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Welcome to European Cardiology. Looking back on the developments that have left their mark on cardiology during the years I have been involved in the discipline, several breakthrough therapies and techniques immediately come to mind. In the early 1990s, I was impressed by the considerable progress achieved in the pharmacological treatment of heart failure, with the paradigm shift regarding the use of beta-blockers and the introduction of angiotensin-converting enzyme inhibitors.

Subsequent non-pharmacological therapies such as implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death and the concept of cardiac resynchronisation therapy (CRT) in selected patients kept my interest up. In invasive cardiology, the largest impact was made by primary percutaneous coronary intervention as the preferred strategy in acute coronary syndromes and the introduction of drug-eluting stents.

So far, the new millennium has seen some rapid progress in cardiac imaging modalities. Cardiac magnetic resonance has set the standard in various applications; multi-slice computed tomography non-invasively delivers incredible pictures of coronary arteries with relatively low exposure to radiation; 3D echocardiography has improved the understanding of, and eased the communication concerning, cardiac pathologies, especially valve disease, and has become almost indispensable for non-coronary interventions in the cath lab. Speaking of the latter, transcatheter aortic valve implantation has clearly been the most recent spectacular development; and transcatheter mitral valve therapies, including the implantation of a MitraClip device, are hot on its heels. In electrophysiology, pulmonary vein ablation has established itself as an interventional treatment option in atrial fibrillation.

We have progressively succeeded in treating myocardial infarction, hypertension and heart failure. Today, we are faced either with new issues or known problems ocurring at enhanced levels. For example, aortic stenosis in the elderly is diagnosed more frequently and we are now able to treat it even in patients formerly deemed untreatable. ICDs and CRT devices have to be looked after and also replaced in large numbers, which can barely be achieved even by large outpatient clinics. Moreover, medical progress and the associated ageing of the population pose an enormous economic problem to the healthcare systems worldwide. The accurate prediction of outcomes and careful selection of patients for new and expensive therapies based on appropriate imaging techniques, or perhaps on new technologies such as telemedicine, might help to overcome some of these problems.

This issue of European Cardiology aims to provide expert reviews of some of the most pertinent developments in many of the aforementioned fields in cardiology. While we have made great progress, it is clear that many exciting times still lie ahead. Enjoy your reading.