Atherosclerotic Plaque Composition and Classification Identified by Coronary CT: Assessment of CT-generated Plaque Maps Compared with VH-IVUS and Histology.

Atherosclerotic Plaque Composition and Classification Identified by Coronary CT: Assessment of CT-generated Plaque Maps Compared with VH-IVUS and Histology.

Circ Cardiovasc Imaging. 2013 Aug 19. [Epub ahead of print]

Atherosclerotic Plaque Composition and Classification Identified by Coronary CT: Assessment of CT-generated Plaque Maps Compared with VH-IVUS and Histology.

Source

1University of Cambridge and Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.

Abstract

BACKGROUND:

-Computed tomography is used routinely for coronary angiography and higher-risk features of plaques can also be identified. However, the ability of CT to discriminate individual plaque components and classify plaques according to accepted histological definitions is unknown.

METHODS AND RESULTS:

-We first determined CT attenuation ranges for individual plaque components using combined in vivo CT co-registered with virtual histology intravascular ultrasound (VH-IVUS) in 108 plaques from 57 patients. Comparison with contrast attenuation created plaque/contrast attenuation ratios that were significantly different for each component. In a separate validation cohort of 47 patients, these “Plaque Maps” correlated significantly with VH-IVUS-determined plaque component volumes (necrotic core (r=0.41, p=0.002), fibrous plaque (r=0.54, p<0.001), calcified plaque (r=0.59, p<0.001), total plaque (r=0.62, p<0.001)). We also assessed VH-IVUS and CT Plaque Maps against co-registered histology in 72 (VH-IVUS) and 87 (CT) segments from 8 post-mortem coronary arteries. The diagnostic accuracy of CT to detect calcified plaque (83% vs. 92%), necrotic core (80% vs. 65%) and fibroatheroma (80% vs. 79%) was comparable to VH-IVUS. However, while VH-IVUS could identify thin-cap fibroatheromas (TCFA) with a diagnostic accuracy of between 74-82% (depending on the TCFA definition used), the spatial resolution of CT prevented direct identification of TCFA.

CONCLUSIONS:

-CT-derived Plaque Maps based on contrast-adjusted attenuation ranges can define individual plaque components with a similar accuracy to VH-IVUS ex vivo. However, coronary CT Plaque Maps could not reliably classify plaques and identify TCFA, such that high-risk plaques may be misclassified or overlooked.

KEYWORDS:

atherosclerosis, imaging

PMID:

 

23960215

 

[PubMed – as supplied by publisher]

ESC Congress 2012

ESC Congress 2012

31 Aug 2013 – 04 Sep 2013 , Amsterdam – Netherlands 

Effect of nighttime aircraft noise exposure on endothelial function and stress hormone release in healthy adults

Effect of nighttime aircraft noise exposure on endothelial function and stress hormone release in healthy adults

Conclusion In healthy adults, acute nighttime aircraft noise exposure dose-dependently impairs endothelial function and stimulates adrenaline release. Noise-induced ED may be in part due to increased production in reactive oxygen species and may thus be one mechanism contributing to the observed association of chronic noise exposure with cardiovascular disease.

Post-mortem cardiac 3-T magnetic resonance imaging

Post-mortem cardiac 3-T magnetic resonance imaging

J Am Coll Cardiol. 2013 Aug 13;62(7):617-29. doi: 10.1016/j.jacc.2013.01.089. Epub 2013 Apr 3.

Post-mortem cardiac 3-T magnetic resonance imaging: visualization of sudden cardiac death?

Source

Forensic Imaging Center Bern, Institute of Forensic Medicine, University of Bern, Bern, Switzerland. Electronic address: christian.jackowski@irm.unibe.ch.

 

A decade of reversal.

A decade of reversal.

Mayo Clin Proc. 2013 Aug;88(8):790-8. doi: 10.1016/j.mayocp.2013.05.012. Epub 2013 Jul 18.

A decade of reversal: an analysis of 146 contradicted medical practices.

Source

National Cancer Institute, National Institutes of Health, Bethesda, MD. Electronic address: vinayak.prasad@nih.gov.

Abstract

OBJECTIVE:

To identify medical practices that offer no net benefits.

METHODS:

We reviewed all original articles published in 10 years (2001-2010) in one high-impact journal. Articles were classified on the basis of whether they addressed a medical practice, whether they tested a new or existing therapy, and whether results were positive or negative. Articles were then classified as 1 of 4 types: replacement, when a new practice surpasses standard of care; back to the drawing board, when a new practice is no better than current practice; reaffirmation, when an existing practice is found to be better than a lesser standard; and reversal, when an existing practice is found to be no better than a lesser therapy. This study was conducted from August 1, 2011, through October 31, 2012.

RESULTS:

We reviewed 2044 original articles, 1344 of which concerned a medical practice. Of these, 981 articles (73.0%) examined a new medical practice, whereas 363 (27.0%) tested an established practice. A total of 947 studies (70.5%) had positive findings, whereas 397 (29.5%) reached a negative conclusion. A total of 756 articles addressing a medical practice constituted replacement, 165 were back to the drawing board, 146 were medical reversals, 138 were reaffirmations, and 139 were inconclusive. Of the 363 articles testing standard of care, 146 (40.2%) reversed that practice, whereas 138 (38.0%) reaffirmed it.

CONCLUSION:

The reversal of established medical practice is common and occurs across all classes of medical practice. This investigation sheds light on low-value practices and patterns of medical research.

Lungs in a warming world: climate change and respiratory health.

Lungs in a warming world: climate change and respiratory health.

Chest. 2013 May;143(5):1455-9. doi: 10.1378/chest.12-2384.

Lungs in a warming world: climate change and respiratory health.

Source

Center for Health and the Global Environment, Harvard School of Public Health, Boston Children’s Hospital, Boston, MA 02215, USA.

Abstract

Climate change is a health threat no less consequential than cigarette smoking. Increased concentrations of greenhouse gases, and especially CO₂, in the earth’s atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, temperature variability, air pollution, forest fires, droughts, and floods, all of which put respiratory health at risk. These changes in climate and air quality substantially increase respiratory morbidity and mortality for patients with common chronic lung diseases such as asthma and COPD and other serious lung diseases. Physicians have a vital role in addressing climate change, just as they did with tobacco, by communicating how climate change is a serious, but remediable, hazard to their patients.

PMID:

 

23648909

 

[PubMed – in process]

http://www.thepreparedminds.com/archives/6680

http://www.thepreparedminds.com/archives/6680

The impact of integration of a multidetector computed tomography annulus area sizing algorithm on outcomes of transcatheter aortic valve replacement: a prospective, multicenter, controlled trial.