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Coronary Artery Disease: HELP
Articles from NIH Bethesda
Based on 198 articles published since 2008
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These are the 198 published articles about Coronary Artery Disease that originated from NIH Bethesda during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8
1 Editorial Bridging the Sex Gap in Early Myocardial Infarction Mortality: Why It Matters. 2017

Cook, Nakela L. ·From the Immediate Office of the Director, National Heart, Lung, and Blood Institute, Bethesda, MD. nakela.cook@nih.gov. ·Circ Cardiovasc Qual Outcomes · Pubmed #29246885.

ABSTRACT: -- No abstract --

2 Editorial Cholesterol Lowering in 2015: Still Answering Questions About How and in Whom. 2015

Greenland, Philip / Lauer, Michael S. ·Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois2Senior Editor, JAMA. · Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland. ·JAMA · Pubmed #26172891.

ABSTRACT: -- No abstract --

3 Editorial Coronary computed tomographic angiography and incidental pulmonary nodules. 2014

Bluemke, David A. ·From the National Institutes of Health, Bethesda, MD. bluemked@nih.gov. ·Circulation · Pubmed #25015341.

ABSTRACT: -- No abstract --

4 Editorial Computed tomography perfusion to assess physiological significance of coronary stenosis in the post-FAME era (Fractional Flow Reserve versus Angiography for Multivessel Evaluation). 2013

Arai, Andrew E. ·Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland. Electronic address: araia@nih.gov. ·J Am Coll Cardiol · Pubmed #23773869.

ABSTRACT: -- No abstract --

5 Review Imaging the myocardial ischemic cascade. 2018

Stillman, Arthur E / Oudkerk, Matthijs / Bluemke, David A / de Boer, Menko Jan / Bremerich, Jens / Garcia, Ernest V / Gutberlet, Matthias / van der Harst, Pim / Hundley, W Gregory / Jerosch-Herold, Michael / Kuijpers, Dirkjan / Kwong, Raymond Y / Nagel, Eike / Lerakis, Stamatios / Oshinski, John / Paul, Jean-François / Slart, Riemer H J A / Thourani, Vinod / Vliegenthart, Rozemarijn / Wintersperger, Bernd J. ·Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Rd NE, Atlanta, GA, 30322, USA. aestill@emory.edu. · Center of Medical Imaging, University Medical Center Groningen, Groningen, The Netherlands. · Department of Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA. · Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands. · Department of Radiology, University of Basel Hospital, Basel, Switzerland. · Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Rd NE, Atlanta, GA, 30322, USA. · Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany. · Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands. · Departments of Internal Medicine & Radiology, Wake Forest University, Winston-Salem, NC, USA. · Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA. · Department of Radiology, Haaglanden Medical Center, The Hague, The Netherlands. · Department of Cardiology, Brigham and Women's Hospital, Boston, MA, USA. · Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital, Frankfurt/Main, Germany. · Department of Medicine, Emory University, Atlanta, GA, USA. · Department of Radiology, Institut Mutualiste Montsouris, Paris, France. · Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. · Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA. · Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands. · Department of Medical Imaging, University of Toronto, Toronto, Canada. ·Int J Cardiovasc Imaging · Pubmed #29556943.

ABSTRACT: Non-invasive imaging plays a growing role in the diagnosis and management of ischemic heart disease from its earliest manifestations of endothelial dysfunction to myocardial infarction along the myocardial ischemic cascade. Experts representing the North American Society for Cardiovascular Imaging and the European Society of Cardiac Radiology have worked together to organize the role of non-invasive imaging along the framework of the ischemic cascade. The current status of non-invasive imaging for ischemic heart disease is reviewed along with the role of imaging for guiding surgical planning. The issue of cost effectiveness is also considered. Preclinical disease is primarily assessed through the coronary artery calcium score and used for risk assessment. Once the patient becomes symptomatic, other imaging tests including echocardiography, CCTA, SPECT, PET and CMR may be useful. CCTA appears to be a cost-effective gatekeeper. Post infarction CMR and PET are the preferred modalities. Imaging is increasingly used for surgical planning of patients who may require coronary artery bypass.

6 Review Bridging the gap for lipid lowering therapy: plaque regression, coronary computed tomographic angiography, and imaging-guided personalized medicine. 2017

Kwan, Alan C / Aronis, Konstantinos N / Sandfort, Veit / Blumenthal, Roger S / Bluemke, David A. ·a Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MA , USA. · b Radiology and Imaging Sciences, Department of the National Institutes of Health , Bethesda , MD , USA. · c Department of Cardiology , Johns Hopkins University School of Medicine , Baltimore , MA , USA. ·Expert Rev Cardiovasc Ther · Pubmed #28657444.

ABSTRACT: INTRODUCTION: Lipid-lowering therapy effectively decreases cardiovascular risk on a population level, but it remains difficult to identify an individual patient's personal risk reduction while following guideline directed medical therapy, leading to overtreatment in some patients and cardiovascular events in others. Recent improvements in cardiac CT technology provide the ability to directly assess an individual's atherosclerotic disease burden, which has the potential to personalize risk assessment for lipid-lowering therapy. Areas covered: We review the current unmet need in identifying patients at elevated residual risk despite guideline directed medical therapy, the evidence behind plaque regression as a potential marker of therapeutic response, and highlight state-of-the-art advances in coronary computed tomographic angiography (CCTA) for measurement of quantitative and qualitative changes in coronary atherosclerosis over time. Literature search was performed using PubMed and Google Scholar for literature relevant to statin therapy and residual risk, coronary plaque regression measurement, and CCTA assessment of quantitative and qualitative change in coronary atherosclerosis. Expert commentary: We discuss the potential ability of CCTA to guide lipid-lowering therapy as a bridge between population and personalized medicine in the future, as well as the potential barriers to its use.

7 Review Cardiac Applications of PET-MR. 2017

Bergquist, Peter J / Chung, Michael S / Jones, Anja / Ahlman, Mark A / White, Charles S / Jeudy, Jean. ·Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. · Department of Radiology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA. · Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. jjeudy@umm.edu. · University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA. jjeudy@umm.edu. ·Curr Cardiol Rep · Pubmed #28401505.

ABSTRACT: PURPOSE OF REVIEW: The purpose of this study was to provide an overview of the clinical applications of PET-MR in the setting of cardiac imaging with emphasis on specific scenarios where both techniques together provided added information. RECENT FINDINGS: Synergy of cardiac PET and MR fusion may hold similar promise eliminating ionizing radiation and improving tissue contrast. Future development of new hybrid scanners, use of new imaging tracers, and clinical applications are significant factors which will influence its use. Both positron emission tomography (PET) and cardiac magnetic resonance imaging (CMR) provide important anatomic and physiologic information with regard to the heart. Being able to combine the data from these two examinations in a hybrid technique allows for a more complete evaluation of cardiac pathology. While hybrid PET-CT has already established the utility of a combined imaging approach, the use of CMR in lieu of CT allows for elimination of ionizing radiation and for improved tissue contrast.

8 Review CT calcium scoring. History, current status and outlook. 2017

Sandfort, V / Bluemke, D A. ·Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA. · Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA. Electronic address: david.bluemke@nih.gov. ·Diagn Interv Imaging · Pubmed #27423708.

ABSTRACT: Cardiovascular risk assessment has assumed a prominent role in the course of preventive care of all adults. Traditionally cardiovascular risk assessment has been performed using risk factors including gender, age, smoking history, lipid status, diabetes status, and family history. Increasingly, imaging has been deployed to directly detect coronary atherosclerotic disease. Quantification of coronary calcium (e.g., Agatston method, calcium mass and volume) is readily detected using helical CT scanners. Large multicenter cohort studies have enabled a better understanding of the relevance of coronary calcium detection. The purpose of this review is to review the methods for quantification of coronary artery calcium, as well as to present current and future perspectives on calcium scoring for cardiovascular risk stratification.

9 Review Coronary Computed Tomography Angiography in the Evaluation of Chest Pain of Suspected Cardiac Origin. 2016

Bittencourt, Marcio Sommer / Hulten, Edward A / Veeranna, Vikas / Blankstein, Ron. ·From Center for Clinical and Epidemiological Research, University Hospital & São Paulo State Cancer Institute, University of São Paulo School of Medicine, Brazil (M.S.B.);Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B.);Cardiology Service, Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD (E.A.H.) · andCardiovascular Imaging Program, Departments of Medicine and Radiology · Brigham and Women's Hospital · Harvard Medical School, Boston, MA (V.V., R.B.). ·Circulation · Pubmed #27185023.

ABSTRACT: -- No abstract --

10 Review Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73). 2016

Ramsden, Christopher E / Zamora, Daisy / Majchrzak-Hong, Sharon / Faurot, Keturah R / Broste, Steven K / Frantz, Robert P / Davis, John M / Ringel, Amit / Suchindran, Chirayath M / Hibbeln, Joseph R. ·Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA Chris.Ramsden@nih.gov. · Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA. · Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA. · Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA. · Medtronic, Minneapolis, MN, USA. · Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. · Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA Psychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA. · Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA. ·BMJ · Pubmed #27071971.

ABSTRACT: OBJECTIVE: To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and meta-analysis. DESIGN: The MCE (1968-73) is a double blind randomized controlled trial designed to test whether replacement of saturated fat with vegetable oil rich in linoleic acid reduces coronary heart disease and death by lowering serum cholesterol. Recovered MCE unpublished documents and raw data were analyzed according to hypotheses prespecified by original investigators. Further, a systematic review and meta-analyses of randomized controlled trials that lowered serum cholesterol by providing vegetable oil rich in linoleic acid in place of saturated fat without confounding by concomitant interventions was conducted. SETTING: One nursing home and six state mental hospitals in Minnesota, United States. PARTICIPANTS: Unpublished documents with completed analyses for the randomized cohort of 9423 women and men aged 20-97; longitudinal data on serum cholesterol for the 2355 participants exposed to the study diets for a year or more; 149 completed autopsy files. INTERVENTIONS: Serum cholesterol lowering diet that replaced saturated fat with linoleic acid (from corn oil and corn oil polyunsaturated margarine). Control diet was high in saturated fat from animal fats, common margarines, and shortenings. MAIN OUTCOME MEASURES: Death from all causes; association between changes in serum cholesterol and death; and coronary atherosclerosis and myocardial infarcts detected at autopsy. RESULTS: The intervention group had significant reduction in serum cholesterol compared with controls (mean change from baseline -13.8%v-1.0%; P<0.001). Kaplan Meier graphs showed no mortality benefit for the intervention group in the full randomized cohort or for any prespecified subgroup. There was a 22% higher risk of death for each 30 mg/dL (0.78 mmol/L) reduction in serum cholesterol in covariate adjusted Cox regression models (hazard ratio 1.22, 95% confidence interval 1.14 to 1.32; P<0.001). There was no evidence of benefit in the intervention group for coronary atherosclerosis or myocardial infarcts. Systematic review identified five randomized controlled trials for inclusion (n=10,808). In meta-analyses, these cholesterol lowering interventions showed no evidence of benefit on mortality from coronary heart disease (1.13, 0.83 to 1.54) or all cause mortality (1.07, 0.90 to 1.27). CONCLUSIONS: Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes. Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.

11 Review The Link Between Inflammatory Disorders and Coronary Heart Disease: a Look at Recent Studies and Novel Drugs in Development. 2016

Teague, H / Mehta, Nehal N. ·National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA. · National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA. nehal.mehta@nih.gov. · Cardiovascular and Pulmonary Branch, NHLBI, National Institutes of Health, 10 Center Drive, CRC, Room 5-5140, Bethesda, MD, 20892, USA. nehal.mehta@nih.gov. ·Curr Atheroscler Rep · Pubmed #26739273.

ABSTRACT: Inflammation is a critical component in the development of coronary heart disease (CHD), specifically in the process of atherogenesis. Human translational and preclinical studies have demonstrated that inflammation contributes to the development, sustainment, and progression of atherosclerosis, and epidemiological studies demonstrate that human diseases associated with increased systemic inflammation increase the risk of CHD-related events. Therefore, over the last decade, multiple clinical studies were designed to target the inflammatory cascade in order to reduce the risk of CHD and to identify which populations may benefit from these preventative treatment strategies. This review briefly summarizes inflammation as a risk factor in atherosclerosis, human disease states associated with accelerated atherosclerosis, and current treatment strategies for CHD targeting the inflammatory cascade.

12 Review Cardiovascular magnetic resonance phase contrast imaging. 2015

Nayak, Krishna S / Nielsen, Jon-Fredrik / Bernstein, Matt A / Markl, Michael / D Gatehouse, Peter / M Botnar, Rene / Saloner, David / Lorenz, Christine / Wen, Han / S Hu, Bob / Epstein, Frederick H / N Oshinski, John / Raman, Subha V. ·Ming Hsieh Department of Electrical Engineering, University of Southern California, 3740 McClintock Ave, EEB 406, Los Angeles, California, 90089-2564, USA. knayak@usc.edu. · Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA. jfnielse@umich.edu. · Mayo Clinic, Rochester, MN, USA. mbernstein@mayo.edu. · Department of Radiology, Northwestern University, Chicago, IL, USA. mmarkl@northwestern.edu. · Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. p.gatehouse@rbht.nhs.uk. · Cardiovascular Imaging, Imaging Sciences Division, Kings's College London, London, UK. rene.botnar@kcl.ac.uk. · Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. david.saloner@ucsf.edu. · Center for Applied Medical Imaging, Siemens Corporation, Baltimore, MD, USA. christine.lorenz@siemens.com. · Imaging Physics Laboratory, National Heart Lung and Blood Institute, Bethesda, MD, USA. han.wen@nih.gov. · Palo Alto Medical Foundation, Palo Alto, CA, USA. hub@pamf.org. · Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA, USA. fredepstein@virginia.edu. · Departments of Radiology and Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, USA. jnoshin@emory.edu. · Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA. raman.1@osu.edu. ·J Cardiovasc Magn Reson · Pubmed #26254979.

ABSTRACT: Cardiovascular magnetic resonance (CMR) phase contrast imaging has undergone a wide range of changes with the development and availability of improved calibration procedures, visualization tools, and analysis methods. This article provides a comprehensive review of the current state-of-the-art in CMR phase contrast imaging methodology, clinical applications including summaries of past clinical performance, and emerging research and clinical applications that utilize today's latest technology.

13 Review Noninvasive Imaging of Atherosclerotic Plaque Progression: Status of Coronary Computed Tomography Angiography. 2015

Sandfort, Veit / Lima, Joao A C / Bluemke, David A. ·From the Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S., D.A.B.) · and Department of Radiology (J.A.C.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, MD. ·Circ Cardiovasc Imaging · Pubmed #26156016.

ABSTRACT: The process of coronary artery disease progression is infrequently visualized. Intravascular ultrasound has been used to gain important insights but is invasive and therefore limited to high-risk patients. For low-to-moderate risk patients, noninvasive methods may be useful to quantitatively monitor plaque progression or regression and to understand and personalize atherosclerosis therapy. This review discusses the potential for coronary computed tomography angiography to evaluate the extent and subtypes of coronary plaque. Computed tomographic technology is evolving and image quality of the method approaches the level required for plaque progression monitoring. Methods to quantify plaque on computed tomography angiography are reviewed as well as a discussion of their use in clinical trials. Limitations of coronary computed tomography angiography compared with competing modalities include limited evaluation of plaque subcomponents and incomplete knowledge of the value of the method especially in patients with low-to-moderate cardiovascular risk.

14 Review New Insights from Major Prospective Cohort Studies with Cardiovascular Magnetic Resonance (CMR). 2015

Arai, Andrew E. ·National Heart, Lung and Blood Institute, National Institutes of Health, US Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD, 20892-1061, USA, araia@nih.gov. ·Curr Cardiol Rep · Pubmed #25939757.

ABSTRACT: Since 1948, epidemiology studies played an important role in understanding cardiovascular disease and afforded an opportunity to learn about newer diagnostic tests. In 2000, the MESA Study incorporated several advanced cardiovascular imaging modalities including cardiac magnetic resonance imaging (MRI) and coronary artery calcium scans. The decade of follow-up enabled prognosis studies, an important step beyond association studies. In brief, left ventricular hypertrophy by cardiac MRI predicted incident heart failure and stroke. In the MESA Study, coronary artery calcium was a better predictor of coronary artery disease end points than the non-contrast-enhanced MRI scan. In the ICELAND MI substudy of the AGES-Reykjavik Study, a contrast-enhanced MRI scan detected many more unrecognized myocardial infarctions (MIs) (UMIs) than detected by electrocardiography and documented these UMI had adverse prognostic significance. Thus, cardiac MRI has been successfully incorporated into large population studies and shown added value over conventional measurements of cardiovascular disease.

15 Review Cardiovascular imaging in 2013: New era of evidence-based medicine with noninvasive imaging. 2014

Pattanayak, Puskar / Bluemke, David A. ·National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Engineering, 10 Center Drive, Bethesda, MD 20892, USA. ·Nat Rev Cardiol · Pubmed #24419259.

ABSTRACT: In 2013, advances in noninvasive imaging methods pushed traditional boundaries in the detection, diagnosis, and functional assessment of coronary artery disease, atherosclerotic plaque, and myocardial function. We highlight five important studies that demonstrate how these developments are allowing medicine to become increasingly evidence-based and personalized.

16 Review Using advanced noninvasive imaging techniques to probe the links between regional coronary artery endothelial dysfunction and atherosclerosis. 2014

Iantorno, Micaela / Weiss, Robert G. ·Critical Care Medicine Department, National Institutes of Health, 10 Center Drive, Room 2C145, Bethesda, MD, USA; Department of Medicine, Cardiology Division, The Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21205 USA. · Department of Medicine, Cardiology Division, The Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21205 USA. Electronic address: rweiss@jhmi.edu. ·Trends Cardiovasc Med · Pubmed #24296299.

ABSTRACT: Cardiovascular disease remains the number one cause of death in the US annually. The development in recent years of imaging strategies that can identify coronary endothelial dysfunction noninvasively provides new information about the early presence and local spatial heterogeneity of endothelial function in patients with, and those at risk for, coronary artery disease. In this article, we will briefly review the mechanisms relating endothelial function and atherosclerosis, contemporary imaging strategies now able to quantify coronary endothelial function noninvasively, and recent insights on human coronary endothelial function.

17 Review Detection of high-risk atherosclerotic plaque: report of the NHLBI Working Group on current status and future directions. 2012

Fleg, Jerome L / Stone, Gregg W / Fayad, Zahi A / Granada, Juan F / Hatsukami, Thomas S / Kolodgie, Frank D / Ohayon, Jacques / Pettigrew, Roderic / Sabatine, Marc S / Tearney, Guillermo J / Waxman, Sergio / Domanski, Michael J / Srinivas, Pothur R / Narula, Jagat. ·Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, Maryland 20892, USA. flegj@nhlbi.nih.gov ·JACC Cardiovasc Imaging · Pubmed #22974808.

ABSTRACT: The leading cause of major morbidity and mortality in most countries around the world is atherosclerotic cardiovascular disease, most commonly caused by thrombotic occlusion of a high-risk coronary plaque resulting in myocardial infarction or cardiac death, or embolization from a high-risk carotid plaque resulting in stroke. The lesions prone to result in such clinical events are termed vulnerable or high-risk plaques, and their identification may lead to the development of pharmacological and mechanical intervention strategies to prevent such events. Autopsy studies from patients dying of acute myocardial infarction or sudden death have shown that such events typically arise from specific types of atherosclerotic plaques, most commonly the thin-cap fibroatheroma. However, the search in human beings for vulnerable plaques before their becoming symptomatic has been elusive. Recently, the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study demonstrated that coronary plaques that are likely to cause future cardiac events, regardless of angiographic severity, are characterized by large plaque burden and small lumen area and/or are thin-cap fibroatheromas verified by radiofrequency intravascular ultrasound imaging. This study opened the door to identifying additional invasive and noninvasive imaging modalities that may improve detection of high-risk atherosclerotic lesions and patients. Beyond classic risk factors, novel biomarkers and genetic profiling may identify those patients in whom noninvasive imaging for vulnerable plaque screening, followed by invasive imaging for risk confirmation is warranted, and in whom future pharmacological and/or device-based focal or regional therapies may be applied to improve long-term prognosis.

18 Review Serum bilirubin and genes controlling bilirubin concentrations as biomarkers for cardiovascular disease. 2010

Lin, Jing-Ping / Vitek, Libor / Schwertner, Harvey A. ·Office of Biostatistics Research, Division of Cardiovascular Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA. ·Clin Chem · Pubmed #20693308.

ABSTRACT: BACKGROUND: Serum bilirubin has been consistently shown to be inversely related to cardiovascular disease (CVD). Recent studies showed serum bilirubin to be associated with CVD-related factors such as diabetes, metabolic syndrome, and body mass index. Although the association of serum bilirubin with CVD has been found in both retrospective and prospective studies, less information is available on the role of genes that control bilirubin concentrations and their association with CVD. CONTENT: In this review, we provide detailed information on the identity of the major genes that control bilirubin concentrations and their association with serum bilirubin concentrations and CVD risk. We also update the results of the major studies that have been performed on the association between serum bilirubin, CVD, and CVD-related diseases such as diabetes or metabolic syndrome. Studies consistently indicate that bilirubin concentrations are inversely associated with different types of CVD and CVD-related diseases. A conditional linkage study indicates that UGT1A1 is the major gene controlling serum bilirubin concentrations, and this finding has been confirmed in recent genomewide association studies. Studies also indicate that individuals homozygous for UGT1A1*28 have a significantly lower risk of developing CVD than carriers of the wild-type alleles. SUMMARY: Serum bilirubin has a protective effect on CVD and CVD-related diseases, and UGT1A1 is the major gene controlling serum bilirubin concentrations. Pharmacologic, nonpharmacologic, or genetic interventions that increase serum bilirubin concentrations could provide more direct evidence on the role of bilirubin in CVD prevention.

19 Review Screening asymptomatic subjects for subclinical atherosclerosis: not so obvious. 2010

Lauer, Michael S. ·Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892, USA. lauerm@nhlbi.nih.gov ·J Am Coll Cardiol · Pubmed #20620725.

ABSTRACT: -- No abstract --

20 Review Multicenter epidemiological studies of atherosclerosis imaging. 2009

Liu, Songtao / Bluemke, David A. ·Radiology and Imaging Sciences, National Institutes of Health/Clinical Center, Bethesda, MD 20892, USA. ·Top Magn Reson Imaging · Pubmed #20805734.

ABSTRACT: Cardiovascular disease is the leading course of death and disability. Conventional cardiac risk factors do not fully explain the level of cardiovascular risk, incidence of coronary artery disease, and coronary events. Risk stratification and therapy based solely on these conventional risk factors may overlook a population who would benefit from lifestyle and risk factor modification. Thus, research has recently focused on improving risk assessment with new tools in an effort to better identify subjects at highest risk and in need of aggressive management. Cardiovascular imaging, both in coronary and extracoronary arterial beds, has proven to be very helpful in this regard. In this article, we review the current literature from multicenter epidemiology studies on the utility of noninvasive imaging modalities for risk stratification in the context of conventional risk factor evaluation.

21 Review Microvascular angina and the continuing dilemma of chest pain with normal coronary angiograms. 2009

Cannon, Richard O. ·Translational Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA. cannonr@nih.gov ·J Am Coll Cardiol · Pubmed #19712795.

ABSTRACT: Since initial reports over 4 decades ago, cases of patients with angina-like chest pain whose coronary angiograms show no evidence of obstructive coronary artery disease and who have no structural heart disease continue to be a common occurrence for cardiologists. Many features of this patient population have remained constant with successive reports over time: a female predominance, onset of symptoms commonly between 40 and 50 years of age, pain that is severe and disabling, and inconsistent responses to conventional anti-ischemic therapy. Because patients may have had abnormal noninvasive testing that led to performance of coronary angiography, investigators have sought to show an association of this syndrome with myocardial ischemia. Abnormalities in coronary flow and metabolic responses to stress have been reported by several groups, findings consistent with a microvascular etiology for ischemia and symptoms, but others have questioned the presence of ischemia, even in patients selected for abnormal noninvasive testing. Despite considerable efforts by many groups over 4 decades, the syndrome remains controversial with regard to pathophysiology, diagnosis, and management.

22 Review Coronary artery calcification screening: estimated radiation dose and cancer risk. 2009

Kim, Kwang Pyo / Einstein, Andrew J / Berrington de González, Amy. ·Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA. ·Arch Intern Med · Pubmed #19597067.

ABSTRACT: BACKGROUND: Multidetector computed tomography has been proposed as a tool for routine screening for coronary artery calcification in asymptomatic individuals. As proposed, such screening could involve tens of millions of individuals, but detailed estimates of radiation doses and potential risk of radiation-induced cancer are not currently available. We estimated organ-specific radiation doses and associated cancer risks from coronary artery calcification screening with multidetector computed tomography according to patient age, frequency of screening, and scan protocol. METHODS: Radiation doses delivered to adult patients were calculated from a range of available protocols using Monte Carlo radiation transport. Radiation risk models, derived using data from Japanese atomic bomb survivors and medically exposed cohorts, were used to estimate the excess lifetime risk of radiation-induced cancer. RESULTS: The radiation dose from a single coronary artery calcification computed tomographic scan varied more than 10-fold (effective dose range, 0.8-10.5 mSv) depending on the protocol. In general, higher radiation doses were associated with higher x-ray tube current, higher tube potential, spiral scanning with low pitch, and retrospective gating. The wide dose variation also resulted in wide variation in estimated radiation-induced cancer risk. Assuming screening every 5 years from the age of 45 to 75 years for men and 55 to 75 years for women, the estimated excess lifetime cancer risk using the median dose of 2.3 mSv was 42 cases per 100 000 men (range, 14-200 cases) and 62 cases per 100 000 women (range, 21-300 cases). CONCLUSIONS: These radiation risk estimates can be compared with potential benefits from screening, when such estimates are available. Doses and therefore risks can be minimized by the use of optimized protocols.

23 Review Hyper IgE syndrome: an update on clinical aspects and the role of signal transducer and activator of transcription 3. 2008

Paulson, Michelle L / Freeman, Alexandra F / Holland, Steven M. ·Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA. ·Curr Opin Allergy Clin Immunol · Pubmed #18978467.

ABSTRACT: PURPOSE OF REVIEW: Hyper IgE syndrome (HIES) is a primary immunodeficiency characterized by eczema, recurrent skin and lung infections, elevated serum IgE, and connective tissue and skeletal abnormalities. We present newly recognized aspects of the clinical phenotype and discuss recent genetic and immunologic findings. RECENT FINDINGS: In 2007, mutations in signal transducer and activator of transcription 3 (STAT3) were determined to be the cause of autosomal-dominant HIES. Mutations lead to disruption of STAT3-dependent pathways, which are crucial for signaling of many cytokines, including IL-6 and IL-10. On the one hand, cells from STAT3-defective patients have a proinflammatory profile with elevated TNFalpha and IFNgamma; on the other hand, STAT3 mutations result in the inability to produce IL-17 or form Th17 cells. SUMMARY: HIES was previously defined on the basis of clinical manifestations and laboratory markers that were not specific to the disease. With the identification of STAT3 mutations as the cause of HIES, we can definitively characterize the disease at molecular and immunologic levels. Future study of HIES and STAT3 will help us understand eczema, IgE regulation, infection susceptibility, coronary artery disease, scoliosis, and bronchiectasis as well as provide mechanistic insights into treatment.

24 Review Congenital cardiovascular disease in Turner syndrome. 2008

Bondy, Carolyn A. ·National Institute of Child Health and Human Development, National Institutes of Health-Developmental Endocrinology Branch, Bethesda, MD 20892, USA. bondyc@mail.nih.gov ·Congenit Heart Dis · Pubmed #18373744.

ABSTRACT: Turner syndrome (TS), or monosomy X, occurs in approximately 1/2000 live born females. Intelligence is normal and short stature is the most obvious and consistent feature of the syndrome. Congenital cardiovascular disease affects approximately 50% of individuals and is the major cause of premature mortality in adults. Unfortunately, this most important aspect of the syndrome has received little attention outside of pediatric medicine, and adult cardiological follow-up is seriously lacking. This review describes the spectrum of cardiovascular defects with particular attention to identifying risk factors for aortic dissection/rupture. X-chromosome genetic pathways implicated in Turner cardiovascular disease, including premature coronary artery disease, are discussed. Recent guidelines for diagnosis and treatment of girls and women with TS are reviewed.

25 Review Advances in clinical applications of cardiovascular magnetic resonance imaging. 2008

Bandettini, W P / Arai, A E. ·Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1061, USA. ingkanisorn@nih.gov ·Heart · Pubmed #18208827.

ABSTRACT: Cardiovascular magnetic resonance (CMR) is an evolving technology with growing indications within the clinical cardiology setting. This review article summarises the current clinical applications of CMR. The focus is on the use of CMR in the diagnosis of coronary artery disease with summaries of validation literature in CMR viability, myocardial perfusion, and dobutamine CMR. Practical uses of CMR in non-coronary diseases are also discussed.

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