Noninvasive Detection of the Presence of Atherosclerotic Disease

Asymptomatic atherosclerotic disease is defined as the presence of abnormal function or structure of the vessel wall due to atherosclerosis. In this early stage, patients cannot be warned by ischemic chest pain (angina pectoris).Also, functional tests, like exercise ECG, stress echocardiography, perfusion scintigraphy, or perfusion magnetic resonance imaging (MRI), will be negative, because there is not yet a critical lumen narrowing leading to inducible perfusion abnormalities or myocar-dial ischemia. Intravascular (intracoronary) ultrasound (IVUS) is an excellent tool to diagnose and follow up preclinical atherosclerosis.6 It is, however, an invasive tool requiring arterial access (cardiac catheterization).

Pathology studies have documented that levels of traditional risk factors are associated with the extent and severity of atherosclerosis. However, at every level of risk factor exposure, there is substantial variation in the amount of atherosclerosis. This variation in disease is probably due to genetic susceptibility, combinations and interactions with other risk factors, including life habits, duration of exposure to the specific level of the risk factors and such factors as biological and laboratory variability. Therefore, no blood test exists that "proves" the presence of atherosclerotic disease. All the known traditional (e.g. hypercholesterolemia) and modern (e.g. elevated C-reactive protein) risk factors increase the likelihood of atherosclerosis, but they do not prove its existence in an individual person. Therefore functional and imaging techniques have to be used for diagnosing atherosclerosis at this early stage. A variety of noninvasive tests are available for determining the presence of asymptomatic atherosclerosis in various vascular beds.

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