University National Heart Hospital, Department of Noninvasive Imaging and Diagnostic, Sofia 1309, Bulgaria
Received: 07 November, 2015; Accepted: 01 February, 2016; Published: 03 February, 2016
Krasimira Hristova, MD, PhD, Associated Professor of Cardiology, University National Heart Hospital, Department of Noninvasive Imaging and Diagnostic, Sofia 1309, Bulgaria, E-mail:
Hristova K (2016) The Role of Noninvasive Imaging for Detection High Risk Patients with Subclinical Atherosclerosis. Arch Clin Hypertens 1(1): 004-012.
© 2016 Hristova K. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Atherosclerosis; Dyslipidemia; High risk patients; Noninvasive imaging
AI: Augmentation Index; AS: Arterial Stiffness; BP: Blood Pressure; CVD: Cardiovascular Diseases; eNOS: Endothelial NO Synthase; EPIV: Echo Particle Image Velocimetry; FMD: Flow-Mediated Vasodilatation; HDL: Chigh-Density Lipoprotein Cholesterol; IMT: Intima Media Thickness; LDL: Clow-Density Lipoprotein Cholesterol; PWV: Pulse Wave Velocity; TG: Triglycerides; us- CRP: ultra-sensitive C-Reactive Protein;
Non-invasive imaging is widely used to assess vascular dysfunction, including measurement of flow-mediated vasodilatation of the brachial artery (FMD), pulse wave velocity (PWV), the augmentation index (AI), and central blood pressure. Endothelial dysfunction, a main contributor of atherosclerosis is possible diagnostic tool by FMD. An arterial stiffness, assessing by the PWV and/or arterial dispensability and beta stiffness index have been associated with cardiovascular risk. Ultrasound-based methods are used to assess elastic properties of the arterial walls in studies of arterial stiffness and atherosclerosis. In asymptomatic individuals is essential in order to detect, predict and prevent cardiovascular diseases first be estimated based on the global assessment of risk factors? Nowadays is recommended in daily routine screening for coronary artery disease in asymptomatic individuals with intermediate (10-20% 10-year risk of coronary artery disease) or high risk (>20% 10-year risk of coronary artery disease) to provide a further screening.
Assessment of CVD risk relates to the availability of effective treatments that inhibit the development and progression of atherosclerosis early in the life . Effective therapeutic intervention has advanced the concept of primary prevention of CAD. Primary prevention focuses on identifying asymptomatic individuals without prior history of CVD, who are at sufficiently high risk for a future CVD event to justify gradually more intensive risk reduction efforts. The causes of atherosclerosis, which are reliable for cardiovascular diseases, are among the leading of occasion for morbidity and mortality in the world. The coronary heart disease due to atherosclerosis is increasing in last years in developing countries. Chronic inflammatory diseases are associated with increasing of cardiovascular disease prevalence and outcomes of subclinical atherosclerosis and might detect the once of endothelial dysfunction by FMV method [2-4]. This phenomenon, called pathological remodeling, has been accelerated and may attribute to traditional risk factors, associated with atherosclerosis, but could also be the result of other autoimmune and inflammatory mechanisms that are aggravated in chronic inflammatory diseases and benefit in certain diseases, studied recently, such as chronic inflammatory arthritis and conjunctivitis .
Knowing the high prevalence of CVD and its risk factors , a major challenge is associated with primary prevention of CVD involves identification of new early risk factors as well as early diagnosis of subclinical CVD in asymptomatic individuals who are at The sudden death is the primary consequence of coronary artery disease in 50% of men and 64% of women. Historically an early detection of atherosclerosis has become eligible due to the noninvasive imaging techniques for patients with risk factors, allowing assessing and confirming plaque presence and estimating the extent of the flow limiting stenosis. This remodeling of the arterial wall is accelerated in diseases mentioned as inflammatory-related abnormalities and autoimmune mechanisms may work synergistically with traditional risk factors, making them particularly harmful and therefore contribute to endothelial dysfunction, which is considered the first step in atherogenesis.
The arterial wall is consist of 3 layers (ie, the intima, including the endothelium, the media, and the adventitia) and has individual importance in systemic circulation. The vascular endothelium settled in proper way the vascular tone, hemostasis and/or vascular permeability. The media is the major determinant of arterial elasticity, which regulates the conduit function (delivery of blood to tissues) and cushioning effect (for generation of continuous blood flow). Failure of these functions results in organ/vascular damage. The diagnosis of early changes of arterial status is possible since the development of new imaging techniques, which are commonly proposed to study not only mechanical properties but elastic properties. Except, these noninvasive methods are encouraging for assessing subclinical atheroma and the degree of it penetration by measuring the IMT, AS and the EPIV used in the calculation of the constraint of the carotid wall and of the level of endothelial dysfunction by the FMV method ..
The screening protocol contain in a few specific biomarkers directly related to the progression of atherosclerosis (the study of metalloproteases or bio protease obtained from a sample of urine, or of plasma to be systematically associated with previous methods , let to improve the results by the end of treatment and directed by our future prognostic decisions .. Some of these biomarkers are still in the research stage. Still biomarkers which are using in daily practice for assessment of cardiovascular risk are LDL-C, HDL-C, TG, us-CRP, glycated hemoglobin, creatinine clearance, von Will brand factor, myeloperoxidases, cytokines, and other markers of platelet reactivity. Currently the oxidative stress and calcium score (calculated by coronary computed tomography) used as a noninvasive end point in epidemiological studies and clinical trials to gauge progression and regression of atherosclerosis .
Accordingly, assessment of properties correlated with plaque composition is needed for detection of subclinical atherosclerosis and might become a screening tool for use in daily practice in asymptomatic patients with risk factors. In 21st century the risk stratification is basically preventive measures aimed at reducing the occurrence of cardiovascular events . Consequently, the aim of the present research is to promote the screening and early detection of subclinical atherosclerosis in asymptomatic patients with cardiovascular risk factors via mass screening or individual screening .
Cardiovascular risk factors
Cardiovascular risk factors (Figure 1) are modifiable parameters closely related with the outcomes of a cardiovascular occurrence that increase the probability of this event: hypertension increases the probability of death by 13% [12,13], tobacco by 9%, [14-16], dyslipidemia by 8 % with its atherogenic effect, and by 7 % malnutrition, as well as increasing the incidence of diabetes, obesity, and high body mass index, except where age remains the only non-modifiable risk factor [17,18]. Some risk factors such as hypertension , smoking, and diabetes were assessed in multiple models for stratification of the cardiovascular risk in the general population. This hypothesis of an overall estimated risk to predict the cardiovascular risk, which plays a key role in individualized efficacy of the treatment [20,21].