Reviews & Analysis

The Apple Heart Study demonstrates that the Apple Watch can detect atrial fibrillation inferred from the smartwatch heart-rate sensor with a high positive predictive value. However, we must now contend with many clinically relevant unknowns that were not addressed by the study, such as the ramifications of a false-positive result.

In this Consensus Statement, Garg and colleagues describe the current evidence on the use of cardiovascular magnetic resonance imaging for the assessment of mitral regurgitation, highlight its current clinical utility, and recommend a standardized imaging protocol and report.

Findings from a large, international study comprising 4.9 million people with mild hypertension suggest that thiazide and thiazide-like diuretics might be more effective and safer than other first-line antihypertensive drugs. However, the study was not randomized, and the findings might be explained by a phenomenon known as ‘confounding by indication’.

In this Perspectives article, Oatmen and colleagues propose that, because abnormal fibroblast populations present in pressure-overload hypertrophy and cancer have similar molecular features, chemotherapeutic agents might be effective in preventing the progression of pressure-overload hypertrophy to heart failure with preserved ejection fraction.

Results from a prospective study by Santema and colleagues suggest that women with heart failure and reduced ejection fraction might need lower doses of standard heart failure drugs than men. However, this conclusion was formed on the basis of data from a small proportion of the population studied and might only be relevant to participants taking β-blockers.

In this Review, Rosenbaum and colleagues give a broad perspective on the genetic causes of dilated cardiomyopathy to provide a context for a discussion of the pragmatic use of genetic testing in heart failure clinics for patients presenting with new-onset dilated cardiomyopathy.

The myocardial viability substudy from the STICH trial has reaffirmed the 10-year survival benefit of CABG surgery in patients with left ventricular dysfunction, but whether myocardial viability must be present for the long-term benefits of revascularization to be realized remains inconclusive.

Preclinical data and small clinical trials suggest that remote ischaemic conditioning (RIC) therapy protects patients with acute myocardial infarction undergoing percutaneous coronary intervention. In the CONDI-2/ERIC-PPCI trial, RIC proved to be safe but did not have any short-term benefits in reducing cardiac-related death and hospitalization for heart failure.

In this Review, Cai and colleagues discuss the complex crosstalk between different oxidase systems and the consequences of this crosstalk in mediating cardiovascular disease processes, focusing on the central role of particular NADPH oxidase isoforms activated in specific cardiovascular diseases.

Inherited arrhythmias are a major cause of sudden cardiac death, particularly among young individuals. In this Review, Offerhaus and colleagues provide an overview of the epidemiology of inherited ventricular arrhythmias, focusing on natural history, prevalence and patient demographics.

Non-atherosclerotic processes are important contributors to a substantial number of acute coronary syndrome events. In this Review, Gulati and colleagues discuss the diagnosis, management and prognosis of patients with spontaneous coronary artery dissection, coronary artery embolism, vasospasm, myocardial bridging or stress-induced cardiomyopathy (Takotsubo syndrome).

This Review summarizes the role of transcription factors and epigenetic remodelling in modulating macrophage plasticity, provides an overview of the cooperative action of transcription factors and epigenetic modifiers controlling macrophage activation in the context of atherosclerosis and inflammation, and highlights the therapeutic potential of modulating transcription factor activity.

November 2019 marks 15 years since the launch of Nature Reviews Cardiology. To celebrate, we invited six of our Advisory Board members to discuss some of the highlights of cardiovascular research in the past 15 years and to make some projections about scientific research in the next 15 years.

This Review discusses the evolving indications of transcatheter aortic valve implantation (TAVI), including the latest clinical trials in young and low-risk patients with symptomatic severe aortic stenosis and ongoing studies exploring TAVI for other indications, including severe bicuspid aortic valve stenosis and pure native aortic regurgitation, highlighting procedural implications and caveats of new and future indications.

Rheumatic heart disease is a complication of group A streptococcal infection and rheumatic fever. In this Review, Muhamed and colleagues assess the emerging role of genome-wide association studies in detecting loci associated with genetic susceptibility to rheumatic heart disease.

Although saphenous vein grafts (SVGs) are the most commonly used conduit in coronary artery bypass graft surgery, vein graft failure (VGF) occurs in almost half of all patients with SVGs by 10 years after surgery. In this Review, Caliskan and colleagues discuss approaches to prevent saphenous VGF, including optimal harvesting techniques and intraoperative preservation strategies.

The non-canonical axis of the renin–angiotensin system (RAS) has an important role in cardiovascular physiology and disease. In this Review, Ocaranza and colleagues discuss the interplay between components of the counter-regulatory RAS and the therapeutic potential of targeting this system to treat cardiovascular disease.

Clonal haematopoiesis of indeterminate potential (CHIP) commonly occurs as a result of mutations in transcriptional regulators and is associated with a doubling of the risk of atherosclerotic cardiovascular disease. Jaiswal and Libby propose that CHIP contributes to the increased inflammation seen in ageing and thereby explains some of the age-related risk of cardiovascular disease.

Pulmonary arterial hypertension (PAH) is characterized by right ventricular hypertrophy and the absence of underlying cardiac or pulmonary disease. In this Review, Southgate and colleagues discuss the latest advances in the identification of genetic variants underlying PAH development and progression.

The shear stress generated by flowing blood has major effects on vascular function, with low shear stress promoting vascular dysfunction and atherosclerosis. This Review describes the latest findings on how endothelial cells decode complex shear stress environments to regulate physiological and pathophysiological responses, highlighting the role of pathways involved in embryonic development.