Reviews & Analysis

Magnetically guided navigation of a wire or devicein vivocould increase the accuracy of angiographic intervention significantly, especially in tortuous or chronic occluded arteries. In this Technology Insight, Ramcharitar and colleagues examine this novel technology and provide an up-to-date analysis of what is currently possible and an insight to what the future holds.

In this update on the cardiac manifestations of hypertension and the aging process, Susic and Frohlich discuss the distinct pathophysiological mechanisms behind these two closely related entities, examine the clinical correlates, and outline future hypertension therapies.

The percutaneous repair of mitral regurgitation is a new and rapidly evolving field, offering a less-invasive alternative to surgery. Written by two leaders in percutaneous, nonsurgical repair of heart valves, this Review examines the elements influencing patient selection for percutaneous valve repair, such as underlying valve pathology and the characteristics of the various percutaneous devices.

In this month's Case Study, Kataoka and colleagues report a patient who experienced three episodes of syncope over the course of 2 years. Electrocardiography and 24h Holter monitoring revealed occasional premature ventricular complexes arising from the right ventricular outflow tract which, on a subsequent occasion, triggered an arrhythmic episode that degenerated into ventricular fibrillation. She was treated with radiofrequency catheter ablation and was fitted with an implantable cardioverter-defibrillator.

Rapid stabilization and regression of atherosclerosis, even for advanced complex plaques, has been achieved experimentally in both animals and humans. In this insightful Review, Kevin Williams, Jonathan Feig and Edward Fisher examine the successes and failures of many established and experimental interventions to induce plaque regression, and discuss how regression of atheromata could become a realistic therapeutic goal.

Hypertrophic cardiomyopathy is the most common inherited cardiac disorder. In this Review the authors summarize current knowledge on the genetics, disease mechanisms, and correlations between phenotype and genotype in patients with hypertrophic cardiomyopathy, and discuss the implications of genetic testing in routine clinical practice.

Myocardial involvement is a rare complication of tuberculosis. Here, Khurana et al. report a case involving a 30-year-old man who presented with ventricular tachycardia. He was successfully treated with antiarrhythmic, antituberculous and steroid pharmacotherapy followed by implantation of a cardioverter-defibrillator.

The management of patients with corticosteroid-dependent recurrent pericarditis is problematic. In this opinion piece, Imazio et al. assert that corticosteroids are over-prescribed, particularly in cases where the disease etiology is unknown. The authors discuss the weak evidence-base for the use of corticosteroids in pericarditis, and propose a treatment strategy for the minority of cases where these agents are indicated.

Surgical valve repair or replacement is currently the 'gold standard' treatment for prosthetic paravalvular leaks, despite the fact that the risks of reoperation frequently prohibit surgery in elderly patients with comorbidities. Bhindi and colleagues review the emerging field of percutaneous leak closure—an attractive, less-invasive alternative for the treatment of paravalvular leaks in high-risk patients.

Pheochromocytomas are catecholamine-producing tumors situated in the adrenal medulla. In this month's Case Study, Kobal and colleagues describe an unusual presentation of pheochromocytoma: cyclic waves of hypertension alternating with hypotension. The patient was successfully treated with phentolamine, intravenous fluids and doxazosin, before eventually undergoing surgical removal of the tumor.

Despite being an increasingly recognized clinical syndrome, the mechanism of stress or 'Takotsubo' cardiomyopathy remains unknown. In this thought-provoking Review, Lyon et al. present their novel hypothesis for the mechanism behind stress cardiomyopathy, and examine what implications this hypothetical pathophysiology could have for the use of drugs or devices in the treatment of patients with this syndrome.

In light of recent studies demonstrating a lack of benefit with late reperfusion, Sammy Elmariah, Sidney Smith and Valentin Fuster review the data for and against late reperfusion for ST-segment elevation myocardial infarction. The effects of current medical therapies, risk-stratification techniques and indications for the use of late reperfusion over medical management are also examined.

Rapidly developing experimental work has provided new insights into atrial fibrillation pathophysiology that will lead to new mechanism-based therapies. Statins and omega-3 polyunsaturated fatty acids have shown antiarrhythmic potential, exceeding any effect related to the treatment of underlying heart disease. Here Irina Savelieva and John Camm provide a contemporary evidence-based insight into how these agents could be exploited to prevent or reverse atrial remodeling in patients with atrial fibrillation.