Review Articles in 2020

SGLT2 inhibitors improve cardiovascular and renal outcomes even in patients without diabetes mellitus. In this Review, Cowie and Fisher describe the additional mechanisms of benefit of SGLT2 inhibitors, unrelated to improved glycaemic control.

In this Review, Gerd Heusch revisits the pathophysiology of myocardial ischaemia–reperfusion injury, discusses the latest developments in cardioprotective interventions and the signalling pathways involved, identifies the challenges for their clinical translation and advocates the use of additive cardioprotective interventions and a focus on patients with severe haemodynamic alterations.

In this Review, Alfieri and colleagues focus on new concepts on mitral valve pathophysiology and patient risk profile assessment to guide the indication and timing of the management of mitral valve regurgitation. The authors also describe new imaging modalities and contemporary surgical and transcatheter techniques, highlighting the need for a multidisciplinary approach.

The development of the coronary vasculature involves numerous cellular sources and a multitude of distinct processes. In this Review, Smart and colleagues describe the latest insights into the mechanisms involved in coronary vessel formation during development and disease, which might contribute to the identification of therapeutic targets for the promotion of neovascularization after myocardial infarction.

Dysregulation of intracellular Ca²⁺ handling in cardiomyocytes occurs in heart failure and atrial fibrillation. In this Review, Marks and colleagues focus on diastolic Ca²⁺ leak from the sarcoplasmic reticulum via RYR2 as a feature and potential therapeutic target in both heart failure and atrial fibrillation.

In this Review, Roos-Hesselink and colleagues describe how the physiological adaptations during pregnancy can induce cardiometabolic complications or an exacerbation of existing cardiometabolic disease, and discuss the epidemiology, pathophysiology, diagnosis and management of cardiometabolic diseases acquired or presenting during pregnancy, including hypertensive disorders, gestational diabetes mellitus, thromboembolic disorders and peripartum cardiomyopathy.

Extracellular vesicles are a heterogeneous group of natural particles that can deliver their biologically active molecular cargo to recipient cells. In this Review, the authors outline the endogenous properties of extracellular vesicles that make them natural delivery agents and the features that can be improved by bioengineering for the treatment of cardiovascular diseases.

The heart is an endocrine organ, producing atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in a regulated manner. In this Review, the authors discuss the physiological regulation and actions of the cardiac natriuretic peptides and their clinical use as powerful diagnostic and prognostic biomarkers of heart disease.

Congestion is the main reason for hospitalization in patients with acute decompensated heart failure and is an important target for therapy. In this Review, Boorsma and colleagues distinguish between intravascular congestion and tissue congestion, and hypothesize that specifically treating these two different forms of congestion could improve patient outcomes.

Non-hyperaemic pressure measurements have emerged as a useful tool to guide coronary interventions and are recommended as a substitute for fractional flow reserve (FFR). In this Review, van de Hoef and colleagues explain the rationale for the use of non-hyperaemic pressure ratios instead of FFR for stenosis evaluation.

A strong relationship exists between exposure to air pollution and cardiovascular events. In this Review, Rajagopalan and colleagues summarize the evidence supporting the detrimental effects of air pollution on cardiovascular health and describe the potential mechanisms involved in air pollution-mediated cardiovascular mortality.

NSAIDs are effective, widely used analgesics, but their use is associated with increased risks of thrombosis and heart failure. In this Review, the authors assess the cardiovascular safety of NSAIDs and present an approach for their use in the holistic management of pain.

Novel strategies to improve blood pressure control and treat drug-resistant hypertension are needed despite the efficacy and widespread availability of current antihypertensive drugs. In this Review, Mahfoud and colleagues summarize the pathophysiological rationale and available clinical evidence for device-based therapies for hypertension, including renal sympathetic denervation.

Single-cell RNA sequencing (scRNA-seq) technologies have helped to identify rare cell populations and allowed the comparison of healthy and diseased tissues at single-cell resolution. This Review discusses the available scRNA-seq tools and summarizes the scRNA-seq findings that have contributed to our understanding of cardiovascular development and disease.

The cardiotoxicity spectrum of cancer therapies has broadened and is gaining increasing importance with an ever-growing repertoire of therapeutics. This Review provides an updated overview of cardiotoxicity and arrhythmias associated with cancer therapies, summarizing the latest developments at the juncture of cardiology, oncology and haematology and the emerging field of cardio-oncology.

Heart failure with preserved ejection fraction (HFpEF) is the predominant form of heart failure among elderly patients. In this Review, Borlaug describes the challenges of diagnosing HFpEF, summarizes the current recommendations for treatment and describes a new strategy of categorizing patients with HFpEF into phenotypically homogeneous subgroups to facilitate the individualization of treatment.

This Review outlines the mechanisms of cancer therapy-related vascular toxicity and provides recommendations for screening, treatment and prevention in the context of available evidence and society guidelines. The Review focuses on the main types of arterial toxicity, acute vasospasm, acute thrombosis and accelerated atherosclerosis, and provides an update on cancer therapy-related venous thromboembolism and pulmonary hypertension.

Accumulating evidence supports the critical role of T cells as drivers and modifiers of atherosclerosis. In this Review, Ley and colleagues describe the latest advances in our understanding of the role of T cell subsets in atherosclerosis, discuss the process of T cell homing to atherosclerotic plaques and highlight potential T cell-related therapies for atherosclerosis.

Moderate exercise improves cardiovascular health and is associated with physiological cardiac adaptations; by contrast, the hearts of endurance athletes can undergo maladaptations, including myocardial fibrosis and arrhythmias. In this Review, Parry-Williams and Sharma discuss whether excessive endurance exercise might damage both diseased and otherwise normal hearts.

Diabetic cardiomyopathy occurs as a result of the dysregulated glucose and lipid metabolism, increased oxidative stress and activation of pro-inflammatory pathways associated with diabetes mellitus, which can induce cardiac remodelling and dysfunction. In this Review, Tan and colleagues discuss the pathogenesis of diabetic cardiomyopathy and describe signalling pathways that might be potential therapeutic targets.