Reviews & Analysis

The existence of diabetic cardiomyopathy has been debated; however, substantial data now demonstrate that diabetes impairs ventricular function independent of other risk factors. Here Lebeche et al. examine the hypothesis that impaired calcium regulation and insulin signaling contribute to the detrimental effect of diabetes on cardiomyocyte function. How these two abnormalities interact to induce cardiac dysfunction is also investigated.

Although optimum treatment for patients with acute ST-segment elevation myocardial infarction has been established through randomized clinical trials, the majority of patients do not receive all the guideline-recommended therapies promptly. In this Review, Keith Fox and Kurt Huber present a European perspective on the disparities between the evidence base and clinical practice in the treatment of ST-segment elevation myocardial infarction and propose that an integrated network of care, aimed at minimizing delays between symptom onset and treatment, is essential to improving outcomes among these patients.

Patients with fulminant myocarditis present with acute-onset, severe heart failure and are often in cardiogenic shock. However, if patients are quickly diagnosed and given aggressive treatment, most will make a full recovery. Gupta et al. highlight the importance of early recognition of fulminant myocarditis and provide a comprehensive review of its epidemiology, pathophysiology, clinical presentation, methods of diagnosis, management, and prognosis.

In this opinion piece, Hideo Mitamura presents some of the new strategies that are increasing the use of automated external defibrillators (AEDs) by lay persons in Japan. Professor Mitamura hopes that, if other countries follow in adopting initiatives such as internet-based maps showing the location of public-access AEDs, the lives of many who suffer an out-of-hospital cardiac arrest will be saved.

Tohru Minamino and Issei Komuro examine the research on age-associated vascular pathophysiology at the cellular level, specifically telomere shortening, DNA damage and the replicative ability of cardiovascular cells, particularly stem cells or progenitor cells. They explore vascular senescence in the context of human progeroid syndromes and what the future holds for the treatment of age-associated vascular disease.

Device infection is devastating in individuals with permanent pacemakers or implantable cardioverter-defibrillators. In this month's Case Study, Simon and colleagues present a patient who had a duel pacemaker lead infection and tricuspid valve endocarditis. They examine the best course of action for this serious complication.

Despite the wealth of research into C-reactive protein (CRP), it remains unclear which patient populations would benefit from and should be targeted for high-sensitivity assay CRP testing. In this important Review, Musunuru et al. address the relevance of CRP in a variety of scenarios encountered in clinical practice—from primary prevention of cardiovascular disease, stroke and diabetes mellitus, to secondary prevention of cardiovascular disease.

Results of the STRADIVARIUS and ADAGIO-Lipids trials have fuelled debate about the use of the controversial CB1 receptor antagonist rimonabant. Here, Vincenzo Di Marzo discusses the key findings from these studies and their potential clinical sequelae, and identifies a subgroup of patients who might derive the most benefit from this drug.

Patients with asymptomatic, severe aortic stenosis are at risk of cardiac death. In this Viewpoint, Pellikka and Sundt assert that aortic valve replacement should be considered in these patients, if surgery is likely to prolong life expectancy. Risk stratification of the asymptomatic aortic stenosis patient remains inadequate, however, and the decision to operate must be individualized, particularly in the elderly. The authors call for a randomized trial to help optimize the selection of patients for surgery.

Werner Mohl and coauthors present their Viewpoint examining pressure-controlled intermittent coronary sinus occlusion (PICSO). Here they postulate that PICSO should be introduced into the clinic as a valuable technique for activation of venous endothelium to initiate myocardial recovery and induce regeneration.

How should trial-derived evidence be interpreted so that findings can be applied directly in patient care? By understanding study design and statistical methodology, the results of observational studies, prospective randomized trials, and registry studies can be reconciled. Here Brown and coworkers examine different study designs and their impact on the interpretation of data.

SERCA2a is one of the most promising targets for the treatment of heart failure. Kawase and Hajjar examine mounting evidence demonstrating the beneficial effects associated with SERCA2a overexpression, and provide a balanced discussion of the risks associated with SERCA2a as a target for the treatment of cardiovascular disease.

Clozapine is an atypical antipsychotic drug which has been linked to the development of cardiovascular side-effects. Here, Azzam et al. describe a 42-year-old male with refractory schizophrenia who presented with severe dilated cardiomyopathy, which was thought to have been caused by clozapine therapy.

Despite statin therapy, patients with diabetes still face a substantial residual cardiovascular risk. The need for additional therapies is, therefore, sorely needed. Here Staels et al. explore to what extent peroxisome proliferator-activated receptor α agonists, such as fibrates, can improve the lipid profile and associated risk markers.

The immune system is instrumental in the pathogenesis of atherosclerosis. Here, Jacob George examines the growing knowledge of the role of regulatory T cells in atherosclerosis development. This field of research holds great potential for future development of novel therapeutic modalities designed to attenuate atherosclerosis and stabilize vulnerable plaques.

Ventricular tachycardia (VT) is a cause of early, intermediate and late morbidity and mortality in patients who have undergone palliative repair of congenital heart disease. Christopher Snyder provides a concise overview regarding the etiology of ventricular tachycardia in these patients and in-depth information to aid diagnosis, risk assessment and long-term management of postoperative VT in this unique population.

Transposition of the great arteries is a common but serious congenital heart malformation. It is estimated that approximately 9,000 patients in the US live with an atrial-level repair. Barry Love and colleagues discuss the anatomy, potential late complications, and appropriate therapies in this patient group—everything needed to properly care for these patients.

Congenital heart defects can remain undiagnosed until adulthood. In this Case Study, Alegriaet al. describe a 20-year-old male presenting with systemic hypertension who was found to have coarctation of the aorta, a bicuspid aortic valve, an ascending aortic aneurysm and an atrial septal defect. He was successfully treated in a single surgical procedure.

Patients with dilated cardiomyopathy and functional mitral regurgitation (MR) have a very poor prognosis. Surgical correction of MR in this setting is controversial because survival benefit has not been proven; however, patients who have undergone mitral repair often show substantial symptomatic improvement and reverse left ventricular remodeling. Here, Michele De Bonis and Ottavio Alfieri argue that these 'end-stage' patients should not be denied surgery, and that mitral repair should be performed before irreversible deterioration occurs.

Here, Stephen Westaby highlights the promise of new blood pumps in severely symptomatic patients with heart failure, a patient population with very limited treatment options.