doi: 10.1161/01.CIR.0000087480.94275.97
(Circulation. 2003;108:1664.)
© 2003 American Heart Association, Inc.
Review: Current Perspective |
From Vulnerable Plaque to Vulnerable Patient
A Call for New Definitions and Risk Assessment Strategies: Part I
From The Center for Vulnerable Plaque Research, University of Texas—Houston, The Texas Heart Institute, and President Bush Center for Cardiovascular Health, Memorial Hermann Hospital, Houston (M. Naghavi, S.W.C., S.L., M.M., A.Z., J.T.W.); The Leducq Center for Cardiovascular Research, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (P.L., M.A.); Department of Cardiology and Institute of Experimental Clinical Research, Aarhus University, Aarhus, Denmark (E.F.); Experimental Cardiology Laboratory, Vascular Biology of the University Medical Center in Utrecht, the Netherlands (G.P.); Ohio State University (J.R.); the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, NY (Z.F.); Cardiac Catheterization Laboratory at the VA Medical Center, University of Kentucky, Lexington (P.M.); Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (P.H.S.); Division of Cardiology, New England Medical Center, Boston, Mass (S.W.); Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, La (P.R.); Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC (A.B., A.F., R.V.); Department of Radiology, University of Washington, Seattle (C.Y.); Stanford University Medical Center Stanford, Calif (P.J.F.); Cardiovascular Health Research Unit, University of Washington, Seattle (D.S.S.); Department of Cardiology, Athens Medical School, Athens, Greece (C.S.); Catheterization Laboratory, Thorax Center, Erasmus University, Rotterdam, the Netherlands (C.L.d.K.); Division of Cardiology, Department of Medicine, University of Turku, Finland (K.E.J.A.); Institute of Arteriosclerosis Research and the Institute of Clinical Chemistry and Laboratory Medicine, Central Laboratory, Hospital of the University of Münster, Munich, Germany (G.A.); Department of Clinical Radiology, University of Münster, Munich, Germany (C.R.B.); Mayo Clinic Medical School, Jacksonville, Fla (J.H.C.); Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (Z.S.G.); Bristol Heart Institute, Bristol University, Bristol, United Kingdom (C.J.); Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (I.-K.J.); Department of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany (W.K.); University of Kentucky, Lexington, Ky (R.A.L.); R.L. Roudebush VA Medical Center, Indianapolis, Ind (K.M.); School of Public Health, University of Texas—Houston, Houston, Texas (J.D.); Division of Cardiology, University of California Los Angeles, Los Angeles, Calif (M. Navab); Fondazione Salvatore Maugeri, University of Pavia, Pavia, Italy (S.G.P.); Department of Cardiovascular Therapeutics, Pfizer Global Research and Development, Ann Arbor Laboratories, Ann Arbor, Mich (M.D.R.); Paul Dudley White Coronary Care System at St. Agnes HealthCare, Baltimore, Md (R.B.); Center for Human Nutrition, University of Texas Health Science Center, Dallas (S.M.G.); Lenox Hill Hospital, New York, NY (R.M.); Catheterization Laboratories, Ospedale San Raffaele and Emo Centro Cuore Columbus, Milan, Italy (A.C.); Human Genetics Center, Institute of Molecular Medicine, Houston, Tex (E.B.); Department of Medicine, Baylor College of Medicine, Houston, Tex (C.B., W.I.); Minneapolis Heart Institute and Foundation, Minneapolis, Minn (R.S.S.); Division of Cardiology, University of Maryland School of Medicine, Baltimore, Md (R.V.); Karolinska Institute, Center for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden (G.K.H.); Section of Cardiology, University of Chicago, Ill (D.P.F.); Vascular Physiology and Thrombosis Research Laboratory of the Atherosclerosis Research Center, Cedars-Sinai Medical Center, Los Angeles, California (S.K.); Cardiology Department, Hannover University, Hannover, Germany (H.D.); Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill (P.G.); UCLA School of Medicine and Cedars-Sinai Medical Center, Los Angeles, Calif (P.K.S.); Massachusetts General Hospital, Harvard Medical School and CIMIT (Center for Integration of Medicine and Innovative Technology), Boston, Mass (J.E.M.); Cardiovascular Division, Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Mass (P.M.R.); and Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis (D.P.Z.).
Correspondence to Morteza Naghavi, MD, Association for Eradication of Heart Attack, 2472 Bolsover, No. 439, Houston, TX 77005. E-mail mn{at}vp.org
Abstract
Atherosclerotic cardiovascular disease results in >19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs. The recognition of the role of the vulnerable plaque has opened new avenues of opportunity in the field of cardiovascular medicine. This consensus document concludes the following. (1) Rupture-prone plaques are not the only vulnerable plaques. All types of atherosclerotic plaques with high likelihood of thrombotic complications and rapid progression should be considered as vulnerable plaques. We propose a classification for clinical as well as pathological evaluation of vulnerable plaques. (2) Vulnerable plaques are not the only culprit factors for the development of acute coronary syndromes, myocardial infarction, and sudden cardiac death. Vulnerable blood (prone to thrombosis) and vulnerable myocardium (prone to fatal arrhythmia) play an important role in the outcome. Therefore, the term "vulnerable patient" may be more appropriate and is proposed now for the identification of subjects with high likelihood of developing cardiac events in the near future. (3) A quantitative method for cumulative risk assessment of vulnerable patients needs to be developed that may include variables based on plaque, blood, and myocardial vulnerability. In Part I of this consensus document, we cover the new definition of vulnerable plaque and its relationship with vulnerable patients. Part II of this consensus document focuses on vulnerable blood and vulnerable myocardium and provide an outline of overall risk assessment of vulnerable patients. Parts I and II are meant to provide a general consensus and overviews the new field of vulnerable patient. Recently developed assays (eg, C-reactive protein), imaging techniques (eg, CT and MRI), noninvasive electrophysiological tests (for vulnerable myocardium), and emerging catheters (to localize and characterize vulnerable plaque) in combination with future genomic and proteomic techniques will guide us in the search for vulnerable patients. It will also lead to the development and deployment of new therapies and ultimately to reduce the incidence of acute coronary syndromes and sudden cardiac death. We encourage healthcare policy makers to promote translational research for screening and treatment of vulnerable patients.
Key Words: coronary disease • plaque • myocardial infarction • atherosclerosis • death, sudden
This article has been cited by other articles:
 |
|
 |
|
  F. A. Jaffer, C. Vinegoni, M. C. John, E. Aikawa, H. K. Gold, A. V. Finn, V. Ntziachristos, P. Libby, and R. Weissleder Real-Time Catheter Molecular Sensing of Inflammation in Proteolytically Active Atherosclerosis Circulation, October 28, 2008; 118(18): 1802 - 1809. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention Circulation, September 30, 2008; 118(14): 1497 - 1518. [Full Text] [PDF]
|
|
|
|
|
|
D. A. Bluemke, S. Achenbach, M. Budoff, T. C. Gerber, B. Gersh, L. D. Hillis, W. G. Hundley, W. J. Manning, B. F. Printz, M. Stuber, et al. Noninvasive Coronary Artery Imaging: Magnetic Resonance Angiography and Multidetector Computed Tomography Angiography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention, and the Councils on Clinical Cardiology and Cardiovascular Disease in the Young Circulation, July 29, 2008; 118(5): 586 - 606. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Alfonso The "vulnerable" stent why so dreadful? J. Am. Coll. Cardiol., June 24, 2008; 51(25): 2403 - 2406. [Full Text] [PDF]
|
|
|
|
 |
|
 J. N. Redgrave, P. Gallagher, J. K. Lovett, and P. M. Rothwell Critical Cap Thickness and Rupture in Symptomatic Carotid Plaques: The Oxford Plaque Study Stroke, June 1, 2008; 39(6): 1722 - 1729. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Wintermark, S.S. Jawadi, J.H. Rapp, T. Tihan, E. Tong, D.V. Glidden, S. Abedin, S. Schaeffer, G. Acevedo-Bolton, B. Boudignon, et al. High-Resolution CT Imaging of Carotid Artery Atherosclerotic Plaques AJNR Am. J. Neuroradiol., May 1, 2008; 29(5): 875 - 882. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Yoshida, O. Narumi, M. Chin, K. Inoue, T. Tabuchi, K. Oda, M. Nagayama, N. Egawa, M. Hojo, Y. Goto, et al. Characterization of Carotid Atherosclerosis and Detection of Soft Plaque with Use of Black-Blood MR Imaging AJNR Am. J. Neuroradiol., May 1, 2008; 29(5): 868 - 874. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Nussberger, J.-F. Aubert, K. Bouzourene, M. Pellegrin, D. Hayoz, and L. Mazzolai Renin Inhibition by Aliskiren Prevents Atherosclerosis Progression: Comparison With Irbesartan, Atenolol, and Amlodipine Hypertension, May 1, 2008; 51(5): 1306 - 1311. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Ambrose In Search of the "vulnerable plaque": can it be localized and will focal regional therapy ever be an option for cardiac prevention? J. Am. Coll. Cardiol., April 22, 2008; 51(16): 1539 - 1542. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Rundek, H. Arif, B. Boden-Albala, M. S. Elkind, M. C. Paik, and R. L. Sacco Carotid plaque, a subclinical precursor of vascular events: The Northern Manhattan Study Neurology, April 1, 2008; 70(14): 1200 - 1207. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. von Lukowicz, P. O. Hassa, C. Lohmann, J. Boren, V. Braunersreuther, F. Mach, B. Odermatt, M. Gersbach, G. G. Camici, B. E. Stahli, et al. PARP1 is required for adhesion molecule expression in atherogenesis Cardiovasc Res, April 1, 2008; 78(1): 158 - 166. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Rossi, A. Nuzzo, G. Origliani, and M. G. Modena Prognostic role of flow-mediated dilation and cardiac risk factors in post-menopausal women. J. Am. Coll. Cardiol., March 11, 2008; 51(10): 997 - 1002. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Saam, H. R. Underhill, B. Chu, N. Takaya, J. Cai, N. L. Polissar, C. Yuan, and T. S. Hatsukami Prevalence of American Heart Association type VI carotid atherosclerotic lesions identified by magnetic resonance imaging for different levels of stenosis as measured by duplex ultrasound. J. Am. Coll. Cardiol., March 11, 2008; 51(10): 1014 - 1021. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Gottlieb and J. A.C. Lima Screening High-Risk Patients With Computed Tomography Angiography Circulation, March 11, 2008; 117(10): 1318 - 1332. [Full Text] [PDF]
|
|
|
|
|
|
A. Fougerat, S. Gayral, P. Gourdy, A. Schambourg, T. Ruckle, M. K. Schwarz, C. Rommel, E. Hirsch, J.-F. Arnal, J.-P. Salles, et al. Genetic and Pharmacological Targeting of Phosphoinositide 3-Kinase-{gamma} Reduces Atherosclerosis and Favors Plaque Stability by Modulating Inflammatory Processes Circulation, March 11, 2008; 117(10): 1310 - 1317. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Laughlin, S. C. Newcomer, and S. B. Bender Importance of hemodynamic forces as signals for exercise-induced changes in endothelial cell phenotype J Appl Physiol, March 1, 2008; 104(3): 588 - 600. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. M. Heikkila, S. Latti, M. J. Leskinen, J. K. Hakala, P. T. Kovanen, and K. A. Lindstedt Activated Mast Cells Induce Endothelial Cell Apoptosis by a Combined Action of Chymase and Tumor Necrosis Factor-{alpha} Arterioscler. Thromb. Vasc. Biol., February 1, 2008; 28(2): 309 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A. Wasserman, A. R. Sharrett, S. Lai, A. S. Gomes, M. Cushman, A. R. Folsom, D. E. Bild, R. A. Kronmal, S. Sinha, and D. A. Bluemke Risk Factor Associations With the Presence of a Lipid Core in Carotid Plaque of Asymptomatic Individuals Using High-Resolution MRI: The Multi-Ethnic Study of Atherosclerosis (MESA) Stroke, February 1, 2008; 39(2): 329 - 335. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Vidula, L. Tian, K. Liu, M. H. Criqui, L. Ferrucci, W. H. Pearce, P. Greenland, D. Green, J. Tan, D. B. Garside, et al. Biomarkers of Inflammation and Thrombosis as Predictors of Near-Term Mortality in Patients with Peripheral Arterial Disease: A Cohort Study Ann Intern Med, January 15, 2008; 148(2): 85 - 93. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. V. Raman, M. W. Winner III, T. Tran, M. Velayutham, O. P. Simonetti, P. B. Baker, J. Olesik, B. McCarthy, A. K. Ferketich, and J. L. Zweier In Vivo Atherosclerotic Plaque Characterization Using Magnetic Susceptibility Distinguishes Symptom-Producing Plaques J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 49 - 57. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. R. S. Packard and P. Libby Inflammation in Atherosclerosis: From Vascular Biology to Biomarker Discovery and Risk Prediction Clin. Chem., January 1, 2008; 54(1): 24 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Saba and G. Mallarini MDCTA of Carotid Plaque Degree of Stenosis: Evaluation of Interobserver Agreement Am. J. Roentgenol., January 1, 2008; 190(1): W41 - W46. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Takumi, S. Lee, S. Hamasaki, K. Toyonaga, D. Kanda, K. Kusumoto, H. Toda, T. Takenaka, M. Miyata, R. Anan, et al. Limitation of Angiography to Identify the Culprit Plaque in Acute Myocardial Infarction With Coronary Total Occlusion: Utility of Coronary Plaque Temperature Measurement to Identify the Culprit Plaque J. Am. Coll. Cardiol., December 4, 2007; 50(23): 2197 - 2203. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Hausleiter, T. Meyer, M. Hadamitzky, M. Zankl, P. Gerein, K. Dorrler, A. Kastrati, S. Martinoff, and A. Schomig Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease: the Coronary Angiography by Computed Tomography with the Use of a Submillimeter resolution (CACTUS) trial Eur. Heart J., December 2, 2007; 28(24): 3034 - 3041. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Simon, G. Chironi, and J. Levenson Comparative performance of subclinical atherosclerosis tests in predicting coronary heart disease in asymptomatic individuals Eur. Heart J., December 2, 2007; 28(24): 2967 - 2971. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Shah, P. Balan, M. Weinberg, V. Reddy, R. Neems, M. Feinstein, J. Dainauskas, P. Meyer, M. Goldin, and S. B. Feinstein Contrast-enhanced ultrasound imaging of atherosclerotic carotid plaque neovascularization: a new surrogate marker of atherosclerosis? Vascular Medicine, November 1, 2007; 12(4): 291 - 297. [Abstract] [PDF]
|
|
|
|
 |
|
 D. Cui, E. Thorp, Y. Li, N. Wang, L. Yvan-Charvet, A. R. Tall, and I. Tabas Pivotal Advance: Macrophages become resistant to cholesterol-induced death after phagocytosis of apoptotic cells J. Leukoc. Biol., November 1, 2007; 82(5): 1040 - 1050. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Q. Chen, L. Zhang, Y. F. Liu, L. Chen, X. P. Ji, M. Zhang, Y. X. Zhao, G. H. Yao, C. Zhang, X. L. Wang, et al. Prediction of atherosclerotic plaque ruptures with high-frequency ultrasound imaging and serum inflammatory markers Am J Physiol Heart Circ Physiol, November 1, 2007; 293(5): H2836 - H2844. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Sabeti, O. Schlager, M. Exner, W. Mlekusch, J. Amighi, P. Dick, G. Maurer, K. Huber, R. Koppensteiner, O. Wagner, et al. Progression of Carotid Stenosis Detected by Duplex Ultrasonography Predicts Adverse Outcomes in Cardiovascular High-Risk Patients Stroke, November 1, 2007; 38(11): 2887 - 2894. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A Blumenthal, A. Sherwood, S. D. Rogers, M. A. Babyak, P. Murali Doraiswamy, L. Watkins, B. M. Hoffman, C. O'Connell, J. J. Johnson, S. M. Patidar, et al. Understanding prognostic benefits of exercise and antidepressant therapy for persons with depression and heart disease: the UPBEAT study rationale, design, and methodological issues Clinical Trials, October 1, 2007; 4(5): 548 - 559. [Abstract] [PDF]
|
|
|
|
|
|
J. Horiguchi, C. Fujioka, M. Kiguchi, Y. Shen, C. E. Althoff, H. Yamamoto, and K. Ito Soft and Intermediate Plaques in Coronary Arteries: How Accurately Can We Measure CT Attenuation Using 64-MDCT? Am. J. Roentgenol., October 1, 2007; 189(4): 981 - 988. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Angelini, M. Della Barbera, and G. Thiene Interventional procedures for atherothrombosis: pathology of retrieved material Heart, October 1, 2007; 93(10): 1301 - 1308. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Ebeling Barbier, T. Bjerner, T. Hansen, J. Andersson, L. Lind, J. Hulthe, L. Johansson, and H. Ahlstrom Clinically Unrecognized Myocardial Infarction Detected at MR Imaging May Not Be Associated with Atherosclerosis Radiology, October 1, 2007; 245(1): 103 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.-G. Chassot, A. Delabays, and D. R. Spahn Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction Br. J. Anaesth., September 1, 2007; 99(3): 316 - 328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. White, S. J. Duffy, A. S. Walton, J. F. Ng, G. E. Rice, S. Mukherjee, J. A. Shaw, G. L. Jennings, A. M. Dart, and B. A. Kingwell Matrix metalloproteinase-3 and coronary remodelling: Implications for unstable coronary disease Cardiovasc Res, September 1, 2007; 75(4): 813 - 820. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. Jaffer, P. Libby, and R. Weissleder Molecular Imaging of Cardiovascular Disease Circulation, August 28, 2007; 116(9): 1052 - 1061. [Full Text] [PDF]
|
|
|
|
|
|
Y. Wang, Y. Zheng, W. Zhang, H. Yu, K. Lou, Y. Zhang, Q. Qin, B. Zhao, Y. Yang, and R. Hui Polymorphisms of KDR Gene Are Associated With Coronary Heart Disease J. Am. Coll. Cardiol., August 21, 2007; 50(8): 760 - 767. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): e1 - e157. [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology Eur. Heart J., July 1, 2007; 28(13): 1598 - 1660. [Full Text] [PDF]
|
|
|
|
|
|
T. Saam, T. S. Hatsukami, N. Takaya, B. Chu, H. Underhill, W. S. Kerwin, J. Cai, M. S. Ferguson, and C. Yuan The Vulnerable, or High-Risk, Atherosclerotic Plaque: Noninvasive MR Imaging for Characterization and Assessment Radiology, July 1, 2007; 244(1): 64 - 77. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Ostling, B. Hedblad, G. Berglund, and I. Goncalves Increased Echolucency of Carotid Plaques in Patients With Type 2 Diabetes Stroke, July 1, 2007; 38(7): 2074 - 2078. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. S. Chatzizisis, A. U. Coskun, M. Jonas, E. R. Edelman, C. L. Feldman, and P. H. Stone Role of Endothelial Shear Stress in the Natural History of Coronary Atherosclerosis and Vascular Remodeling: Molecular, Cellular, and Vascular Behavior J. Am. Coll. Cardiol., June 26, 2007; 49(25): 2379 - 2393. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Saba, G. Caddeo, R. Sanfilippo, R. Montisci, and G. Mallarini CT and Ultrasound in the Study of Ulcerated Carotid Plaque Compared with Surgical Results: Potentialities and Advantages of Multidetector Row CT Angiography AJNR Am. J. Neuroradiol., June 1, 2007; 28(6): 1061 - 1066. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.D. Hardie, C.M. Kramer, P. Raghavan, E. Baskurt, and K.R. Nandalur The Impact of Expansive Arterial Remodeling on Clinical Presentation in Carotid Artery Disease: A Multidetector CT Angiography Study AJNR Am. J. Neuroradiol., June 1, 2007; 28(6): 1067 - 1070. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. N. Tziakas, J. C. Kaski, G. K. Chalikias, C. Romero, S. Fredericks, I. K. Tentes, A. X. Kortsaris, D. I. Hatseras, and D. W. Holt Total Cholesterol Content of Erythrocyte Membranes Is Increased in Patients With Acute Coronary Syndrome: A New Marker of Clinical Instability? J. Am. Coll. Cardiol., May 29, 2007; 49(21): 2081 - 2089. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Wierman and W. M. Kohrt Review Article: Vascular and Metabolic Effects of Sex Steroids: New Insights Into Clinical Trials Reproductive Sciences, May 1, 2007; 14(4): 300 - 314. [Abstract] [PDF]
|
|
|
|
|
|
F. A. Jaffer, D.-E. Kim, L. Quinti, C.-H. Tung, E. Aikawa, A. N. Pande, R. H. Kohler, G.-P. Shi, P. Libby, and R. Weissleder Optical Visualization of Cathepsin |