Reviews & Analysis

A major obstacle in cardiac stem cell investigations is the ability to monitor cell engraftment and survival following implantation within the myocardium. In this Review, Dr. Lau and colleagues examine cardiac cellular imaging modalities, including the combinatorial use of several probes in multimodality imaging. Their discussion focuses on data from the past 5 years.

Stable angina pectoris is a major contributor to disability in patients with coronary artery disease. Accurate identification of the extent and distribution of stable angina pectoris could vastly improve management and secondary prevention of underlying coronary artery disease. This Review assesses the strengths and limitations of contemporary methods for detection.

Cardiac rehabilitation can reduce cardiovascular risk factors and prevent cardiac morbidity and mortality as part of a comprehensive secondary-prevention strategy. However, evidence indicates that cardiac rehabilitation programs are currently underutilized, primarily because many patients are not referred to these programs by their health-care providers. The authors of this Review examine how novel referral strategies can help to improve cardiac rehabilitation referral and enrollment rates.

New methods of cardiac troponin measurement accurately characterize patients as they present to the emergency department. Decisions on admission or discharge within 1–2 h of initial assessment (rather than 6–12 h thereafter), therefore, have become feasible. This development has potential for a major influence on how patients with chest pain are managed.

Endoscopic harvesting of saphenous veins for use in CABG surgery has become standard practice worldwide. This strategy reduces postoperative infection and hospital stay, and increases patients' satisfaction when compared with open harvest. However, long-term follow-up data provided by Lopes et al. indicate that widespread use of this technique must be urgently reviewed.

The novel antiplatelet agent ticagrelor was evaluated against clopidogrel in the PLATO trial of patients with acute coronary syndromes. This article discusses the main findings and importance of this study, including the reduction in mortality associated with ticagrelor therapy.

In this Review, Dr. van den Borne and colleagues examine the role of myofibroblasts in beneficial and adverse myocardial remodeling after myocardial infarction. The authors also briefly discuss strategies for imaging myofibroblasts, which might be useful for the early detection of adverse remodeling events and for predicting the risk of heart failure.

Leptin is thought to be intricately involved in pathophysiological mechanisms linking obesity and cardiovascular disease. In this Review, Dr. Sweeney highlights what is currently known about the cardiovascular effects of leptin and discusses how these effects may explain the so-called obesity paradox.

The measurement of natriuretic peptides has emerged as an important tool for the diagnosis and risk stratification of patients with heart failure, but the use of these markers for monitoring treatment remains under question. In this Review, Drs. O'Donoghue and Braunwald explore the evolving role of natriuretic peptides in the guidance of heart failure therapy and appraise data from clinical trials in this field.

Over the past two decades, there has been rapid progress in our understanding of the pleiotropic actions of relaxin in the cardiovascular system. In this Review, Dr. Du and colleagues discuss basic knowledge of relaxin signaling mechanisms, findings from experimental animal models of cardiovascular diseases, and findings from clinical trials on relaxin.

Continuing our series of Reviews on Molecular Imaging, Drs. Dobrucki and Sinusas discuss the applications of PET and single photon emission CT (SPECT) for the evaluation of cardiovascular disease, including myocardial metabolism, neurohumoral activity, atherosclerosis, ventricular remodeling, and angiogenesis.

In this Review, the authors discuss new developments in the understanding of how thoracic aortic aneurysms arise. They describe the developmental origins of the thoracic aorta, mutations in the structural components of the thoracic aorta that are associated with aneurysms, and advances in treatment strategies.

In this Review, the authors discuss the difficulties with assessing the response to cardiac resynchronization therapy in the treatment of advanced heart failure. They discuss the problems with current methods used and the potential benefits of molecular imaging techniques.

The role of endovascular therapy in patients with renal artery stenosis continues to be very controversial. Two reports have added notable findings to the growing body of evidence on this subject. The investigators of these studies aimed to clarify which patients, if any, would benefit from renal artery stent placement.

The results of the CRIB-2 trial, which show that the mineralocorticoid receptor blocker (MRB) spironolactone improves left ventricular mass and aortic stiffness in patients with early stage chronic kidney disease (CKD), provide impetus for large-scale clinical trials to evaluate the effects of this strategy on clinical outcomes. The optimum choice of MRB and its dose, however, remain uncertain given the potential risk of hyperkalemia in patients with CKD.

The diagnosis of unexplained cardiac arrest could soon become obsolete, as so-called molecular autopsy can now be used to identify its underlying causes. The current view of this subject is discussed, and some personal opinions are presented on the assessment of survivors of sudden cardiac arrest and relatives of individuals who do not survive.

Yang and colleagues report on their single-center experience with high-field coronary MRA using a new MR contrast agent. Data on 30 patients were compared with conventional X-ray angiography. Their new coronary MRA approach seems favourable when compared with previous MRA methods.

In this Perspectives article, the authors discuss the need for national policies to add ress the global problem of noncommunicable diseases. They present their views on the benefits of national policies and the processes involved in developing and implementing such policies.

In the past 5 years, technological advances in multidetector CT imaging have enabled the development of complementary myocardial applications beyond coronary imaging. In this Review, the authors describe these advances and discuss the clinical potential of such imaging for a broad range of applications.

Consumption of omega-3 fatty acids is recommended by many international cardiology associations on the basis of abundant evidence for their cardioprotective nature. In this Review, Lee et al. discuss whether fish or fish-oil supplements are the best source of omega-3 fatty acids, and whether recommendations for omega-3 supplementation are warranted in view of the rapid depletion of world fish stocks.