Reviews & Analysis

Alterations in β-adrenergic-receptor signal transduction play a major part in the development of heart failure. Although pharmacologic and device-based therapy can lessen morbidity and mortality, better understanding of these mechanisms should improve outcomes. Much of the current understanding of β-adrenergic signaling pathways and polymorphisms is summarized in this review.

Shear stress plays an essential part in the maintenance of healthy blood vessels, and locations of low shear stress can create predilection sites for eccentric plaque growth. This review discusses the mechanobiologic mechanisms related to shear stress that might have a role in plaque rupture.

Anticoagulation is a necessary part of interventional cardiology, despite the associated bleeding risks. In this review, Martin T Rothman presents an overview of how the various anticoagulant drugs weigh up against one another when used in combination with percutaneous coronary intervention.

Electronic pacemakers are lifesaving devices but require regular maintenance and do not readily respond to the demands of exercise and emotion. This viewpoint focuses on the rapidly evolving field of biological pacemakers, addresses the issues that need to be confronted before clinical use and discusses how far we are from a clinical reality.

Patients with systemic lupus erythematosus are at a high risk of developing premature atherosclerosis and cardiovascular disease, but the mechanisms responsible for this are not fully understood. This review discusses traditional and lupus-specific risk factors that are likely to be involved, and outlines how risk assessments should be included in effective management of this disease.

Mutations inSCN5A, the gene encoding the α subunit of the cardiac sodium channel, are associated with a number of cardiac rhythm syndromes, including Brugada syndrome. This review discusses the genotypic and phenotypic characteristics, cellular mechanisms, diagnosis and management of Brugada syndrome.

Revascularization is currently recommended for patients with unprotected left main coronary artery disease. In this review, Chieffo and Colombo discuss the safety and effectiveness of percutaneous interventions involving drug-eluting stents as an alternative approach for treating this disease.

Shear stress plays an essential part in the maintenance of healthy vessels. If risk factors for atherosclerosis are present, low shear stress can lead to abnormalities, possibly creating predilection sites for eccentric plaque growth. The role of shear stress in the development of plaque prone to rupture is explored.

Patients who receive most types of modern prosthetic heart valve are currently also given long-term, low-intensity anticoagulation therapy to reduce the risk of thromboembolic complications. In this review, the authors discuss the current recommendations for anticoagulation therapy and the data on which these recommendations are based.

Hypertrophic cardiomyopathy is a widespread condition that is often neglected and undiagnosed. Although there are still large gaps in our knowledge of the basic disease mechanisms, population studies have shown us that patients can have normal life expectancy but often develop disease-related complications. In this Viewpoint, Franco Cecchi, Magdi Yacoub and Iacopo Olivotto highlight the disease's screening and treatment, and some of the exciting new knowledge in the field.

Multislice CT, with 16, 32 or 64 rows per image, can provide an image quality that has improved the noninvasive diagnosis of disorders such as atherosclerotic plaque or coronary anomalies. This review summarizes the main data available and, despite various remaining confounding factors to image quality, calls for guidelines.

Despite improvements in therapy, sudden cardiac death still poses a major problem for cardiovascular patients. In very high-risk patients, half of premature deaths are sudden. Certain inotropic drugs can increase the risk of death, but mechanical devices can provide prophylactic benefits. Winslowet al. sum up the major issues and challenges in this review.

Patients with long QT syndrome can experience life-threatening arrhythmias and related mortality is high among symptomatic, untreated people. Identification of several responsible genes and their effects on ion channels has advanced understanding of this disorder. Here, Peter Schwartz reviews how these discoveries have, or have not, modified management and changed the direction of research.

Informed consent is a necessary element of good clinical practice. It is important that the physician or investigator assesses patients' competence and understanding, and facilitates their participation in the decision-making process, beyond just providing information. Here, Anders Ågård discusses how consent procedures should be adapted to match a patients' degree of involvement in the decision and capacity to understand, in light of how things are in the real world.

Cardiovascular complications, including cardiomyopathy and cardiac arrhythmias, are frequently seen in patients with muscular dystrophies. This review discusses the pathogenesis of the main forms of muscular dystrophy and focuses on how appropriate management of these disorders can improve the function, well being and longevity of patients.

Macrophage foam cells have important roles in physiological processes, including atherogenesis and lipoprotein metabolism, but they are also fundamental for the development and progression of atherosclerosis. As we understand more about the biology of these cells, therapeutic approaches for atherosclerosis that target macrophage foam cells are becoming a reality, as discussed in this review.

Cyclo-oxygenase 2 inhibitors, although offering gastrointestinal benefits, seem to have an adverse cardiovascular risk profile. The nature of this risk is still desperately underinvestigated. Given the recent withdrawals of certain agents from the US market, this review attempts to pull together the major data available so far and asks where studies should go next.