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In this Review, Daniel Mark examines the use of health-related quality of life (QOL) as an outcome measure in clinical cardiovascular research. The main concepts, assumptions, tools, and methods used to assess QOL are discussed. Applied research into QOL outcomes in coronary artery disease, heart failure, and atrial fibrillation are also summarized, with an emphasis on experience from large, randomized clinical trials.
Coronary artery disease (CAD) is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), but its clinical relevance is controversial. In this Review, Danson et al. summarize the methods of assessing CAD in TAVI populations, and the data on the safety and efficacy of percutaneous coronary intervention in patients undergoing TAVI.
Ischaemic conditioning is an endogenous cardioprotective strategy that involves the application of brief cycles of ischaemia and reperfusion either directly to the heart, or to a remote organ or tissue, and which has been shown to reduce infarct size. In this Review, Hausenloy and Yellon summarize the various forms of ischaemic conditioning and pharmacological cardioprotection, and highlight the challenges of translating these methods into the clinical setting.
In this Review, Brown et al. describe the role of biomechanical forces, including wall shear stress and plaque structural stress, in the development and progression of coronary atherosclerosis. The calculation and integration of biomechanical parameters might improve our ability to detect arterial regions at risk of atherosclerosis, enabling better identification of patients at high risk of adverse clinical events.
The leads of cardiovascular implantable electronic devices often need to be extracted because, for example, of infection or the lead has been recalled. In this Review, Wazni and Wilkoff summarize the common indications and techniques for lead extraction, and assess data on the safety, efficacy, and outcomes of these procedures.
The Purkinje system can be a source of arrhythmias and has been shown to trigger ventricular fibrillation. The complexity of the molecular mechanisms of ventricular fibrillation, and the incomplete understanding of Purkinje arrhythmogenicity, make the identification of vulnerable individuals challenging. In this Review, Haissaguerre and colleagues discuss the current knowledge of the pathophysiological mechanisms underlying Purkinje-related arrhythmias, and highlight the current therapeutic options.
