Risk factors for and management of heart failure

Download the Issue @ a Glance podcast Subscribe to the EHJ Podcast ![Graphic][1] Heart failure is the final common pathway of many cardiovascular risk factors and of most forms of heart disease. Myocardial ischaemia and reperfusion with evolving oxidative stress,1 either as repetitive episodes during increased demand or as a cause of myocardial infarction leading to scar formation and ventricular remodelling, is the most common form of this syndrome. Furthermore, different forms of myocardial disease either due to genetic causes2 or acquired in response to risk factors such as hypertension3,4 and/or diabetes5 are also of importance. Finally, congenital heart disease, either in the young or in adults, often leads to pump failure and death.6 This issue begins with a Current Opinion article entitled ‘ Should extensive myocardial ischaemia prompt revascularization in chronic coronary disease? ’ by Raymond J. Gibbons from the Mayo Clinic in Rochester, MN, USA.7 Although stress-induced ischaemia was widely accepted in clinical decision-making for patients with coronary artery disease at the end of the 20th century, more recent trials on stress imaging and subanalysis thereof have raised concerns about the validity of this approach. The authors reviewed the three large clinical trials of coronary artery bypass surgery performed in the 1970s, as well as the landmark literature regarding stress imaging from the same era, to identify the best evidence supporting the utility of stress-induced ischaemia, as reflected in early clinical practice guidelines. They then examined the new evidence from contemporary trials in the 21st century, as well as the associated substudies focusing on stress imaging. Some of them have raised concerns about this dogma, and the impact of this new evidence on current clinical practice guidelines and appropriate use criteria. They identified multiple internal and external inconsistencies in current clinical … [1]: /embed/inline-graphic-1.gif