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Coronary microvascular obstruction and dysfunction (CMVO) is common in patients with ST-segment elevation myocardial infarction (STEMI) despite prompt reperfusion. In this Review, the authors discuss the mechanisms of CMVO as well as strategies to reduce its incidence and improve prognosis.
In this Review, Mably and Wang summarize the expression, functions and molecular mechanisms of long non-coding RNAs (lncRNAs) in cardiac hypertrophy and failure. The authors also discuss lncRNAs as novel targets for the diagnosis and treatment of these conditions.
In this Review, Tsimikas and co-workers re-examine the role of lipoprotein(a) in the regulation of platelet function and propose areas for future research to define its clinical relevance for cardiovascular disease.
The NLRP3 inflammasome can sense cardiac ischaemic and non-ischaemic injury, amplify the inflammatory response and induce inflammatory cell death. In this Review, Toldo and Abbate describe the role of the NLRP3 inflammasome in numerous cardiac pathologies and summarize evidence on the use of agents targeting the NLRP3 inflammasome and related cytokines.
A panel of experts from the World Heart Federation provide a revised set of guidelines for the echocardiographic detection of rheumatic heart disease (RHD) in patients living in RHD-endemic regions. The guidelines provide updated screening and confirmatory criteria, as well as a new stage-based classification of RHD based on risk of disease progression, which will improve the diagnosis and subsequent management of patients with RHD.
In this Perspective article, Garg and colleagues discuss the evidence linking abnormal aortic flow patterns with adverse cardiovascular outcomes and describe how changes in aortic flow can be targeted by novel aortic valve interventions.
In this Review, Tsimikas and Witztum discuss the role of oxidized phospholipids (OxPLs) in atherosclerosis, describe the methods for measuring OxPLs on apolipoprotein B-containing lipoproteins (OxPL–apoB) and their relationship with lipoprotein(a), and discuss the clinical applications of the OxPL–apoB measurement for improving diagnosis, prognosis, risk reclassification and therapeutic interventions in patients with atherosclerotic cardiovascular disease.
Low socioeconomic position (SEP) is associated with an increased risk of cardiovascular disease (CVD), but whether this association is causal is uncertain. In this Review, Bann and colleagues discuss how evidence from divergent study designs can help in understanding the causal relationship between SEP and CVD and how this relationship might have been affected by the COVID-19 pandemic.
Hypoxic conditions encountered at high altitude affect all physiological functions. In this Review, Richalet et al. describe the cardiovascular responses to acute and chronic exposure to hypoxia and provide recommendations that clinicians can give to patients with cardiovascular disease who wish to travel to high-altitude destinations.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) has been the focus of an increasing number of studies in the past decade. In this Review, Tavella and colleagues detail the prevalence and clinical presentation of MINOCA, describe the mechanisms underlying the syndrome, and summarize the sex-specific and ethnicity-specific differences in the clinical features, pathophysiological mechanisms, treatment and prognosis of MINOCA.
The menopausal transition period, which begins with irregular menstrual cycles and ends with the final menstrual period, is associated with an increase in cardiovascular risk. In this Review, Mehta and Manson describe the metabolic and cardiovascular changes that occur during the menopausal transition period and summarize the evidence on the use of targeted interventions to slow the progression of atherosclerosis.
In this Review, Swirski and co-workers discuss how lifestyle factors modulate haematopoiesis and leukocyte migration in the context of cardiovascular homeostasis and disease, with particular focus on the role of the nervous system as the key executor connecting environmental influences to leukocyte behaviour.
In this Review, the authors discuss the clinical and experimental data on immunomodulatory effects of evidence-based treatments for heart failure and their primary mechanisms of action, and highlight potential therapeutic targets and opportunities for the development and application of novel immunomodulatory treatments for heart failure.
Some species have a greater capacity for cardiac regeneration than others. In this Review, Weinberger and Riley summarize the diverse array of vertebrates that have been studied for their cardiac regenerative potential and the core mechanisms that regulate cardiac regeneration across vertebrate species.
In this Review, Marsan et al. discuss the different clinical scenarios in which valvular heart diseases and cardiomyopathies coexist, either as the cause of one another or because of a common aetiology, to highlight the need for an improved classification of these diseases with potential repercussions in clinical management and personalized treatment.
In the infarcted heart, pericytes have crucial roles in inflammatory signalling, angiogenesis, and scar formation and stabilization. In this Review, Avolio and colleagues discuss the numerous roles of cardiac pericytes in homeostasis and disease and describe the potential of pericyte-based therapy for restoring the perivascular niche after myocardial infarction.
Dual antiplatelet therapy (DAPT) reduces the risk of ischaemic events but can increase the risk of bleeding in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Gorog and colleagues provide consensus statements on strategies to reduce the risk of bleeding by de-escalating the intensity or abbreviating the duration of DAPT.
In this Roadmap, Föllmer et al. summarize the evidence for the application of artificial intelligence (AI) technology to the imaging of vulnerable plaques in coronary arteries and discuss the current and future approaches to addressing the limitations of AI-guided coronary plaque imaging, such as bias, uncertainty and generalizability.
Heart transplantation for patients with advanced heart failure is limited by a shortage of donor organs. In this Review, Jou and colleagues explore the options to increase the supply of donor hearts, including transplantation from donors with HCV, HIV or SARS-CoV-2 infection, national opt-out organ donation policies, donation after circulatory death, and xenotransplantation.
In this Review, the authors present an overview of the role of fibroblast growth factor 23 (FGF23) and klotho in normal mineral homeostasis, discuss disordered mineral homeostasis in chronic kidney disease (CKD), and explore CKD-associated FGF23 excess and klotho deficiency as novel risk factors and potential therapeutic targets for cardiovascular disease.
