Reviews & Analysis

Marvin J Slepian and Jack G Copeland present their Viewpoint on the University of Arizona's experience with the CardioWest^™total artificial heart (TAH-t) in patients with protracted refractory cardiogenic shock accompanying acute myocardial infarction. The authors assert that the TAH-t could provide a lifeline to patients whose prognosis would otherwise be bleak.

In this Viewpoint, Edward Frohlich provides an update to his Review from 2004 and posits that the role of salt in hypertension is far more complex than thought previously—that it 'simply' raises arterial pressure.

In this month's Case Study, Satoda et al. describe a patient who presented with an acute myocardial infarction 5 weeks after giving birth. Angiography revealed a severe diffuse lesion of the left anterior descending artery, which was later confirmed to be a spiral dissection. The lesion resolved after two months of medical therapy, and the patient recovered well.

In this Review, Kathryn Taubert, Nathaniel Clark and Robert Smith explore the common features and risks of cardiovascular disease, cancer and diabetes—disease which together are responsible for more than 25 million deaths in the world each year. They examine the important role of cardiology health-care providers with regards to risks for other chronic conditions and occult disease.

In this instructive Therapy Insight, Dellegrottaglie et al. examine the role of magnetic resonance angiography (MRA) in the initial diagnosis and subsequent management of patients with peripheral arterial disease, comparing this technique with other diagnostic modalities. They explain, in simple terms, current MRA methodologies and ongoing technical improvements as they apply to the evaluation of lower extremity vessels.

Identifying high-risk individuals with hypertrophic cardiomyopathy is paramount as the first clinical expression is often the most devastating—sudden cardiac death. Miller and colleagues review the established or 'major' risk factors used to identify high-risk patients, and discuss the possible and future risk factors for hypertrophic cardiomyopathy-related sudden cardiac death.

Cardiogenic shock is the leading cause of death in patients with acute ST-segment elevation myocardial infarction. In this Viewpoint, Drs Henriques and de Mol introduce the AMC MACH (Academic Medical Center Mechanical support for Acute Congestive Heart failure in STEMI patients) program and discuss how newly available percutaneous left ventricular assist devices used in this scheme could provide a bridge to heart transplantation or recovery in patients who would otherwise be unlikely to survive.

In this article, Professors Yacoub and Miller review the current status of left-ventricular-assist-device (LVAD) therapy for patients with chronic heart failure. The authors discuss the advantages and disadvantages of the available devices, how the indications for LVADs have evolved, and address the question 'are LVADs ready for long-term use?'

Dietary quality is fundamental in the prevention of chronic disease. Here, Stephanie Chiuve and Walter Willett respond to the food guide MyPyramid, the most visible source of US nutrition policy and dietary guidance. They discuss why they feel MyPyramid fails to provide the public with clear information about healthy food choices, and assess the current evidence on diet and chronic diseases.

Rajamani and Chaturvedi examine the lessons learnt from landmark trials including NASCET and the ECST, which explored the role of carotid endarterectomy for ischemic stroke prevention in patients with symptomatic carotid artery stenosis. They go on to discuss the best perioperative medical treatment, the recommendations for patients with asymptomatic internal carotid artery stenosis, and the stroke risk after concomitant CABG surgery.

In addition to environmental factors, genetic variation exerts a sizeable, complex influence on lipoprotein phenotypes. Rebecca Pollex and Robert Hegele review recent progress on genomic variants and cholesterol metabolism, focusing on key, well-characterized genes that are determinants of plasma lipoproteins and have shown consistent results over the years, and discuss their potential utility in clinical cardiology.

The Case Study by Satoda and colleagues, published in this issue ofNature Clinical Practice Cardiovascular Medicine, provides Paolo Angelini with an intriguing introduction to his Viewpoint on spontaneous coronary artery dissection (SCAD). Dr Angelini discusses our current understanding of this condition, and highlights recent progress in refining the diagnosis and definition of SCAD, made possible by new imaging modalities.

Understanding the genetic basis of coronary heart disease (CHD) could refine cardiovascular risk stratification, facilitating the development of new therapies. Here Kullo and Ding focus on the genetics behind the clinical manifestations rather than the risk factors for CHD, and provide an update on the findings to date, the challenges faced and new techniques for identifying clinically relevant genetic determinants of CHD.

Hormones, growth factors, DNA-binding proteins and enzymes can all display intracrine functionality. Here Richard Re and Julia Cook examine the role intracrines have in the heart and vasculature, and argue that understanding the principles of intracrine physiology could help the development of more-effective therapeutic interventions in cardiovascular disease.

Four years on from JNC 7, William Elliott and Henry Black examine the epidemiology and attendant risks of prehypertension, and discuss the controversial issue of drug treatment for individuals with blood pressures in the prehypertensive range.

Atrioesophageal fistula is a rare but potentially fatal complication of radiofrequency catheter ablation for atrial fibrillation. Early recognition of this condition is crucial, and raising awareness could help reduce mortality. Here, Scanavaccaet al. discuss how and why fistulas occur, and suggest ways in which they could be avoided in future.

In the follow-up to their first article examining the evidence for a cardiomyopathy of obesity and the mechanisms behind this condition, Chiew Wong and Thomas Marwick evaluate possible pharmacologic and nonpharmacologic strategies for treating obesity cardiomyopathy in the context of currently understood mechanisms.