Accuracy of 64-row multidetector computed tomography in detecting coronary artery disease in 134 symptomatic patients: Influence of calcification

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• 作者：Tiong Kiam Ong ; Sze Piaw Chin ; Chee Khoon Liew ; Wei Ling Chan ; M. Tobias Seyfarth ; Houng Bang Liew ; Annuar Rapaee ; Yean Yip Alan Fong ; Choon Kiat Ang ; Kui Hian Sim
• 关键词：Magnetic resonance imaging ; Echocardiography ; Thrombus ; Ischemic heart disease ; Heart failure
• 刊名：American Heart Journal
• 出版年：2006
• 出版时间：June 2006
• 年：2006
• 卷：151
• 期：6
• 页码：1323.e1-1323.e6
• 全文大小：170 K

文摘

It has been hypothesized that angiotensin-converting enzyme (ACE) inhibition, independent from its effect on ventricular function and blood pressure, could affect the atherosclerotic process and reduce the incidence of ischemic events and its complications. Several large clinical outcome trials were designed to test this hypothesis: QUIET, HOPE, EUROPA, PEACE, and IMAGINE. The results of the PEACE study were recently reported, leaving the IMAGINE study as the last chapter in our efforts to evaluate the role of ACE inhibition in coronary artery disease with preserved left ventricular function. In this report, we compare these studies with respect to their methodology and patient population and analyze the unique nature of the last ongoing study, IMAGINE.

The reported studies show that patients with coronary artery disease who are at low-to-moderate or high risk should receive an ACE inhibitor if tolerated. However, when the absolute risk of a patient decreases, and intensive contemporary management is given, with good control of risk factors, the absolute and perhaps relative benefits of an ACE inhibitor decrease and their routine use in these patients may not be warranted. The role of ACE inhibition started early post–coronary artery bypass graft in patients with preserved left ventricular function, and intensive contemporary management remains to be determined and should get answered by the IMAGINE study. Moreover, the IMAGINE population is not only a lower risk population than those enrolled in HOPE or EUROPA, but also the risk for this population is bimodal in nature (early post-revascularization inflammation and thrombosis vs long-term atherosclerosis progression) and may provide further insight into underlying mechanisms.