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Abstract: For many years invasive angiographic techniques have been considered as the gold standard for the assessment of large arterial abnormalities. However, the complexities and complications inherent to invasive imaging have meant that more recently non-invasive techniques such as echocardiography, Magnetic Resonance Imaging (MRI) and multidetector CT (MDCT) have been increasingly used in congenital cardiovascular disorders. In particular, MDCT has emerged as a fundamental tool for the diagnosis and pre-surgical work-up of aortic abnormalities due to its high spatial resolution, large area of coverage, and short scan time, and therefore is now one of the most widely used modalities for the detection of congenital abnormalities of the aorta. The purpose of this pictorial review is to review the spectrum of abnormalities of the aorta than can be reliably detected by MDCT both in infants and in adulthood. Abnormalities of the aortic root, ascending aorta, aortic arch, and descending aorta will be described separately. [Copyright &y& Elsevier]

Background Restenosis of the carotid artery is common following carotid endarterectomy, but analysis of lesion composition has mostly been based on histological study of explanted restenotic lesions. This study investigated the ability of 3T cardiovascular magnetic resonance (CMR) to determine the components of recurrent carotid artery disease and examined whether these differed from primary atherosclerotic plaque. Methods 50 patients underwent 3T CMR of both carotid arteries using a standard multicontrast protocol: time-of-flight (TOF), T1-weighted (T1W), T2-weighted (T2W), and PD-weighted (PDW) Turbo-Spin-Echo (TSE) sequences. 25 patients had previously undergone carotid endarterectomy (mean time since surgery 1580 days, range 45-6560 days), and 25 with primary asymptomatic atherosclerotic plaques served as controls. Two experienced reviewers analysed the multicontrast CMR images according to the presence or absence of major plaque features and assigned an overall classification type. Results In patients with recurrent carotid disease following endarterectomy, the mean degree of restenosis was 51% (range 30-90%). Three distinct types of restenosis were identified: 5 patients (20%) showed CMR characteristics of fibro-atheromatous tissue, 11 patients (44%) had plaque features consistent with possible myointimal (fibromuscular) hyperplasia, and 6 patients (24%) had recurrent plaque suggestive of further lipid accumulation. Three patients (12%) showed evidence of post-surgical dissection of the carotid intima. Compared to primary atherosclerotic plaques, restenotic plaques were more likely to contain fibro-atheromatous tissue (p = 0.05) and smooth muscle (p < 0.01), and less likely to contain lipid (p < 0.01). Composition did not differ significantly between patients with early and late restenosis. Conclusions As defined by CMR, restenotic lesions of the carotid artery fall into three distinct types and differ in composition from primary atherosclerotic plaques. If validated by subsequent histological studies, these findings could suggest a role for CMR in detecting high-risk (i.e. lipid-rich) restenotic lesions. [ABSTRACT FROM AUTHOR]

Background: Atherosclerotic plaques in carotid arteries can be characterized in-vivo by multicontrast cardiovascular magnetic resonance (CMR), which has been thoroughly validated with histology. However, the non-quantitative nature of multicontrast CMR and the need for extensive post-acquisition interpretation limit the widespread clinical application of in-vivo CMR plaque characterization. Quantitative T2 mapping is a promising alternative since it can provide absolute physical measurements of plaque components that can be standardized among different CMR systems and widely adopted in multi-centre studies. The purpose of this study was to investigate the use of in-vivo T2 mapping for atherosclerotic plaque characterization by performing American Heart Association (AHA) plaque type classification, segmenting carotid T2 maps and measuring in-vivo T2 values of plaque components. Methods: The carotid arteries of 15 atherosclerotic patients (11 males, 71 ± 10 years) were imaged at 3 T using the conventional multicontrast protocol and Multiple-Spin-Echo (Multi-SE). T2 maps of carotid arteries were generated by mono-exponential fitting to the series of images acquired by Multi-SE using nonlinear least-squares regression. Two reviewers independently classified carotid plaque types following the CMR-modified AHA scheme, one using multicontrast CMR and the other using T2 maps and time-of-flight (TOF) angiography. A semi-automated method based on Bayes classifiers segmented the T2 maps of carotid arteries into 4 classes: calcification, lipid-rich necrotic core (LRNC), fibrous tissue and recent IPH. Mean ± SD of the T2 values of voxels classified as LRNC, fibrous tissue and recent IPH were calculated. Results: In 37 images of carotid arteries from 15 patients, AHA plaque type classified by multicontrast CMR and by T2 maps (+ TOF) showed good agreement (76% of matching classifications and Cohen's ? = 0.68). The T2 maps of 14 normal arteries were used to measure T2 of tunica intima and media (T2 = 54 ± 13 ms). From 11865 voxels in the T2 maps of 15 arteries with advanced atherosclerosis, 2394 voxels were classified by the segmentation algorithm as LRNC (T2 = 37 ± 5 ms) and 7511 voxels as fibrous tissue (T2 = 56 ± 9 ms); 192 voxels were identified as calcification and one recent IPH (236 voxels, T2 = 107 ± 25 ms) was detected on T2 maps and confirmed by multicontrast CMR. Conclusions: This carotid CMR study shows the potential of in-vivo T2 mapping for atherosclerotic plaque characterization. Agreement between AHA plaque types classified by T2 maps (+TOF) and by conventional multicontrast CMR was good, and T2 measured in-vivo in LRNC, fibrous tissue and recent IPH demonstrated the ability to discriminate plaque components on T2 maps. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "A Prospective Natural-History Study of Coronary Atherosclerosis," by G. W. Stone, A. Maehara, A. J. Lansky et al in the January 20, 2011 issue.

Background: A 52-year-old man presented with central chest pain, which he had experienced for 8 h. He had no other associated symptoms and no prior history of cardiovascular disease.Investigations: Electrocardiography, chest radiography, coronary angiography, aortic angiography, echocardiography, CT thorax with contrast.Diagnosis: Ruptured aneurysm of the sinus of Valsalva.Management: Emergency sternotomy and pericardiotomy, followed by aortic root replacement. [ABSTRACT FROM AUTHOR]

There is a pressing need for robust imaging markers to assist in the development of drugs for the treatment of atherosclerosis. Conventional imaging methods provide quantitative and morphological data but may be inadequate for assessing a new generation of therapies that modify plaque biology directly. Here, we compare the main imaging modalities used to image atherosclerosis in the clinical-trial setting, and assess their ability to predict clinical outcomes for a given sample size. We consider how emerging molecular and cellular imaging techniques could offer the possibility to quantify changes in biological function at the level of the plaque, even without gross structural change. [ABSTRACT FROM AUTHOR]

Abstract: Higher specialist training in cardiology has undergone significant reform across numerous countries in recent years. A number of factors have driven these changes, from the legal requirement to reduce working hours (i.e., the European Working Time Directive) to the increasing sub-specialisation within cardiology and the need for appropriately focussed training within these sub-specialties. Cardiac imaging provides a neat framework in which to examine the effect of such changes. Technological advances in echocardiography, nuclear cardiology, computed tomography and magnetic resonance imaging have seen an unprecedented increase in the utilisation of all techniques. The need to deliver appropriate training is recognised and numerous accreditation schemes exist within cardiovascular imaging, with the aim of demonstrating that specified levels of experience and expertise have been attained. However, in the United Kingdom, there has been a change from the traditional experience-based training scheme to a new, competency-based training program, with regular use of workplace-based assessments to prove competence in a specified area or procedure. As this training model is implemented, it will produce a generation of trainees for whom individual accreditation schemes carry less value, given the competency assessment inherently present within their new training system. This article discusses the role of accreditation in the era of competency-based specialist training from a cardiac imaging perspective using the UK experience to highlight the challenges facing trainees and to encourage a debate around how best to ensure cardiac imaging specialists are fully competent at the end of their specific training programs. [Copyright &y& Elsevier]

An abstract of the conference paper "In-vivo T2 mapping of atherosclerotic plaques in carotid arteries," by Luca Biasiolli and colleagues is presented.

A letter to the editor is presented in response to an article about the use of extended-release niacin to treat hypertension by Allen J. Taylor in the November 26, 2009 issue.

The article focuses on published studies related to cardiology. A study published within the journal "JAMA" revealed that smoking cessation provides rapid vascular benefit. Another study published within the "New England Journal of Medicine," showed stenting versus surgery in left main stem disease. Also in the same journal is a study suggesting that there is a relationship between sudden cardiac arrest and early repolarisation.

The article provides information on the medical developments for coronary artery diseases. General cardiology features several medical alternatives for heart disease treatment. Dark chocolate contains flavonols that help lower blood pressure. Torcentrapib is described as an inhibitor of cholesterol ester transfer protein (CETP) that increase high-density lipoportein (HDL) cholesterol level. Valsartan in diastolic dysfunction (VALIDD) shows effective diagnosis in hypertension.

The article cites several research articles about cardiovascular disease published in the web site www.heartjnl.com. It includes "Differences in Mortality and Use of Revascularization in Black and White Patients With Acute MI Admitted to Hospitals With and Without Revascularization Services," "Kidney Disease, Framingham Risk Scores, and Cardiac and Mortality Outcomes," and "Management Patterns in Relation to Risk Stratification Among Patients With Non-ST Elevation Acute Coronary Syndromes."

The article lists several papers from non-cardiology journals about cardiovascular, which includes topic on general cardiology and interventional cardiology.

The article presents the abstracts of various papers on cardiology, including "Major and minor ECG abnormalities in asymptomatic women and risk of cardiovascular events and mortality," by P. Denes and colleagues; "Weekend versus weekday admission and mortality for myocardial infarction," by W. J. Kastis; and "Long-term risk of cardiovascular disease in 10-year survivors of breast cancer," by M. J. Hooning and colleagues.

Presents abstracts of medical research. They include "Do dopamine agonists cause valvular heart disease?" "Improved heart failure performance measures required," and "Alcohol, blood pressure and cardiovascular risk."

Abstract: Cannabis smoking is on the increase both in the United Kingdom and in the United States. For over three decades it has been known that cannabis has pathophysiological effects on the cardiovascular system, and previously an association with an increased risk of myocardial infarction has been reported. However, it is not yet known whether cannabis contributes directly to coronary artery disease. We describe two distinct cases; in the first cannabis use precipitated a malignant arrhythmia in a patient with critical ischaemia from longstanding coronary artery disease. In the second, a young patient presented with an acute myocardial infarction that had started whilst smoking marijuana; subsequently diffuse coronary artery disease was found at angiography despite the patient''s low risk factor status. Patients who are known cannabis smokers and who have cardiovascular disease should be warned that it is likely to aggravate coronary ischaemia, and may even trigger myocardial infarction. [Copyright &y& Elsevier]

Objectives: We validate a novel CT coronary angiography (CCTA) coronary calcium scoring system.Methods: Calcium was quantified on CCTA images using a new patient-specific attenuation threshold: mean + 2SD of intra-coronary contrast density (HU). Using 335 patient data sets a conversion factor (CF) for predicting CACS from CCTA scores (CCTAS) was derived and validated in a separate cohort (n = 168). Bland-Altman analysis and weighted kappa for MESA centiles and Agatston risk groupings were calculated.Results: Multivariable linear regression yielded a CF: CACS = (1.185 × CCTAS) + (0.002 × CCTAS × attenuation threshold). When applied to CCTA data sets there was excellent correlation (r = 0.95; p < 0.0001) and agreement (mean difference -10.4 [95% limits of agreement -258.9 to 238.1]) with traditional calcium scores. Agreement was better for calcium scores below 500; however, MESA percentile agreement was better for high risk patients. Risk stratification was excellent (Agatston groups k = 0.88 and MESA centiles k = 0.91). Eliminating the dedicated CACS scan decreased patient radiation exposure by approximately one-third.Conclusion: CCTA calcium scores can accurately predict CACS using a simple, individualized, semiautomated approach reducing acquisition time and radiation exposure when evaluating patients for CAD. This method is not affected by the ROI location, imaging protocol, or tube voltage strengthening its clinical applicability.Key Points: • Coronary calcium scores can be reliably determined on contrast-enhanced cardiac CT • This score can accurately risk stratify patients • Elimination of a dedicated calcium scan reduces patient radiation by a third. [ABSTRACT FROM AUTHOR]

The article focuses on the researches on cardiovascular disorders that are published in different non-cardiology periodicals. It mentions that a study found that women with a history of kidney stones have high risk of coronary heart disease. It informs that another research found that subclinical coronary artery disease is associated with longer duration of overall and abdominal obesity. It reports that another research found that blood pressure telemonitoring may help in improved control.

The article discusses the findings of several studies related to cardiology, heart failure and electrophysiology. It reports that the production of the proatherosclerotic metabolite trimethylamine-N-oxide (TMAO) from dietary phosphatidylcholine depends on the metabolism by the intestinal microbiota. It also states that biventricular pacing is superior to right ventricular (RV) pacing in patients with high degree atrioventricular block and co-existing left ventricular systolic dysfunction.

The article offers information on several cardiovascular related topics that were published in non-cardiology journals. It states that using beta-blockers can minimize the mortality rates and cardiovascular risks after noncardiac surgery. It states about the discovery of low-density lipoprotein cholesterol (LDL-C) genes associated with familial hypercholesterolaemia and also informs about implantable cardioverter-defibrillators (ICDs).

The article focuses on a clinical trial which found that increased pain-free and maximum walking times is associated with angiotensin-converting enzyme inhibitor ramipril, which improves symptoms of intermittent claudication. It is concluded that postoperative morbidity, mortality and resource utilization is improved with the implementation of a conservative blood transfusion strategy.

The article focuses on research related to several cardiovascular diseases mentioned in non-cardiology journals. It informs that cinacalcet, a calcimimetic agent, used for reducing the levels of parathormone, calcium and phosphorous, fails to improve cardiovascular outcomes in dialysis. It also informs that implantable cardioverter-defibrillator reduces mortality of patients with high risk of ventricular arrhythmias.

The article focuses on the updates in the field of cardiology. Firstly, it talks about acute myocardial infarction (MI) mortality between states with and without public reporting. The use of percutaneous coronary intervention was lower for states with public reporting. Secondly, it talks about benefits of B-blockade in stable coronary artery diseases. Thirdly, it says that tight glycaemic control can be achieved with a low hypoglycemic rate after cardiac surgery on children.

An introduction is presented in which the editor discusses various topics within the issue including intravascular ultrasound (IVUS), stent thrombosis (ST) and drug eluting stents (DES).

The article discusses several studies on cardiovascular medicine. A study on the efficacy of rivaroxaban in preventing stroke in patients with non-valvular atrial fibrillation concluded that the drug is not inferior to warfarin in preventing stroke or systemic embolism. Another study assessed the incidence of aortic complications among patients with bicuspid aortic valve (BAV) which concluded that incidence of aortic dissection in BAV is higher than that of the general population.

The article presents a peer review of cardiology-related research studies. It looks into a study on the risk factors associated with early and delayed stroke and the implications for short- and long-term survival after coronary artery bypass. It comments on a study which examines the effective treatment of saphenous vein graft lesions using either drug-eluting stents (DESs) or bare-metal stents (BMSs). It also explores a study on the influence of operator experience on carotid stenting outcomes.

The article focuses on various cardiology related studies published in journals not related to cardiovascular activities. As stated, one of the studies revealed that intravenous enoxaparin is successful in treating cardiovascular disorders resulting in overall clinical benefits. As further stated, another study highlighted that high-density lipoproteins are not effective in treating patients with coronary artery disease.

The article presents information related to cardiovascular diseases on topics including effect of fatty acid levels in congestive heart failure (CHF), effect of low vitamin D levels in atherosclerosis and increase in mortality rate from cardiovascular disease by the use of non-steroidal anti-inflammatory drugs. Further, it discusses the lower risk of CHF due to higher level of eicosapentaenoic acid and increase in media thickness and carotid plaque thickness due to low levels of vitamin D.

The article focuses on a study which reports various clinical profile of stress cardiomyopathy conditions known as "takotsubo" that is prominently found in post menopausal women through cardiac magnetic resonance diagnostic imaging techniques.

The authors reflect on the optical coherence tomography (OCT). The authors mentions the use of OCT in the examination of stent trut in patients. The authors state that in 5,931 patients examined with stent strut, 98.4% showed adequate neointimal coverage and revealed the absence of intra-stent thrombus. The authors suggest that drug-elution timescale is suitable for minimal intimal proliferation while having stent strut coverage of eight months.

The article presents abstracts of various studies related to cardiovascular system that were published in different non cardiology journals including one on the efficacy of Coronary Artery Bypass Graft (CABG) surgery for poor systolic left ventricle (LV) function, another on patients with complex severe coronary disease and one on fibrate therapy

The article discusses several studies on cardiology which were published in non-cardiology journals. I. J. Dahabreh and J. K. Paulus examined the link between episodic physical and sexual activity with the triggering of acute cardiac events, published in the "Journal of American Medical Association." M. Than and colleagues considered a diagnostic protocol to assess patients with chest pain symptoms, published in "Lancet." A study by N. L. Mills and colleagues focused on the implementation of a sensitive troponin I assay and risk of myocardial infarction.

The article focuses on the Balloon Pump-Assisted Coronary Intervention Study (BCIS-1) which examined the role of intra-aortic balloon pump (IABP) in high-risk percutaneous coronary intervention (PCI). The study used 301 patients with severe left ventricular dysfunction and extensive coronary disease. Major adverse cardiac and cardiovascular events (MACCE) at hospital discharge was observed in 15.2% of patients with elective IABP insertion, and in 16.0% of those where IABP was not planned

The article offers information on a study which assessed whether self-management by people with poorly controlled hypertension resulted in better blood pressure control compared with usual care. A brief description of the study population is offered. Study subjects were randomly assigned to either self-management, including home blood pressure measurements and self-titration of hypertensive drugs, or casual care. Primary endpoint was change in mean systolic blood pressure between baseline and each follow-up point at 6 months and 12 months.

The article discusses the Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH). For the study, researchers analyzed survivors of myocardial infarction who were assigned to either B12/folate or placebo. They found that vitamins lessened homocysteine levels. They did not observe a difference in the number of deaths.

The article discusses the findings of a study on the comparison of the safety and efficacy of second-generation everolimus and paclitaxel-eluting stents in real-life practice.

The article discusses the results of the Platelet inhibition and patient Outcomes (PLATO) trial on the effectiveness of ticagrelor in treating patients with an acute coronary syndrome. According to the author, the PLATO trial demonstrates the superiority of ticagrelor over clopidogrel. The author adds that all-cause mortality was reduced with ticagrelor. However, there is no difference between ticagrelor and clopidogrel in terms of rates of major or severe bleeding events.

The article presents abstracts on heart diseases topics which include the benefits of treating iron depletion in heart failure, C reactive protein (CRP) and the association between intracellular stress and atherosclerosis.

The article reports on the alterations in advanced life support guidelines for long-term survival in adult out-of-hospital cardiac arrest. One of the alterations has been to stress chest compression continuity at the resuscitation earliest stages with a much lessened prominence provided to advanced airway interventions. In Arizona, emergency medical teams offer airway management having standard bag-valve-mask ventilation or passive ventilation.

The article presents a study which examines the capability of Niacin of raising high-density lipoprotein (HDL)-cholesterol and lowering triglyceride levels. The study compared the effects of niacin or ezetimibe on carotid media thickness through the Halting Atherosclerosis (HALTS) trial. It reveals the capability of niacin to reduce lipoproteins and triglyceride. It also discovers niacin's greater efficacy compared to ezetimibe.

An abstract of the article "ACE and ARB in combination give no added benefits," by Alistair Lindsay is presented.

The article reports on the medical study which explores the clinical effect of novel endothelin antagonist Darusentan on managing patients with hypertension and diabetes. It notes that edema occurred in 27% of research subjects treated with darusentan. Moreover, darusentan is an effective anti-hypertensive agent, however, it requires diuretic therapy to treat associated fluid retention.

An abstract of the article "Does cardiac resynchronisation therapy benefit patients with NYHA I & II heart failure?" is presented.

An abstract of the article "Journal Scan," by Alistair Lindsay is presented.

The article focuses on the introduction of a best-practiced model coronary computed tomography (CT) scan acquisition for the Advanced Cardiovascular Imaging Consortium (ACIC) in Michigan. It states that the model concentrated on various features of cardiac computed tomography angiography (CCTA) imaging which includes patient instructions, medical history, and use of ß blockers. It notes that ACIC is a multicentre collaborative quality improvement programme.