Searchinggj for Vulnerable Subject · Searchinggj for Vulnerable Subject Best results for the...
Transcript of Searchinggj for Vulnerable Subject · Searchinggj for Vulnerable Subject Best results for the...
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Searching for Vulnerable Subject g j
Best results for the Patient
• Actual Model(symptoms) 43% Survival
Best results for the Patient
( y p )CVD’s Risk Factors, Drugs, CABG, Devices…
• Long Term Model 85% SurvivalgGenetic Panel
Select and monitor
85% SurvivalSignificant impact on
productivity and Costs Population at riskTreat specific Patients
p ysaving.
Treat specific Patients2www.cardiovascularprevention.com
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Who is the Vulnerable Subject ?j
He is an High risk person:- Asymptomatic
h i b li i l h l i- having subclinical atherosclerosisnot detectable by common risk factor assessment
He needs aggressive treatment , but he do not know it- Almost all vulnerable individuals have detectable subclinical atherosclerosis- New technology can identify vulnerable individuals with
ffi i t di tisufficient predictive power
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Cholesterol FailedCholesterol Failed
Quantification of Cholesterol and common Risk Factors failed to predict more than 1/3 of future cardiac death rising from Ischemic heart disease
LDL Goal Cholesterol LDL goals are progressively lowered for CVD prevention, in agree to
Patient 2001* 2004†
High-risk < 100 < 70
NCEP panel IIIModerate-risk < 130 < 100
Low-risk < 160 < 160
4NCEP ATP III = National Cholesterol Education Program Adult Treatment Panel III; LDL = low-density
lipoprotein: Charles H. Hennekens, MD; Medscape General Medicine. 2006;8(1):54. www.cardiovascularprevention.com
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Carotid Intima Media Thickness (CIMT)Carotid Intima-Media Thickness (CIMT)
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CALCIUM SCORECALCIUM SCOREI th l t l ifi ti t t• In the normal artery calcification are not present.
• The presence of coronary calcification indicates the existence of coronary diseasethe existence of coronary disease.
• The amount of calcification was correlated with the amount of plaque and the number ofthe amount of plaque and the number of coronary stenoses.
• The research of coronary calcium is an excellent ymethod of screening asymptomatic patients.
• The positive predictive power varies from 20 to 35% d ti di ti i l t35% and negative predictive power is close to 100%.
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CALCIUM SCORE ASSOCIATED WITH OTHER RISK FACTORS
(From: Raggi e coll. Am. Heart J. March 2001).
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SURVIVAL IN RELATION TO CALCIUM SCORE
Survival in 4474 males 3219 females with more than one risk factor in relation to the values of calcium scores measured by EBCT
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in relation to the values of calcium scores measured by EBCT (Bethesda conference, Jacc 41, 11 2003)
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Coronary TC Angiography and Calcium score
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Coronary TC Angiography 3D rendering
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Coronary TC AngiographyCoronary TC Angiography
Little calcified plaque(arrows)
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Coronary TC Angiography
Proximal LAD
Small calcifiedSmall calcified plaque (arrows)
particular
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Coronary TC Angiography
Cx Artery and collateral branch
RA and IVP artery
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Right Artery and small septal vessels(arrows)g y p ( )
Coronary TC Angiography Traditional Coronary Angiography
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Searching for Vulnerable Subject CV Risk Personal rankingCV Risk Personal ranking
Very High Risk: >20%
High: >2%High :6<20%g
Intermediate : 0.6-5,9 %
L <0 5 %15
Low: <0.5 %www.cardiovascularprevention.com
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16www.cardiovascularprevention.com
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Noninvasive Screening for Coronary Artery Disease With ComputedNoninvasive Screening for Coronary Artery Disease With Computed Tomography Is Useful
Melvin E. Clouse, MD,
17www.cardiovascularprevention.com
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Our Program:Discover the Vulnerable Subject
§ Clinical historyActual MethodOur Method
§ y
§ Common Risk Factors study
Risk Factors evaluation in agreement of F i h d l§ New CVD's Markers
§ C I M T
Framingham model and
NCEP Panel III =§ Calcium Score Index
§ Coronary CT
Insufficient 50%
§ Coronary CT angiography (if indicated)
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