ABI
: ankle–brachial index
ACCORD
: Action to Control Cardiovascular Risk in Diabetes
ADVANCE
: Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation
AGREE
: Appraisal of Guidelines Research and Evaluation
AHA
: American Heart Association
apoA1
: apolipoprotein A1
apoB
: apolipoprotein B
CABG
: coronary artery bypass graft surgery
CARDS
: Collaborative AtoRvastatin Diabetes Study
CCNAP
: Council on Cardiovascular Nursing and Allied Professions
CHARISMA
: Clopidogrel for High Athero-thrombotic Risk and Ischemic Stabilisation, Management, and Avoidance
CHD
: coronary heart disease
CKD
: chronic kidney disease
COMMIT
: Clopidogrel and Metoprolol in Myocardial Infarction Trial
CRP
: C-reactive protein
CURE
: Clopidogrel in Unstable Angina to Prevent Recurrent Events
CVD
: cardiovascular disease
DALYs
: disability-adjusted life years
DBP
: diastolic blood pressure
DCCT
: Diabetes Control and Complications Trial
ED
: erectile dysfunction
eGFR
: estimated glomerular filtration rate
EHN
: European Heart Network
EPIC
: European Prospective Investigation into Cancer and Nutrition
EUROASPIRE
: European Action on Secondary and Primary Prevention through Intervention to Reduce Events
GFR
: glomerular filtration rate
GOSPEL
: Global Secondary Prevention Strategies to Limit Event Recurrence After MI
GRADE
: Grading of Recommendations Assessment, Development and Evaluation
HbA1c
: glycated haemoglobin
HDL
: high-density lipoprotein
HF-ACTION
: Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing
HOT
: Hypertension Optimal Treatment Study
HPS
: Heart Protection Study
HR
: hazard ratio
hsCRP
: high-sensitivity C-reactive protein
HYVET
: Hypertension in the Very Elderly Trial
ICD
: International Classification of Diseases
IMT
: intima-media thickness
INVEST
: International Verapamil SR/Trandolapril
JTF
: Joint Task Force
LDL
: low-density lipoprotein
Lp(a)
: lipoprotein(a)
LpPLA2
: lipoprotein-associated phospholipase 2
LVH
: left ventricular hypertrophy
MATCH
: Management of Atherothrombosis with Clopidogrel in High-risk Patients with Recent Transient Ischaemic Attack or Ischaemic Stroke
MDRD
: Modification of Diet in Renal Disease
MET
: metabolic equivalent
MONICA
: Multinational MONItoring of trends and determinants in CArdiovascular disease
NICE
: National Institute of Health and Clinical Excellence
NRT
: nicotine replacement therapy
NSTEMI
: non-ST elevation myocardial infarction
ONTARGET
: Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial
OSA
: obstructive sleep apnoea
PAD
: peripheral artery disease
PCI
: percutaneous coronary intervention
PROactive
: Prospective Pioglitazone Clinical Trial in Macrovascular Events
PWV
: pulse wave velocity
QOF
: Quality and Outcomes Framework
RCT
: randomized clinical trial
RR
: relative risk
SBP
: systolic blood pressure
SCORE
: Systematic Coronary Risk Evaluation Project
SEARCH
: Study of the Effectiveness of Additional Reductions in Cholesterol and
SHEP
: Systolic Hypertension in the Elderly Program
STEMI
: ST-elevation myocardial infarction
SU.FOL.OM3
: SUpplementation with FOlate, vitamin B6 and B12 and/or OMega-3 fatty acids
Syst-Eur
: Systolic Hypertension in Europe
TNT
: Treating to New Targets
UKPDS
: United Kingdom Prospective Diabetes Study
VADT
: Veterans Affairs Diabetes Trial
VALUE
: Valsartan Antihypertensive Long-term Use
VITATOPS
: VITAmins TO Prevent Stroke
VLDL
: very low-density lipoprotein
WHO
: World Health Organization

### 1.1 Introduction

Atherosclerotic cardiovascular disease (CVD) is a chronic disorder developing insidiously throughout life and usually progressing to an advanced stage by the time symptoms occur. It remains the major cause of premature death in Europe, even though CVD mortality has …

/pdf/european-guidelines-on-cardiovascular-disease-prevention-in-4z4nw4311i.pdf

European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (Version 2012)

CA : A Cancer Journal for Clinicians

Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim to assist physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are not substitutes for textbooks. The legal implications of medical guidelines have been discussed previously.

A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC web site (http://www.escardio.org/knowledge/guidelines/rules).

In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. A critical evaluation of diagnostic and therapeutic procedures is performed, including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in the tables below.

The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. Any changes in conflict of interest that arise during the writing period must be notified to the ESC. The Task Force report was entirely …

/pdf/european-guidelines-on-cardiovascular-disease-prevention-in-17acj3uib4.pdf

European guidelines on cardiovascular disease prevention in clinical practice (version 2012) : the fifth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts).

Guidelines and Expert Consensus Documents summarize and evaluate all available evidence with the aim of assisting physicians in selecting the best management strategy for an individual patient suffering from a given condition, taking into account the impact on outcome and the risk–benefit ratio of diagnostic or therapeutic means. Guidelines are no substitutes for textbooks and their legal implications have been discussed previously. Guidelines and recommendations should help physicians to make decisions in their daily practice. However, the ultimate judgement regarding the care of an individual patient must be made by his/her responsible physician(s).

The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines/rules).

Members of this Task Force were selected by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) to represent all physicians involved with the medical and surgical care of patients with coronary artery disease (CAD). A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk–benefit ratio. Estimates of expected health outcomes for society are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in Tables 1 and 2 .

View this table:

Table 1 
Classes of recommendations



View this table:

Table 2 
Levels of evidence



The members of the Task Force have provided disclosure statements of all relationships that might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at European Heart House, headquarters of the ESC. Any changes in conflict of interest that arose during the writing period were notified to the ESC. The Task Force report received its entire financial support from the ESC and EACTS, without any involvement of the pharmaceutical, device, or surgical industry.

ESC …

/pdf/guidelines-on-myocardial-revascularization-the-task-force-on-3qs3gmu7h5.pdf

Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)

Atherosclerotic cardiovascular disease results in >19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs. The recognition of the role of the vulnerable plaque has opened new avenues of opportunity in the field of cardiovascular medicine. This consensus document concludes the following. (1) Rupture-prone plaques are not the only vulnerable plaques. All types of atherosclerotic plaques with high likelihood of thrombotic complications and rapid progression should be considered as vulnerable plaques. We propose a classification for clinical as well as pathological evaluation of vulnerable plaques. (2) Vulnerable plaques are not the only culprit factors for the development of acute coronary syndromes, myocardial infarction, and sudden cardiac death. Vulnerable blood (prone to thrombosis) and vulnerable myocardium (prone to fatal arrhythmia) play an important role in the outcome. Therefore, the term "vulnerable patient" may be more appropriate and is proposed now for the identification of subjects with high likelihood of developing cardiac events in the near future. (3) A quantitative method for cumulative risk assessment of vulnerable patients needs to be developed that may include variables based on plaque, blood, and myocardial vulnerability. In Part I of this consensus document, we cover the new definition of vulnerable plaque and its relationship with vulnerable patients. Part II of this consensus document focuses on vulnerable blood and vulnerable myocardium and provide an outline of overall risk assessment of vulnerable patients. Parts I and II are meant to provide a general consensus and overviews the new field of vulnerable patient. Recently developed assays (eg, C-reactive protein), imaging techniques (eg, CT and MRI), noninvasive electrophysiological tests (for vulnerable myocardium), and emerging catheters (to localize and characterize vulnerable plaque) in combination with future genomic and proteomic techniques will guide us in the search for vulnerable patients. It will also lead to the development and deployment of new therapies and ultimately to reduce the incidence of acute coronary syndromes and sudden cardiac death. We encourage healthcare policy makers to promote translational research for screening and treatment of vulnerable patients.

/pdf/from-vulnerable-plaque-to-vulnerable-patient-a-call-for-new-47rrnyxj2m.pdf

From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II.

Objective: The determination of renal tissue oxygenation by BOLD-MRI in chronic kidney disease (CKD) patients has given heterogeneous results, possibly due to the lack of a widely accepted procedure to analyze the R2* maps. We present a new technique for the analysis of renal BOLD-MRI called the twelve-layer concentric objects method (TLCO). We measured its reproducibility and assessed whether differences in the intra-renal distribution of R2* as a measure of oxygenation were detected between CKD patients and controls. Figure. No caption available. Design and method: MR imaging (3 Tesla) was performed under standardized conditions before and 15 min after furosemide injection in 104 CKD patients, 61 hypertensive patients and 42 healthy volunteers. MR images were analyzed with the TLCO technique that divides renal parenchyma in 12 equal layers (see figure). Mean R2* value of each layer was reported, as well as the steepness of the slope of the R2* curve linking the mean R2* from the 3rd to the 7th layer. In a subgroup of 52 individuals (20 controls, 18 moderate CKD, 14 severe CKD) each exam was analyzed by two different observers to assess inter-observer variability. Results: Inter-observer variability was respectively 2.3 ± 0.9%, 1.9 ± 0.8% and 3.0 ± 2.3% in controls, mild to moderate and severe CKD. Mean R2* of the outer (more cortical) layers was significantly higher in CKD suggesting a lower cortical oxygenation. The response to furosemide was smaller in the inner (more medullary) layers, and the R2*slope was flatter in CKD patients than in healthy and hypertensive controls. In multivariable regression analysis, the slope of the R2* profile correlated positively with eGFR in patients with an eGFR < 90 ml/min/1.73m2 (p < 0.001). Conclusions: Our data confirm the hypothesis that renal cortical oxygenation is reduced in CKD and show in humans that the level of cortical oxygenation correlates with the severity of chronic kidney disease. The TLCO-technique is highly reproducible and provides layer-by-layer information on renal R2* values from the cortex to the medulla. Analysis of the slope factor offers information on the intra-renal distribution of R2*, and as such represents a measure of cortico-medullary differentiation.

[op.4d.06] reduction of cortical oxygenation in chronic kidney disease: evidence obtained with bold-mri and a new analytic technique.

/pdf/103-non-invasive-measurement-of-coronary-artery-flow-1yj5iy2swa.pdf

103 Non-invasive measurement of coronary artery flow velocity at rest and during handgrip stress in healthy subjects using 3 T MRI

Relaxometry studies in preterm and at-term newborns have provided insight into brain microstructure, thus opening new avenues for studying normal brain development and supporting diagnosis in equivocal neurological situations. However, such quantitative techniques require long acquisition times and therefore cannot be straightforwardly translated to in utero brain developmental studies. In clinical fetal brain magnetic resonance imaging routine, 2D low-resolution T2-weighted fast spin echo sequences are used to minimize the effects of unpredictable fetal motion during acquisition. As super-resolution techniques make it possible to reconstruct a 3D high-resolution volume of the fetal brain from clinical low-resolution images, their combination with quantitative acquisition schemes could provide fast and accurate T2 measurements. In this context, the present work demonstrates the feasibility of using super-resolution reconstruction from conventional T2-weighted fast spin echo sequences for 3D isotropic T2 mapping. A quantitative magnetic resonance phantom was imaged using a clinical T2-weighted fast spin echo sequence at variable echo time to allow for super-resolution reconstruction at every echo time and subsequent T2 mapping of samples whose relaxometric properties are close to those of fetal brain tissue. We demonstrate that this approach is highly repeatable, accurate and robust when using six echo times (total acquisition time under 9 minutes) as compared to gold-standard single-echo spin echo sequences (several hours for one single 2D slice).

https://serval.unil.ch/resource/serval:BIB_75CF6AA69B7C.P001/REF.pdf

T2 Mapping from Super-Resolution-Reconstructed Clinical Fast Spin Echo Magnetic Resonance Acquisitions

Background In non-contrast coronary MRA, the non-selective T2Prep 1-2 has been widely used for contrast enhancement between the coronary blood-pool and the myocardium. This non-selective pre-pulse affects the magnetization both inside and outside the field-of-view, resulting in a reduced steady-state magnetization of the inflowing blood, and consequently a penalty in SNR. We hypothesize that a slice-selective T2Prep would leave the magnetization of blood outside the imaged volume unaffected, and thereby minimize SNR penalty for inflowing blood. The purpose of this work was to implement a slice-selective T2Prep coronary MRA sequence and to assess the SNR gain quantitatively.

/pdf/slice-selective-implementation-of-an-adiabatic-t2prep-1ma9n4t839.pdf

Matthias Stuber

Papers

[op.4d.06] reduction of cortical oxygenation in chronic kidney disease: evidence obtained with bold-mri and a new analytic technique.

103 Non-invasive measurement of coronary artery flow velocity at rest and during handgrip stress in healthy subjects using 3 T MRI

T2 Mapping from Super-Resolution-Reconstructed Clinical Fast Spin Echo Magnetic Resonance Acquisitions

Slice-selective implementation of an adiabatic T2Prep sequence increases coronary artery conspicuity at 3T

Loss of cardiac rotation in anterolateral infarction