Reviews & Analysis

Considerable controversy continues to surround diastolic heart failure—is diastolic heart failure even a separate entity from systolic heart failure? In this Review, Maral Ouzounian, Douglas Lee and Peter Liu examine the evolving understanding of this important, albeit controversial, condition from molecular mechanisms to how the population is affected.

In this opinion piece, Dr Alejandro Lucia and colleagues assert that physically inactive modern lifestyles are incompatible with our genetic makeup, which is essentially unchanged from that of our Paleolithic ancestors. The authors highlight the importance of regular physical exercise in preventing the 'diseases of civilization' and to achieving cardiovascular health.

In this month's Case Study, Cha and colleagues present a 51-year-old male patient referred for consideration for heart transplantation because of recently diagnosed congestive heart failure refractory to medical therapy. He was diagnosed with cardiomyopathy resulting from pulmonary vein tachycardia, which was treated with catheter-based radiofrequency ablation of pulmonary vein tachycardia focus.

There is considerable semantic confusion when it comes to differentiating between the array of chemically and functionally distinct progestins used therapeutically. Hermsmeyer et al. consider the research reported to date, clearly distinguishing between the cardiovascular actions of estrogen, medroxyprogesterone acetate (a synthetic progestin) and progesterone (the naturally occurring progestin).

Noninvasivein vivoimaging to monitor the trafficking or homing of hematopoietic progenitor cells to vascular lesions is essential for both basic research and clinical practice. Here Qiu and Yang examine molecular MRI of stem-progenitor cells in atherosclerosis. They discuss advanced techniques for magnetic labeling of stem-progenitor cells, and how this modality could be used to monitor stem-progenitor cells migrating to injured arteries and vascular gene therapy mediated by stem-progenitor cells.

Förstermann reviews oxidative stress—the enzymes responsible for generating reactive oxygen species and the enzymatic and nonprotein systems designed to protect from vascular disease. He discusses how oxidative stress is involved in endothelial dysfunction, how it contributes to vascular disease, and by what therapeutic approaches it could be prevented.

In this month's Case Study, De Visser and colleagues present a 75-year-old male patient with a recent history of transient ischemic attack who underwent routine cardiological evaluation before a cystectomy. He was found to have coronary artery disease and an aortic valve papillary fibroelastoma—a rare, benign cardiac tumor. Multislice CT was successfully used to visualize the tumor and coronary arteries, before the patient underwent surgical excision of the tumor and an end-to-side anastomosis of the left internal mammary artery and the left anterior descending coronary artery.

There is much debate surrounding the etiology of cognitive decline following CABG surgery. In this Viewpoint, Neuropsychologist Ola Selnes postulates that this worrying complication is likely to be attributable to patient-related factors, such as the extent of pre-existing cerebrovascular disease, rather than to cardiopulmonary bypass.

The premature termination of the torcetrapib trial in December 2006 was widely publicized. A year on, Anatol Kontush, Maryse Guérin and M John Chapman revisit cholesteryl ester transfer protein inhibition as a potential therapeutic target and review recent developments in HDL-raising therapy with a focus on torcetrapib trials.

In light of the recent furore over late stent thrombosis and drug-eluting stents, Drs Stephan Windecker and Peter Jüni present their thorough review of the benefits and risks of first-generation sirolimus-eluting and paclitaxel-eluting stents, providing practical advice on the use of these devices in different patient groups.

Here, Mark Awad, Hugh Calkins and Daniel Judge tackle the known genetic mutations associated with arrhythmogenic right ventricular dysplasia/cardiomyopathy, and examine the complex issues surrounding genetic analysis in the clinical assessment of individuals with this condition.

Premature ventricular complexes are a common form of arrhythmia and are typically considered to be benign. In this month's Case Study, however, Ezzat and colleagues present a patient with dilated cardiomyopathy which was postulated to be caused by premature ventricular complexes arising from the right ventricular outflow tract. She was successfully treated by electrophysiological mapping and cryoablation of the ectopic focus.

The development of aortic regurgitation is often insidious and rate of disease progression varies between individuals. As such, symptoms do not necessarily correlate with objective evidence of ventricular dysfunction and the most appropriate criteria for risk stratification and optimum medical therapy remain controversial. Here the epidemiology of AR and evolution of practice guidelines regarding diagnosis and treatment are examined.

Atherosclerosis can remain below the clinical horizon for a long time. Acute vascular disease, however, can manifest clinically at almost any stage. Brightness ultrasonographic imaging of the carotid arterial walls can depict all stages of atherosclerotic arterial wall changes as a continuous variable. Here de Grootet al. describe the role of carotid IMT measurements as a tool in risk evaluation of individuals and explore how this technique could advance atherosclerosis research.

A substantial proportion of cardiovascular morbidity and mortality in developing countries is caused by cardiac complications of 'neglected diseases', such as Chagas disease, endomyocardial fibrosis, and rheumatic heart disease. Here, Yacoub et al. discuss management strategies for what they believe are potentially preventable diseases.

Elucidating arrhythmia mechanisms in heart failure at the basic ionic level will facilitate the design of novel therapeutic approaches. In this Review, Nass and colleagues examine some of the important changes in ventricular ion channels and calcium-handling proteins that underlie electrical remodeling.

A definitive diagnosis of cardiac sarcoidosis relies on the results of endomyocardial biopsy. In this Case Study Greif et al. describe a patient whose biopsy was negative for sarcoidosis—leading to a diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Sarcoidosis was only revealed after the patient had progressed to end-stage heart failure and undergone cardiac transplantation several years later.

Quantitative assessment of plaque composition has not been possible with grayscale IVUS analysis—until now. Here König and coworkers examine intravascular ultrasonography-derived virtual histology, a method which can provide detailed analysis of plaque morphology, providing more information on the vulnerability of coronary plaques and, in turn, the risk of acute clinical events.

Little is known about the basic pathologic mechanisms in acute decompensated heart failure (ADHF), despite ADHF being a large clinical problem. Here, David Feldman, Terry Elton, Benjamin Sun, Mickey Martin and Mark Ziolo focus on β-adrenergic receptor signaling as one of the final common pathways that could directly contribute to ADHF.

Diuretics are used for symptomatic treatment of chronic heart failure; however, no randomized trials have yet assessed the long-term effects of these agents on morbidity and mortality. In this article, Vaz Pérez and colleagues question the assumption that long-term diuretic therapy is beneficial and opine that the currently available data do not support the routine use of diuretics as a cornerstone of long-term medical treatment for patients with chronic heart failure.