Physio-pharmacological evaluation of myocardial performance: an integrative approach

Time for primary review 14 days. Despite major advances in the understanding of cardiovascular physiology and pathophysiology and the development of new therapies in the 20th century, cardiovascular disease is projected to become the leading overall cause of mortality worldwide within the next couple of decades 1. In the western world, an increasing proportion of older people in the population accounts for the lack of reduction in the absolute number of cardiovascular deaths, whereas in developing countries, part of the reason is the adoption of “western” lifestyles and their accompanying coronary risk factors as socioeconomic status gradually improves and mortality from infectious and other diseases of early life decrease. There remain significant gaps in our understanding of many aspects of cardiovascular diseases and the contribution of risk factors such as smoking, hypercholesterolaemia, hypertension and diabetes. In addition, increasing numbers of patients who survive ischaemic cardiac disorders develop heart failure. Traditionally, the focus of research into cardiovascular disease was the heart and myocardium, but in the last several decades, the importance of the vasculature and of other body systems has been better appreciated. The field of vascular biology has blossomed. Traditionally, investigators focused on mechanical function. However, in the last several decades, investigative approaches have broadened dramatically, ranging from molecular and cellular biology and physiology, to in vitro and in vivo studies in animal models of disease, to studies of individual human subjects, to population genetics and epidemiology. The methodologies available and their precision have altered out of all recognition compared to the approaches of 40–50 years ago. Within this context, the questions that are considered in this article are: How should myocardial performance best be assessed? What are the advantages and disadvantages of currently used methodologies? How far can and should reductionism be pursued? What is the relevance of … * Corresponding author. Tel.: +44 1222 742338; Fax: +44 1222 743500; E-mail: shaham2@cf.ac.uk