Preventing myocardial infarction: use and limitation of non-invasive imaging modalities

Abstract Identifying patients at high risk of coronary events is the main focus of cardiovascular prevention. For primary prevention score and risk cards are very low cost solutions, but only of limited efficacy, thus justifying the use of non-invasive imaging testing for the purpose of increasing the ‘diagnostic gain’. Considering all the diagnostic tests employed, only few demonstrated significant additional contribution to the risk score stratification. Coronary imaging with high speed volumetric computed tomography can provide essential information in ruling out and/or definition of coronary artery disease but also has limitations as far as the biological risk, the costs, and the difficulties of putting into perspective the results obtained in asymptomatic patients.

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Perspectives on the Future of Stress Testing

Ellestad's Stress Testing ◽

10.1093/med/9780190225483.003.0029 ◽

2018 ◽

pp. 543-546

Author(s):

L. Samuel Wann ◽

Gregory S. Thomas

Keyword(s):

Stress Testing ◽

Cardiac Computed Tomography ◽

Low Cost ◽

Obstructive Coronary Artery Disease ◽

Positron Emission ◽

The Future ◽

Individual Capacity ◽

Artery Disease ◽

Definition Of ◽

Prediction Of Prognosis

The chapter Perspectives on the Future of Stress Testing forecasts changes in the ability to detect atherosclerosis in the form of obstructive and non-obstructive coronary artery disease and ischemia. These will continue to include low cost and widely available exercise testing as well as embracing new technology such as mobile sensors, biomarkers, and genetic testing. Continued advancements in positron emission tomography, cardiac computed tomography, and cardiac magnetic resonance imaging will create new opportunities for better definition of myocardial blood flow and prediction of prognosis. While we will continue to expand our ability to measure greater detail of aspects of cardiac structure, function and metabolism, the humanity of a clinician being at the side of the treadmill while our whole patients exercise to their individual capacity remains a valuable diagnostic, educational and bonding opportunity

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Future Trends in Coronary CT Angiography

Intravascular Imaging - Advances in Bioinformatics and Biomedical Engineering ◽

10.4018/978-1-61350-095-8.ch022 ◽

2011 ◽

pp. 360-366

Author(s):

George D. Giannoglou ◽

Sotirios A. Katranas

Keyword(s):

High Speed ◽

Coronary Ct Angiography ◽

Multislice Ct ◽

Calcium Score ◽

Non Invasive ◽

Coronary Ct ◽

Endothelial Shear Stress ◽

Artery Disease ◽

Anomalous Coronary ◽

Anomalous Coronary Arteries

Coronary computed tomography angiography (CCTA) is surrounded by the safety non-invasive methods offer and the advantages of high speed that multislice CT is associated with. While calcium score and recognition of anomalous coronary arteries are acceptable applications, CCTA reveals new fields of research on coronary artery disease, including lumen, bypass grafts, and stents patency, as well as endothelial shear stress and coronary stiffness measurements.

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Vacuum magnetic levitation transport: definition of optimal characteristics

Transportation systems and technology ◽

10.17816/transsyst20162318-35 ◽

2016 ◽

Vol 2 (3) ◽

pp. 18-35 ◽

Cited By ~ 4

Author(s):

V M Fomin ◽

V I Zvegintsev ◽

D J Nalivaichenko ◽

Y A Terent’ev

Keyword(s):

High Speed ◽

Magnetic Levitation ◽

Aerodynamic Drag ◽

Low Cost ◽

Balance Of Power ◽

Cost Of Energy ◽

Wide Circle ◽

Definition Of ◽

Working Parameters ◽

The Cost

Known to a wide circle of specialists of the transport, the concept of "Evacuated Тube Тransport Technology" (ET3) [1] is an energy efficient complex magnetic levitation, vacuum and superconducting technology for high-speed ground transportation. The concept is presented as the most effective solution to problem increase the speed and capacity of the transport system c is acceptable the cost of moving passengers and cargo, and low cost of energy. To determine the optimal ranges of working parameters of the considered transportation system the analysis of the characteristics of the rarefied environment. Based on considerations of balance of power the cost of maintaining the vacuum in the system and to overcome aerodynamic drag throughout the speed range of the vehicle (TC) (500÷6500 km/h) it is shown that the lower bound of the optimal depth of vacuum to the vacuum environment, for the vehicle to relatively low speeds, is 25÷80 PA. For vehicles with speeds close to the maximum I would like to have the pressure of 1 PA or less.

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Abstract 11802: Coronary Artery Calcification is the Strongest Predictor of Abnormal Duke Prognostic Coronary Artery Disease Index

Circulation ◽

10.1161/circ.130.suppl_2.11802 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Aman M Shah ◽

Iosif Kelesidis ◽

Naeema Hasan ◽

Ainhoa Torrens ◽

Valentin Fuster ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Characteristic Curve ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Imaging Biomarkers ◽

Framingham Risk ◽

Asymptomatic Patients ◽

Coronary Events ◽

Artery Disease

Background: Cardiac CT angiography (CCTA) is a useful non-invasive tool to assess coronary artery disease (CAD). The CCTA derived modified Duke prognostic CAD index (MDS) has been shown to predict coronary events in symptomatic patients. No prior study has investigated MDS in asymptomatic patients or the relationship of conventional biomarkers of CAD with MDS. Objective: We sought to determine the ability of clinical, serologic, and imaging biomarkers of CAD to predict abnormal MDS in asymptomatic patients. Methods: There were 374 asymptomatic patients in the High Risk Plaque Study who were evaluated by clinical, serologic, and imaging biomarkers of CAD that underwent CCTA. MDS was calculated from CCTA using a 16-segment convention for coronary tree (high MDS defined as ≥3). The association of MDS with clinical, serologic, and imaging biomarkers was assessed. Results: There were 58 patients identified with high MDS. These patients had lower HDL-C (44 v. 53, p<0.001) and higher CACS (899 v. 26, p<0.001), Framingham risk score (17.5 v. 11, p<0.001), carotid intima-media thickness (0.82 v. 0.74, p=0.001), and triglycerides (150 v. 136, p = 0.011). In multivariate analysis, only CACS≥400 (OR = 15.3, 95% CI: 7.4-31.5, p<0.001) and CACS overall (OR = 6.02, 95% CI: 3.58 - 10.09, p<0.001) independently predicted MDS. Receiver operating characteristic curve analysis revealed improved prediction of MDS with addition of CACS: from AUC = 0.7531 to 0.8951. Conclusion: In asymptomatic patients, CACS is the strongest independent predictor of MDS when compared to conventional biomarkers of CAD.

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Evaluation Of Vascular Disorder Effect On Bioimpedance Values Using Finite Element Method

10.29007/1p64 ◽

2020 ◽

Author(s):

Hoang Anh Vy Ngo ◽

Thu Uyen Le Thi ◽

Quang Linh Huynh ◽

Thuy Nguyen Nhu Son

Keyword(s):

Cardiovascular Diseases ◽

Blood Vessels ◽

Low Cost ◽

Vascular Diseases ◽

The Body ◽

Bioimpedance Analysis ◽

Non Invasive ◽

Aneurysm Wall ◽

The Status ◽

Artery Disease

Cardiovascular diseases are the first cause of death globally: more people die annually from these diseases than from any other causes. These diseases are a group of disorders of the heart and blood vessels that appears silently but lead to many serious consequences for life. Vascular diseases including atherosclerosis, aneurysm, peripheral artery disease... affect the arteries, veins, or capillaries throughout the body and around the heart. Therefore, assessment of the quality of blood vessels early is extremely necessary in order to prevent cardiovascular diseases. Bioimpedance analysis is a non-invasive, safe, and low-cost technique that is widely used for diagnosing various diseases. This study conducts a novel method to evaluate the status of the blood vessels in two cases: stenosis and aneurysm based on bioimpedance signals. A 3D model of the forearm with several layers (skin, fat, muscle, bone, and blood vessel) and electrodes is simulated by using Comsol Multiphysics software. The electric impedance in different vascular conditions is examined. The results show that vessel impedance changed substantially because of vascular disorders. The bioimpedance signals vary according to the sizes of plaque and aneurysm wall. Consequently, bioimpedance analysis is reliable to detect vascular diseases and able to be applied in the near future.

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Coronary risk stratification of patients with newly diagnosed heart failure

Open Heart ◽

10.1136/openhrt-2019-001074 ◽

2019 ◽

Vol 6 (2) ◽

pp. e001074 ◽

Cited By ~ 2

Author(s):

Rasmus Bo Hasselbalch ◽

Mia Pries-Heje ◽

Thomas Engstrøm ◽

Andreas Sandø ◽

Merete Heitmann ◽

...

Keyword(s):

Heart Failure ◽

Geographical Location ◽

Multislice Ct ◽

Newly Diagnosed ◽

Non Invasive ◽

Clinical Risk ◽

Male Sex ◽

Artery Disease ◽

Definition Of ◽

The Cost

ObjectiveCoronary artery disease (CAD) is frequent in patients with newly diagnosed heart failure (HF). Multislice CT (MSCT) is a non-invasive alternative to coronary angiography (CAG) suggested for patients with a low-to-intermediate risk of CAD. No established definition of such patients exists. Our purpose was to develop a simple score to identify as large a group as possible with a suitable pretest risk of CAD.MethodsRetrospective study of patients in Denmark undergoing CAG due to newly diagnosed HF from 2010 to 2014. All Danish patients were registered in two databases according to geographical location. We used data from one registry and multiple logistic regression with backwards elimination to find predictors of CAD and used the derived OR to develop a clinical risk score called the CT-HF score, which was subsequently validated in the other database.ResultsThe main cohort consisted of 2171 patients and the validation cohort consisted of 2795 patients with 24% and 27% of patients having significant CAD, respectively. Among significant predictor, the strongest was extracardiac arteriopathy (OR 2.84). Other significant factors were male sex, smoking, hyperlipidaemia, diabetes mellitus, angina and age. A proposed cut-off of 9 points identified 61% of patients with a 15% risk of having CAD, resulting in an estimated savings of 15% of the cost and 21% of the radiation.ConclusionsA simple score based on clinical risk factors could identify HF patients with a low risk of CAD; these patients may have benefitted from MSCT as a gatekeeper for CAG.

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From Cardiac Rehabilitation to Ambulatory Preventive Care: The Swiss Way

Swiss Sports & Exercise Medicine ◽

10.34045/ssem/2016/10 ◽

2016 ◽

Vol 64 (2) ◽

Keyword(s):

Cardiac Rehabilitation ◽

Social Services ◽

Peripheral Artery Disease ◽

Preventive Care ◽

Primary Care Physicians ◽

Stable Coronary Artery Disease ◽

Cardiovascular Prevention ◽

Peripheral Artery ◽

Asymptomatic Patients ◽

Artery Disease

Over the last years, cardiac rehabilitation services have expanded their indication to include not just patients after myocardial infarction or surgery, but also a variety of non-acute cardiovascular disease (CVD) states like stable coronary artery disease, peripheral artery disease, neurovascular disease as well as asymptomatic patients with no history of CVD but with a constellation of cardiovascular risk factors, especially metabolic syndrome and diabetes mellitus. In 2015, 110 ambulatory cardiovascular prevention and rehabilitation programs existed in Switzerland: 57 for cardiac, 17 for peripheral artery disease and 36 for diabetes rehabilitation. Rehabilitative and preventive care is provided by a team of professionals including preventive cardiologists, exercise experts (physiotherapists and sports scientists), nurses, dieticians, psychologists, occupational therapists and social services experts. It seems reasonable to combine professional efforts by integrating prevention and rehabilitation for all high risk patients. The creation of cardiovascular prevention centers, which bring together professionals and patients in dedicated hospital or community settings is a promising first step. In 2015, 7 centers have been recognized as specialized cardiovascular prevention centers in Switzerland. Furthermore, community-based and patient-centered activities and programs have a great potential to contribute to improved preventive care and to support long-term adherence. A closer cooperation between professional preventive teams in prevention centers and the primary care physicians has a great potential to contribute to close this gap and to provide seamless primary and secondary preventive care for patients in need and the society.

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