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After 40 years of spectacular technological innovation, catheter ablation has become central to the treatment of cardiac arrhythmias, revolutionizing patient care but with no consideration for environmental sustainability. With climate change being the biggest threat to humanity, all stakeholders urgently need to promote more virtuous and circular practices in the catheterization laboratory.
While there is understandable excitement about the development of new cardiovascular drugs, an unmet and equally important need is to perform new clinical trials of old drugs, including to determine their longer-term effects and if and when they should be discontinued after years of use. New trials of old drugs can inform clinical practice and are much needed.
Immune checkpoint inhibitors (ICIs) have become a pillar of cancer therapy. The cardiovascular complications of ICIs extend beyond myocarditis and can involve any component of the cardiovascular system, including the pericardium, coronary arteries and conduction system. Clinicians caring for patients treated with ICIs must be vigilant for the cardiovascular complications of these therapies, which might portend a poor prognosis.
Cytotoxic CD8+ T cells specific for the cardiac protein α-myosin heavy chain have a key role in immune-checkpoint-inhibitor-associated myocarditis, according to a study published in Nature.
In this Review, McGarrah and White outline the major factors regulating branched-chain amino acid (BCAA) abundance and metabolic fate, highlight molecular mechanisms connecting impaired BCAA homeostasis to cardiovascular disease and discuss the epidemiological evidence connecting BCAAs with various cardiovascular disease states.
In this Review, Fischmeister and colleagues describe cAMP and cGMP signalling in cardiomyocytes and summarize the various phosphodiesterase (PDE) families expressed in the heart and how they are modified in heart failure. They also assess the potential use of inhibitors or activators of specific PDEs to treat heart failure.
Hydrogen sulfide (H2S) is a gaseous signalling molecule with important roles in cardiovascular health and disease. In this Review, Kevil and colleagues discuss the role of H2S, its synthesizing enzymes and metabolites, their roles in the cardiovascular system, and their involvement in cardiovascular disease and associated pathologies.
The mortality and birth prevalence of congenital heart disease (CHD) have shifted in the past 50 years owing to advances in diagnosis and treatment. In this Review, Marelli and colleagues discuss the effect of this shift in CHD epidemiology on outcomes and disease burden in adult patients and describe new initiatives and technology that can improve the delivery of health care.
