated concentrations of troponin in myocardial injury and chronic cardiac disease are also discussed.

Spiral-wave generators, or 'rotors', have been identified by advanced mapping methods in experimental and clinical atrial fibrillation (AF). In this Review, Nattel and colleagues describe the concepts of phase mapping and spiral-wave rotors, and summarize the ways in which rotor sources might be involved in AF maintenance. They also consider the relevance of spiral-wave rotors to the management of patients with AF.

Autophagy is a ubiquitous cellular catabolic process responsive to energy stress. Activation of autophagy is cardioprotective in some settings (ischaemia and ischaemic preconditioning), but sustained autophagy has been linked with cardiopathology in other settings (prolonged pressure overload and heart failure). In this Review, induction of autophagy associated with cardiac benefit or detriment is considered, and prospects for pharmacological intervention are discussed.

The use of electronic cigarettes has increased dramatically in the past decade, but its effects on cardiovascular health are still unknown. In this Review, Benowitz and Fraiman discuss the constituents, exposure, and potential mechanisms of cardiovascular toxicity of electronic cigarettes compared with conventional tobacco cigarettes.

Accumulating evidence has challenged the dogma of monocytes as short-lived macrophage precursors. Monocyte populations are heterogeneous and have subset-specific functions. This Review provides an updated view of the role of monocytes in cardiovascular disease and their relationship with macrophages, highlighting current theories on monocyte ontogeny, and discussing the effects of dyslipidaemia on monocyte production, phenotype, and function.

The role of hypertriglyceridaemia as a risk factor for coronary artery disease (CAD) is debated. In this Review, Reiner summarizes the causes of hypertriglyceridaemia, and discusses whether elevated blood triglyceride levels are an important and independent risk factor for CAD. Finally, current and emerging management options for hypertriglyceridaemia are detailed.

Mitochondrial metabolism is essential for the dynamic regulation of cardiac and vascular tissues, and the relevance of basic mitochondrial biology in cardiovascular disease is being increasingly recognized. In this Review, the authors explore the physical interaction between mitochondria and sarco/endoplasmic reticulum, discussing how the communication between these two organelles is involved in cardiovascular pathologies.

From a global perspective, the large and diverse African population is disproportionately affected by cardiovascular disease. In their Review, Keates et al. provide a contemporary overview of the cardiovascular risk profile of the African population by summarizing the historical pattern of cardiovascular disease in Africa.

Antithrombotic therapy, including antiplatelet and anticoagulant agents, is the cornerstone of pharmacological treatment to optimize clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). In this Review, Franchi et al. provide an overview of currently available antithrombotic therapies used in these patients, results from pivotal clinical trials and their implications for guidelines, as well as recommendations for clinical practice.