Aspects Of Cardiovascular Disease Research Articles

Stargazing microRNA maps a new miR-21 star for cardiac hypertrophy.

Left ventricular hypertrophy is an initial compensatory mechanism in response to cardiac stress that can degenerate into heart failure and sudden cardiac death. Recent studies have shown that microRNAs (miRs) regulate several aspects of cardiovascular diseases. In this issue of the JCI, Bang and colleagues identified an exosome-mediated communication mechanism between cardiac fibroblasts and cardiomyocytes. Specifically, cardiac fibroblasts secrete miR-enriched exosomes, which are subsequently taken up by cardiomyocytes, in which they alter gene expression. In particular, a passenger strand miR, miR-21*, was identified as a potent paracrine factor that induces cardiomyocyte hypertrophy when shuttled through exosomes. These advanced comprehensive analyses represent a major step forward in our understanding of cardiovascular physiopathology, providing a promising adjunctive target for possible therapeutic approaches, namely the miR-mediated paracrine signaling network.

Effects of superoxide donor menadione in adult Rat myocardium are associated with increased diastolic intracellular calcium

Superoxide anions have been associated with many aspects of cardiovascular disease. Menadione is a superoxide anion donor that alters the heart’s electrical and mechanical functions. The aim of this study was to demonstrate simultaneous changes in intracellular Ca 2+ ([Ca 2+ ]i) and mechanical activity in intact adult cardiac myocytes, and mechanical activity and electrical activity in isolated whole hearts in order to provide greater insight into the mechanisms associated with the detrimental effects of menadione on the myocardium. Isolated hearts from adult male Wistar rats (n = 11, 200–250 g) were Langendorff perfused at 38°C with a Krebs–Henseleit solution. A saline-filled balloon was placed in the left ventricle (LV) in order to measure diastolic and developed pressure. Monophasic action potentials were simultaneously recorded from the epicardial surface. External stimulation at 5 Hz and intrinsic pacing were used throughout a 10 min control period and 30 min exposure to 50 µM menadione. Single LV myocytes (n = 7 from n = 4 animals) were loaded with the Ca2+-indicator Fura4-AM, stimulated at 1 Hz and exposed to 50 µM menadione. Myocyte length was simultaneously measured with [Ca 2+ ]i using a video edge detection system. In isolated hearts, exposure to menadione significantly decreased contractility and action potential duration (with a simi lar time course); intrinsic heart rate and rhythmicity. Diastolic pressure was significantly increased. In single adult myocytes, menadione caused a significant increase in diastolic [Ca 2+ ]i and a decrease in resting cell length and led to spontaneous release of [Ca 2+ ]i. We conclude that the effects of menadione upon electrical and mechanical activity of the heart are at least in part a consequence of dysregulation of [Ca 2+ ]i handling and the subsequent increase in diastolic [Ca 2+ ] alterations in [Ca 2+ ]i are consistent with the generation of delayed after depolarization arrhythmias.

Older couples with and without cardiovascular disease: Testing associations between and among affective communication, marital satisfaction, physical and mental health.

The American Heart Association (Go et al., 2013) estimated that about 2,150 Americans die each day from cardiovascular disease (CVD). For those 65 years of age or older, the total cost of heart related services in 2009 was $121.2 billion (Go et al., 2013). Many people live with the chronic conditions of cardiovascular disease (Petersen et al., 2005). Researchers have identified the genetic, medical, and lifestyle habits of those with CVD, yet there is a dearth of literature focusing on the relational/social aspects of cardiovascular disease and how such factors are associated with the risk, presentation, and maintenance of cardiovascular illness. Considering that men have a higher lifetime risk for developing CVD than women (51.7% to 39.2%; Roger et al., 2012), the purpose of this study was to compare various aspects of the couple relationship among and between couples with a husband who reports CVD and couples in which neither report CVD.

Cardiogeriatric, the future's cardiology?

Cardiogeriatric, the future's cardiology?

Molecular models of the cardiorenal syndrome

Molecular profiling techniques have provided extensive sets of molecular features characterizing clinical phenotypes, but further extrapolation to mechanistic molecular models of disease pathophysiology faces major challenges. Here, we describe a computational procedure for delineating molecular disease models utilizing omics profiles, and exemplify the methodology on aspects of the cardiorenal syndrome describing the clinical association of declining kidney function and increased cardiovascular event rates. Individual molecular features as well as selected molecular processes were identified as linking cardiovascular and renal pathology as a combination of cross-organ mediators and common pathophysiology. The molecular characterization of the disease presents as a set of molecular processes together with their interactions, composing a molecular disease model of the cardiorenal syndrome. Integrating omics profiles describing aspects of cardiovascular disease and respective profiles for advanced chronic kidney disease on molecular interaction networks, computation of disease term-specific subgraphs, and complemented by subgraph segmentation allowed delineation of disease term-specific molecular models, at their intersection providing contributors to cardiorenal pathology. Building such molecular disease models allows in a generic way to integrate multi-omics sources for generating comprehensive sets of molecular processes, on such basis providing rationale for biomarker panel selection for further characterizing clinical phenotypes.

Cystatin C: An Emerging Biomarker in Cardiovascular Disease

Cystatin C (cys-C) is a small protein molecule (120 amino acid peptide chain, approximately 13kDa) produced by virtually all nucleated cells in the human body. It belongs to the family of papain-like cysteine proteases and its main biological role is the extracellular inhibition of cathepsins. It's near constant production rate, the fact that it is freely filtered from the glomerular membrane and then completely reabsorbed without being secreted from the proximal tubular cells, made it an almost perfect candidate for estimating renal function. The strong correlation between chronic kidney disease (CKD) and cardiovascular disease (CVD) along with the growing understanding of the role of cysteinyl cathepsins in the pathophysiology of CVD inspired researchers to explore the potential association of cys-C with CVD. Throughout the spectrum of CVD (peripheral arterial disease, stroke, abdominal aortic aneurysm, heart failure, coronary artery disease) adverse outcomes and risk stratification have been associated with high plasma levels of cys-C. The exact mechanisms behind the observed correlations have not been comprehensively clarified. Plausible links between high cys-C levels and poor cardiovascular outcome could be impaired renal function, atherogenesis and inflammatory mediators, remodeling of myocardial tissue and others (genetic factors, aging and social habits). The scope of the present article is to systematically review the current knowledge about cys-C biochemistry, metabolism, methods of detection and quantification and pathophysiological associations with different aspects of CVD.

Molecular analysis of the prostacyclin receptor's interaction with the PDZ1 domain of its adaptor protein PDZK1.

The prostanoid prostacyclin, or prostaglandin I2, plays an essential role in many aspects of cardiovascular disease. The actions of prostacyclin are mainly mediated through its activation of the prostacyclin receptor or, in short, the IP. In recent studies, the cytoplasmic carboxy-terminal domain of the IP was shown to bind several PDZ domains of the multi-PDZ adaptor PDZK1. The interaction between the two proteins was found to enhance cell surface expression of the IP and to be functionally important in promoting prostacyclin-induced endothelial cell migration and angiogenesis. To investigate the interaction of the IP with the first PDZ domain (PDZ1) of PDZK1, we generated a nine residue peptide (KK411IAACSLC417) containing the seven carboxy-terminal amino acids of the IP and measured its binding affinity to a recombinant protein corresponding to PDZ1 by isothermal titration calorimetry. We determined that the IP interacts with PDZ1 with a binding affinity of 8.2 µM. Using the same technique, we also determined that the farnesylated form of carboxy-terminus of the IP does not bind to PDZ1. To understand the molecular basis of these findings, we solved the high resolution crystal structure of PDZ1 bound to a 7-residue peptide derived from the carboxy-terminus of the non-farnesylated form of IP (411IAACSLC417). Analysis of the structure demonstrates a critical role for the three carboxy-terminal amino acids in establishing a strong interaction with PDZ1 and explains the inability of the farnesylated form of IP to interact with the PDZ1 domain of PDZK1 at least in vitro.

Soluble Epoxide Hydrolase Inhibitors and Cardiovascular Diseases

Epoxyeicosatrienoic acids (EETs) have been shown to play a role in cardiovascular protection by reducing ischemia reperfusion injury, producing anti-inflammatory effects, and promoting angiogenesis. EETs are regulated through conversion to less active corresponding diols by soluble epoxide hydrolase (sEH). Inhibition of sEH enhances the beneficial properties of EETs and has been investigated as a possible treatment for cardiovascular diseases. sEH inhibitors (sEHIs) have anti-inflammatory effects by stabilizing anti-inflammatory EETs. Additionally, sEHIs strongly inhibit and reverse cardiac hypertrophy. sEHIs have been shown to protect myocardial cells from ischemiareperfusion injury, treat atherosclerosis and prevent the development of hypertension. sEHIs promote blood vessels to release bradykinin via an EET-mediated STAT3 signaling pathway to elicit tolerance to ischemia. Inhibition of sEH has been shown to improve several aspects of cardiovascular diseases, including inflammation, hypertension, cardiac hypertrophy and atherosclerosis. For this reason, sEHIs are promising new pharmaceutical for the treatment of cardiovascular diseases.

Soluble Epoxide Hydrolase Inhibitors and Cardiovascular Diseases

Background: Epoxyeicosatrienoic acids (EETs) have been shown to play a role in cardiovascular protection by reducing ischemia reperfusion injury, producing anti-inflammatory effects, and promoting angiogenesis. EETs are regulated through conversion to less active corresponding diols by soluble epoxide hydrolase (sEH). Inhibition of sEH enhances the beneficial properties of EETs and has been investigated as a possible treatment for cardiovascular diseases. Content: sEH inhibitors (sEHIs) have anti-inflammatory effects by stabilizing anti-inflammatory EETs. Additionally, sEHIs strongly inhibit and reverse cardiac hypertrophy. sEHIs have been shown to protect myocardial cells from ischemiareperfusion injury, treat atherosclerosis and prevent the development of hypertension. sEHIs promote blood vessels to release bradykinin via an EET-mediated STAT3 signaling pathway to elicit tolerance to ischemia. Summary: Inhibition of sEH has been shown to improve several aspects of cardiovascular diseases, including inflammation, hypertension, cardiac hypertrophy and atherosclerosis. For this reason, sEHIs are promising new pharmaceutical for the treatment of cardiovascular diseases. Keywords: Soluble epoxide hydrolase, epoxyeicosatrienoic acids, cardiovascular diseases, fibrinolysis, stabilizing EETs, peroxisomes

Circulating Biomarkers for Metabolic Disorders as a Predictor of Cardiovascular Disease Risk: What‘s New?

The ongoing global rise in the prevalence of overweight and obesity among all ages and ethnic groups has resulted in a real epidemic phenomenon. Subsequently, it is ‘epidemically’ accompanied by a higher incidence of serious health risks, such as the development of cardiovascular disease (CVD), which is potentially present at an earlier age. Epidemiological studies and autopsy data have shown that the atherosclerotic process begins early in childhood [1,2], ‘switching on’ the engine towards CVD at a younger age in susceptible individuals. Traditional risk factors for CVD have been identified in both children and adults and are certainly a tool to identify and stratify individuals with a high risk of future CVD. However, there is increased investigation into novel pathophysiological processes contributing to CVD and several studies suggest that markers of these new aspects of CVD have the potential to improve our capacity of clinical risk stratification, by aiding in the prediction, identification and assessment of atherosclerotic disease [3]. It is believed that with the improvement of our understanding of the role of nontraditional biomarkers and risk factors for CVD in children and adolescents, a lot can be achieved in the prevention of morbidity and mortality due to cardiovascular accidents. As clarified by the American Heart Association in its most recent statement, disease risk factors are measurable biological characteristics of an individual that precede and predict a specific outcome of that disease and are directly involved in the biological causal pathway [4]. Risk factors are of particular importance because they help to identify asymptomatic individuals who have a greater chance of developing the disease in the future.

Impacto da pesquisa básica nos avanços da cardiologia

The impact of basic research on advances in cardiology is undisputable. Didactically and simplistically speaking, we can identify four different levels of work in this field. Firstly, it enables the development of new treatments related to cardiology; in addition, basic research provides tools for studying various aspects of cardiovascular diseases; thirdly, new concepts can be created on topics already studied, and, finally we can use basic research to study the pathophysiological mechanisms involved in different pathologies. In Brazil, the Brazilian Archives of Cardiology (ABC) play a prominent role on publications involving basic research in cardiology. Importantly, as discussed below, the journal has been contributing with expertise covering the four levels of work, as previously cited. Taking into account the development of new treatments, several recent publications have addressed this issue. Interestingly, we can identify several research areas emphasizing new treatments for cardiovascular disease. For example, the dietary manipulation was one of the main areas within the journal. Indeed, a study with animals that underwent hypercaloric diet revealed that obesity induced a decreased vascular reactivity associated to changes in the L-arginine/nitric oxide pathway 1

Of heart and kidney: a complicated love story

The multiple connections that exist between the cardiovascular system and the kidney lead to a complex cardiovascular and renal medicine relationship. It is well established in the literature that chronic kidney disease (CKD) is an important and independent risk factor for cardiovascular disease (CVD). The prevalence of CKD in the general population is about 7%, comparable with the prevalence of diabetes. The main causes of CKD are diabetes and hypertension, worldwide. The prevalence of CVD in the CKD population ranges between 7 and 85% according to the CKD stage and type, and the patient diagnosed with CKD has a higher risk of dying of CVD than of starting renal replacement therapy. There are some particular aspects of CVD in CKD patients that differ from the general population, making its prevention and treatment a challenge for both cardiologists and nephrologists.

2012 Theme Issue on Cardiovascular Disease

OVER THE PAST CENTURY AS THE WEST TRANSItioned from an agrarian to an industrial economy, the nature of the dominant diseases afflicting humans changed from communicable to chronic conditions. During this epidemiologic transition, cardiovascular disease has ascended from an uncommon problem to its current position as the number one cause of death and disability worldwide. This transformation of human disease is continuing as regional economies develop and the global population ages. In many highincome countries the onset of some cardiovascular events is being delayed from middle to older age and more people are living longer with various forms of cardiovascular disease. In middleand lower-income countries the ascendancy of cardiovascular disease has been more rapid than in the West. Although some progress has been made in parts of the world in reversing trends in certain cardiovascular risk factors, major risk factors such as obesity are still on the rise globally. The emergence of this cardiovascular disease epidemic has led to amazing advances in understanding of its pathophysiology and improvements in treatment. Health care systems have evolved to deal with acute manifestations of chronic diseases, such as myocardial infarction and stroke, improving survival and lessening disability. Secondary preventive strategies such as -blockers and angiotensin-converting enzyme inhibitors have improved long-term management. Preventive and public health measures (eg, diet modification and exercise) have reduced the rates of incident myocardial infarction and stroke in the West. However, the challenges to deal with this global burden of risk factors and cardiovascular disease remain substantial. In November, as clinicians and scientists gather to exchange information and ideas about virtually all aspects of cardiovascular disease at the American Heart Association’s Scientific Sessions, JAMA will publish a theme issue on cardiovascular disease. We at JAMA view this as an opportunity to share with our worldwide readers, listeners, and viewers important new findings on understanding of cardiovascular disease as well as of major challenges and future directions in its prevention, treatment, and longer-term management. As we plan for this theme issue, authors are invited to submit manuscripts on any topic related to cardiovascular disease for consideration for this JAMA theme issue. A high priority will be given to manuscripts reporting results of major late-breaking clinical trials and other high-impact studies that will be presented at the American Heart Association’s Scientific Sessions. These will be considered for simultaneous release at the time of the presentation. We are interested in high-quality clinically relevant original research that includes multicenter randomized trials and large-scale observational epidemiological studies. We also welcome scholarly work addressing how to expedite the adoption of effective cardiac therapies into clinical settings. Manuscripts on comparative effectiveness, application of cardiovascular disease treatments in clinical settings, prevention, and novel work that expands understanding of the mechanistic underpinnings of cardiovascular disease will be considered. The effect of cardiovascular disease around the globe is also important to our readers. Interested authors should consult the Instructions for Authors for guidelines on preparation and submission of manuscripts. All submitted manuscripts will undergo JAMA’s usual rigorous editorial review and evaluation. Manuscripts received by July 1, 2012, will have the best chance for inclusion in the 2012 JAMA theme issue on cardiovascular disease. We encourage authors who anticipate presentation of late-breaking studies to communicate with editorial staff as early as possible.

Excellence in clinical practice through the evidence-based medicine.

“There is within medicine, somewhere beneath the pessimism and discouragement resulting from the disarray of the health care system and its stupendous cost, an undercurrent of almost outrageous optimism about what may lie ahead for the treatment of human disease if only we can keep learning” - Lewis Thomas (1) Traditionally, clinicians have been credited with clinical wisdom according to their skills in making a diagnosis and prescribing a treatment. The advent of major investments in biomedical research, leading to new and better tests and treatments, has spurred the development of critical appraisal of the medical literature and evidence-based medicine (2), and application of current best evidence from healthcare research is now an expected adjunct to clinical wisdom. Evidence-based medicine, whose philosophical origins extend back to mid-19th century Paris and earlier, is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (3). The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. Evidence-based medicine initially focused mainly on determining the best research evidence relevant to a clinical problem or decision and applying that evidence to resolve the issue. Subsequent versions of evidence-based decision making have emphasized that research evidence alone is not an adequate guide to action. Rather, clinicians must apply their expertise to assess the patient's problem and must also incorporate the research evidence and the patient's preferences or values before making a management recommendation (4). Similar to other fields, specialists in the field of cardiovascular medicine are faced with the dilemma that many clinical questions in their daily practice to do not have universally agreed answers, but patients increasingly demand the ‘best practice’ from their doctors. In addition time pressures mean that clinicians are unable to keep up with the full spectrum of published research and current resources that collate evidence for clinicians. In our scrupulous scrutiny to provide up-to-date and practical data, our fully online and peer-reviewed journal, Research in Cardiovascular Medicine (RCVM), was founded in 2011. RCVM, the official journal of Rajaie Cardiovascular Medical and Research Center, is dedicated to the clinical and basic researches in the field of cardiovascular medicine. This authoritative medical journal publishes peer-reviewed articles on all aspects of cardiovascular disease, including original articles, systematic reviews, meta-analyses, narrative reviews, short articles, letters, case reports, and interesting images. This journal accepts the articles only from an online submission system. This online editorial system is prepared for manuscript submission, peer reviewing and tracking replications. Our system is customized with training and step-by-step tips in order to provide a very convenient service for authors, reviewers and editors. By available tracking service, authors can track the review process of their submitted manuscript. RCVM is an open-access journal, in order to provide appropriate updated scientific information in the field of cardiovascular medicine for the relevant readers, all around the world and is published in co-operation with Tehran University of Medical Sciences. I hope RCVM meet the high expectations of our readers by providing evidence based data in the field of cardiovascular medicine.

Molecular mechanisms underlying cardiac antihypertrophic and antifibrotic effects of natriuretic peptides

Natriuretic peptides (NPs) exert well-characterized protective effects on the cardiovascular system, such as vasorelaxation, natri- and diuresis, increase of endothelial permeability, and inhibition of renin-angiotensin-aldosterone system. It has been reported that they also possess antihypertrophic and antifibrotic properties and contribute actively to cardiac remodeling. As a consequence, they are involved in several aspects of cardiovascular diseases. Antihypertrophic and antifibrotic actions of NPs appear to be mediated by specific signaling pathways within a more complex cellular network. Elucidation of the molecular mechanisms underlying the effects of NPs on cardiac remodeling represents an important research objective in order to gain more insights on the complex network leading to cardiac hypertrophy, ventricular dysfunction, and transition to heart failure, and in the attempt to develop novel therapeutic agents. The aim of the present article is to review well-characterized molecular mechanisms underlying the antihypertrophic and antifibrotic effects of NPs in the heart that appear to be mainly mediated by guanylyl cyclase type A receptor. In particular, we discuss the calcineurin/NFAT, the sodium exchanger NHE-1, and the TGFβ1/Smad signaling pathways. The role of guanylyl cyclase type B receptor, along with the emerging functional significance of natriuretic peptide receptor type C as mediators of CNP antihypertrophic and antifibrotic actions in the heart are also considered.

Gender differences in cardiac rehabilitation programs from the Italian survey on cardiac rehabilitation (ISYDE-2008)

PurposeIn recent years epidemiological and clinical evidence has shown gender disparities in several aspects of cardiovascular disease. Aim of this study was to identify gender differences in the clinical profile and management of patients admitted to cardiac rehabilitation (CR) programs. PopulationPatients enrolled in the ISYDE-2008 survey were considered. ResultsThe ISYDE-2008 survey enrolled 2281 patients; 604 (26.5%) were women. Compared to men, women were older (mean age 70.8±11.5 versus men's 65.6±11.5years), had less traditional risk factors (low cardiovascular risk profile in 45.3% of women and 38.0% of men, p=0.003), were more frequently admitted after valvular surgery and heart failure, but less for post-acute myocardial infarction and post-by-pass procedure. Women were more frequently admitted to an in-hospital rehabilitation program.Women showed a more complicated acute and rehabilitative course, with 63.2% of them having at least one complication during acute-phase, compared to 52.5% of men, and 48.3% during rehabilitation, compared to 35.0% of men (p<0.0001). During rehabilitation, women underwent exercise tests less frequently, except for the 6-minute walking test. At discharge, women received ACE-inhibitors/ARBs, β-blockers, statins, omega-3 fatty acids, antiplatelet agents less frequently, but more frequently digoxin, amiodarone, diuretics, oral anticoagulants, insulin and anti-depressive drugs. The duration of the rehabilitation program was longer for women. Mortality was very low in the entire population. ConclusionsWomen are less frequently admitted to CR than men. They are older and show a greater cardiovascular burden. Women are more likely to be enrolled in CR after valvular surgery and heart failure than men.

Targeting Inflammation in Cardiovascular Diseases. Still a Neglected field?

Prevention and treatment of atherosclerosis is still a clinical challenge in the cardiovascular medicine. The classical belief that atherosclerotic lesion development solely depends on lipid deposition has been replaced by the current concept that activation of immune and inflammatory responses plays a central role in plaque initiation and progression. In this review we summarize studies on human and genetically modified animals describing a finite number of cellular and molecular mechanisms that underlie immunoinflammation in atherosclerotic plaques. We focus on the pro- and antiinflammatory mediators activated during atherogenesis and the intracellular signaling pathways regulating these events. Besides the advances on established pharmacological agents, we propose potential strategies for reduction/stabilization of atherosclerotic plaques based on the clinical data in inflammatory-associated pathologies and on the encouraging studies in experimental models of atherosclerosis. We emphasize the potential of such novel inhibitors comprising receptor antagonists, neutralizing antibodies, kinase inhibitors, peptide-based technologies, and chemicals as emerging antiinflammatory strategies for the treatment of atherosclerotic disease complications.

Lycopene and Cardiovascular Diseases: An Update

Cardiovascular disease (CVD) is the leading cause of death in Western societies and accounts for up to a third of all deaths worldwide. In comparison to the Northern European or other Western countries, the Mediterranean area has lower rates of mortality from cardiovascular diseases and cancer, and this is attributed, at least in part, to the so-called Mediterranean diet, which is rich in plantderived bioactive phytochemicals. Identification of the active constituents of the Mediterranean diet is therefore crucial to the formulation of appropriate dietary guidelines. Lycopene is a natural carotenoid found in tomato, an essential component of the Mediterranean diet, which, although belonging to the carotenoid family, does not have pro-vitamin A activity but many other biochemical functions as an antioxidant scavenger, hypolipaemic agent, inhibitor of pro-inflammatory and pro-thrombotic factors, thus potentially of benefit in CVD. In particular, the review intends to conduct a systematic analysis of the literature (epidemiological studies and interventional trials) in order to critically evaluate the association between lycopene (or tomato products) supplementation and cardiovascular diseases and/or cardiovascular disease risk factors progression, and to prepare provision of evidence-based guidelines for patients and clinicians. Several reports have appeared in support of the role of lycopene in the prevention of CVD, mostly based on epidemiological studies showing a dose-response relationship between lycopene and CVD. A less clear and more complex picture emerges from the interventional trials, where several works have reported conflicting results. Although many aspects of lycopene in vivo metabolism, functions and clinical indications remain to be clarified, supplementation of low doses of lycopene has been already suggested as a preventive measure for contrasting and ameliorating many aspects of CVD.

Giving and getting more: The Canadian Cardiovascular Society wants you!

Giving and getting more: The Canadian Cardiovascular Society wants you!

The Right Heart and Pulmonary Circulation: Is It Really a Minor Circulation?

Continued education has traditionally been considered to be of great importance in Revista Espanola de Cardiologia. The “Editorial,” “Review Article,” and “Update” sections are the usual means for transmitting to readers the opinions and points of view of experts of known prestige in the different aspects of cardiovascular disease. In the case of the Update section, over the years we have attempted to select areas of obvious interest to a large part of our readers that, not being the object of attention in more classical reviews, would otherwise be overlooked. Thus, the subjects we have attempted to address in a cross-cutting manner in recent years include: “Cardiovascular disease in women” (2006),1 “Non-coronary arterial disease” (2007),2 “Cardiovascular prevention” (2008),3 and “Cardiovascular translational medicine” (2009).4 The subject selected this year for in-depth evaluation, “The right heart and pulmonary circulation,” encompasses several aspects that are undoubtedly attractive. The first is its evident implication in the practice of cardiologists of all hues, whether general or specialized, ranging from those devoted to clinical activity to basic researchers. On the other hand, after decades of highly predominant attention to the left chambers of the heart and the systemic vessels, over the last 15 years we have been witnessing a progressive awareness of the importance of right ventricle (RV) dysfunction in different heart diseases,5 both in those cases in which this chamber plays the leading role in the condition (as in arrhythmogenic right ventricular dysplasia or certain congenital heart diseases) and in those in which it accompanies conditions involving the left heart chambers and valves, significantly modifying the clinical signs and prognosis. To paraphrase the title of a recent report, we now consider that “the left heart will only be able to work as much as the right heart lets it.”6 With respect to the pulmonary circulation, the past decade has witnessed important advances based on a more complete knowledge of the pathophysiology of the different forms of pulmonary hypertension, which has been expressed in a classification that is of evident practical utility, as well as an improved diagnostic approach and, what is more important, the possibility of employing treatments that are useful for the improvement of the symptoms and the prognosis of these patients. Therefore, this Update arrives just in time to help us learn about the latest findings, incorporate the diagnostic and therapeutic advances into our clinical practice and become aware of the uncertainties and gaps left by our current knowledge. The editors of Revista Espanola de Cardiologia can state with pride that among the authors who have agreed to contribute their knowledge to this series of monographs are the major world experts in this field. Approximately half of the reports are written by authors living in the United States, and half were submitted by specialists from different European countries.