Review Articles in 2010

Over the past 30 years, we have witnessed a steady improvement in life expectancy of patients with Marfan syndrome, owing to advances in various treatments. In Part 2 of a 2-part Review on Marfan syndrome, Dr. Cañadas and colleagues discuss the present the state of the art in the management of patients with this disease.

Statin therapy has been associated with improved outcomes in patients with heart failure. However, two large prospective, controlled trials showed neutral effects with rosuvastatin. The authors of this Review highlight data from observational studies that have showed positive outcomes, and discuss how the design of the two large trials may have contributed to the neutral effects of statin therapy on the survival of patients with heart failure.

Imaging techniques that assess myocardial perfusion and coronary anatomy obtain complementary information. Simultaneous dual-modality or sequential multimodal imaging techniques facilitate integration of this information, and thus have the potential to improve diagnostic and prognostic evaluations, as well as care of patients. This Review discusses the clinical utility and future directions of hybrid imaging.

Stress cardiomyopathy, or Takotsubo syndrome, is a transient and reversible disorder that occurs suddenly after emotional or physical stress. It displays symptoms similar to acute myocardial infarction and is found predominantly in postmenopausal women. The underlying cause is still unknown. In this Review, the authors describe the published data relating to stress cardiomyopathy and discuss the possible mechanisms of this cardiac entity.

The introduction of drug-eluting stents (DES) has greatly reduced in-stent restenosis. Improvements to this technology are required, however, as safety and efficacy are still a problem. This Review describes current DES and the methods that are being used to optimize the performance of these stents. The author also suggests the direction of DES in the future, including tailored therapy to improve patient outcomes.

Although currently available anticoagulants, such as warfarin, can prevent stroke in patients with atrial fibrillation, the drug-related bleeding risk remains unacceptably high, and therapy could be contraindicated if the risk exceeds that for stroke. In this Review, Freek Verheugt assesses the performance of new anticoagulants that directly inhibit different stages of the coagulation cascade.

Atrial fibrillation (AF) has multifactorial intracardiac and extracardiac causes. Current development of anti-AF agents is focused on modulation of ion channel activity as well as on upstream therapies that reduce structural substrates. In this Review, Burashnikov and Antzelevitch examine new and emerging pharmacological approaches to rhythm control in patients with AF and summarize the available data on these drugs.

As part of our focus issue on atrial fibrillation, Dewire and Calkins review current strategies and emerging technologies for catheter ablation of patients with this arrhythmia. The authors also discuss the current clinical role of AF ablation in various high-risk groups of patients, such as the elderly and those with concomitant heart failure.

Cell therapy could improve cardiac function in patients with coronary heart disease. In this article, the authors provide an overview of the clinical trials in this field and highlight the limitations of cardiac cell therapy. They also discuss how these issues are being addressed and what the future may hold for this therapy.

Sudden cardiac arrest causes more than 60% of all deaths from cardiovascular disease. In this Review, Adabag and colleagues discuss trends in the incidence of sudden cardiac death (SCD), and the risk factors and triggers of this devastating event. The authors also highlight the lack of a concise definition for SCD and suggest that prospective community surveillance programs, using multiple sources to identify cases, would enable more accurate determination of SCD burden. They also review the growing evidence for the role of public-access defibrillators in improving survival after sudden cardiac arrest.

In this Review, the authors discuss the utilization of multiple, high spatial resolution contrast weightings for thein vivoassessment of carotid atherosclerotic disease. Although 'carotid MRI' is presently an established imaging tool dedicated to research, the burgeoning data from prospective studies has placed it at the precipice of translation to clinical practice.

In this Review, the authors discuss innovations in ventricular assist devices technology as an alternative therapeutic option for patients with advanced heart failure. In particular, they focus on the newer, third-generation VADs that are currently being developed for mechanical cardiac support.

The incidence of prehypertension and hypertension among children and adolescents is rising as a result of the epidemic of youth overweight and obesity. Brian McCrindle addresses this important public health problem by reviewing the evaluation and management aspects of this condition that are specific to infants, children, and adolescents.

Plaque macrophages account for the majority of leukocytes in atherosclerotic plaques, and are believed to differentiate from monocytes recruited from circulating blood. In this Review, Dr Woollard and Dr Geissmann discuss the heterogenous population of monocytes involved in the pathogenesis of atherosclerosis.