Identifying patients at risk: novel diagnostic techniques
Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, OH, USA
* Correspondence: S.E. Nissen, The Cleveland Clinic Foundation, Department of Cardiology, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Tel.: +1-216-445-6852; fax: +1-216-445-6855
nissens{at}ccf.org
Abstract
Techniques that enable the accurate and reproducible detection and measurement of the pathophysiological changes that occur in atherosclerosis, particularly early on in the disease process, will help to identify those who are at highest cardiovascular risk, and may, therefore, improve clinical outcome. It has become apparent that atherosclerosis begins much earlier in life than was previously thought. It is also now known that it is the extent and composition of atheromatous plaque, rather than the degree of stenosis, that determines the risk of plaque disruption and, therefore, has most impact on patient outcome. Traditional techniques that only provide information about lumen size, such as angiography, are thus of limited use in predicting clinical events. Improved understanding of the mechanisms underlying atherogenesis has resulted in the development of several potential techniques for assessing the disease process in humans. These include modalities that detect early structural changes in the coronary arteries, such as electron-beam-computed tomography, magnetic resonance imaging, and intra-vascular ultrasound; and those that detect surrogate markers for coronary atherosclerosis, such as the external vascular ultrasound measurement of carotid intima–media thickness).
Key Words: Carotid intima–media thickness • Electron-beam-computed tomography • Intra-vascular ultrasound • Magnetic resonance imaging