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Cardiovascular imaging

Investigating chest pain: anatomy or function?

22 May, 15 | by Alistair Lindsay

Among patients with chest pain, it is unclear if anatomic assessment of coronary obstruction or functional assessment with stress testing leads to better patient outcomes. In this randomized controlled trial of 10,003 symptomatic patients, individuals were randomly assigned in a 1:1 fashion to either anatomical testing with coronary CT angiography (CTA) or to functional testing by one of several different modalities (exercise ECG (10%), nuclear stress testing (67%) or stress echo (23%)).  Instead of diagnostic accuracy, as is seen with most such studies, the trial was powered for clinical outcomes with a primary composite endpoint of death, myocardial infarction, hospitalization for unstable angina, or major procedural complication.  more…

Coronary artery calcium density is inversely associated with coronary risk

13 Apr, 14 | by Alistair Lindsay


Coronary calcium is associated with cardiovascular disease risk.  However, it may not only be the volume, but the density of coronary calcium that influences risk as more dense calcium may reflect stable plaque at lower risk of inciting coronary events.  The traditional Agatson method of scoring coronary calcium burden does not consider coronary calcium volume and density independently. In this prospective cohort study of 3,398 adults without known cardiovascular disease, the authors examined the predictive value of adding coronary calcium density to Agatston volume scores for cardiovascular disease risk. Over a median follow-up of more than 7 years, there were 265 cardiovascular events in the study population and the Agatston volume score of coronary calcium was positively associated with cardiovascular disease risk. However, the density score was inversely associated with cardiovascular disease risk. Furthermore, the addition of the density score improved a risk prediction model for cardiovascular disease. more…

Atherosclerosis: not just a disease of the modern age?

21 Apr, 13 | by Alistair Lindsay

As life expectancy doubled between 1800 and 2000, atherosclerosis replaced infectious diseases as the main cause of death in the developed world. But is atherosclerosis a purely modern phenomenon, precipitated by lifestyle changes and an ageing population, or was it common in ancient societies too? more…

Cardiac MRI detects myocardial infarction in asymptomatic patients

21 Oct, 12 | by Alistair Lindsay

Unrecognised myocardial infarction (UMI) may be more prevalent than previously suspected.  Although several population studies have described the prevalence of UMI based on ECG findings, this method has limited sensitivity.  Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement has been extensively validated for the detection of myocardial infarction.  The aim of this study was to determine the prevalence and prognosis of recognised and unrecognised MI diagnosed with CMR in a elderly population, and to compare these findings with the use of ECG. more…

CT FFR – de facto?

8 Oct, 12 | by Alistair Lindsay

In recent years invasive coronary angiography (ICA) has been supplemented by the measurement of fractional flow reserve (FFR) to determine whether a coronary stenosis impairs delivery of oxygen to the heart. However this technique has not previously been available through non-invasive methods. While the use of coronary computed tomography (CT) calcium scoring and angiography has been increasing, it remains a limitation of the technique that the haemodynamic significance of any lesions seen cannot be assessed. more…

Novel risk markers – CT looks strong

2 Oct, 12 | by Alistair Lindsay

The primary prevention of cardiovascular disease involves classifying individuals according to their global cardiovascular risk. However, those at intermediate risk represent a particular challenge; while some may require aggressive treatment, others may be best managed by lifestyle measures alone. Biomarkers that have shown promise in improving risk discrimination include carotid intima-media thickness (CIMT), coronary artery calcium (CAC) scoring, brachial flow-mediated dilation (FMD), ankle-brachial index (ABI), high-sensitivity C-reactive protein (CRP) and, in addition, having a family history of coronary heart disease (CHD). Determining whether – and by how much – risk prediction can be improved by various markers could help to determine the most efficient strategy for the use of primary prevention drugs. more…

CIMT does little to augment Framingham risk score

24 Aug, 12 | by Alistair Lindsay

Although current cardiovascular risk equations perform reasonably well in predicting disease, improvement is still needed.  One way to do this would be to include a measure of preclinical atherosclerosis in risk prediction algorithms.  Measurement of common carotid initima-media thickness (CIMT) could be of use in this regard, but evidence that it can aid existing risk scores in prediction of the absolute risk of cardiovascular events has been inconsistent. more…

HIV and arterial inflammation

22 Aug, 12 | by Alistair Lindsay

Patients with Human Immunodeficiency Virus (HIV) demonstrate a high prevalence of noncalcified coronary atherosclerotic lesions.  However, the specific mechanisms that lead to this remain unknown.  In this study Subramanian et al. used 18fluorine-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) to assess arterial wall inflammation in patients with HIV, and compared this to traditional and nontraditional risk makers. more…

cIMT progression poor predictor of cardiovascular outcomes

28 Jul, 12 | by Alistair Lindsay

Carotid intima-media thickness (cIMT) is an ultrasound marker of early atherosclerosis.  Increasing cIMT thickness has been shown to correlate with an increased risk of subsequent cardiovascular events in general populations, independent of other major risk factors.  However, whether a change in cIMT thickness over time affects the risk of cardiovascular events has not been systematically investigated.  The first stage of the PROG-IMT project (individual progression of carotid intima media thickness as a surrogate of vascular risk) analysed the association of cIMT progression with the risk of cardiovascular events on a large dataset derived from general populations. more…

CT Angiography shows incremental prognostic benefit

18 Mar, 12 | by Alistair Lindsay

Recently evidence has emerged suggesting the prognostic value of CT coronary angiography (CTCA), however whether it can provide extra information over and above routine clinical workup – including exercise treadmill testing – remains uncertain.  Dedic et al. determined to answer this question in patients with stable chest pain and suspected coronary artery disease (CAD). more…

Highlighted articles from non-cardiological journals relevant to cardiology.


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