Showing papers in "Current Opinion in Cardiology in 2008"
TL;DR: There is a need to develop and test culturally appropriate interventions to reduce the prevalence of hypertension among these populations to minimize the resultant cardiovascular morbidity and mortality.
Abstract: Purpose of reviewThe impact of socioeconomic status on hypertension is complicated and unclear. In this article, we review the findings of recently published studies pertaining to the association between socioeconomic status and hypertension. Specifically, we focus on several potentially modifiable
245 citations
TL;DR: Current data suggest that high-density lipoprotein possesses various properties beyond reverse cholesterol transport, however, many issues on the exact role of high- density lipop protein remain unknown.
Abstract: Purpose of review The most accepted property of high-density lipoprotein is reverse cholesterol transport. However, other beneficial actions may contribute to the antiatherogenic role of high-density lipoprotein. This review addresses the action of high-density lipoprotein beyond reverse cholesterol transport. Recent findings High-density lipoprotein cholesterol levels are inversely associated with coronary heart disease and other forms of vascular disease. Apart from transferring excess cholesterol to the liver, high-density lipoprotein exhibits favorable effects on oxidation, inflammation, thrombosis and endothelial function. Some of these actions are at least in part attributed to high-density lipoprotein-associated enzymes, such as paraoxonase and platelet-activating factor acetylhydrolase. However, high-density lipoprotein can become dysfunctional and proatherogenic under certain circumstances. Summary Current data suggest that high-density lipoprotein possesses various properties beyond reverse cholesterol transport. However, many issues on the exact role of high-density lipoprotein remain unknown. Future research is needed.
189 citations
TL;DR: For adipose tissue distribution assessment to be clinically useful, the ideal adiposity phenotype should provide a single risk estimate that captures the separate ‘effects’ of abdominal and peripheral adiposity.
Abstract: Purpose of reviewEarlier studies investigating the risk of developing coronary heart disease in relation to body fat distribution showed inconsistent results, and any sex-related difference in disease risk has not been adequately examined. This review aims to assess current findings on the prospecti
172 citations
TL;DR: Risk for acute aortic dissection is increased by more than 100-fold in young and middle-aged women with Turner syndrome, evidenced by the presence of neck webbing and shield chest.
Abstract: Purpose of reviewTurner syndrome is a relatively common disorder of female development with cardinal features of short stature and congenital cardiovascular defects (CHD). Turner syndrome is the most common established cause of aortic dissection in young women, but has received little attention outs
146 citations
TL;DR: The harms of RBC transfusion have potentially serious and long-term consequences for patients and are costly for health services, and evidence should shift clinicians' equipoise towards more restrictive transfusion practice.
Abstract: Purpose of reviewLiterature since 2006 was reviewed to identify the harms and costs of red blood cell (RBC) transfusion.Recent findingsSeveral studies, in people having various cardiac surgery operations, found strong associations of RBC transfusion with mortality and postoperative morbidity. The ef
137 citations
TL;DR: Cardiac hypertrophy, regardless of the cause, is the phenotypic consequence of complex interactions between genetic and nongenetic factors, which raised the importance of diagnosis and treatment algorithms, which are based on both genotype and phenotype information.
Abstract: Purpose of review
Cardiac hypertrophy is a common phenotypic response of the heart to stimulants. It is associated with increased morbidity and mortality in various cardiovascular disorders. Genetic factors are important determinants of phenotypic expression of cardiac hypertrophy, whether in single-gene disorders or in complex traits. We focus on the molecular genetics of cardiac hypertrophy in various conditions with an emphasis on hypertrophic cardiomyopathy, a genetic paradigm of cardiac hypertrophic response.
95 citations
TL;DR: The extent of myocardial compaction may be a continuous trait within the population, underscoring the need for more restrictive diagnostic criteria, as in mitral valve prolapse.
Abstract: Purpose of reviewTo discuss unresolved issues pertaining to aetiology and diagnosis of isolated left ventricular noncompaction.Recent findingsLeft ventricular noncompaction may be sporadic or familial and is linked to mutations in mitochondrial, cytoskeletal, Z-line, and sarcomeric proteins. Severe childhood manifestations include fetal hydrops or sudden infant death syndrome. Adults with severe phenotypes have a similarly guarded prognosis due to heart failure, arrhythmia and thromboembolism. Conversely, healthy individuals may fulfil current imaging criteria for diagnosis. Left ventricular noncompaction is also observed in families with hypertrophic or dilated cardiomyopathy, casting doubt on its acceptance as a distinct disease entity.SummaryThe extent of myocardial compaction may be a continuous trait within the population. Sensitive imaging techniques may detect subtle variations in morphology that fall within the normal range, underscoring the need for more restrictive diagnostic criteria, as in mitral valve prolapse. Conversely, rather than being a root cause of myocardial dysfunction, left ventricular noncompaction may represent a secondary consequence of a genetic alteration, well-tolerated when the heart is otherwise normal. In the presence of a pathogenic mutation, disruption to myocyte function at a molecular level may be the primary disease determinant, with noncompaction arising as a maladaptive remodelling response that compounds the disease process through subendocardial ischaemia and fibrosis.
90 citations
TL;DR: Strategies for distinguishing incidental PFOs from pathogenic ones in cryptogenic stroke patients and for identifying patients at high risk of recurrence are needed.
Abstract: Purpose of reviewControversy surrounds the issue of patent foramen ovale (PFO), stroke, and secondary prevention strategies. Paradoxical embolism is usually a presumed diagnosis, incidental PFOs are common, and treatment options have not been well compared.Recent findingsParadoxical embolism occurs
87 citations
TL;DR: Although new advanced therapies hold promise in PAH secondary to CHD, long-term data are clearly needed and advanced therapies should be considered when other causes of functional limitation, such as iron deficiency, have been first addressed.
Abstract: Purpose of review To present the available data on pathophysiology, clinical presentation, prognosis, and especially management strategies for adult patients with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH). Particular emphasis is placed on differences between other types of PAH and CHD-related PAH, in which clinical presentation and management relate to a constellation of factors, both pulmonary and cardiac. Recent findings Pulmonary vascular disease in adults with CHD and especially its extreme expression, the Eisenmenger syndrome, is a chronic disease with slow progression, leading to multiorgan failure and death, decades after its first clinical presentation. In the last few years, oral advanced therapies for PAH have emerged and are considered for mono or combination therapy for CHD, though the evidence is limited. Supportive care and prevention of complications seem to be at least as important in the overall care of these patients. Summary Although new advanced therapies hold promise in PAH secondary to CHD, long-term data are clearly needed. Advanced therapies should be considered when other causes of functional limitation, such as iron deficiency, have been first addressed. Expertise in CHD as well as PAH is essential for providing adequate care for this patient group with a unique pathophysiology.
80 citations
TL;DR: CTEPH has emerged as a ‘dual’ pulmonary vascular disorder with major vessel vascular remodeling of thrombus organization, combined with a small vessel pulmonary arteriopathy that is a target for classic vasodilator treatments.
Abstract: Purpose of reviewVenous thromboembolism is a spectrum of disease comprising deep vein thrombosis, thrombus in transit, acute pulmonary embolism, and chronic thromboembolic pulmonary hypertension (CTEPH) as a rare and late possible sequela.Recent findingsOn the basis of a prospective long-term study,
80 citations
TL;DR: A shortened QT interval and reduced ventricular refractory period together with an increased dispersion of repolarization constitute the potential substrate for reentry and life-threatening ventricular tachyarrhythmia in patients with short QT-1 syndrome.
Abstract: Purpose of reviewSudden cardiac death in patients without structural heart disease remains a challenge in diagnostics and risk stratification. Genetically determined arrhythmias are a potential cause for a primary electrical disease. A recently discovered primary electrical disease is discussed.Rece
TL;DR: Fibromuscular dysplasia is a noninflammatory, nonatherosclerotic disease that has been reported in almost every arterial bed and primarily affects women aged 15–50 years and consists of antiplatelet therapy for asymptomatic individuals and percutaneous balloon angioplasty for patients with indications for intervention.
Abstract: Purpose of reviewFibromuscular dysplasia is an underdiagnosed and misunderstood disease. The purpose of this review is to inform healthcare providers and the public about a condition that may be more common than previously thought.Recent findingsThere has been little new information published about
TL;DR: A simple algorithm is presented that enables the cardiologist to stratify degenerative mitral valves into those that are repairable by any experienced cardiac surgeon and those that require reference-center referral to deliver a high probability of repair.
Abstract: Purpose of reviewTo highlight the relevance of preoperative differentiation of degenerative mitral valve disease based on etiology (predominantly Barlow's Disease or fibroelastic deficiency) and severity of lesions with an emphasis on how such differentiation by the cardiologist can result in increa
TL;DR: It is time for a systematic preparticipation screening program for all competitive athletes, using at least a standardized comprehensive personal and family history questionnaire and a screening ECG at the time of matriculation to high school and college.
Abstract: Purpose of reviewThe appropriate screening strategy to prevent sudden cardiac death (SCD) in athletes remains a challenging and a highly debated issue The purpose of this review is to examine the added value and controversies of including a 12-lead electrocardiogram (ECG) in addition to a comprehen
TL;DR: Future studies are needed to elucidate pharmacologic options for reducing endothelin-1 system activity especially in older hypertensive adults, though regular aerobic exercise must continue to be a point of emphasis for maintaining/improving vascular health.
Abstract: Purpose of review Endothelin-1 system activation plays an important role in the etiology of atherosclerotic vascular disease. Aging and hypertension are two independent cardiovascular risk factors that have been shown to exhibit increased endothelin-1 system activation. This review focuses on the cardiovascular effects of the endothelin system, its relation to aging and hypertension, as well as potential treatment options. Recent findings Many of the cardiovascular complications associated with both aging and hypertension are attributable, in part, to endothelial dysfunction, particularly vasomotor dysregulation. To date most studies have focused on the effects of aging and hypertension on endothelium-dependent nitric oxide-mediated vasodilation. However, endothelin-1-mediated vasoconstrictor tone increases with age and contributes to the pathogenesis of hypertension. Pharmacologic approaches to reduce endothelin-1 system activation have produced limited results and are largely disease-specific. In contrast, regular aerobic exercise has been shown to be extremely effective at reducing endothelin-1 system activity. Summary Both aging and hypertension represent important cardiovascular disease risk factors that are characterized by increased endothelin-1-mediated vasoconstrictor tone. Future studies are needed to elucidate pharmacologic options for reducing endothelin-1 system activity especially in older hypertensive adults, though regular aerobic exercise must continue to be a point of emphasis for maintaining/improving vascular health.
TL;DR: Significant progress has been made toward revealing molecular changes associated with myocardial recovery from heart failure, and the unique research opportunities offered by left ventricular assist device analysis are beginning to distinguish changesassociated with recovery from those of mechanical unloading alone.
Abstract: Purpose of review There is considerable increase in the use of left ventricular assist devices for the treatment of severe heart failure. Traditionally viewed as a bridge to transplantation and more recently as a destination therapy, left ventricular assist device support is now recognized to offer potential for myocardial recovery through reverse remodeling, a potential that is further enhanced by combination with pharmacologic therapy. In this study, we examine the molecular changes associated with left ventricular assist device support and how these may contribute to the recovery process. Recent findings Studies in both patients and experimental models have demonstrated that improved function is associated with alterations in several key pathways including cell survival, cytokine signaling, calcium handling, adrenergic receptor signaling, cytoskeletal and contractile proteins, energy metabolism, extracellular matrix, and endothelial and microvascular functions. Moreover, the unique research opportunities offered by left ventricular assist device analysis are beginning to distinguish changes associated with recovery from those of mechanical unloading alone and identify potential predictors and novel therapeutic targets capable of enhancing myocardial repair. Summary Significant progress has been made toward revealing molecular changes associated with myocardial recovery from heart failure. These studies also offer new insight into the pathogenesis of heart failure and point to novel therapeutic strategies.
TL;DR: There is substantial evidence of immune modulation promoting the downregulation of inflammatory cytokines thus increasing several important and potentially therapeutic anti-inflammatory cytokines, and it will be necessary to design large multicenter trials to overcome the expected improvements of current therapies, which may overshadow results.
Abstract: Purpose of review The efficacy of already established heart failure therapeutics limits new developments; however, there are still fertile grounds for growth with a better understanding of often overlooked mechanisms of disease. We will review evidence on inflammation and components of the inflammatory process occurring in patients with chronic heart failure, review different therapeutic techniques such as intravenous immunoglobin, plasmapheresis and immuno-adsorption. Recent findings The use of highly specific anti-inflammatory therapeutic strategies in large randomized trials such as anti-TNF-alpha has failed to show clinical benefits; however, by taking a broad spectrum anti-inflammatory approach, strategies as in the ACCLAIM trial have been effective in improving the outcome in a select group of patients. Summary There is substantial evidence of immune modulation promoting the downregulation of inflammatory cytokines thus increasing several important and potentially therapeutic anti-inflammatory cytokines. It will be necessary to design large multicenter trials to overcome the expected improvements of current therapies, which may overshadow results, and to finally elucidate the therapeutic contributions of immune modulation in heart failure.
TL;DR: Animal models and human studies suggest that systemic metabolic derangements may lead to metabolic, functional and structural maladaptation of the heart in diabetes.
Abstract: PURPOSE OF REVIEW Diabetic patients with heart failure have a poor prognosis. Although it has been demonstrated in animal models that metabolic maladaptation plays a pivotal role in contractile dysfunction of the heart, the understanding of 'diabetic cardiomyopathy' and its treatment in humans remains incomplete. RECENT FINDINGS Epidemiological studies show that structural changes in the left ventricle can be demonstrated before onset of clinical diabetes. Diastolic dysfunction is the earliest manifestation that is associated with increasing level of serum-free fatty acids and worsening glycemic control. Spectroscopic and histologic evidence in the human myocardium indicates a maladaptive metabolic response in diabetes, characterized by intramyocellular triglyceride accumulation. Studies also suggest a link between myocardial isoform switching, calcium homeostasis and altered metabolism in the development of heart failure. However, treatment directed at deranged metabolic control in diabetes is effective only in animals, and not in humans. SUMMARY Although clinical studies suggest the existence of 'diabetic cardiomyopathy', it is still difficult to prove causality. However, animal models and human studies suggest that systemic metabolic derangements may lead to metabolic, functional and structural maladaptation of the heart. The exact mechanisms of heart failure in diabetes remain elusive.
TL;DR: Primary care physicians must be aware that they mostly encounter low-risk patients and that the perceived risk does not necessarily correspond with the actual risk, and should be skilled in the use of effective formats for risk communication that are ideally integrated within patient decision aids for cardiovascular risk management.
Abstract: PURPOSE OF REVIEW: Guidelines on primary prevention of cardiovascular disease emphasize identifying high-risk patients for intensive risk-reducing management. These guidelines recommend the identification of individuals with high risk using risk score sheets or risk tables. Patients' misperceptions of risk seem to hamper implementation of the high-risk approach. How appropriate are the risk perceptions of patients? What is known about effective ways of risk communication? RECENT FINDINGS: Cardiovascular risk is often perceived inappropriately in primary care populations; by nearly four in five high-risk patients (incorrect optimism), and by one in five low-risk patients (incorrect pessimism). Communicating cardiovascular risk by means of natural frequencies seems effective to correct inappropriate risk perception, though effects are small. SUMMARY: In communicating cardiovascular disease risk, primary care physicians must be aware that they mostly encounter low-risk patients and that the perceived risk does not necessarily correspond with the actual risk. Professionals should be skilled in the use of effective formats for risk communication that are ideally integrated within patient decision aids for cardiovascular risk management.
TL;DR: New insights into the epidemiology and pathophysiology of diabetes-associated and hypertension-associated cardiac alterations may open the field for novel preventive therapeutic strategies tailored to reduce the risk of heart failure in this large population at risk.
Abstract: Purpose of review Hypertension and diabetes both contribute to cardiovascular disease. The purpose of this review is to summarize novel epidemiological and clinical insights into the risk continuum of blood pressure and abnormalities in glucose metabolism for cardiovascular adverse remodelling, summarize the current mechanistic knowledge on hypertensive heart disease and diabetic cardiomyopathy, outline the effects of hypertension and diabetes on diastolic dysfunction and heart failure with normal ejection fraction, and discuss novel therapeutic aspects in these disease entities. Recent findings The prevalence of diabetes mellitus and hypertension increases in western populations and largely contributes to adverse cardiovascular remodelling and the growing number of patients with heart failure. Recently, diastolic heart failure (i.e., heart failure with normal ejection fraction) has been recognized as a major adverse manifestation of hypertension and diabetes, but convincing therapeutic strategies other than strict risk factor control are still lacking. However, due to clearer definitions and novel noninvasive diagnostic techniques for heart failure with normal ejection fraction, future studies may better define new specific therapeutic approaches. Summary New insights into the epidemiology and pathophysiology of diabetes-associated and hypertension-associated cardiac alterations may open the field for novel preventive therapeutic strategies tailored to reduce the risk of heart failure in this large population at risk.
TL;DR: There has been large variability in the success experienced by population-level CHD prevention trials and best practices have emerged which may be used to inform the design of future trials.
Abstract: Purpose of reviewThe prevalence of coronary heart disease (CHD) risk factors in the population necessitates investment in the design and delivery of effective population-level interventions to prevent and enhance the management of CHD. This review examines the approaches that have been central to th
TL;DR: A multitargeted therapeutic approach using a bile acid sequestrant to improve both cholesterol and glucose management in patients with T2DM may be clinically beneficial.
Abstract: Purpose of reviewIndividuals with type 2 diabetes mellitus (T2DM) have a number of potentially modifiable risk factors, including dyslipidemia, hypertension, and hyperglycemia, that contribute to coronary artery disease risk. Elevated low-density lipoprotein cholesterol (LDL-C) is a major contributo
TL;DR: These two novel technologies offer the fascinating option of performing catheter ablation in a remote-controlled fashion and hopefully will remove invasive electrophysiologists away from patients without the risks of reduced efficacy or increased procedural risks.
Abstract: Purpose of review The aim of this review is to introduce two novel techniques for catheter ablation of various arrhythmias in a remote-controlled fashion. Recent findings The electromechanical system Sensei consists of two steerable sheaths that navigate conventional catheters via a ‘master-slave’ input device. The magnetic navigation system Niobe consists of two outer permanent magnets that cause a uniform magnetic field in which a specialized magnetically equipped catheter has to align in parallel. Both systems can interact with three-dimensional mapping systems and several reports on the clinical effectiveness of the systems have been published, which will be critically discussed in this review. Summary These two novel technologies offer the fascinating option of performing catheter ablation in a remote-controlled fashion. Future studies and head-to-head comparisons with conventional ablation techniques will prove the impact of remote navigation, which hopefully will remove invasive electrophysiologists away from patients without the risks of reduced efficacy or increased procedural risks.
TL;DR: Recent developments suggest that the niacin receptor GPR109A is involved in flushing, but it does not explain multiple actions of niacIn, and actions ofniacin on diacylglycerolacyl transferase 2, ATP synthase β chain, and redox state may explain the multiple actions.
Abstract: Purpose of reviewTo review the recent progress in niacin research that is made in two major areas: new preparations to decrease flushing and niacin's mechanism of actionRecent findingsFlushing, an adverse effect of niacin, results from GPR109A-mediated production of prostaglandin D2 and E2 in Lange
TL;DR: Transcatheter aortic valve implantation has become a clinical reality and will be performed more frequently in the future, when selecting the optimal therapy for individual patients is selected.
Abstract: Purpose of reviewTranscatheter aortic valve implantation is a new, emerging technique that has been performed in elderly and higher-risk patients suffering severe, symptomatic aortic stenosis.Recent findingsInitial clinical results are promising. Important technological progress, i.e. the developmen
TL;DR: Rapidly evolving work indicates that there are important genetic determinants of atrial fibrillation, and suggests that understanding these determinants will help to appreciate better the underlying pathophysiology and to provide new approaches in diagnosis, prevention and treatment of this common cardiac condition.
Abstract: PURPOSE OF REVIEW Atrial fibrillation is traditionally regarded as a sporadic, nongenetic disorder. Nevertheless, recent growing evidence points to an important heritable basis for atrial fibrillation, with significant genetic determinants. This paper reviews recent progress in understanding the role of genetic contributors to the pathogenesis of atrial fibrillation and its familial susceptibility. RECENT FINDINGS Population-based studies have demonstrated a significant heritable component in atrial fibrillation, with specific contributors including single-gene mutations and single-nucleotide polymorphisms. Variants in both ion-channel and nonion-channel genes have been identified as potential atrial fibrillation-risk determinants. In addition, studies have pointed to interesting combined roles of genetic and environmental factors in atrial fibrillation pathogenesis, providing insights into gene-environment interactions. Clinical studies suggest that individual genetic profiles may determine the therapeutic response of atrial fibrillation. SUMMARY Rapidly evolving work indicates that there are important genetic determinants of atrial fibrillation, and suggests that understanding these determinants will help us both to appreciate better the underlying pathophysiology and to provide new approaches in diagnosis, prevention and treatment of this common cardiac condition.
TL;DR: In myocarditis/dilated cardiomyopathy, cardiac-specific and disease-specific antibodies of IgG class are potential biomarkers for identifying ‘at risk’ relatives as well as those patients in whom, in the absence of active infection of the myocardium, immunosuppression, and/or immunomodulation may be beneficial.
Abstract: Purpose of review Myocarditis is a clinically heterogeneous myocardial inflammatory disease, diagnosed by endomyocardial biopsy; it may be idiopathic, infectious, or autoimmune and may lead to dilated cardiomyopathy. Myocarditis and dilated cardiomyopathy represent different stages of an organ-specific autoimmune disease in genetically predisposed individuals. Recent findings In animal models, cell-mediated or antibody-mediated autoimmune myocarditis/dilated cardiomyopathy can be induced by viral infection or immunization with heart-specific autoantigens, or can develop spontaneously in genetically predisposed strains. Susceptibility is based on multiple major histocompatibility complex and nonmajor histocompatibility complex genes. In patients the diagnosis of autoimmune myocarditis/dilated cardiomyopathy requires exclusion of viral genome on endomyocardial biopsy and detection of serum heart-reactive autoantibodies. They are directed against multiple antigens that are found in patients and relatives from about 60% of familial and nonfamilial pedigrees. They predict dilated cardiomyopathy development among relatives, years before disease. Some antibodies have functional effects on cardiac myocytes in vitro, in animals and possibly in a dilated cardiomyopathy subset, responsive to extracorporeal immunoadsorption. Summary In myocarditis/dilated cardiomyopathy, cardiac-specific and disease-specific antibodies of IgG class are potential biomarkers for identifying 'at risk' relatives as well as those patients in whom, in the absence of active infection of the myocardium, immunosuppression, and/or immunomodulation may be beneficial. Future studies should better define the genetic basis of human autoimmune myocarditis/dilated cardiomyopathy.
TL;DR: This review offers an up-to-date perspective on the diagnostic role of cardiovascular magnetic resonance in the genetics era by facilitating appropriate patient selection and preparation, experienced readers and operators, and a dedicated, comprehensive protocol.
Abstract: Purpose of reviewPerceptions of the utility of cardiovascular magnetic resonance in the evaluation of arrhythmogenic right ventricular cardiomyopathy have changed considerably in the past decade. This review offers an up-to-date perspective on the diagnostic role of cardiovascular magnetic resonance in the genetics era.Recent findingsOriginally hailed as a putative gold standard in arrhythmogenic cardiomyopathy, cardiovascular magnetic resonance has received a more guarded reception lately owing to interobserver variability and lack of standardized protocols. Recent studies have nonetheless affirmed its value as an integral component of the diagnostic work-up. Quantitative volume analysis is relatively robust, but visualization of myocardial fat by spin-echo imaging is less reliable. Interpretation of wall motion abnormalities appears reproducible among expert readers. Emerging data suggest a key role for late gadolinium enhancement in detection of left ventricular involvement.SummaryCardiovascular magnetic resonance in arrhythmogenic cardiomyopathy is facilitated by appropriate patient selection and preparation, experienced readers and operators, and a dedicated, comprehensive protocol. Indications for magnetic resonance assessment include proven arrhythmogenic cardiomyopathy in the family, unexplained ventricular arrhythmia, inverted T-waves in the right precordial or lateral leads, and/or family history of sudden cardiac death. Arrhythmia suppression is essential for optimal electrocardiographic triggering and image acquisition.
TL;DR: Two relatively simple but underutilized methods of intraoperative graft assessment have been shown to be predictive of graft failure and wider use of these techniques as well as wider availability of hybrid operating rooms, which will allow intraoperative coronary angiography, may reduce graft failure.
Abstract: Purpose of review Intraoperative graft assessment in coronary artery bypass grafting is infrequently performed. Nevertheless, studies show an immediate graft closure rate of 5–9% and a 1-year closure rate of 20–30%. Recent findings Coronary angiography is the ‘gold standard’ for graft assessment yet has been seldom employed because of logistical problems and image quality. Two methods, transit time flow measurement and intraoperative fluorescence imaging are simple, safe, and expeditious. Intraoperative graft failure detection rates of 2–5% have been reported. Summary Early graft occlusion occurs frequently after coronary artery bypass grafting. Two relatively simple but underutilized methods of intraoperative graft assessment have been shown to be predictive of graft failure. Wider use of these techniques as well as wider availability of hybrid operating rooms, which will allow intraoperative coronary angiography, may reduce graft failure.
TL;DR: Molecular imaging is actively unraveling the biological basis of atherosclerosis in living subjects and will play an important role in assessing novel Atherosclerosis pharmacotherapies in clinical trials in the near-term.
Abstract: Purpose of reviewMolecular imaging aims to illuminate vital molecular and cellular aspects of disease in vivo, and is rapidly translating into the clinical arena Advantages of this field include enabling serial biological studies in living subjects, assessment of pharmaceutical efficacy, and in-viv