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Coronary Artery Disease: HELP
Articles from Singapore Republic
Based on 167 articles published since 2008
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These are the 167 published articles about Coronary Artery Disease that originated from Singapore Republic during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7
1 Editorial The Challenge of Percutaneous Coronary Intervention in Small Vessels. 2017

Loh, Joshua P / Ananthakrishna, Rajiv. ·Department of Cardiology, National University Heart Centre, Singapore. Electronic address: Joshua_py_loh@nuhs.edu.sg. · Department of Cardiology, National University Heart Centre, Singapore. ·Cardiovasc Revasc Med · Pubmed #28131331.

ABSTRACT: -- No abstract --

2 Editorial Biodegradable vascular scaffold: is optimal expansion the key to minimising flow disturbances and risk of adverse events? 2015

Foin, Nicolas / Torii, Ryo / Mattesini, Alessio / Wong, Philip / Di Mario, Carlo. ·National Heart Centre Singapore, Singapore. ·EuroIntervention · Pubmed #25420789.

ABSTRACT: -- No abstract --

3 Review Local Hemodynamic Forces After Stenting: Implications on Restenosis and Thrombosis. 2017

Ng, Jaryl / Bourantas, Christos V / Torii, Ryo / Ang, Hui Ying / Tenekecioglu, Erhan / Serruys, Patrick W / Foin, Nicolas. ·From the National Heart Centre Singapore (J.N., H.Y.A., N.F.) · Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.) · Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom · Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.) · Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.) · National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.) · and Duke-NUS Medical School, National University of Singapore (N.F.). ·Arterioscler Thromb Vasc Biol · Pubmed #29122816.

ABSTRACT: Local hemodynamic forces are well-known to modulate atherosclerotic evolution, which remains one of the largest cause of death worldwide. Percutaneous coronary interventions with stent implantation restores blood flow to the downstream myocardium and is only limited by stent failure caused by restenosis, stent thrombosis, or neoatherosclerosis. Cumulative evidence has shown that local hemodynamic forces affect restenosis and the platelet activation process, modulating the pathophysiological mechanisms that lead to stent failure. This article first covers the pathophysiological mechanisms through which wall shear stress regulates arterial disease formation/neointima proliferation and the role of shear rate on stent thrombosis. Subsequently, the article reviews the current evidence on (1) the implications of stent design on the local hemodynamic forces, and (2) how stent/scaffold expansion can influence local flow, thereby affecting the risk of adverse events.

4 Review Invasive or non-invasive imaging for detecting high-risk coronary lesions? 2017

Patel, Kush / Tarkin, Jason / Serruys, Patrick W / Tenekecioglu, Erhan / Foin, Nicolas / Zhang, Yao-Jun / Crake, Tom / Moon, James / Mathur, Anthony / Bourantas, Christos V. ·a Barts Heart Centre, Barts Health NHS Trust , London , UK. · b Division of Cardiovascular Medicine , University of Cambridge , Cambridge , UK. · c Thoraxcenter , Erasmus Medical Centre , Rotterdam , The Netherlands. · d Faculty of Medicine , National Heart & Lung Institute, Imperial College , London , UK. · e National Heart Centre Singapore , Duke-NUS Medical School , Singapore. · f Nanjing First Hospital , Nanjing Medical University , Nanjing , China. · g Institute of Cardiovascular Sciences , University College London , London , UK. ·Expert Rev Cardiovasc Ther · Pubmed #28256179.

ABSTRACT: INTRODUCTION: Advances in our understanding about atherosclerotic evolution have enabled us to identify specific plaque characteristics that are associated with coronary plaque vulnerability and cardiovascular events. With constant improvements in signal and image processing an arsenal of invasive and non-invasive imaging modalities have been developed that are capable of identifying these features allowing in vivo assessment of plaque vulnerability. Areas covered: This review article presents the available and emerging imaging modalities introduced to assess plaque morphology and biology, describes the evidence from the first large scale studies that evaluated the efficacy of invasive and non-invasive imaging in detecting lesions that are likely to progress and cause cardiovascular events and discusses the potential implications of the in vivo assessment of coronary artery pathology in the clinical setting. Expert commentary: Invasive imaging, with its high resolution, and in particular hybrid intravascular imaging appears as the ideal approach to study the mechanisms regulating atherosclerotic disease progression; whereas non-invasive imaging is expected to enable complete assessment of coronary tree pathology, detection of high-risk lesions, more accurate risk stratification and thus to allow a personalized treatment of vulnerable patients.

5 Review Stress cardiovascular magnetic resonance imaging: current and future perspectives. 2017

Le, Thu-Thao / Huang, Weiting / Bryant, Jennifer Ann / Cook, Stuart Alexander / Chin, Calvin Woon-Loong. ·a Department of cardiovascular medicine , National Heart Centre Singapore , Singapore , Singapore. · b Duke-NUS Medical School , Singapore , Singapore. ·Expert Rev Cardiovasc Ther · Pubmed #28256176.

ABSTRACT: INTRODUCTION: Vasodilator and dobutamine are the main pharmacological agents used in current stress cardiovascular magnetic resonance (CMR). Exercise stress has well-established advantages and it is commonly used in other stress imaging, but the technical considerations have limited its use in stress CMR. In this review, we will describe the diagnostic performance, prognostic value, strengths and challenges of current stress CMR techniques. We will also discuss future perspectives of exercise stress CMR. Areas covered: Despite notable mechanistic differences, vasodilator and dobutamine stress CMR offer similar diagnostic and prognostic value in coronary artery disease. Combined perfusion and wall motion assessment has been explored with dobutamine stress CMR: diagnostic sensitivity improved at the expense of reduced specificity. However, a combined assessment may provide additional prognostic value in selected patients. There is emerging interest and promising data in exercise stress CMR because of the availability of CMR-compatible stress equipment and development of novel real-time sequences that allow imaging during exercise with adequate spatiotemporal resolution. Expert commentary: Exercise stress CMR is able to assess wall motion abnormalities, perfusion defects, exercise capacity and viability in a single examination. This holds important clinical potential in a variety of cardiovascular conditions.

6 Review Biomechanical stress in coronary atherosclerosis: emerging insights from computational modelling. 2017

Thondapu, Vikas / Bourantas, Christos V / Foin, Nicolas / Jang, Ik-Kyung / Serruys, Patrick W / Barlis, Peter. ·Melbourne Medical School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Victoria, Australia · Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria, Australia · University College London Hospitals, National Health Service Foundation Trust, London, UK. · National Heart Centre, Singapore, Singapore · Duke-National University Singapore Medical School, Singapore · Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · National Heart & Lung Institute, Imperial College, London, UK. ·Eur Heart J · Pubmed #28158723.

ABSTRACT: Coronary plaque rupture is the most common cause of vessel thrombosis and acute coronary syndrome. The accurate early detection of plaques prone to rupture may allow prospective, preventative treatment; however, current diagnostic methods remain inadequate to detect these lesions. Established imaging features indicating vulnerability do not confer adequate specificity for symptomatic rupture. Similarly, even though experimental and computational studies have underscored the importance of endothelial shear stress in progressive atherosclerosis, the ability of shear stress to predict plaque progression remains incremental. This review examines recent advances in image-based computational modelling that have elucidated possible mechanisms of plaque progression and rupture, and potentially novel features of plaques most prone to symptomatic rupture. With further study and clinical validation, these markers and techniques may improve the specificity of future culprit plaque detection.

7 Review Computer aided diagnosis of Coronary Artery Disease, Myocardial Infarction and carotid atherosclerosis using ultrasound images: A review. 2017

Faust, Oliver / Acharya, U Rajendra / Sudarshan, Vidya K / Tan, Ru San / Yeong, Chai Hong / Molinari, Filippo / Ng, Kwan Hoong. ·Department of Engineering and Mathematics, Sheffield Hallam University, United Kingdom. · Department of Electronic & Computer Engineering, Ngee Ann Polytechnic, Singapore; Department of Biomedical Engineering, School of Science and Technology, SIM University, Singapore; Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia. · Department of Electronic & Computer Engineering, Ngee Ann Polytechnic, Singapore. · Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. · Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy. · Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: ngkh@ummc.edu.my. ·Phys Med · Pubmed #28010920.

ABSTRACT: The diagnosis of Coronary Artery Disease (CAD), Myocardial Infarction (MI) and carotid atherosclerosis is of paramount importance, as these cardiovascular diseases may cause medical complications and large number of death. Ultrasound (US) is a widely used imaging modality, as it captures moving images and image features correlate well with results obtained from other imaging methods. Furthermore, US does not use ionizing radiation and it is economical when compared to other imaging modalities. However, reading US images takes time and the relationship between image and tissue composition is complex. Therefore, the diagnostic accuracy depends on both time taken to read the images and experience of the screening practitioner. Computer support tools can reduce the inter-operator variability with lower subject specific expertise, when appropriate processing methods are used. In the current review, we analysed automatic detection methods for the diagnosis of CAD, MI and carotid atherosclerosis based on thoracic and Intravascular Ultrasound (IVUS). We found that IVUS is more often used than thoracic US for CAD. But for MI and carotid atherosclerosis IVUS is still in the experimental stage. Furthermore, thoracic US is more often used than IVUS for computer aided diagnosis systems.

8 Review Bioresorbable stents: Current and upcoming bioresorbable technologies. 2017

Ang, Hui Ying / Bulluck, Heerajnarain / Wong, Philip / Venkatraman, Subbu S / Huang, Yingying / Foin, Nicolas. ·National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore. · School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore. · School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore. Electronic address: yingyinghuang@ntu.edu.sg. · National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; DUKE-NUS Medical School, 8 College Road, 169857, Singapore. Electronic address: nicolas.foin@gmail.com. ·Int J Cardiol · Pubmed #27912202.

ABSTRACT: Bioresorbable scaffolds (BRS) represent a novel horizon in interventional cardiology for the treatment of coronary artery disease. The technology was introduced to overcome limitations of current metallic drug-eluting stents such as late in-stent restenosis and permanently caging the vessel. The concept of the BRS is to provide temporal support to the vessel during healing before being degraded and resorbed by the body, promoting restoration of the vessel vasomotion. Currently, there are several BRS that are under development or already commercially available. Although several reviews have elegantly covered progress of current clinical programs and newer scaffold technologies, little is available currently to describe the mechanistic differences between biomaterials used in current and newer bioresorbable technologies. This aim of this review is to discuss the status of the different BRS technologies and materials currently under investigation, explore the newer strategies being adopted to improve material mechanical properties and optimize BRS degradation and summarize the performance of BRS in the clinical setting so far.

9 Review A review of bioresorbable scaffolds: hype or hope? 2017

Tan, Huay Cheem / Ananthakrishna, Rajiv. ·Department of Cardiology, National University Heart Centre, Singapore. ·Singapore Med J · Pubmed #27868135.

ABSTRACT: In the field of percutaneous coronary intervention, the evolution of coronary metal stents has been well established for the past three decades, but research on bioresorbable scaffolds has only gained momentum in the recent past. Although second-generation drug-eluting metal stents are the gold standard for the treatment of obstructive coronary artery disease, a few drawbacks exist. The development of bioresorbable scaffolds is an attempt to overcome the limitations of metal stents. This review highlights the rationale for the bioresorbable scaffold, its properties and potential applications. It also focuses on the current evidence and concerns regarding the application of the bioresorbable scaffold in day-to-day practice.

10 Review Pictorial essay: Uncommon causes of coronary artery encasement. 2016

Yong, Yan Rong / Lath, Narayan / Cheah, Foong Koon / Ng, Yuen Li. ·Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, 169608, Singapore. Electronic address: yongyanrong1984@hotmail.com. · Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, 169608, Singapore. Electronic address: narayan.lath@sgh.com.sg. · Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, 169608, Singapore. Electronic address: cheah.foong.koon@sgh.com.sg. · Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, 169608, Singapore. Electronic address: ng.yuen.li@singhealth.com.sg. ·J Cardiovasc Comput Tomogr · Pubmed #27443748.

ABSTRACT: This pictorial essay presents cases of non-atherosclerotic coronary artery encasement which were encountered in our institution, including malignant lymphoma, Erdheim-Chester disease, immunoglobulin G4 (IgG4)-related disease and Polyarteritis Nodosa. These conditions usually have multisystemic involvement which aid in the diagnosis. Awareness of these uncommon disorders and their ancillary findings can facilitate early, accurate diagnosis and appropriate management.

11 Review Noninvasive fractional flow reserve derived from coronary computed tomography angiography for identification of ischemic lesions: a systematic review and meta-analysis. 2016

Wu, Wen / Pan, Dao-Rong / Foin, Nicolas / Pang, Si / Ye, Peng / Holm, Niels / Ren, Xiao-Min / Luo, Jie / Nanjundappa, Aravinda / Chen, Shao-Liang. ·Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R. China. · National Heart Research Institute, National Heart Centre Singapore, 169609, Singapore. · Department of Cardiology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China. · Department of Cardiology, Aarhus University Hospital, Aarhus, 8000, Denmark. · Division of Vascular Surgery, West Virginia University, Morgantown, 25304, USA. ·Sci Rep · Pubmed #27377422.

ABSTRACT: Detection of coronary ischemic lesions by fractional flow reserve (FFR) has been established as the gold standard. In recent years, novel computer based methods have emerged and they can provide simulation of FFR using coronary artery images acquired from coronary computed tomography angiography (FFRCT). This meta-analysis aimed to evaluate diagnostic performance of FFRCT using FFR as the reference standard. Databases of PubMed, Cochrane Library, EMBASE, Medion and Web of Science were searched. Seven studies met the inclusion criteria, including 833 stable patients (1377 vessels or lesions) with suspected or known coronary artery disease (CAD). The patient-based analysis showed pooled estimates of sensitivity, specificity and diagnostic odds ratio (DOR) for detection of ischemic lesions were 0.89 [95%confidence interval (CI), 0.85-0.93], 0.76 (95%CI, 0.64-0.84) and 26.21 (95%CI, 13.14-52.28). At a per-vessel or per-lesion level, the pooled estimates were as follows: sensitivity 0.84 (95%CI, 0.80-0.87), specificity 0.76 (95%CI, 0.67-0.83) and DOR 16.87 (95%CI, 9.41-30.25). Area under summary receiver operating curves was 0.90 (95%CI, 0.87-0.92) and 0.86 (95%CI, 0.83-0.89) at the two analysis levels, respectively. In conclusion, FFRCT technology achieves a moderate diagnostic performance for noninvasive identification of ischemic lesions in stable patients with suspected or known CAD in comparison to invasive FFR measurement.

12 Review Human Validation of Genes Associated With a Murine Atherosclerotic Phenotype. 2016

Pasterkamp, Gerard / van der Laan, Sander W / Haitjema, Saskia / Foroughi Asl, Hassan / Siemelink, Marten A / Bezemer, Tim / van Setten, Jessica / Dichgans, Martin / Malik, Rainer / Worrall, Bradford B / Schunkert, Heribert / Samani, Nilesh J / de Kleijn, Dominique P V / Markus, Hugh S / Hoefer, Imo E / Michoel, Tom / de Jager, Saskia C A / Björkegren, Johan L M / den Ruijter, Hester M / Asselbergs, Folkert W. ·From the Laboratory of Experimental Cardiology, Division Heart and Lungs (G.P., S.W.v.d.L., S.H., M.A.S., T.B., J.v.S., I.E.H., S.C.A.d.J., H.M.d.R.), Laboratory of Clinical Chemistry and Hematology, Division Laboratories and Pharmacy (G.P.), and Division Heart and Lungs, Department of Cardiology (F.W.A.), University Medical Center Utrecht, Utrecht, The Netherlands · Vascular Biology Unit, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden (H.F.A., J.L.M.B.) · Institut für Schlaganfall- und Demenzforschung (ISD) Klinikum der Universität München, Munich, Germany (M.D., R.M.) · Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.) · Department of Neurology, University of Virginia, Charlottesville (B.B.W.) · Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (H.S.) · Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany (H.S.) · Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom (N.J.S.) · Leicester National Institute of Health Research Biomedical Research Unit in Cardiovascular Disease, Leicester, United Kingdom (N.J.S.) · Department of Surgery, National University of Singapore, Singapore (D.P.V.d.K.) · Cardiovascular Research Institute (CVRI), National University Health System, Singapore, Singapore (D.P.V.d.K.) · Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (D.P.V.d.K.) · Department of Neurosciences, University of Cambridge, Cambridge, United Kingdom (H.S.M.) · The Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom (T.M.) · Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (J.L.M.B.) · Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estoni ·Arterioscler Thromb Vasc Biol · Pubmed #27079880.

ABSTRACT: OBJECTIVE: The genetically modified mouse is the most commonly used animal model for studying the pathogenesis of atherosclerotic disease. We aimed to assess if mice atherosclerosis-related genes could be validated in human disease through examination of results from genome-wide association studies. APPROACH AND RESULTS: We performed a systematic review to identify atherosclerosis-causing genes in mice and carried out gene-based association tests of their human orthologs for an association with human coronary artery disease and human large artery ischemic stroke. Moreover, we investigated the association of these genes with human atherosclerotic plaque characteristics. In addition, we assessed the presence of tissue-specific cis-acting expression quantitative trait loci for these genes in humans. Finally, using pathway analyses we show that the putative atherosclerosis-causing genes revealed few associations with human coronary artery disease, large artery ischemic stroke, or atherosclerotic plaque characteristics, despite the fact that the majority of these genes have cis-acting expression quantitative trait loci. CONCLUSIONS: A role for genes that has been observed in mice for atherosclerotic lesion development could scarcely be confirmed by studying associations of disease development with common human genetic variants. The value of murine atherosclerotic models for selection of therapeutic targets in human disease remains unclear.

13 Review Clinical Outcomes of Bioresorbable Scaffold in Coronary Artery Disease: A Systematic Literature Review. 2016

Keh, Yann Shan / Yap, Jonathan / Yeo, Khung Keong / Koh, Tian Hai / Eeckhout, Eric. ·Department of Cardiology, National Heart Centre Singapore, Singapore. · Duke-NUS Graduate Medical School, Singapore. · Division of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. ·J Interv Cardiol · Pubmed #26728234.

ABSTRACT: OBJECTIVES: We aim to perform a systematic literature review on all studies reporting the clinical outcomes of the use of bioresorbable scaffolds (BRS) in different settings of coronary artery disease (CAD). BACKGROUND: BRS are designed to provide early support of the vessel wall postangioplasty, deliver antiproliferative agents to prevent excessive hyperplastic healing responses and finally "disappear" when no longer required. Emerging data have provided evidence of their use in specific clinical scenarios. METHODS: A comprehensive literature search was performed by 2 independent reviewers utilizing MEDLINE, EMBASE, and Cochrane Library databases. The only 2 CE marked BRS: everolimus-eluting Bioresorbable vascular scaffold ABSORB BVS and the myolimus-eluting DESolve Bioresorbable Coronary Scaffold (BCS) System were included. RESULTS: The studies were categorized into: ST elevation myocardial infarction (STEMI), stable CAD, and "all-comers" group. Thirty-one studies were included; 8 in STEMI patients (all ABSORB), 15 in stable CAD patients. In the STEMI group (n = 606), acute procedural success ranged from 96% to 100%, cardiac mortality 0-9.1%, recurrent MI and stent thrombosis rates were 0-4.3%. In the stable CAD group, the 13 ABSORB studies (n = 3259) demonstrated cardiac mortality rate of 0-0.6%, recurrent MI rate 0-4.5%, and stent thrombosis rate 0-4.3% CONCLUSIONS: Current clinical data suggest the BRS, especially the ABSORB BVS, may represent a reasonable alternative to DES in uncomplicated coronary anatomy.

14 Review Narrative review of health-related quality of life and its predictors among patients with coronary heart disease. 2016

Muhammad, Imran / He, Hong-Gu / Kowitlawakul, Yanika / Wang, Wenru. ·Ward B65 (General Medicine/Cardiology), Khoo Teck Phuat Hospital, Singapore. · Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. ·Int J Nurs Pract · Pubmed #25039442.

ABSTRACT: This paper summarizes the empirical evidence concerning health-related quality of life (HRQoL) of patients with coronary heart disease (CHD) and attempts to identify its significant predictors. A systematic search of the literature from 2002 to 2012 was conducted using seven electronic databases (CINAHL, ScienceDirect, Medline, Scopus, PsycINFO, PubMed and Web of Science) using the search terms 'HRQoL'. 'CHD', 'social support', 'depression', 'anxiety', 'psychosocial factors', 'sociodemographic factors', 'clinical factors' and 'predictors'. A total of 1052 studies were retrieved, of which 24 articles were included in this review. Previous studies have consistently demonstrated the negative impact of CHD on HRQoL, citing three major types of predictive factors: sociodemographic, clinical and psychosocial factors. Studies have also highlighted the advantageous use of HRQoL as a gauge for treatment satisfaction and efficacy. There are, however, few studies that collectively investigate the relationship among concepts such as HRQoL, anxiety and depression, social support, and sociodemographic and clinical factors in relation to CHD. This review highlights the need to conduct further study on HRQoL of patients with CHD in the Asian context. Such research will promote patient-centric care and improved patient satisfaction through incorporation of the concept of HRQoL into clinical practice.

15 Review The challenge of coronary calcium on coronary computed tomographic angiography (CCTA) scans: effect on interpretation and possible solutions. 2015

Andrew, Makmur / John, Hoe. ·Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore. Andrew.makmur@gmail.com. · Department of Radiology, Mt Elizabeth Hospital, Singapore, Singapore. johnwmhoe@gmail.com. ·Int J Cardiovasc Imaging · Pubmed #26408105.

ABSTRACT: Coronary calcium seen on coronary computed tomographic angiography (CCTA) scans is a common diagnostic challenge which can make interpretation difficult. It is the most common cause of false positive (FP) results from CCTA compared with invasive coronary angiography (ICA), and affects the positive predictive results. At the same time, coronary calcium can result in false negative (FN) results, and this again can affect the reported diagnostic accuracy of CCTA, as the high negative predictive value of CCTA compared to ICA is one of its strengths. This paper reviews the reasons that coronary calcium can cause FP and FN results, and the effects of the morphologies and sizes of the calcified plaques, with particular regard to their relationship with the visualization of the contrast-filled lumen of the coronary artery. Some possible solutions to overcome the limitations of reading CCTA scans with calcified plaques also are discussed, with a view to improving the accuracy of interpreting and reporting CCTA scans; these solutions include using the degree of residual visible contrast-filled lumen to help assess the likelihood of significant associated coronary stenosis, and applying newer technical developments such as dual-energy imaging and volume calcium subtraction.

16 Review Biomechanical Modeling to Improve Coronary Artery Bifurcation Stenting: Expert Review Document on Techniques and Clinical Implementation. 2015

Antoniadis, Antonios P / Mortier, Peter / Kassab, Ghassan / Dubini, Gabriele / Foin, Nicolas / Murasato, Yoshinobu / Giannopoulos, Andreas A / Tu, Shengxian / Iwasaki, Kiyotaka / Hikichi, Yutaka / Migliavacca, Francesco / Chiastra, Claudio / Wentzel, Jolanda J / Gijsen, Frank / Reiber, Johan H C / Barlis, Peter / Serruys, Patrick W / Bhatt, Deepak L / Stankovic, Goran / Edelman, Elazer R / Giannoglou, George D / Louvard, Yves / Chatzizisis, Yiannis S. ·Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece; Cardiovascular Department, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom. · FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium. · California Medical Innovations Institute, San Diego, California. · Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta," Politecnico di Milano, Milan, Italy. · National Heart Centre Singapore, Singapore. · Department of Cardiology and Clinical Research Institute, Kyushu Medical Center, Fukuoka, Japan. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. · Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. · Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan. · Cardiovascular Division, Department of Internal Medicine, Saga University, Saga, Japan. · Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta," Politecnico di Milano, Milan, Italy; Biomechanics Laboratory, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands. · Biomechanics Laboratory, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. · Melbourne Medical School and Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia. · International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade, Belgrade, Serbia. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts. · Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. · Institut Cardiovasculaire Paris Sud, Massy, France. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. Electronic address: ychatzizisis@icloud.com. ·JACC Cardiovasc Interv · Pubmed #26315731.

ABSTRACT: Treatment of coronary bifurcation lesions remains an ongoing challenge for interventional cardiologists. Stenting of coronary bifurcations carries higher risk for in-stent restenosis, stent thrombosis, and recurrent clinical events. This review summarizes the current evidence regarding application and use of biomechanical modeling in the study of stent properties, local flow dynamics, and outcomes after percutaneous coronary interventions in bifurcation lesions. Biomechanical modeling of bifurcation stenting involves computational simulations and in vitro bench testing using subject-specific arterial geometries obtained from in vivo imaging. Biomechanical modeling has the potential to optimize stenting strategies and stent design, thereby reducing adverse outcomes. Large-scale clinical studies are needed to establish the translation of pre-clinical findings to the clinical arena.

17 Review Absorb bioresorbable vascular scaffold: What have we learned after 5 years of clinical experience? 2015

Caiazzo, Gianluca / Kilic, Ismail Dogu / Fabris, Enrico / Serdoz, Roberta / Mattesini, Alessio / Foin, Nicolas / De Rosa, Salvatore / Indolfi, Ciro / Di Mario, Carlo. ·Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy; Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom. · Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom. · Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom; Cardiovascular Department, "Ospedali Riuniti" & University of Trieste, Trieste, Italy. · Department of Heart and Vessels, AOUC Careggi, Florence, Italy. · National Heart Centre Singapore, Singapore. · Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy. · Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom. Electronic address: c.dimario@rbht.nhs.uk. ·Int J Cardiol · Pubmed #26298354.

ABSTRACT: Bioresorbable scaffolds have the potential to introduce a paradigm shift in interventional cardiology, a true anatomical and functional "vascular restoration" instead of an artificial stiff tube encased by persistent metallic foreign body. Early clinical studies using the first commercially available drug-eluting bioresorbable vascular scaffold (BVS) reported very promising safety and efficacy outcomes, comparable to best-in-class second-generation drug-eluting metal stent. To date, more than 60,000 Absorb BVSs have been implanted with only the interim analysis of one randomized trial (ABSORB II RCT) available. Recent registries have challenged the initial claim that BVS is immune from Scaffold Thrombosis (ST). However, suboptimal device expansion and insufficient intracoronary imaging guidance can explain higher than expected ST, especially in complex lesions. The aim of this review article is to critically evaluate the results of the available Absorb BVS studies and discuss the lessons learned to optimize lesion selection and implantation technique of such devices.

18 Review Optical coherence tomography to evaluate coronary stent implantation and complications. 2015

Hayat, Umair / Thondapu, Vikas / Ul Haq, Muhammad Asrar / Foin, Nicolas / Jang, Ik-Kyung / Barlis, Peter. ·aCardiovascular Research Group, Melbourne Medical School, The University of Melbourne bDepartment of Mechanical Engineering, Melbourne School of Engineering, University of Melbourne, Melbourne, Victoria, Australia cNational Heart Research Institute, National Heart Centre Singapore, Singapore dMassachusetts General Hospital, Harvard University, Boston, Massachusetts, USA. ·Coron Artery Dis · Pubmed #26247272.

ABSTRACT: Coronary optical coherence tomography (OCT) is now an established imaging technique in many catheterization laboratories worldwide. With its near-histological view of the vessel wall and lumen interface, it offers unprecedented imaging quality to improve our understanding of the pathophysiology of atherosclerosis, plaque vulnerability, and vascular biology. Not only is OCT used to accurately detect atherosclerotic plaque and optimize stent position, but it can further characterize plaque composition, quantify stent apposition, and assess stent tissue coverage. Given that its resolution of 15 μm is well above that of angiography and intravascular ultrasound, OCT has become the invasive imaging method of choice to examine the interaction between stents and the vessel wall. This review focuses on the application of OCT to examine coronary stents, the mechanisms of stent complications, and future directions of OCT-guided intervention.

19 Review Advances in three-dimensional coronary imaging and computational fluid dynamics: is virtual fractional flow reserve more than just a pretty picture? 2015

Poon, Eric K W / Hayat, Umair / Thondapu, Vikas / Ooi, Andrew S H / Ul Haq, Muhammad Asrar / Moore, Stephen / Foin, Nicolas / Tu, Shengxian / Chin, Cheng / Monty, Jason P / Marusic, Ivan / Barlis, Peter. ·aDepartment of Mechanical Engineering, Melbourne School of Engineering bNorth West Academic Centre, Melbourne Medical School cIBM Research Collaboratory for Life Sciences-Melbourne, Victoria Life Sciences Computation Initiative, The University of Melbourne, Melbourne, Victoria, Australia dNational Heart Research Institute Singapore, National Heart Centre Singapore, Singapore eBiomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. ·Coron Artery Dis · Pubmed #26247271.

ABSTRACT: Percutaneous coronary intervention (PCI) has shown a high success rate in the treatment of coronary artery disease. The decision to perform PCI often relies on the cardiologist's visual interpretation of coronary lesions during angiography. This has inherent limitations, particularly due to the low resolution and two-dimensional nature of angiography. State-of-the-art modalities such as three-dimensional quantitative coronary angiography, optical coherence tomography and invasive fractional flow reserve (FFR) may improve clinicians' understanding of both the anatomical and physiological importance of coronary lesions. While invasive FFR is the gold standard technique for assessment of the haemodynamic significance of coronary lesions, recent studies have explored a surrogate for FFR derived solely from three-dimensional reconstruction of the invasive angiogram, and therefore eliminating need for a pressure wire. Utilizing advanced computational fluid dynamics research, this virtual fractional flow reserve (vFFR) has demonstrated reasonable correlation with invasive measurements and remains an intense area of ongoing study. However, at present, several limitations and computational fluid dynamic assumptions may preclude vFFR from widespread clinical use. This review demonstrates the tight integration of advanced three-dimensional imaging techniques and vFFR in assessing coronary artery disease, reviews the advantages and disadvantages of such techniques and attempts to provide a glimpse of how such advances may benefit future clinical decision-making during PCI.

20 Review Biomarkers of Coronary Artery Disease Differ Between Asians and Caucasians in the General Population. 2015

Gijsberts, Crystel M / den Ruijter, Hester M / Asselbergs, Folkert W / Chan, Mark Y / de Kleijn, Dominique P V / Hoefer, Imo E. ·Laboratory of Experimental Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands; ICIN-Netherlands Heart Institute, Utrecht, the Netherlands. Electronic address: c.m.gijsberts@umcutrecht.nl. · Laboratory of Experimental Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands. · Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, the Netherlands; Institute of Cardiovascular Science, Population Health Sciences, University College London, London, United Kingdom. · Department of Cardiology, National University Singapore, Singapore; Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore. · Laboratory of Experimental Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands; Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore; Department of Surgery, National University Singapore, Singapore. ·Glob Heart · Pubmed #26014657.

ABSTRACT: Coronary artery disease (CAD) markers have not been thoroughly investigated among Asians. The incidence of CAD, however, is rising rapidly in Asia. In this review, we systematically discuss publications that compare CAD biomarkers between Asians and Caucasians in the general population. A PubMed search yielded 5,570 hits, containing 59 articles describing 47 unique cohorts that directly compare Asians with Caucasians. Ten biomarkers were taken into account for this review: total cholesterol; triglycerides; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; C-reactive protein; glucose; insulin; glycated hemoglobin; fibrinogen; and plasminogen activator inhibitor-1. Triglycerides were 1.13-fold higher in South Asians than in Caucasians, and insulin levels were 1.33-fold higher. In Japanese and Chinese subjects, lower C-reactive protein levels were reported: 0.52 and 0.36-fold, respectively. Ethnicity-specific prognostic measures of CAD biomarkers were rarely reported. CAD biomarker levels differ between Asians and Caucasians and among Asian ethnic groups in population-based cohorts. The ethnicity-specific prognostic value of CAD biomarkers is yet to be determined.

21 Review A qualitative systematic review of the prevalence of coronary artery disease in systemic sclerosis. 2015

Ali, Hassan / Ng, Kiat R / Low, Andrea H L. ·Department of Rheumatology and Immunology, Singapore General Hospital, Singapore City, Singapore. ·Int J Rheum Dis · Pubmed #25884668.

ABSTRACT: AIMS: To review existing literature on the prevalence/incidence of coronary artery disease (CAD), and secondarily highlight risk factors for CAD in systemic sclerosis (SSc). METHODS: A PubMed and Cochrane Central Register of Controlled Trials search of studies (till 30 November 2013) relating to SSc and CAD was performed, retrieving 180 titles. INCLUSION CRITERIA: studies reporting CAD prevalence/incidence in SSc based on autopsy findings, coronary artery calcium scores, coronary angiographic findings and physician/patient-reported CAD. EXCLUSION CRITERIA: (i) not written in English; (ii) not concerned with human subjects; (iii) single case reports or review articles; (iv) genetic studies; and 95) other surrogate outcome measures of atherosclerosis. Quality assessment was done using the Newcastle-Ottawa score (range 0-9). RESULTS: Thirteen studies (Newcastle-Ottawa score 5-8) were selected. Of eight studies with controls, seven reported increased CAD prevalence (10-56%) or incidence (2.3%) compared to controls (prevalence 2-44%; incidence 1.5%). Of five studies without controls, CAD prevalence was 8-32%. Five of six studies reported that traditional cardiovascular risk factors were similar/reduced in SSc compared to controls. SSc was an independent risk factor for CAD, in addition to age (n = 2), hypercholesterolaemia (n = 3), male gender (n = 1), hypertension and diabetes (n = 1). Disease duration, renal involvement and pulmonary arterial hypertension were associated with CAD. CONCLUSIONS: Systemic sclerosis is associated with an increased prevalence/incidence of CAD. SSc is an independent risk factor for CAD. The association of CAD with SSc-related factors requires further research. Meanwhile, patients with SSc should be screened and treated for identified traditional cardiovascular risk factors.

22 Review Optical coherence tomography in bioabsorbable stents: mechanism of vascular response and guidance of stent implantation. 2014

Mattesini, A / Pighi, M / Konstantinidis, N / Ghione, M / Kilic, D / Foin, N / Dall'ara, G / Secco, G G / Valente, S / Di Mario, C. ·NIHR Biomedical Research Unit Royal Brompton & Harefield NHS Foundation Trust, London, UK2 Interventional Cardiology Unit Department of Heart and Vessels Florence University AOU Careggi, Florence, Italy3 National Heart Centre Singapore, Singapore4 University of Eastern Piedmont "Maggiore della Carità" Hospital, Novara, Italy - c.dimario@rbht.nhs.uk. ·Minerva Cardioangiol · Pubmed #24500218.

ABSTRACT: Fully biodegradable L-polylactic acid stents (biodegradable vascular scaffold, BVS), the latest breakthrough in the area of coronary implants, entered clinical trials in 2005 and became commercially available in 2011. Optical coherence tomography (OCT) was used from the first implants to study the vessel wall response and the timing of the resorption process in man. Analysis of BVS with OCT has several advantages over that of metallic stents. BVS polymeric struts are transparent to the light so that scaffold integrity, apposition to the underlying wall, presence of thrombus and hyperplasia, and changes in the strut characteristics over time can be easily studied. We present a comprehensive review of the findings OCT provided when used as a research tool in serial examination up to five years for investigation of the mechanism of resorption, neointimal coverage, shrinkage and late lumen enlargement. We also report our experience with OCT in 47 lesions of various complexity as a practical means of percutaneous coronary intervention guidance during BVS implantation.

23 Review Perioperative applications of deformation (myocardial strain) imaging with speckle-tracking echocardiography. 2014

Chong, Adrian / MacLaren, Graeme / Chen, Robert / Connelly, Kim A. ·Division of Cardiology, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. · Cardiothoracic Intensive Care Unit, National University Health System, Singapore. · Department of Critical Care Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. · Division of Cardiology, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. Electronic address: connellyk@smh.ca. ·J Cardiothorac Vasc Anesth · Pubmed #24231194.

ABSTRACT: -- No abstract --

24 Review Electrocardiogram-based predictors of sudden cardiac death in patients with coronary artery disease. 2011

Liew, Reginald. ·Department of Cardiology, National Heart Centre, and Duke-NUS Graduate Medical School, Singapore. reginald.liew.k.c@nhcs.com.sg ·Clin Cardiol · Pubmed #21717472.

ABSTRACT: Current recommendations on which patients with coronary artery disease (CAD) should be offered an implantable cardioverter defibrillator for the primary prevention of sudden cardiac death (SCD) rely heavily on the presence of depressed left ventricular ejection fraction. Because the majority of SCD victims with CAD have preserved left ventricular function, additional cardiac investigations are likely to play an increasing role in the risk stratification of CAD patients. A number of studies have demonstrated that certain parameters on the traditional 12-lead electrocardiogram (ECG) and other ECG-based investigations (such as signal-averaged ECG, heart rate turbulence, T-wave alternans) can provide important information on the underlying cardiac substrate abnormality that may predispose to ventricular arrhythmias and SCD. This article reviews some of the evidence for these ECG-based tests as predictors of SCD in patients with CAD and addresses their advantages and limitations.

25 Review Statin therapy in the prevention and treatment of atrial fibrillation. 2011

Lee, Yi Lin / Blaha, Michael J / Jones, Steven R. ·Department of General Medicine, Tan Tock Seng Hospital, Singapore. ·J Clin Lipidol · Pubmed #21262503.

ABSTRACT: Atrial fibrillation (AF) is the most common adult rhythm disorder, and it is associated with a substantial rate of morbidity and economic burden. There is an increasing body of literature in which the authors investigated the pleiotropic effects of statin therapy in relation to AF. In this comprehensive review, we examine the mechanism of AF as well as potential mechanisms supporting statin use in both the prevention and treatment of AF. In clinical studies, statin therapy appears to be useful in the prevention of AF in patients with coronary artery disease and possibly congestive heart failure and in the prevention of perioperative AF in cardiac surgery. Its utility in patients with paroxysmal AF may be limited to the prevention of incident AF, but it does not appear to inhibit the progression of paroxysmal AF to chronic AF. Further large scale, randomized, placebo-controlled studies are needed in perioperative use in noncardiac surgery and in patients undergoing ablation or cardioversion of AF.

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