The below list represents only planned manuscripts. Some of these
manuscripts have not been received by the Editorial Office yet. Papers
submitted to MDPI journals are subject to peer-review.
Title: Coronary Artery Calcium Screening: Does it Perform Better Than Other Cardiovascular Risk Stratification Tools?
Authors: Irfan Zeb and Matthew Budoff
Affiliation: Bronx-Lebanon Hospital Center; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
Abstract: Coronary artery calcium (CAC) has been advocated as one of the strong cardiovascular risk prediction markers. It performs better across a wide range of Framingham risk categories (6% to 10% and 10% to 20% 10-year risk categories) and also helps reclassifying the risk of these subjects into either higher or lower risk categories based on CAC scores. It also performs better among population subgroups where Framingham risk score does not perform well, especially young subjects, women, family history of premature coronary artery disease and ethnic differences in coronary risk. The absence of CAC is also associated with excellent prognosis, with 10-year event rate of 1%. Studies have also compared with other commonly used markers of cardiovascular disease risk such as Carotid intima-media thickness and highly sensitive C-reactive protein. CAC also performs better compared with carotid intima-media thickness and highly sensitive C-reactive protein in prediction of coronary heart disease and cardiovascular disease events. CAC scans are associated with relatively low radiation exposure (0.9 to 1.1 mSv) and provides information that can be used not only for risk stratification but also can be used to track the progression of atherosclerosis and the effects of statins.
Title: A Review of the Effect of Diet on Cardiovascular Calcification
Authors: Rachel Nicoll, John McLaren Howard and Michael Y Henein
Affiliation: Department of Public Health and Clinical Medicine and Heart Centre, Umea University, Umea, Sweden; Acumen Lab, Tiverton, Devon, UK
Abstract: Cardiovascular (CV) calcification is known as sub-clinical atherosclerosis and is recognised as a predictor of CV events and mortality. As yet there is no treatment for CV calcification and conventional CV risk factors are not consistently correlated, leaving clinicians uncertain as to optimum management for these patients. For this reason, a review of studies investigating diet and serum levels of macro- and micronutrients was carried out in an attempt to determine whether any might worsen or prevent CV calcification. Although there were few human studies of macronutrients, nevertheless transfats and simple sugars, which can increase serum glucose or disturb serum insulin, should be avoided, while long chain omega-3 fats from oily fish may be protective. Among the micronutrients, an intake of c800mg/d calcium was beneficial in those without renal disease or hyper-parathyroidism, while inorganic phosphorus from food preservatives and colas may induce calcification. A high intake of magnesium (≥380 mg/d) and phylloquinone (500mcg/d) proved protective, as did a serum 25(OH)D concentration of ≥75nmol/l. Although oxidative damage appears to be a cause of CV calcification, the antioxidant vitamins proved to be largely ineffective, while supplementation of α-tocopherol may induce it. Nevertheless other antioxidant compounds (epigallocatechin gallate from green tea and resveratrol from red wine and grapes) were protective. Finally, a homocysteine concentration >12mcmol/l was predictive of CV calcification, although a plasma folate concentration of >39.4nmol/l could both lower homocysteine and protect against calcification. In terms of a dietary programme, these recommendations indicate avoiding processed foods and drinks and adopting a diet high in oily fish and vegetables. The micronutrients magnesium and vitamin K may be worthy of further investigation as a treatment option for CV calcification.
Title: Ultrasound Tissue Characterization of Vulnerable Atherosclerotic Plaque
Authors: Eugenio Picano and Marco Paterni
Affiliation: CNR, Institute of Clinical Physiology, Pisa, Italy
Abstract: A thrombotic occlusion of a ruptured coronary atherosclerotic plaque may result in unstable angina, myocardial infarction or death, whereas embolization from a plaque in carotid arteries may result in transient ischemic attack or stroke. The atherosclerotic plaque prone to such clinical events is termed high-risk or vulnerable plaque, and its identification in humans before they become symptomatic has been elusive to date. Ultrasonic tissue characterization of the atherosclerotic plaque is possible with different techniques -- such as vascular, transesophageal, and intravascular ultrasound -- on a variety of arterial segments, including carotid, aorta, and coronary districts. The image analysis can be based on visual, video-densitometric or radiofrequency methods and identifies three distinct textural patterns: hypo-echoic (corresponding to lipid- and hemorrhage-rich plaque), iso- or moderately hyper-echoic (fibrotic or fibro-fatty plaque), and markedly hyperechoic with shadowing (calcific plaque). Hypoechoic or dishomogeneous plaques, with spotty microcalcification and large plaque burden, with plaque neovascularization and surface irregularities by contrast-enhanced ultrasound, are more prone to clinical complications than hyperechoic, extensively calcified, homogeneous plaques with limited plaque burden, smooth luminal plaque surface and absence of neovascularization. Plaque ultrasound morphology is important, along with plaque geometry, in determining the atherosclerotic prognostic burden in the individual patient. New quantitative methods beyond backscatter (to include speed of sound, attenuation, strain, temperature, and high order statistics) are under development to evaluate vascular tissues. Although not yet ready for widespread clinical use, tissue characterization is listed by the American Society of Echocardiography roadmap to 2020 as one of the most promising fields of application in cardiovascular ultrasound imaging, offering unique opportunities for the early detection and treatment of atherosclerotic disease.