ADVANCES IN THE DIAGNOSIS OF CORONARY ATHEROSCLEROSIS Edited by Suna F. Kiraç Advances in the Diagnosis of Coronary Atherosclerosis Edited by Suna F. Kiraç Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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Used under license from Shutterstock.com First published October, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Advances in the Diagnosis of Coronary Atherosclerosis, Edited by Suna F. Kiraç p. cm. ISBN 978-953-307-286-9 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Chapter 1 Mechanisms of Disease: Novel Polymorphisms in Coronary Artery Disease 1 Asghar Ghasemi, Morteza Seifi and Mahmood Khosravi Chapter 2 Multifunctional Role of TRAIL in Atherosclerosis and Cardiovascular Disease 19 Katsuhito Mori, Masanori Emoto and Masaaki Inaba Chapter 3 Indications for Coronary Angiography 33 Karl Poon and Darren Walters Chapter 4 History of Coronary Angiography 69 Ryotaro Wake, Minoru Yoshiyama, Hidetaka Iida, Hiroaki Takeshita, Takanori Kusuyama, Hitoshi Kanamitsu, Hideya Mitsui, Yukio Yamada, Shinichi Shimodozono and Kazuo Haze Chapter 5 Coronary Angiography - Physical and Technical Aspects 81 Maria Anna Staniszewska Chapter 6 Procedural Techniques of Coronary Angiography 95 Jasmin Čaluk Chapter 7 Risks and Complications of Coronary Angiography: Contrast Related Complications 121 S. Mohammad Reza Khatami Chapter 8 Complications of Cardiac Catetherization 149 Mariano García-Borbolla, Rafael García-Borbolla and Begoña Balboa Chapter 9 Diagnosis and Management of Complications of Invasive Coronary Angiography 169 Jong-Seon Park and Young-Jo Kim VI Contents Chapter 10 Coronary Angiography and Contrast-Induced Nephropathy 181 Omer Toprak Chapter 11 Coronary Angiography in Patients with Chronic Kidney Disease 203 Luís Henrique Wolff Gowdak and José Jayme Galvão de Lima Chapter 12 Cardiac Catheterization and Coronary Angiography in Patients with Cardiomyopathy 219 Ali Ghaemian Chapter 13 Contrast-Induced Nephropathy in Patients with Type 2 Diabetes Mellitus and Coronary Artery Disease: Update and Practical Clinical Applications 235 Richard E. Katholi and Charles R. Katholi Chapter 14 Quantitative Coronary Angiography in the Interventional Cardiology 255 Salvatore Davide Tomasello, Luca Costanzo and Alfredo Ruggero Galassi Chapter 15 Summarized Coronary Artery Caliber and Left Ventricle Mass for Scoring of Cardiac Ischemia: Diagnostic and Prognostic Value 273 Edvardas Vaicekavicius Chapter 16 Woven Coronary Artery 297 Ayşe Yıldırım and A. Deniz Oğuz Chapter 17 Image Post-Processing and Interpretation 305 Masahiro Jinzaki, Minoru Yamada and Sachio Kuribayashi Chapter 18 Novel Insights Into Stenosis on Coronary Angiography–Outline of Functional Assessment of Stable Angina Patients with Angiographic Stenosis 331 Shinichiro Tanaka Chapter 19 Optimization of Radiation Dose and Image Quality in Cardiac Catheterization Laboratories 345 Octavian Dragusin, Christina Bokou, Daniel Wagner and Jean Beissel Chapter 20 Protection of the Patient and the Staff from Radiation Exposure During Fluoroscopy-Guided Procedures in Cardiology 367 Verdun Francis R., Aroua Abbas, Samara Eleni, Bochud François and Stauffer Jean-François Preface Coronary artery disease (CAD) and its consequences are the most important morbidity and mortality reasons in the developed and developing countries. Advanced imaging techniques (intravascular ultrasound, MR and CT angiography, SPECT/CT, PET/CT, PET/MRI) and novel serologic biomarkers (C-reactive protein, interleukin 6, matrix metalloproteinase, P-selectin, intracellular adhesion molecule 1 and tumor necrosis factor ) provide early diagnosis of CAD and protect patients from hard cardiac events. Non-invasive techniques are being widely used in the diagnosis and management while conventional CAG is still the most commonly performed test in the cases at high risk. Following the first cardiac catheterization performed, first selective CAG has been reported at the end of 1950's. Patient specific and procedure-related complications range widely from minor ones with short term sequelae to life threatening events that may cause irreversible end-point if urgent treatment is not adequately provided. The important risk factors for complications are older age, renal insufficiency, uncontrolled diabetes mellitus, morbid obesity, and iodine allergy. However, operator skills and the type of invasive procedure being performed remain as the most important predictors to undesired outcomes. The risk-to-benefit ratio of the CAG should be considered carefully on an individual basis. Coronary CTA and CMRA among advanced imaging systems offer anatomical informations not only for coronary vessels but also for peripheral vascular structures, and assessment of the left and right ventricular functions is possible in same image series. Quantified coronary artery calcification and many post-processing images (2-D images and the different 3-D rendering images such as volume rendering, multiplanar reformation, partial maximum intensity projection, curved multiplanar reformation) should be evaluated to increase diagnostic accuracy. High calcification level signs atherosclerotic changes in the coronary arteries, but is not specific for luminal obstruction. Because the absence of detectable calcium deposition has a high negative predictive value for CAD, CAC value is a significant predictive determinant for prognosis in asymptomatic patients. As with coronary angiography, myocardial perfusion abnormality may not be detected even there is coronary lesion causing a luminal narrowing of greater than 50 % defined by CTA and MRA. In asymptomatic and intermediate likelihood patients, assessment of myocardial perfusion by single photon emission computed tomography (SPECT) or positron emission tomography (PET) appears to be valuable even when coronary arteries are normal in angiography. X Preface If gated study is added, left ventricular systolic and diastolic functions can be investigated simultaneously with myocardial perfusion. This field includes a overview of molecular targeted imaging, permeability of the coronary vessel wall, and interventional coronary MR. Recent developments in the field of ultrasonography have allowed us to objectively quantify global and regional ventricular function, and also, to get real-time evaluation of coronary walls and calcium load of atherosclerotic plaques. While we achieve more knowledge about atherosclerotic lesions by IVUS, tissue Doppler imaging has attempted us to assess myocardial function. On the other hand, radiation exposure is the most limited factor for CTA and MPS gated SPECT procedures and needs particular attention. Ionizing radiation doses, hazardous effects and general radiation protection principles should be known for optimal protection of the patients. Mainly radiation safety rules, various techniques and equipments that may be used to reduce patient and staff radiation exposure during diagnostic and therapeutic procedures especially cardiac interventional fluoroscopic procedures have been detailed discussed in this book. In this field cardiac MR, which is a powerful non-invasive technique for the simultaneously assessment of coronary artery anatomy and function, has a great promise as a radiation-free method. But, it currently lays behind CTA for noninvasive coronary angiography because of some limitation factors such as metallic implants and equipment design. Selection of the most appropriate diagnostic test in special situations such as chronic kidney disease (CKD) and diabetes mellitus is an other important issue. Although coronary angiography is a valuable tool, the major challenges with coronary angiography relate to when it is appropriate to perform and what the risks are associated with the procedure. Because renal function may be more and more impair with contrast agents used during CAG, and sometimes dialysis may be needed. Therefore, stress echocardiography, MRA and nuclear cardiac tests are often recommended to rule out the presence of CAD in those patients and the presence of any risk factor must be assessed on an individual basis in order to prevent for a soft or hard local or systemic complications. Contrast induced nephropathy (CIN) remains an important clinical issue in these patients, pre-treatment with theophylline combined with volume expansion using sodium bicarbonate; acetylcysteine; use of the lowest possible dose of contrast material (CM), and ISO-osmolar CM or low osmolar CM are advised to prevent CIN. Contrast induced nephropathy is diagnosed if a rapid renal dysfunction is occurred after CM administration without obviously any other cause of acute kidney insufficiency. Serum creatinine (sCr) is the standard marker for detecting CIN; however little changes in sCr after CM exposure may be seen but it is not considered clinically relevant. Therefore, glomerular filtration rate which usually measured by creatinine clearance is usually accepted as the most accurate method for the assessment of kidney function. But, even in patients with stable sCr the GFR may significantly be declined. Recently more sensitive markers (Cystatin-C and Neutrophilic gelatinase associated lipocaline) than sCr for GFR have been developed and validated. Cystatin-C is presented as more accurate marker than sCr for predicting renal function. Readers will get detailed discussions about advantages, [...]... previously, the existence of five different types of TRAIL receptors and the crosstalk among multiple post-receptor signaling pathways may explain these diverse effects On the basis of in vitro findings, it is very difficult to speculate the impact of TRAIL on atherosclerotic lesions in vivo, although the in vitro findings clearly indicate the involvement of the TRAIL/TRAIL receptor system in atherogenesis In. .. In the next section, we try summarizing and discussing whether TRAIL protects against or exacerbates atherosclerosis in ways aside from its function as a mere pro-apoptotic factor 2.2 Role of TRAIL in atherosclerosis and vascular injury (in vivo findings) With regard to the role of TRAIL in the vascular wall, Secchiero et al first demonstrated compelling in vivo findings using diabetic apolipoprotein... 8 weeks The larger lesions in TRAIL −/− apoE −/− mice appeared to be due to an increase in the number of lesional VSMCs, suggesting the anti-atherogenic action of TRAIL Intriguingly, the difference in atheromatous lesion size among these mice became smaller at 12 weeks In contrast to Secchiero’s findings, the lack of TRAIL had no effect on the macrophage content in the atheromatous lesions There are... that the DDAH1 (dimethylarginine dimethylaminohydrolase 1) loss -of- function polymorphism is associated with both increased risk of thrombosis stroke and CAD (Ding et al., 2010) Growing evidence has shown that inflammation plays crucial roles in the development of coronary artery disease Interleukin-16 (IL-16), a multifunctional cytokine, is involved in a series of inflammatory disorders One finding indicates... signaling 2 TRAIL and the cardiovascular system TRAIL and its receptors are known to be expressed in the cardiovascular system Therefore, it is easily hypothesized that TRAIL systems may be involved in cardiovascular homeostasis and disorders To begin with, we will summarize several in vitro findings that demonstrate 22 Advances in the Diagnosis of Coronary Atherosclerosis the direct effects of TRAIL... regulation, interacting with Rb p107 protein) in KDR gene promoter region, which may alter KDR expression Exonic polymorphisms SNP1192G/A (rs2305948, in exon 7) and SNP1719A/T (rs1870377, in exon 11) are located in the third and fifth NH2-terminal IG-like 10 Advances in the Diagnosis of Coronary Atherosclerosis domains within the extracellular region, which are important for ligand binding, and result in nonsynonymous... predominant human renalase protein detectable in plasma, kidney, heart, skeletal muscle, 8 Advances in the Diagnosis of Coronary Atherosclerosis and liver The functional significance of the spliced isoforms is not known It has weak AA similarities to MAO-A and MAO-B and distinct substrate specificity and inhibitor profile, which indicates that it represents a new class of FAD-containing monoamine oxidases... recruits the adaptor protein Fas-associated death domain (FADD) through the death domains (DD) of each protein Subsequently, FADD interacts with caspase-8 and/or -10 through the death effector domain (DED) of each protein, resulting in the assembly of a death-inducing signaling complex (DISC) In the type I pathway, extrinsic signals proteolytically activate caspase-8 and/or -10 followed by stimulation of. .. mimic the atherosclerotic lesions observed in humans (Secchiero et al., 2006) That is, intraperitoneal administration of recombinant human TRAIL into these mice resulted in a transient high concentration of TRAIL and subsequent protection against the development of atherosclerosis (Secchiero et al., 2006) Secchiero et al carefully investigated the effects of TRAIL on in vivo atherosclerotic lesions using... 10q23.33 The major isoform of renalase contains 342 amino acids comprising a signal peptide (amino acids 1–17), a flavin-adenine dinucleotide (FAD) binding domain (amino acids 4–45), and a monoamine oxidase domain (amino acids 75–342) Evidence exists for at least four alternatively- spliced isoforms of renalase (Desir, 2009) The most common isoform (renalase1) is encoded by exons 1–4, 6–7, and 9 It is the . ADVANCES IN THE DIAGNOSIS OF CORONARY ATHEROSCLEROSIS Edited by Suna F. Kiraç Advances in the Diagnosis of Coronary Atherosclerosis Edited. 10q23.33. The major isoform of renalase contains 342 amino acids comprising a signal peptide (amino acids 1–17), a flavin-adenine dinucleotide (FAD) binding domain (amino acids 4–45), and a monoamine. polymorphism in the flavin-adenine dinucleotide-binding domain of human renalase (Glu37Asp) has recently been described. This is the only reported common coding single-nucleotide polymorphism in the