Reviews & Analysis

Atrial fibrillation affects millions of people worldwide and significantly increases the risk of ischemic stroke. In this month's Viewpoint, Alan Go examines the use of anticoagulant therapy, the problems faced and future therapeutic options for the prevention of stroke in patients with atrial fibrillation.

Coronary artery bypass grafting can now be performed without the use of the cardiopulmonary bypass pump, a technique known as “off-pump” coronary bypass. Despite data from nonrandomized retrospective trials showing a benefit to the off-pump technique, skepticism remains. This review discusses the evidence to date, focusing on data from prospectively randomized studies.

Stroke is an important complication of cardiac surgery. The degree of risk is significantly influenced by the presence, extent and location of atherosclerosis in the ascending aorta. Per Bergman and Jan van der Linden provide an overview of the current perioperative measures that can be taken to lessen this risk.

Patients with insulin resistance syndromes are at an increased risk of developing cardiovascular disease. This review discusses the relationship between insulin resistance and heart disease, and describes how aggressive risk factor management and multifactoral treatment approaches are being used to improve the clinical outcomes of these patients.

In 2004, the UK became the first country to make statins available without a prescription. Jonathan Abrams discusses the benefits and dangers of nonprescription statins, as the debate continues about whether low-dose statins should be sold over the counter in the US.

In children born with only one ventricle, the systemic and pulmonary venous blood mixes. The Fontan operation, by which the blood flows through the creation of a serial arrangement in which no ventricle interposes, has become the procedure of choice. The development of this therapy and the current issues associated with it are discussed here.

The importance of easy bedside investigations at an early stage is undeniable. Therefore, the introduction of hand-held ultrasound devices in settings such as the primary bedside diagnosis of patients is a welcome advance. The approaches to training, best use and reimbursement to aid this technology's introduction are discussed.

The roles of N-terminal proBNP, an inactive amino acid product of BNP prohormone cleavage, seem to be many-fold in heart disease. Here, Lisa C Costello-Boerrigter and John C Burnett Jr explore some of the ways in which this biomarker can aid diagnosis and prediction of prognosis in various cardiovascular diseases.

Structural remodeling of the heart is known to be related to various processes mediated by mechanical, neurohormonal and cytokine routes. Disruption in the production and breakdown of collagen fibers is a prominent mechanism in left-ventricular fibrosis. Javier Díez and colleagues discuss noninvasive diagnostic methods for such hypertrophy and possible therapeutic strategies to promote its reduction

In 2004 the ACC/AHA guideline for the management of patients with STEMI was refocused and expanded. It has become the ultimate reference for managing patients with STEMI, and here Robert Giugliano and Eugene Braunwald highlight the significant changes between the 1999 and 2004 versions that will most affect practicing clinicians.

Since its inception over 30 years ago, the Fontan principle has become well established for the management of single-ventricle circulations. In this Viewpoint, Carin van Doorn and Marc de Leval discuss the procedure's selection criteria, the surgical technique and the management of the Fontan state.

Catheter ablation for atrial fibrillation has rapidly become used worldwide. This review provides an overview of the three main approaches currently used to perform ablation of the pulmonary veins. The efforts being made to raise efficacy from its current 70–80% and lower the risk of major complications from 5% are also discussed.

Atrial fibrillation and obesity share obstructive sleep apnea as a comorbidity. The data on the relationship between atrial fibrillation and obstructive sleep apnea have, however, generally been extrapolated from studies with other focuses. Gami et al. present the findings so far to summarize current understanding and identify avenues for future study.

In patients who require revascularization after myocardial infarction, noninvasive imaging tests can be useful to assess whether target areas of the myocardium are viable. Delayed-enhancement MRI allows direct visualization of potentially damaged regions, but it is still a new technique. This review explores its role in the routine evaluation of coronary artery disease patients.

The preclinical data for gene therapy's role in revascularization heralded much promise. In the phase II studies, though, little progress seems to have been made. Pislaru and Simari chart gene therapy's course to date and discuss whether and where research can continue, and conclude that all hope is not lost.

The prevalence of valve disease is increasing worldwide. Given the need to reduce the occurrence of complications experienced with mechanical and tissue valve replacements, and the realization that normal heart valves perform extremely complex functions, tissue engineering of heart valves appears to be the next logical step. In this Viewpoint, Magdi Yacoub and Johanna JM Takkenberg discuss the future of tissue engineered heart valves.

As yet, 22 cases of short QT syndrome have been confirmed but other cases have probably been overlooked. This syndrome is a heritable primary electrical disease of the heart that can lead to atrial fibrillation and sudden cardiac death. The knowledge to date on this little recognized disorder is presented.

Congestive heart failure and chronic kidney disease are severe diseases, but a frequently complicated individually by anemia. If all three disorders are present, a vicious circle ensues, in which each component causes or worsens the other two. This review discusses the inter-relationships and how to approach correction or alleviation of this syndrome.