Reviews & Analysis

Bioresorbable vascular scaffolds (BVS) are new-generation stents that offer considerable advantages over traditional metallic implants. In this Review, Indolfi and colleagues provide an overview of the clinical studies on BVS, highlighting the importance of BVS implantation technique and the emerging safety profile of these devices in percutaneous coronary intervention.

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease. In this Review, Sen-Chowdhry et al. discuss the guideline recommendations for the evaluation and management of HCM, and provide a summary of the important advances in genetics, imaging, and molecular research on HCM.

Brugada syndrome is a major cause of sudden cardiac death in young patients without structural heart disease. In this Review, Sieira and colleagues summarize the mechanisms involved in the development of Brugada syndrome, and discuss the available options for risk stratification and management.

The primary analysis of FIRE AND ICE demonstrated that cryoablation was noninferior to radiofrequency ablation for the primary efficacy end point of first documented clinical failure. Secondary analysis suggested that cryoablation had advantages over radiofrequency ablation in terms of rehospitalizations and repeat procedures; however, the validity of these results must be questioned.

The chairs of the ESC Task Force, the chairs of the ACC/AHA/HFSA Writing Committee, and an independent opinion leader in the field offer their expert insight into the new guidelines for the management of heart failure, highlighting what is new, what the main differences are between the two sets of guidelines, and what steps should be taken to improve the guidelines in future updates.

Genome editing is being rapidly adopted into all fields of biomedical research, including the cardiovascular field. In this Review, Strong and Musunuru discuss the applications of genome-editing technology, including zinc finger nucleases, TALENs, and CRISPR/Cas9 systems, throughout cardiovascular disease research, their current limitations, and the prospect ofin vivogenome-editing therapies in the future.

Arterial access is fundamental to contemporary interventional cardiology. In this Review, Rao and Stone compare the clinical evidence for femoral versus radial access, and how best to achieve haemostasis with each approach, including the use of manual compression and vascular closure devices.

In a new scientific statement, the AHA addresses the revolution brought by smartphones and social media to the field of emergency cardiology. New, attractive opportunities exist alongside new dangers. Information is currently delivered to the Internet without control. Trustworthy medical information is needed: it is time for scientific societies to take action.

Atrial fibrillation (AF) usually begins in a self-terminating paroxysmal form. In this Review, Nattel and Dobrev extensively summarize the electrophysiological basis for paroxysmal AF occurrence and maintenance, as well as the molecular mechanisms forming the underlying substrate, drawing on data from both patients with AF and animal models of spontaneous AF. The authors also consider potential factors governing progression from paroxysmal to persistent AF.

Atherothrombosis underlies numerous manifestations of cardiovascular disease, including coronary artery disease (CAD) and cerebrovascular disease (CVD). Treatment of patients with concomitant CAD and CVD is complex, owing to their increased risk of both ischaemia and bleeding. Capodanno et al. review the use of antithrombotic drugs for the secondary prevention of atherothrombotic events in patients with concomitant CAD and CVD, particularly those with a history of noncardioembolic stroke or transient ischaemic attack.

Clinical guidelines advocate oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation and ≥1 risk factors for stroke, but 40% of eligible patients receive aspirin, and those at greatest risk are least likely to be prescribed OAC. Why is there a discrepancy between guidelines and clinical practice?

The success of transcatheter aortic valve implantation (TAVI) is centred around the collaboration between cardiac surgeons and interventional cardiologists. A report from the German Quality Assurance Registry on TAVI now suggests that clinical outcomes in hospitals without cardiac surgery departments are similar to those in centres with onsite cardiac surgery support.

After some alarming results of intensified glucose control in patients with type 2 diabetes mellitus, and noninferiority (without superiority) of alogliptin, saxagliptin, sitagliptin, and lixisenatide treatment compared with placebo, the positive results in survival and cardiovascular and renal outcomes with empagliflozin and liraglutide have been acknowledged with enthusiasm by diabetologists and should deeply interest cardiologists.

Takotsubo syndrome is often thought to be the result of catecholamine-mediated myocardial stunning triggered by emotional or physiological stress. In this Perspectives article, Kastaun and colleagues discuss the latest studies evaluating the psychoneuroendocrinological and psychosocial mechanisms underlying the pathophysiology of Takotsubo syndrome.

In this Perspectives article, Ormerod et al. propose that dynamic left ventricular systolic dysfunction provoked by obstruction in hypertrophic cardiomyopathy is a manifestation of inefficient cardiac energy utilization. This mid-systolic drop in left ventricular Doppler ejection velocities has been termed the 'lobster claw abnormality'. Energy insufficiency is also present in nonobstructive hypertrophic cardiomyopathy, and this paradigm might suggest novel therapies.

Patients with acute coronary syndromes have an increased risk of stent thrombosis. A considerable proportion of these patients are also at increased risk of bleeding, representing a challenge to optimal selection of stent type and duration of dual antiplatelet therapy. Recent evidence supports polymer-free drug-eluting stents as a safe and effective option for this challenging subset of patients.

A recent pooled analysis of data from four studies found no increased risk of cardiovascular events and death with increased sodium intake in patients without hypertension. However, the study estimated sodium intake using only overnight urine collections rather than 24-h samples, and sodium excretion was not constantly monitored.

The mechanisms of thromboembolism in patients with atrial fibrillation are complex and not well understood, and existing stroke risk scores are limited in their predictive capacity. In this Review, Calenda et al. discuss stroke risk assessment in atrial fibrillation and explain how the atrial myopathy concept might help to refine stroke risk prediction.

Nutraceuticals are natural compounds that are beneficial for the prevention or treatment of disease. In their Review, Moss and Ramji summarize the preclinical and clinical studies to evaluate the efficacy of various nutraceuticals, such as polyunsaturated fatty acids, flavanols, and vitamins C and E, for the prevention of atherosclerosis.

Diagnosis and treatment in patients with an aborted cardiac arrest (ACA) pose a challenge for cardiologists, because the underlying causes of ACA and the appropriate therapies are varied. In this Perspectives article, Schwartz and Dagradi offer their view on how genetics is shaping the management of survivors of ACA, and discuss the importance of genetic testing for the protection of these patients and their families.