Molecular imaging of inflammation and intraplaque vasa vasorum: A step forward to identification of vulnerable plaques?

Current developments in cardiovascular biology and imaging enable the noninvasive molecular evaluation of atherosclerotic vascular disease. Intraplaque neovascularization sprouting from the adventitial vasa vasorum has been identified as an independent predictor of intraplaque hemorrhage and plaque rupture. These intraplaque vasa vasorum result from angiogenesis, most likely under influence of hypoxic and inflammatory stimuli. Several molecular imaging techniques are currently available. Most experience has been obtained with molecular imaging using positron emission tomography and single photon emission computed tomography. Recently, the development of targeted contrast agents has allowed molecular imaging with magnetic resonance imaging, ultrasound and computed tomography. The present review discusses the use of these molecular imaging techniques to identify inflammation and intraplaque vasa vasorum to identify vulnerable atherosclerotic plaques at risk of rupture and thrombosis. The available literature on molecular imaging techniques and molecular targets associated with inflammation and angiogenesis is discussed, and the clinical applications of molecular cardiovascular imaging and the use of molecular techniques for local drug delivery are addressed

Knowledge translation in heart failure

The treatment of heart failure has expanded over the past three decades with large numbers of new medications and healthcare innovations available for these patients. At the same time, the prevalence of heart failure continues to increase across Canada and these patients are managed by a variety of clinicians from differing backgrounds in both primary care and hospital settings. Despite national recommendations advocating uptake of these new therapies, their utilization remains limited and inconsistent across the country. This review discusses the importance of knowledge translation in heart failure and examines the barriers to implementation of new therapies and models of care, providing a range of solutions to facilitate the delivery of guideline-directed care for heart failure patients