Contemporary role of cardiac magnetic resonance in the management of patients with suspected or known coronary artery disease

Cardiac magnetic resonance imaging (CMR) is a useful non-invasive radiation-free imaging modality for the management of patients with coronary artery disease (CAD). CMR cine imaging provides the “gold standard” assessment of ventricular function, late gadolinium enhancement (LGE) provides useful data for the diagnosis and extent of myocardial scar and viability, while stress imaging is an established technique for the detection of myocardial perfusion defects indicating ischemia. Beyond its role in the diagnosis of CAD, CMR allows accurate risk stratification of patients with established CAD. This review aims to summarize the data regarding the role of CMR in the contemporary management of patients with suspected or known coronary artery disease

The effect of bevacizumab on cardiovascular prognosis of patients with cancer

Bevacizumab is an antibody against VEGF, widely used in the treatment of cancer. Aim of the present study is the evaluation of its impact in the cardiovascular prognosis of cancer patients.A sample of 147 patients suffering from metastatic breast or colorectal cancer were staged and planned to receive first line therapy of conventional chemo, with the addition of bevacizumab or not, according to the discretion of the oncologist. All patients were evaluated before the initiation of the therapy, at 6 and 18 months after the end of it. The 18-month estimate for freedom from cardiovascular event was 88.4±4.1% for bevacizumab and 98.6±1.4% for the controls (p=0.05). All cardiovascular events were myocardial infarctions and were significantly higher in the bevacizumab group compared to the control group (9.21% versus 1.40%, p=0.03). Multivariate analysis showed that the use of bevacizumab and the presence of LBBB and the use of bevacizumab were the only independent predictors of cardiovascular events (p<0.001).Regarding echocardiographic evaluation, the Sa wave, the index evaluating the systolic function of myocardium, was significantly lower at 6 months (10.93±4.64 versus 9.90±3.59 cm/s, p=0.0007), and remained significantly lower at 18 months (10.93±4.64 versus 9.03±9.56 cm/s, p=0.003). Regarding measurements evaluating the diastolic function, E/E ratio significantly increased both at 6 months (5.83±2.53 versus 7.86±3.45, p=0.0005), and at 18 months follow up (5.83±2.53 versus 7.84±3.45, p=0.004).Το αντίσωμα της μπεβασιζουμάμπης, που έχει σαν στόχο τον VEGF, χρησιμοποιείται ευρέως στη θεραπεία του καρκίνου. Σκοπό της παρούσας μελέτης αποτελεί η εκτίμηση της καρδιαγγειακής πρόγνωσης των ογκολογικών ασθενών που έλαβαν συστηματικά μπεβασιζουμάμπη.Ένα δείγμα 147 ασθενών που έπασχαν από μεταστατικό καρκίνο του μαστού ή του παχέος εντέρου, σταδιοποιήθηκαν και επιλέχθηκε να λάβουν 1ης γραμμής χημειοθεραπεία με συμβατικό σχήμα κι ανάλογα με την εκτίμηση του ογκολόγου προστέθηκε στο σχήμα αυτό μπεβασιζουμάμπη ή όχι. Ο έλεγχος των ασθενών έγινε σε 3 φάσεις: την ημέρα πριν την έναρξη της θεραπείας, έξι (6) μήνες και δεκαοχτώ (18) μήνες μετά το τέλος της θεραπείας. Το ποσοστό ασθενών ελεύθερων καρδιαγγειακών συμβαμάτων στους 18 μήνες ήταν 88.4 ± 4.1% για την μπεβασιζουμάμπη και 98.6 ± 1.4% για την ομάδα ελέγχου (p=0.05). Όλα τα καρδιαγγειακά συμβάματα αφορούσαν έμφραγμα του μυοκαρδίου (Myocardial Infarction, MI) και ήταν σημαντικά υψηλότερη η επίπτωση στην ομάδα της μπεβασιζουμάμπης σε σύγκριση με την ομάδα ελέγχου (9,21% έναντι του 1,40%, p = 0,03). Η πολυπαραγοντική ανάλυση αναγνώρισε το LBBB στο αρχικό ηλεκτροκαρδιογράφημα, καθώς και τη χορήγηση μπεβασιζουμάμπης σαν τους μόνους ανεξάρτητους προδιαθεσικούς παράγοντες για εμφάνιση καρδιαγγειακών συμβαμάτων (p<0.001). Στην υπερηχογραφική μελέτη, όσον αφορά τους δείκτες αξιολόγησης της συστολικής λειτουργίας, το Sa ήταν σημαντικά χαμηλότερο στους 6 μήνες (10.93±4.64 έναντι 9.90±3.59 cm/s, p=0.0007), και παρέμεινε σημαντικά χαμηλότερο στους 18 μήνες (10.93±4.64 έναντι 9.03±9.56 cm/s, p=0.003). Από τους δείκτες εκτίμησης διαστολικής δυσλειτουργίας, ο δείκτης E/E΄ αυξήθηκε στους 6 μήνες (5.83±2.53 έναντι 7.86±3.45, p=0.0005)

Statins and Vulnerable Plaque

Background: Atherosclerosis is a systemic, progressive lipid-driven inflammatory disease of the arterial vascular wall leading progressively to plaque development. The vulnerable plaque, the one considered to be the leading cause of cardiovascular events seems to exhibit a large and soft lipid-rich necrotic core covered by a thin and inflamed fibrous cap. Statin treatment is considered as one of the most effective methods for vulnerable plaque stabilization, currently being the principal drug in primary and secondary prevention of cardiovascular disease. Objective: We sought to evaluate the beneficial effect of statins on biological processes involved in the evolution of vulnerable plaques Method: We performed a systematic review of the literature searching MEDLINE via Pubmed for all experimental and human studies implementing statins in vulnerable plaque. Results: Statins seem to have a beneficial role in plaque stabilization and patient outcome. It seems that this effect is mediated by improving endothelial function, decreasing oxidative stress and inflammation, reducing inflammatory activation and inhibiting thrombogenic response. Although these data are quite promising, it remains to be determined the extent of a potent benefit of the pleiotropic effects of statin therapy in clinical setting. Conclusion: Prospective randomized trials should be conducted in order to further elucidate differences among type and dose of statin therapy, duration of treatment and association with LDL levels and clinical outcome