Multimodality Imaging to Detect Vulnerable Plaque in Coronary Arteries and Its Clinical Application

Postmortem studies have described the association between the thin-cap fibroatheroma (TCFA) and the occurrence of acute coronary syndrome (ACS). Both noninvasive and invasive techniques have been refined and used as a research tool to visualize the plaque at a high risk of disruption. There has been a considerable effort to develop the imaging modalities that offer detailed visualization of coronary pathology and accurately predict the adverse cardiac outcomes. This chapter provides an overview of the current and experimental coronary imaging methods to detect vulnerable plaque and discuss the potential implication of multimodality imaging in clinical practice

Transcatheter Aortic Valve Implantation: What Lies Ahead?

  Ttranscatheter aortic valve implantation (TAVI) is currently reserved for high surgical risk or inoperable patients. In 2007, TAVI actually represented approximately 1.2% of all aortic valve procedures in Europe; this percentage increased to 6.5% in 2008. With an expectation of ~9000 TAVI procedures to be performed in 2009, TAVI may represent nearly13% of all aortic valve procedures. It is forecasted that by 2012 transcatheter valve therapies will account for approximately 40% of the total heart valve procedures performed in Europe. One major limiting factor relates to procedural complications of TAVI. Conduction abnormalities and the need for permanent pacemaker, paravalvular aortic regurgitation, stroke and vascular complications have received particular attention. The future and widespread adoption of TAVI will rely on a number of inter-related factors, including long-term durability and safety data, randomized controlled trials comparing TAVI with surgical aortic valve replacement and reimbursement for the technology