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Coronary artery disease: new insights and their implications for radiology

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Abstract

Coronary artery disease (CAD) diminishes local, regional, or global blood supply to the heart and is most commonly caused by coronary atherosclerosis. New insights into the etiology of atherosclerosis suggest that CAD is an inflammatory disorder that responds well to modulation rather than an unchangeable chronic process. Since 75% of all acute coronary syndromes result from rupture of atherosclerotic plaques, factors causing rupture have a crucial role. Magnetic resonance imaging and CT have the potential to visualize the composition of coronary artery plaques and thus to identify plaques at risk. Considering the new insights into stunning and hibernation, myocardial late enhancement on MRI might provide pivotal information for therapeutic decision making among lysis therapy, catheter intervention, and bypass surgery. Exercise electrocardiography without or with right precordial leads, stress echocardiography, and stress scintigraphy are simple clinical procedures to identify CAD with high sensitivities of 67, 92, 76, and 88%, respectively. The MRI and CT have to be compared with these good results. Nevertheless, we are expecting that MRI and CT will replace the conventional diagnostic modalities, gain a central role in diagnosing patients with suspected CAD, and prove to be cost-effective in this regard.

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References

  1. Lusis AJ (2000) Atherosclerosis. Nature 407:233–241

    Article  CAS  PubMed  Google Scholar 

  2. Ross R, Glomset JA (1976) The pathogenesis of atherosclerosis (first of two parts). N Engl J Med 295:369–377

    CAS  PubMed  Google Scholar 

  3. Libby P (1995) Molecular bases of the acute coronary syndromes. Circulation 91:2844–2850

    CAS  PubMed  Google Scholar 

  4. van der Wal AC, Das PK, Tigges AJ, Becker AE (1992) Adhesion molecules on the endothelium and mononuclear cells in human atherosclerotic lesions. Am J Pathol 141:1427–1433

    PubMed  Google Scholar 

  5. Lehr HA, Hubner C, Nolte D et al. (1991) Oxidatively modified human low-density lipoprotein stimulates leukocyte adherence to the microvascular endothelium in vivo. Res Exp Med (Berl) 191:85–90

    Google Scholar 

  6. Cushing SD, Berliner JA, Valente AJ et al. (1990) Minimally modified low-density lipoprotein induces monocyte chemotactic protein 1 in human endothelial cells and smooth muscle cells. Proc Natl Acad Sci USA 87:5134–5138

    CAS  PubMed  Google Scholar 

  7. Stary HC, Chandler AB, Dinsmore RE et al. (1995) A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation 92:1355–1374

    CAS  PubMed  Google Scholar 

  8. Falk E, Shah PK, Fuster V (1995) Coronary plaque disruption. Circulation 92:657–671

    CAS  Google Scholar 

  9. Galis ZS, Muszynski M, Sukhova GK et al. (1994) Cytokine-stimulated human vascular smooth muscle cells synthesize a complement of enzymes required for extracellular matrix digestion. Circ Res 75:181–189

    CAS  PubMed  Google Scholar 

  10. van der Wal AC, Becker AE, van der Loos CM, Das PK (1994) Site of intimal rupture or erosion of thrombosed coronary atherosclerotic plaques is characterized by an inflammatory process irrespective of the dominant plaque morphology. Circulation 89:36–44

    PubMed  Google Scholar 

  11. Gertz SD, Roberts WC (1990) Hemodynamic shear force in rupture of coronary arterial atherosclerotic plaques. Am J Cardiol 66:1368–1372

    CAS  PubMed  Google Scholar 

  12. Jennings RB, Murry CE, Steenbergen C Jr, Reimer KA (1990) Development of cell injury in sustained acute ischemia. Circulation 82:112

    Google Scholar 

  13. Heyndrickx GR, Millard RW, McRitchie RJ, Maroko PR, Vatner SF (1975) Regional myocardial functional and electrophysiological alterations after brief coronary artery occlusion in conscious dogs. J Clin Invest 56:978–985

    CAS  PubMed  Google Scholar 

  14. Diamond GA, Forrester JS, Luz PL de, Wyatt HL, Swan HJ (1978) Post-extrasystolic potentiation of ischemic myocardium by atrial stimulation. Am Heart J 95:204–209

    CAS  PubMed  Google Scholar 

  15. Shan K, Bick RJ, Poindexter BJ et al. (2000) Altered adrenergic receptor density in myocardial hibernation in humans: a possible mechanism of depressed myocardial function. Circulation 102:2599–2606

    CAS  PubMed  Google Scholar 

  16. Murry CE, Jennings RB, Reimer KA (1986) Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 74:1124–1136

    PubMed  Google Scholar 

  17. Tunstall-Pedoe H, Vanuzzo D, Hobbs M et al. (2000) Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations. Lancet 355:688–700

    Article  CAS  PubMed  Google Scholar 

  18. Kopp AF, Schroeder S, Baumbach A et al. (2001) Non-invasive characterisation of coronary lesion morphology and composition by multislice CT: first results in comparison with intracoronary ultrasound. Eur Radiol 11:1607–1611

    Article  CAS  PubMed  Google Scholar 

  19. Buffon A, Biasucci LM, Liuzzo G, D’Onofrio G, Crea F, Maseri A (2002) Widespread coronary inflammation in unstable angina. N Engl J Med 347:5–12

    Article  PubMed  Google Scholar 

  20. Nieman K, Rensing BJ, van Geuns RJ et al. (2002) Usefulness of multislice computed tomography for detecting obstructive coronary artery disease. Am J Cardiol 89:913–918

    Article  PubMed  Google Scholar 

  21. Achenbach S, Giesler T, Ropers D et al. (2001) Detection of coronary artery stenoses by contrast-enhanced, retrospectively electrocardiographically gated, multislice spiral computed tomography. Circulation 103:2535–2538

    CAS  PubMed  Google Scholar 

  22. Nieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PM, de Feyter PJ (2002) Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 106:2051–2054

    Article  PubMed  Google Scholar 

  23. Wielopolski PA, van Geuns RJ, de Feyter PJ, Oudkerk M (2000) Coronary arteries. Eur Radiol 10:12–35

    CAS  PubMed  Google Scholar 

  24. Jakobs TF, Becker CR, Ohnesorge B et al. (2002) Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG-controlled tube current modulation. Eur Radiol 12:1081–1086

    PubMed  Google Scholar 

  25. Hunink MG, Kuntz KM, Fleischmann KE, Brady TJ (1999) Noninvasive imaging for the diagnosis of coronary artery disease: focusing the development of new diagnostic technology. Ann Intern Med 131:673–680

    CAS  PubMed  Google Scholar 

  26. Sakuma H, Kawada N, Takeda K, Higgins CB (1999) MR measurement of coronary blood flow. J Magn Reson Imaging 10:728–733

    Article  CAS  PubMed  Google Scholar 

  27. Kim RJ, Wu E, Rafael A et al. (2000) The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 343:1445–1453

    CAS  PubMed  Google Scholar 

  28. Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med 300:1350–1358

    CAS  PubMed  Google Scholar 

  29. Richter WS, Munz DL (1997) Nuclear medicine diagnosis in the characterization of atherosclerotic plaques. Dtsch Med Wochenschr 122:761–766 [in German]

    CAS  PubMed  Google Scholar 

  30. Davies MJ (2000) The pathophysiology of acute coronary syndromes. Heart 83:361–366

    Article  CAS  PubMed  Google Scholar 

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Acknowledgement

We thank B. Herwig for assistance with preparation of the article.

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Authors and Affiliations

  1. Department of Radiology, Charité Medical School, Freie Universität und Humboldt-Universität zu Berlin, Schumannstrasse 20/21, P.O. Box 10098, 10117, Berlin, Germany

    Marc Dewey, Dietmar Kivelitz, Matthias Taupitz, Susanne Wagner & Bernd Hamm

  2. Division of Cardiology, Angiology and Pneumology, Medical Department and Outpatient Centre, Charité Medical School, Berlin, Germany

    Adrian C. Borges & Gert Baumann

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  1. Marc Dewey
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  2. Adrian C. Borges
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  3. Dietmar Kivelitz
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  4. Matthias Taupitz
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  5. Susanne Wagner
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  6. Gert Baumann
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  7. Bernd Hamm
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Correspondence to Marc Dewey.

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Dewey, M., Borges, A.C., Kivelitz, D. et al. Coronary artery disease: new insights and their implications for radiology. Eur Radiol 14, 1048–1054 (2004). https://doi.org/10.1007/s00330-003-2175-2

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  • DOI: https://doi.org/10.1007/s00330-003-2175-2

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