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| Prof John Deanfield, Prof John P. Kastelein and Prof Thomas F. Lüscher, Zürich 2009 | |
Cardiovascular disease is the number one cause of death and disability in the United States and most European countries, despite the impressive successes in the development of drugs to treat atherosclerosis and its complications during the past twenty years. Indeed, by the time that heart problems are detected, the underlying cause, atherosclerosis, is usually quite advanced, having progressed in silence for decades. Thus more emphasis should be put on the preventing of atherosclerosis at an early stage.
Cardiovascular imaging is one of the most important topics of modern cardiology. Rapidly evolving technologies can now not only visualise the heart, but also the arterial wall and its components in every stage of atherosclerosis from healthy blood vessel to arterial occlusion, and thus also from childhood into old age.
These techniques are providing new insights into the progression of atherosclerosis and can also be used in clinical trials to demonstrate the effectiveness of specific drugs on the atherosclerotic process. Endothelial dysfunction is thought to be an important factor in the pathogenesis of atherosclerosis, hypertension, coronary artery disease and heart failure. Over the past decade, several non invasive techniques have evolved, among them ultrasound devices to evaluate flow-mediated dilatation (FMD), an index of endothelial function in the brachial artery. The ultrasound assessment of brachial artery FMD is attractive because of the non-invasive nature of the technique and allows repeated measurements over time, to study the effectiveness of various interventions that may affect vascular health. It is therefore particularly well suited for the study of the earliest stages of atherosclerosis in children and adults, thus providing maximum opportunity for prevention. In addition, in a complementary manner magnetic resonance imaging (MRI) can be used to assess vascular structure and plaque composition rather than endothelial function for further assessment. Such studies can allow to assess the vascular protective effects of new and promising drugs in a relatively small patient cohort and short period of time prior to the planning of expensive and large clinical outcome studies.
Prof John Deanfield, Prof John P. Kastelein and Prof Thomas F. Lüscher
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