Kommentar zu den neuen Leitlinien (2012) der Europäischen Gesellschaft für Kardiologie zur kardiovaskulären Prävention

The new European guidelines on cardiovascular disease (CV) prevention are supported by nine medical societies. They have been restructured, are shorter and more readable. Each subchapter starts with key messages and recommendations are labelled with an evidence level. The subchapter ends with the most important newest information and persisting gaps of evidence for further research. The most important change is the categorization of cardiovascular risk in four levels: low (<1%), medium (1%-<5%), high (5%-<10%) and very high risk (>10%). All patients with CV disease are in the very high risk group with, e.g. a low-density lipoprotein (LDL) cholesterol goal of <70 mg/dl (<1.8 mmol/l). Treatment adherence and behavioral changes can best be achieved by motivational interviews which require some time. The physician has the responsibility for clear recommendations in the discharge summary after hospitalization and for offering help and feedback in the implementation phase of behavioral change.     

Current complications and challenges in nonalcoholic steatohepatitis screening and diagnosis

Nonalcoholic steatohepatitis (NASH) can lead to complications such as liver failure, cirrhosis and hepatocellular carcinoma. The diagnostic gold standard for NASH is liver biopsy; however, other noninvasive methods have been developed. In this article, the authors evaluate current methods in NASH screening and diagnosis. Routine radiologic modalities were found to detect hepatic steatosis accurately, but were unable to establish the diagnosis of NASH or stage of fibrosis. Newly developed elastography based techniques seem promising to estimate liver fibrosis. Other noninvasive tests such as FibroTest, ELF, Hepascore, FIB-4, NFS, FLI and ION (biochemical panels) have AUROCs ranging between 0.80–0.98 for detecting advanced fibrosis but lack specificity for detecting mild fibrosis. Noninvasive tools, especially elastography, identify NASH associated advanced fibrosis potentially reducing liver biopsies. More research is needed to validate the clinical utility of these tests.     

Bovine Model of Chronic Ischemic Cardiomyopathy: Implications for Ventricular Assist Device Research

Ventricular assist devices (VADs) have emerged as a successful treatment option for advanced heart failure. The objective of this study was to develop a clinically relevant model of chronic ischemic cardiomyopathy to investigate functional, histological, and molecular changes during mechanical circulatory support. In calves (n = 17, 94 ± 7 kg), 90 μm microspheres were injected percutaneously into the left coronary artery. Serial echocardiography was performed weekly to evaluate cardiac function. Sixty days after coronary microembolization, a terminal study was performed via thoracotomy to measure hemodynamics. Regional myocardial and end‐organ blood flows were quantified with 15‐μm fluorescent‐labeled microspheres. Myocardial fibrosis, myocyte size, and myocardial apoptosis were quantified with histological stains. Eleven animals survived coronary microembolization and exhibited clinical and statistically significant echocardiographic and hemodynamic signs of severe systolic dysfunction. Statistically significant decreases in regional myocardial blood flow and increases in myocardial fibrosis, myocyte size, total myocardial apoptosis, and cardiac myocyte‐specific apoptosis were observed. End‐organ hypoperfusion was observed. Coronary microembolization induced stable and reproducible chronic left ventricular failure in calves. The anatomical size and physiology of the bovine heart and thorax are appropriate to study novel interventions for the clinical management of heart failure. This model is an appropriate physiological substrate in which to test VAD and adjunctive biological therapies.