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Mi CH, Qi XY, Zhou YW, Ding YW, Wei DX, Wang Y. Advances in medical polyesters for vascular tissue engineering. DISCOVER NANO 2024; 19:125. [PMID: 39115796 PMCID: PMC11310390 DOI: 10.1186/s11671-024-04073-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/25/2024] [Indexed: 08/11/2024]
Abstract
Blood vessels are highly dynamic and complex structures with a variety of physiological functions, including the transport of oxygen, nutrients, and metabolic wastes. Their normal functioning involves the close and coordinated cooperation of a variety of cells. However, adverse internal and external environmental factors can lead to vascular damage and the induction of various vascular diseases, including atherosclerosis and thrombosis. This can have serious consequences for patients, and there is an urgent need for innovative techniques to repair damaged blood vessels. Polyesters have been extensively researched and used in the treatment of vascular disease and repair of blood vessels due to their excellent mechanical properties, adjustable biodegradation time, and excellent biocompatibility. Given the high complexity of vascular tissues, it is still challenging to optimize the utilization of polyesters for repairing damaged blood vessels. Nevertheless, they have considerable potential for vascular tissue engineering in a range of applications. This summary reviews the physicochemical properties of polyhydroxyalkanoate (PHA), polycaprolactone (PCL), poly-lactic acid (PLA), and poly(lactide-co-glycolide) (PLGA), focusing on their unique applications in vascular tissue engineering. Polyesters can be prepared not only as 3D scaffolds to repair damage as an alternative to vascular grafts, but also in various forms such as microspheres, fibrous membranes, and nanoparticles to deliver drugs or bioactive ingredients to damaged vessels. Finally, it is anticipated that further developments in polyesters will occur in the near future, with the potential to facilitate the wider application of these materials in vascular tissue engineering.
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Affiliation(s)
- Chen-Hui Mi
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Department of Life Sciences and Medicine, Northwest University, Xi'an, 710069, China
| | - Xin-Ya Qi
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Department of Life Sciences and Medicine, Northwest University, Xi'an, 710069, China
| | - Yan-Wen Zhou
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Department of Life Sciences and Medicine, Northwest University, Xi'an, 710069, China
| | - Yan-Wen Ding
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Department of Life Sciences and Medicine, Northwest University, Xi'an, 710069, China
| | - Dai-Xu Wei
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Department of Life Sciences and Medicine, Northwest University, Xi'an, 710069, China.
- School of Clinical Medicine, Chengdu University, Chengdu, China.
- Shaanxi Key Laboratory for Carbon-Neutral Technology, Xi'an, 710069, China.
| | - Yong Wang
- Department of Interventional Radiology and Vascular Surgery, Second Affiliated Hospital of Hainan Medical University, Haikou, China.
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Wu Z, Chen C, Zhang B, Tang L, Shi W, Liao D, Di G, Davis JR, Wang H. EGFP-EGF1-conjugated poly(lactic-co-glycolic acid) nanoparticles, a new diagnostic tool and drug carrier for atherosclerosis. Int J Nanomedicine 2019; 14:2609-2618. [PMID: 31043777 PMCID: PMC6469482 DOI: 10.2147/ijn.s199695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background EGFP-EGF1-conjugated poly(lactic-co-glycolic acid) (PLGA) nanoparticle (ENP) has a specific affinity to tissue factor (TF). The aim of this study was to investigate the target delivery of ENP to plaques and its uptake in a mouse model of atherosclerosis in vivo and in vitro. Materials and methods Coumarin-6- and 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindotricarbo cyanine iodide (DiR)-loaded ENPs were synthesized using a double-emulsion method. Mouse vascular smooth muscle cells (VSMCs) were induced with MCP-1 to obtain an increased TF expression. Fluorescence microscopy and flow cytometry assay were performed to examine the uptake of coumarin-6-loaded ENPs in cellular models. An animal model of atherosclerosis was established with an ApoE (−/−) mouse fed with continuous high-fat diets for 14 weeks. DiR-loaded ENPs (DiR-ENPs) were injected via the caudal vein. The distribution of DiR-ENPs was examined through organ imaging and confocal laser scanning microscopy. Results Results indicated TFs were highly expressed in the cellular model. The uptake of coumarin-6-loaded ENPs was significantly higher than that of common PLGA nanoparticles. Thickening of intima and lipid deposition in the aorta could be observed in atherosclerosis mouse models. Confocal laser scanning microscopy organ imaging showed ENPs accumulated in vessels with atherosclerotic plaques, which coincided with high expressions of TF. Conclusion This study showed that EGFP-EGF1-conjugated PLGA nanoparticles could be effectively delivered to atherosclerotic plaques in vivo and taken up by VSMCs with high TF expressions in vitro. Thus, it could be a promising carrier for targeted therapy of atherosclerosis.
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Affiliation(s)
- Zhilin Wu
- Anesthesiology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China,
| | - Chen Chen
- Anesthesiology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China,
| | - Bo Zhang
- Haematology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Liang Tang
- Haematology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Wei Shi
- Haematology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Danying Liao
- Haematology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Gaohong Di
- Anesthesiology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China,
| | - Jacques Rj Davis
- Anesthesiology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China,
| | - Hui Wang
- Anesthesiology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China,
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Raggi P, Baldassarre D, Day S, de Groot E, Fayad Z. Non-invasive imaging of atherosclerosis regression with magnetic resonance to guide drug development. Atherosclerosis 2016; 251:476-482. [DOI: 10.1016/j.atherosclerosis.2016.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 12/17/2022]
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Apostolakis IZ, Nandlall SD, Konofagou EE. Piecewise Pulse Wave Imaging (pPWI) for Detection and Monitoring of Focal Vascular Disease in Murine Aortas and Carotids In Vivo. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:13-28. [PMID: 26168432 PMCID: PMC4703464 DOI: 10.1109/tmi.2015.2453194] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Atherosclerosis and Abdominal Aortic Aneurysms (AAAs) are two common vascular diseases associated with mechanical changes in the arterial wall. Pulse Wave Imaging (PWI), a technique developed by our group to assess and quantify the mechanical properties of the aortic wall in vivo, may provide valuable diagnostic information. This work implements piecewise PWI (pPWI), an enhanced version of PWI designed for focal vascular diseases. Localized, sub-regional PWVs and PWI moduli ( EPWI ) were estimated within 2-4 mm wall segments of murine normal, atherosclerotic and aneurysmal arteries. Overall, stiffness was found to increase in the atherosclerotic cases. The mean sub-regional PWV was found to be 2.57±0.18 m/s for the normal aortas (n = 7) with a corresponding mean EPWI of 43.82±5.86 kPa. A significant increase ( (p ≤ 0.001)) in the group means of the sub-regional PWVs was found between the normal aortas and the aortas of mice on high-fat diet for 20 ( 3.30±0.36 m/s) and 30 weeks ( 3.56±0.29 m/s). The mean of the sub-regional PWVs ( 1.57±0.78 m/s) and EPWI values ( 19.23±15.47 kPa) decreased significantly in the aneurysmal aortas (p ≤ 0.05) . Furthermore, the mean coefficient of determination (r(2)) of the normal aortas was significantly higher (p ≤ 0.05) than those of the aneurysmal and atherosclerotic cases. These findings demonstrated that pPWI may be able to provide useful biomarkers for monitoring focal vascular diseases.
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Affiliation(s)
| | - Sacha D. Nandlall
- Department of Biomedical Engineering Columbia University, New York, NY 10027 USA
| | - Elisa E. Konofagou
- Departments of Biomedical Engineering and Radiology, Columbia University, New York, NY 10027 USA ()
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Toepperwein MA, Pruski LA, Blalock CL, Lemelle OR, Lichtenstein MJ. Getting the Word Out: Teaching Middle-School Children about Cardiovascular Disease. J Clin Lipidol 2012; 2:179-88. [PMID: 19122871 DOI: 10.1016/j.jacl.2008.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cardiovascular disease (CVD) has roots in childhood; since CVD begins early, a clear strong case for early education focused on CVD primary prevention exists. Scientists are not traditionally involved in disseminating health knowledge into public education. Similarly, public school teachers typically do not have access to biomedical research that may increase their students' health science literacy. One way to bridge the 'cultural' gap between researchers and school teachers is to form science education partnerships. In order for such partnerships to be successful, teams of scientists and teachers must 'translate' biomedical research into plain language appropriate for students.In this article, we briefly review the need for improving health literacy, especially through school-based programs, and describe work with one model scientist/teacher partnership, the Teacher Enrichment Initiatives. Examples of cardiovascular research 'translated' into plain language lessons for middle school students are provided and practical considerations for researchers pursuing a science education partnership are delineated.
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Affiliation(s)
- Mary Anne Toepperwein
- Barshop Institute for Longevity and Aging Studies, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, Telephone: 210-567-4398
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Shiga Y, Miura SI, Nishikawa H, Nakamura A, Arimura T, Mitsutake R, Iwata A, Saku K. Regression of coronary plaque after coronary artery bypass graft. J Cardiol Cases 2012; 5:e92-e95. [PMID: 30532913 DOI: 10.1016/j.jccase.2012.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 11/18/2011] [Accepted: 01/04/2012] [Indexed: 11/17/2022] Open
Abstract
A 62-year-old woman complained of sudden chest pain and 64-multidetector row computed tomography (MDCT) was performed. The volume-rendered image showed severe stenosis of the left main coronary trunk artery (LMT). The mean density of the plaque was 32.4 hounsfield units (HU), which indicated soft plaque. Coronary angiography (CAG) showed significant focal stenosis of the LMT. Since the patient had experienced chest pain, and since focal stenosis of the LMT was demonstrated, lipid-lowering therapy using statin and coronary artery bypass graft (CABG, right internal mammary artery-left anterior descending branch, left internal mammary artery-obtuse marginal branch) were applied. Three years after treatment, 64-MDCT showed mild stenosis and a regression of plaque in the LMT. The mean density of the plaque was 73.1 HU (intermediate plaque). CAG showed a degradation of CABG flow, in addition to mild stenosis of the LMT. In conclusion, lipid-lowering therapy with statins may stabilize soft coronary plaque. In addition, non-invasive MDCT is a useful tool for diagnosing coronary artery disease, and for evaluating the size and properties of coronary plaque.
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Affiliation(s)
- Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroaki Nishikawa
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ayumi Nakamura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ryoko Mitsutake
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
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Techniques for Phenotyping Coronary Artery Disease in the Cardiac Catheterization Laboratory for Applications in Translational Research. J Cardiovasc Transl Res 2011; 4:385-92. [DOI: 10.1007/s12265-011-9274-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 03/11/2011] [Indexed: 10/18/2022]
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Oshinski JN, Delfino JG, Sharma P, Gharib AM, Pettigrew RI. Cardiovascular magnetic resonance at 3.0 T: current state of the art. J Cardiovasc Magn Reson 2010; 12:55. [PMID: 20929538 PMCID: PMC2964699 DOI: 10.1186/1532-429x-12-55] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 10/07/2010] [Indexed: 12/12/2022] Open
Abstract
There are advantages to conducting cardiovascular magnetic resonance (CMR) studies at a field strength of 3.0 Telsa, including the increase in bulk magnetization, the increase in frequency separation of off-resonance spins, and the increase in T1 of many tissues. However, there are significant challenges to routinely performing CMR at 3.0 T, including the reduction in main magnetic field homogeneity, the increase in RF power deposition, and the increase in susceptibility-based artifacts.In this review, we outline the underlying physical effects that occur when imaging at higher fields, examine the practical results these effects have on the CMR applications, and examine methods used to compensate for these effects. Specifically, we will review cine imaging, MR coronary angiography, myocardial perfusion imaging, late gadolinium enhancement, and vascular wall imaging.
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Affiliation(s)
- John N Oshinski
- Department of Radiology, Emory University School of Medicine, 1364 Clifton Road, Room AG34, Atlanta, GA 30322, USA
- Department of Biomedical Engineering, Emory University and the Georgia Institute of Technology, 101 Woodruff Circle Woodruff Memorial Building, Suite 2001, Atlanta, Georgia 30322, USA
| | - Jana G Delfino
- Department of Radiology, Emory University School of Medicine, 1364 Clifton Road, Room AG34, Atlanta, GA 30322, USA
| | - Puneet Sharma
- Department of Radiology, Emory University School of Medicine, 1364 Clifton Road, Room AG34, Atlanta, GA 30322, USA
| | - Ahmed M Gharib
- Laboratory of Integrative Cardiovascular Imaging, Department of Radiology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Clinical Research Center, Bldg. 10, Rm. 3-5340, MSC 1263, 10 Center Dr., Bethesda, MD 20892, USA
| | - Roderic I Pettigrew
- Laboratory of Integrative Cardiovascular Imaging, Department of Radiology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Clinical Research Center, Bldg. 10, Rm. 3-5340, MSC 1263, 10 Center Dr., Bethesda, MD 20892, USA
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Thompson JB, Blaha M, Resar JR, Blumenthal RS, Desai MY. Strategies to reverse atherosclerosis: an imaging perspective. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2010; 10:283-93. [PMID: 18647584 DOI: 10.1007/s11936-008-0049-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Several treatment strategies, including lowering low-density lipoprotein cholesterol with intensive statin therapy, reducing triglycerides with fibrates, and raising high-density lipoprotein cholesterol with nicotinic acid, have the potential to induce atherosclerosis regression. Atherosclerosis imaging techniques including intravascular ultrasound, carotid ultrasound to measure carotid intima-media thickness, and cardiovascular MRI are established modalities for describing longitudinal changes in the quantity and quality of atherosclerotic plaque. An increasing number of clinical trials are using radiologic measures of subclinical atherosclerosis as surrogate end points in lieu of the traditional "hard" end points of myocardial infarction and death. This approach has great appeal, as improvements in atherosclerosis imaging now enable the characterization of early atheromas and positive remodeling within the vessel wall before the plaque becomes obstructive. Additional prospective data correlating these surrogate end points with hard outcomes are needed to determine whether atherosclerosis regression will be the major determinant of future treatment strategies.
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Affiliation(s)
- Jason B Thompson
- Division of Cardiology, The Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie 568, Baltimore, MD 21287, USA.
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Bauer M, Möhlenkamp S, Lehmann N, Schmermund A, Roggenbuck U, Moebus S, Stang A, Mann K, Jöckel KH, Erbel R. The effect of age and risk factors on coronary and carotid artery atherosclerotic burden in males—Results of the Heinz Nixdorf Recall Study. Atherosclerosis 2009; 205:595-602. [DOI: 10.1016/j.atherosclerosis.2009.01.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 12/22/2008] [Accepted: 01/05/2009] [Indexed: 01/01/2023]
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Schanberg LE, Sandborg C, Barnhart HX, Ardoin SP, Yow E, Evans GW, Mieszkalski KL, Ilowite NT, Eberhard A, Levy DM, Kimura Y, von Scheven E, Silverman E, Bowyer SL, Punaro L, Singer NG, Sherry DD, McCurdy D, Klein-Gitelman M, Wallace C, Silver R, Wagner-Weiner L, Higgins GC, Brunner HI, Jung L, Soep JB, Reed A. Premature atherosclerosis in pediatric systemic lupus erythematosus: risk factors for increased carotid intima-media thickness in the atherosclerosis prevention in pediatric lupus erythematosus cohort. ACTA ACUST UNITED AC 2009; 60:1496-507. [PMID: 19404953 DOI: 10.1002/art.24469] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate risk factors for subclinical atherosclerosis in a population of patients with pediatric systemic lupus erythematosus (SLE). METHODS In a prospective multicenter study, a cohort of 221 patients underwent baseline measurements of carotid intima-media thickness (CIMT) as part of the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) trial. SLE disease measures, medications, and traditional risk factors for atherosclerosis were assessed. A standardized protocol was used to assess the thickness of the bilateral common carotid arteries and the mean maximal IMT of 12 segments. Univariable analysis identified potential associations with CIMT, which were examined in multivariable linear regression modeling. RESULTS Based on the mean-mean common or the mean-max CIMT as the dependent variable, univariable analysis showed significant associations of the following variables with increased CIMT: increasing age, longer SLE duration, minority status, higher body mass index (BMI), male sex, increased creatinine clearance, higher lipoprotein(a) level, proteinuria, azathioprine treatment, and prednisone dose. In multivariable modeling, both azathioprine use (P=0.005 for the mean-mean model and P=0.102 for the mean-max model) and male sex (P<0.001) were associated with increases in the mean-max CIMT. A moderate dosage of prednisone (0.15-0.4 mg/kg/day) was associated with decreases in the mean-max CIMT (P=0.024), while high-dose and low-dose prednisone were associated with increases in the mean-mean common CIMT (P=0.021) and the mean-max CIMT (P=0.064), respectively. BMI (P<0.001) and creatinine clearance (P=0.031) remained associated with increased mean-mean common CIMT, while increasing age (P<0.001) and increasing lipoprotein(a) level (P=0.005) were associated with increased mean-max CIMT. CONCLUSION Traditional as well as nontraditional risk factors were associated with increased CIMT in this cohort of patients in the APPLE trial. Azathioprine treatment was associated with increased CIMT. The relationship between CIMT and prednisone dose may not be linear.
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Chen SN, Ballantyne CM, Gotto AM, Marian AJ. The 9p21 susceptibility locus for coronary artery disease and the severity of coronary atherosclerosis. BMC Cardiovasc Disord 2009; 9:3. [PMID: 19173706 PMCID: PMC2637231 DOI: 10.1186/1471-2261-9-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 01/27/2009] [Indexed: 12/25/2022] Open
Abstract
Background Case-control Genome-Wide Association Studies (GWAS) have identified single nucleotide polymorphisms (SNPs) at the 9p21 locus as risk factors for coronary artery disease (CAD). The locus does not contain a clear candidate gene. Hence, the results of GWAS have raised an intense interest in delineating the basis for the observed association. We analyzed association of 4 SNPs at the 9p21 locus with the severity and progression of coronary atherosclerosis, as determined by serial quantitative coronary angiograms (QCA) in the well-characterized Lipoprotein Coronary Atherosclerosis Study (LCAS) population. The LCAS is a randomized placebo-control longitudinal follow-up study in patients with CAD conducted to test the effects of fluvastatin on progression or regression of coronary atherosclerosis. Methods Extensive plasma lipid levels were measured at the baseline and 2 1/2 years after randomization. Likewise serial QCA was performed at the baseline and upon completion of the study. We genotyped the population for 4 SNPs, previously identified as the susceptibility SNPs for CAD in GWAS, using fluorogenic 5' nuclease assays. We reconstructed the haplotypes using Phase 2, analyzed SNP and haplotype effects using the Thesias software as well as by the conventional statistical methods. Results Only Caucasians were included since they comprised 90% of the study population (332/371 with available DNA sample). The 4 SNPs at the 9p21 locus were in tight linkage disequilibrium, leading to 3 common haplotypes in the LCAS population. We found no significant association between quantitative indices of severity of coronary atherosclerosis, such as minimal lumen diameter and number of coronary lesions or occlusions and the 9p21 SNPs and haplotypes. Likewise, there was no association between quantitative indices of progression of coronary atherosclerosis and the SNPs or haplotypes. Similarly, we found no significant SNP or haplotype effect on severity and progression of coronary atherosclerosis. Conclusion We conclude the 4 SNPs at the 9p21 locus analyzed in this study do not impart major effects on the severity or progression of coronary atherosclerosis. The effect size may be very modest or the observed association of the CAD with SNPs at the 9p21 locus in the case-control GWAS reflect involvement of vascular mechanisms not directly related to the severity or progression of coronary atherosclerosis.
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Affiliation(s)
- Suet Nee Chen
- Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, and Texas Heart Institute, Houston, TX 77030, USA.
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Oudkerk M, Stillman AE, Halliburton SS, Kalender WA, Möhlenkamp S, McCollough CH, Vliegenthart R, Shaw LJ, Stanford W, Taylor AJ, van Ooijen PMA, Wexler L, Raggi P. Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging. Eur Radiol 2008; 18:2785-807. [DOI: 10.1007/s00330-008-1095-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 05/05/2008] [Accepted: 05/19/2008] [Indexed: 01/07/2023]
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Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging. Int J Cardiovasc Imaging 2008; 24:645-71. [PMID: 18504647 PMCID: PMC2493606 DOI: 10.1007/s10554-008-9319-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 05/06/2008] [Indexed: 01/07/2023]
Abstract
Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multi-detector CT is discussed.
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Erbel R, Möhlenkamp S, Jöckel KH, Lehmann N, Moebus S, Hoffmann B, Schmermund A, Stang A, Siegrist J, Dragano N, Grönemeyer D, Seibel R, Mann K, Bröcker-Preuss M, Kröger K, Volbracht L. Cardiovascular risk factors and signs of subclinical atherosclerosis in the Heinz Nixdorf Recall Study. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:1-8. [PMID: 19578446 DOI: 10.3238/arztebl.2008.0001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 08/07/2007] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Modern investigation modalities allow markers of atherosclerosis to be detected at a subclinical stage. The aim of the study was to analyze the prevalence of these markers in relation to traditional risk factors. METHODS The population based study included 4814 participants, aged 45 to 75 years, with a response rate of 55.8% of those contacted. The patients' history, psychosocial and environmental risk factors were assessed. RESULTS The prevalence of obesity was 26.2% in men and 28.1% in women, 26% of men and 21% of women were smokers. Hypertension was found in 46% of men and 31% of women, diabetes in 9.3% of men and 6.3% of women. Markers of subclinical peripheral arterial disease were found in 6.4% of men and 5.1% of women, of subclinical carotid artery disease in 43.2% and 30.7%, and of subclinical coronary artery calcification in 82.3% and 55.2%, respectively. The prevalence of coronary calcification measured using an Agatston Score >100 was in 40% in men and 15% in women, using a score >400, 16.8% and 4.5%, respectively. DISCUSSION A high prevalence of subclinical atherosclerosis was found in the older population. The follow-up period will demonstrate whether the detection of markers of subclinical atherosclerosis will improve risk stratification beyond that offered by traditional risk factors.
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Affiliation(s)
- Raimund Erbel
- Klinik für Kardiologie,Westdeutsches Herzzentrum, Universitätsklinikum Essen,Universität Duisburg-Essen, Hufelandstrasse 55, Essen, Germany.
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Abstract
Atherosclerosis is a prevalent disease affecting millions of Americans. Despite our advances in diagnosis and treatment, atherosclerosis is the leading cause of death in America. High-resolution magnetic resonance imaging has overcome the limitations of current angiographic techniques and has emerged as a leading noninvasive imaging modality for atherosclerotic disease. Atherosclerosis of the arterial wall of the human carotid, aortic, peripheral and coronary arteries have all been successfully evaluated. In addition, the power of magnetic resonance imaging to differentiate the major components of atherosclerotic plaque has been validated. The ability to image the vessel wall and risk stratify atherosclerotic plaque will create management decisions not previously faced, and has the potential to change the way atherosclerosis is treated.
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Affiliation(s)
- Christopher M Kramer
- University of Virginia Health System, Department of Medicine, Lee Street, Box 800170, Charlottesville, VA 22908, USA.
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Gotto AM, Farmer JA. Atherosclerosis: Pathogenesis, Morphology, and Risk Factors. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hartmann M, von Birgelen C, Mintz GS, van Houwelingen GK, Eggebrecht H, Böse D, Wieneke H, Verhorst PMJ, Erbel R. Relation between plaque progression and low-density lipoprotein cholesterol during aging as assessed with serial long-term (> or =12 months) follow-up intravascular ultrasound of the left main coronary artery. Am J Cardiol 2006; 98:1419-23. [PMID: 17126642 DOI: 10.1016/j.amjcard.2006.06.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 06/20/2006] [Accepted: 06/20/2006] [Indexed: 11/29/2022]
Abstract
Because of the clinical benefit of lipid lowering in older patients, we hypothesized that the relation between low-density lipoprotein (LDL) cholesterol serum levels and coronary plaque progression may persist throughout aging. We analyzed serial intravascular ultrasound (IVUS) data of 60 left main stems (18 +/- 9 months apart) and evaluated the relation between LDL cholesterol levels and coronary plaque progression at different ages. The population (n = 60) was divided into 3 groups according to age: tertile 1 (n = 20) was a mean age of 48 +/- 6 years (median 51, range 33 to 55), tertile 2 (n = 20) was a mean age of 58 +/- 2 years (median 59, range 55 to 61), and tertile 3 (n = 20) was a mean age of 66 +/- 6 years (median 65, range 61 to 83). Between groups, there was no significant difference in non-age-related demographics, clinical data, lipid profiles, or medications (e.g., statins). There was a positive linear relation between LDL cholesterol and annual changes in plaque plus media area in all age tertiles, which was statistically significant in tertiles 2 and 3 (r = 0.56, p <0.01; r = 0.50, p <0.02) and showed a strong trend in tertile 1 (r = 0.41, p = 0.07). The estimated LDL cholesterol thresholds, which, as determined by regression analysis, would correspond to no plaque progression, were 74, 60, and 78 mg/dl, respectively, in tertiles 1, 2, and 3. In conclusion, serial IVUS data in left main coronary arteries suggest that the relation between LDL cholesterol serum levels and plaque progression persists during aging.
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Affiliation(s)
- Marc Hartmann
- The Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
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19
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Dumont D, Behler RH, Nichols TC, Merricks EP, Gallippi CM. ARFI imaging for noninvasive material characterization of atherosclerosis. ULTRASOUND IN MEDICINE & BIOLOGY 2006; 32:1703-11. [PMID: 17112956 DOI: 10.1016/j.ultrasmedbio.2006.07.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 06/22/2006] [Accepted: 07/11/2006] [Indexed: 05/12/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the United States, with 70% of CVD mortalities the result of sequelae of atherosclerosis. An urgent need for enhanced delineation of vulnerable plaques has catalyzed the development of novel atherosclerosis imaging strategies that use X-ray computed tomography, magnetic resonance and ultrasound modalities. As suggested by the pathophysiology of plaque development and progression to vulnerability, insight to the focal material, i.e., mechanical, properties of arterial walls and plaques may enhance atherosclerosis characterization. We present acoustic radiation force impulse (ARFI) ultrasound in application to mechanically characterizing a raised focal atherosclerotic plaque in an iliac artery extracted from a relevant pig model. ARFI results are correlated to matched immunohistochemistry, indicating elastin and collagen composition. In regions of degraded elastin, slower recovery rates from peak ARFI-induced displacements were observed. In regions of collagen deposition, lower ARFI-induced displacements were achieved. This work demonstrates ARFI for characterizing the material nature of an atherosclerotic plaque.
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Affiliation(s)
- Douglas Dumont
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
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20
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Abstract
Early and accurate diagnostic testing is a critical factor in the detection and optimal management of coronary artery disease (CAD); thus, noninvasive cardiac imaging has become a central tool for CAD evaluation. Currently, tests used for evaluating CAD include conventional resting and stress electrocardiogram, echocardiography, and myocardial perfusion imaging--the most widely used imaging test for evaluation of suspected myocardial ischemia. Emerging techniques for noninvasive assessment of myocardial perfusion and coronary angiography include cardiac computed tomography, cardiac magnetic resonance imaging, and positron emission tomography. The distinctive pathophysiology of atherosclerosis can be used together with imaging techniques to diagnose and assess risk for CAD. Imaging modalities for cardiac risk stratification include a diverse array of tools, such as noninvasive tests that visualize presymptomatic atherosclerosis to sophisticated radionuclide protocols that identify myocardial viability. Of the noninvasive imaging tests, gated SPECT is the most accurate method for risk stratification of CAD. Myocardial perfusion imaging with SPECT has improved accuracy and image quality such that a shift from diagnostic to prognostic use has occurred. Radionuclide myocardial perfusion imaging has played an important role in CAD evaluation since the introduction of thallium-201 (Tl-201) in the 1970s. Although Tl-201 has high sensitivity, specificity, and reproducibility, it also has physical properties that limit its use and affect image quality. Currently, Tc-99m tetrofosmin and sestamibi are the most commonly used agents for a variety of resting and stress protocols, both have similar diagnostic accuracy profiles. The field of nuclear cardiology has grown steadily over the past few decades, as more practitioners recognize its clinical applications and value in managing cardiovascular disease. There is abroad spectrum of noninvasive and invasive testing available for the diagnosis and management of patients with cardiovascular disease. Advances in computer technology have made sophisticated devices, such as the gated SPECT, a routine part of cardiology.
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Affiliation(s)
- D Douglas Miller
- Medical College of Georgia School of Medicine, Medical College of Georgia, Augusta, GA 30912, USA.
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Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, Guerci AD, Lima JAC, Rader DJ, Rubin GD, Shaw LJ, Wiegers SE. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 2006; 114:1761-91. [PMID: 17015792 DOI: 10.1161/circulationaha.106.178458] [Citation(s) in RCA: 998] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Johnson KM, Dowe DA, Catanzano TM, Brink JA. Regression of Coronary Atherosclerotic Plaque as Shown by CT Arteriography. AJR Am J Roentgenol 2006; 187:W241. [PMID: 16861524 DOI: 10.2214/ajr.05.2070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Sirtori CR, Fumagalli R. LDL-cholesterol lowering or HDL-cholesterol raising for cardiovascular prevention. Atherosclerosis 2006; 186:1-11. [PMID: 16310198 DOI: 10.1016/j.atherosclerosis.2005.10.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 10/05/2005] [Accepted: 10/13/2005] [Indexed: 10/25/2022]
Abstract
A number of reports have indicated that both lowering low density lipoprotein (LDL)-cholesterol and raising high density lipoprotein (HDL)-cholesterol can result in significant cardiovascular benefit, both in terms of reduction of events and also, to a variable extent, of atheromatous lesions. LDL and HDL have opposite roles in body cholesterol regulation and, in theory, both reduced deposition (LDL reduction) and increased removal (raised HDL) can improve vascular disease. A number of reports over the last 30 years have attempted to quantitate with cholesterol balance/turnover studies, the correlations between LDL and HDL levels and body cholesterol pool sizes. More recently, these studies have evaluated the effects of LDL or HDL changes on cholesterol elimination. Data have, at times, been fully consistent with theoretical expectations, whereas at others they have not. Evaluation of these, at times, historical data provides, however, an important clue to the understanding of current results with different medications for the management of lipoprotein disorders.
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Affiliation(s)
- Cesare R Sirtori
- Department of Pharmacological Sciences, University of Milano, Via Balzaretti, 20133 Milano, Italy.
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Hinton DP, Cury RC, Chan RC, Wald LL, Sherwood JB, Furie KL, Pitts JT, Schmitt F. Bright and black blood imaging of the carotid bifurcation at 3.0T. Eur J Radiol 2006; 57:403-11. [PMID: 16443343 DOI: 10.1016/j.ejrad.2005.12.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 12/12/2005] [Accepted: 12/15/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate our preliminary experience at 3.0 T with imaging of the carotid bifurcation in healthy and atherosclerotic subjects. Application at 3.0 T is motivated by the signal-to-noise gain for improving spatial resolution and reducing signal averaging requirements. MATERIALS AND METHODS We utilized a dual phased array coil and applied 2D, 3D time of flight (TOF) and turbo spin echo (TSE) sequences with comparison of two lumen signal suppression methods for black blood (BB) TSE imaging including double inversion preparation (DIR) and spatial presaturation pulses. The signal-to-noise ratios (SNR) of healthy carotid vessel walls were compared in 2D and 3D BB TSE acquisitions. The bright and black blood multi-contrast exam was demonstrated for a complex carotid plaque. RESULTS Contrast-to-noise (CNR) greater than 150 was achieved between the lumen and suppressed background for 3D TOF. For BB, both methods provided sufficient lumen signal suppression but slight residual flow artifacts remained at the bifurcation level. As expected 3D TSE images had higher SNR compared to 2D, but increased motion sensitivity is a significant issue for 3D at high field. For multi-contrast imaging of atherosclerotic plaque, fibrous, calcified and lipid components were resolved. The CNR ratio of fibrous (bright on PDW, T2W) and calcified (dark in T1W, T2W, PDW) plaque components was maximal in the T2W images. The 3D TOF angiogram indicating a 40% stenosis was complemented by 3D multi-planar reformat of BB images that displayed plaque extent. Detection of intimal thickening, the earliest change associated with atherosclerotic progression was observed in BB PDW images at 3.0 T. CONCLUSIONS High SNR and CNR images have been demonstrated for the healthy and diseased carotid. Improvements in RF coils along with pulse sequence optimization, and evaluation of endogenous and exogenous contrast mechanisms will further enhance carotid imaging at 3.0T.
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Affiliation(s)
- Denise P Hinton
- MGH/MIT/HMS, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA.
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Meru AV, Mittra S, Thyagarajan B, Chugh A. Intermittent claudication: an overview. Atherosclerosis 2005; 187:221-37. [PMID: 16386260 DOI: 10.1016/j.atherosclerosis.2005.11.027] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Revised: 10/26/2005] [Accepted: 11/20/2005] [Indexed: 11/26/2022]
Abstract
Intermittent claudication (IC) is defined by leg muscle pain, cramping and fatigue brought on by ambulation/exercise; relieved on rest; and caused by inadequate blood supply and is the primary symptom of peripheral arterial disease (PAD). PAD has a detrimental effect on the quality of life. PAD is a debilitating atherosclerotic disease of the lower limbs and is associated with an increased risk of cardiovascular morbidity and mortality. IC is an extremely important marker of atheroma. Up to 60% patients with IC have significant underlying coronary and/or carotid disease and 40% of all patients suffering from IC die or suffer a stroke within 5 years of presentation. The therapeutic intervention of IC essentially aims at providing symptomatic relief and reducing the systemic cardiovascular complications. Although exercise therapy is one of the most efficacious conservative treatments for claudication, the pharmacotherapeutic goals can be best achieved through an increase in the walking capacity to improve quality of life and a decrease in rates of amputation. In the development of treatment for IC, an aggressive non-pharmacological intervention and pharmacological treatment of the risk factors associated with IC are considered. In the next 2 years, the results of major trials of drugs that stabilize and regress atherosclerosis such as statins and angiotensin converting enzyme inhibitors, and anti-platelet agents, recombinant growth factors and immune modulators will be available for IC. Levocarnitine (l-carnitine) and a derivative, propionyl levocarnitine, are emerging agents that increase the pain-free walking and improve the quality of life in IC patients by working at the metabolism and exercise performance of ischemic muscles. This article provides a comprehensive review of the pathophysiology involved, diagnosis of IC and existing and emerging pharmacotherapies with rationale for their use in its treatment.
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Affiliation(s)
- Ashwinkumar V Meru
- New Drug Discovery Research, Department of Pharmacology, Ranbaxy Laboratories Limited, R&D, Plot 20, Sector 18, Udyog Vihar Industrial Area, Gurgaon 122001, Haryana, India.
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26
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Abstract
The utility of stress myocardial perfusion imaging (MPI) for the diagnosis and prognosis of coronary artery disease (CAD) has been firmly established in numerous clinical studies and has become an essential component of clinical practice. Stress MPI is now used regularly to guide initial risk stratification and management of patients with CAD. Because stress MPI provides an assessment of the physiologic significance of CAD, it is a particularly attractive procedure for assessing follow-up risk. Today, sequential stress MPI is being used increasingly to track disease progression, assess follow-up risk, detect restenosis following revascularization, and evaluate the efficacy of aggressive medical therapy and risk-factor modification. By providing serial snapshots of the disease and its impact on perfusion, sequential stress MPI may alter treatment decisions and ultimately improve long-term patient management and outcomes. Use of sequential stress MPI to detect changes in perfusion following surgical or medical therapies is being tested currently in the Clinical Outcomes Using Revascularization and Aggressive Drug Evaluation (COURAGE) and Adenosine Sestamibi Single-Photon Emission Computed Tomography Postinfarction Evaluation (INSPIRE) trials.
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Affiliation(s)
- Leslee J Shaw
- Department of Medicine and Imaging, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
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