Review Articles in 2016

The dual-acting angiotensin-receptor–neprilysin inhibitor (ARNI) LCZ696, approved for treatment of heart failure with reduced ejection fraction, is the first approval for chronic neprilysin inhibition. Neprilysin metabolizes many peptides, suggesting many potential consequences of chronic neprilysin inhibition, both beneficial and adverse. This Review summarizes current knowledge on neprilysin inhibitor therapy, and the possible consequences of chronic inhibition.

Microorganisms that populate the human body have been shown to be involved in metabolic and cardiovascular disorders, but the precise mechanisms are not completely understood. In this Review, Lindskog Jonsson and Bäckhed describe the different pathways by which the gut microbiota might affect the development of atherosclerosis.

Inflammatory processes are central to the development and complications of atherosclerosis and acute myocardial infarction. In this Review, Ruparelia et al. summarize the inflammatory pathways involved in these cardiovascular diseases, highlight contemporary techniques to characterize and quantify inflammation, and consider how they might be used to guide specific treatments.

Depression is a highly prevalent risk factor for incident coronary heart disease (CHD) and for cardiovascular morbidity and mortality in patients with established CHD. In this Review, Carney and Freedland consider the evidence for depression as a cardiac risk factor, and summarize the biological and behavioural mechanisms that might link depression to CHD. They also consider whether treatment of depression can prevent cardiac morbidity and mortality in patients with CHD.

Peripheral artery disease (PAD) is undergoing a major epidemiological transition, with a rapid shift from high-income to low-income and middle-income countries. In this Review, Fowkes et al. describe the measurement of PAD in populations, as well as the worldwide prevalence, risk factors, and burden of the disease.

The association between exercise and increased risk of atrial fibrillation among athletes is well established. In this Review, Guasch and Mont discuss the evidence supporting the existence of exercise-induced arrhythmias and describe the special considerations for management of these patients.

Genetic cardiomyopathies are complex diseases with heterogeneous clinical presentations and phenotypes, and mild pathology can overlap with physiological variation, particularly in athletes. In this Review, three of the most common and controversial areas are discussed, including left ventricular hypertrophy; left ventricular dilatation, noncompaction, and fibrosis; and arrhythmias originating from the right ventricle.

Thyroid hormones have an important role in maintaining cardiovascular homeostasis, and subtle changes in thyroid hormone concentrations adversely influence the cardiovascular system. In this Review, Jabbar et al. discuss the role of thyroid hormones in the pathogenesis and management of cardiovascular diseases such as heart failure and acute myocardial infarction, and outline the utility of therapy with thyroid hormones for the management of these conditions.

Women with atrial fibrillation (AF) generally experience worse symptoms, poorer quality of life, and have higher risk of stroke and death than men with AF. In this Review, Ko et al. summarize the evidence on sex-specific differences in the utilization and outcomes of treatments for AF, including rate-control and rhythm-control strategies, and stroke-prevention therapy.

3D printing applications for cardiovascular care range from models for education to planning and simulation of interventions and the generation of implantable devices. This Review summarizes the current cardiovascular 3D printing strategies and applications, including the workflow from image acquisition to the generation of a hand-held model, and highlights the future perspectives of cardiovascular 3D printing.

The cardiovascular benefits of weight loss in patients with obesity are well documented. Bariatric surgery is an effective and long-lasting strategy for weight loss, and can improve many cardiovascular risk factors such as hypertension and dyslipidaemia. In this Review, Beamish and colleagues highlight the effects of bariatric surgery on cardiovascular risk factors and outcomes.

Unstable plaques have been used as a target for imaging and drug discovery, and as a model of atherosclerosis in preclinical experiments. In this Review, Pasterkamp and colleagues describe the temporal shift in the characteristics of plaques in patients with acute coronary syndrome, and argue that the 'vulnerable plaque' concept might no longer be relevant to current practice.

Chronic activation of neurohormonal systems, such as the sympathetic nervous system and the renin–angiotensin–aldosterone system can lead to deleterious effects on the heart. In this Review, Hartupee and Mann describe the effects of neurohormonal activation in patients with heart failure with reduced ejection fraction, and the implications for disease progression.

Bioresorbable vascular scaffolds (BVS) are new-generation stents that offer considerable advantages over traditional metallic implants. In this Review, Indolfi and colleagues provide an overview of the clinical studies on BVS, highlighting the importance of BVS implantation technique and the emerging safety profile of these devices in percutaneous coronary intervention.

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease. In this Review, Sen-Chowdhry et al. discuss the guideline recommendations for the evaluation and management of HCM, and provide a summary of the important advances in genetics, imaging, and molecular research on HCM.

Brugada syndrome is a major cause of sudden cardiac death in young patients without structural heart disease. In this Review, Sieira and colleagues summarize the mechanisms involved in the development of Brugada syndrome, and discuss the available options for risk stratification and management.

Genome editing is being rapidly adopted into all fields of biomedical research, including the cardiovascular field. In this Review, Strong and Musunuru discuss the applications of genome-editing technology, including zinc finger nucleases, TALENs, and CRISPR/Cas9 systems, throughout cardiovascular disease research, their current limitations, and the prospect ofin vivogenome-editing therapies in the future.

Arterial access is fundamental to contemporary interventional cardiology. In this Review, Rao and Stone compare the clinical evidence for femoral versus radial access, and how best to achieve haemostasis with each approach, including the use of manual compression and vascular closure devices.

Atrial fibrillation (AF) usually begins in a self-terminating paroxysmal form. In this Review, Nattel and Dobrev extensively summarize the electrophysiological basis for paroxysmal AF occurrence and maintenance, as well as the molecular mechanisms forming the underlying substrate, drawing on data from both patients with AF and animal models of spontaneous AF. The authors also consider potential factors governing progression from paroxysmal to persistent AF.

Atherothrombosis underlies numerous manifestations of cardiovascular disease, including coronary artery disease (CAD) and cerebrovascular disease (CVD). Treatment of patients with concomitant CAD and CVD is complex, owing to their increased risk of both ischaemia and bleeding. Capodanno et al. review the use of antithrombotic drugs for the secondary prevention of atherothrombotic events in patients with concomitant CAD and CVD, particularly those with a history of noncardioembolic stroke or transient ischaemic attack.