Review Articles in 2009

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.

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.

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.

Randomized trial data on pericardial diseases are scarce, but a number of new studies are moving the management of these conditions from empirically-based to evidence-based medicine. Massimo Imazio and colleagues show how the emerging data and the first guidelines for pericardial disease can be used to tailor management to the individual patient.

The extent of coronary calcification is thought to reflect the total coronary atherosclerotic burden. In this Review, Drs. Alexopoulos and Raggi discuss the current uncertainty about the role of coronary artery calcium in various disease states, the utility of calcium screening and current recommendations on its use.

Patients of low socioeconomic status (SES) with cardiovascular disease are a highly vulnerable, but often under-served, population. In high income countries in particular, these individuals develop cardiovascular disease younger, have more risk factors, and are less likely to benefit from treatment than are patients of higher socioeconomic status. In this Review, Clark et al. examine how socioeconomic status is linked to adverse cardiovascular outcomes and what clinicians can do to address inequalities.

Rheumatic heart disease is a substantial global health problem that particularly affects developing countries. In this article, Andrew Steer and Jonathan Carapetis review the pathophysiology and epidemiology of this disease and discuss strategies for diagnosis, prevention, and treatment. They also emphasize the importance of secondary prophylaxis programs and highlight the potential for vaccine development.

Myocardial angiogenesis occurs in response to hypoxia in ischemic tissues. This Review discusses imaging techniques that can be used to assess the effectiveness of exogenous angiogenic agents in promoting the growth of collateral vessels in ischemic myocardium.

Ongoing medical education and recertification of specialists is important in minimizing medical errors and ensuring that patients receive quality care. This Review discusses the processes by which cardiovascular specialists are assessed in different geographical regions.

Individualized drug therapy requires physicians to be able to accurately predict an individual's response to a drug. 'Pharmacogenetics' is the study of the role of inheritance in variation in drug response phenotypes. Pharmacogenetics is now moving genome-wide to become 'pharmacogenomics'. This article reviews the development, promise and challenges of pharmacogenomics, using examples of drugs used to treat or prevent cardiovascular disease.

Treatment of hypertension is associated with a reduction in the risk of cardiovascular complications such as stroke. In this Review, Morris Brown discusses vaccines that target components of the renin–angiotensin system as a potential strategy not only for treating hypertension, but for preventing the development of treatment-resistant hypertension.