Open Access Medical Books



Edited by David C. Gaze .

210 pages . 

World Heart Federation, cardiovascular disease is responsible for 17.1 million deaths globally each year. A staggering 82% of these deaths actually occur in the developing world. Such numbers are often difficult to comprehend. The gravity of the situation is enhanced when portrayed as the following: A coronary even occurs every 25 seconds and CHD kills one person every 34 seconds in the United States of America alone. 35 people under the age of 65 die prematurely in the United Kingdom every day due to cardiovascular disease (12,500 deaths per annum). Although the leading killer, the incidence of cardiovascular disease has declined in recent years due to a better understanding of the pathological mechanisms involved and development of targeted therapeutics; along with the implementation of lipid lowering therapy such as statins and new drug regimens including low molecular weight heparin and antiplatelet drugs such as glycoprotein IIb/IIIa receptor inhibitors. Recent advances in acute surgical intervention have also improved mortality, especially with the advent of drug eluting stents and minimally invasive coronary artery bypass grafting, along with improvements in cardioplegia and a systemic hypothermic environment. 
The disease burden has a great financial impact on global healthcare systems and major economic consequences for world economies. Cardiovascular disease cost the UK healthcare system £14.4 billion (€16.7 billion; $22.8 billion) in 2006. Hospital care for patients with cardiovascular disease accounts for approximately 70% of the cost with 20% spent on pharmacological agents. The total cost should include non-healthcare costs such as production losses in the workforce and informal care of people with the disease. Production loss is estimated to cost the UK economy £8.2 billion in 2006 (55% due to death and 45% due to illness).
Informal care cost the UK economy £8.0 billion in 2006. Overall cardiovascular disease is estimated to cost the UK economy £30.7 billion per annum.
This text firstly introduces the heart and circulation and the development and anatomy of the coronary arteries before introducing the all encompassing umbrella of cardiovascular disease and the Pathobiology of ischemic heart disease (IHD). The epidemiological burden of Ischemic heart disease is described on a global scale; followed by risk factors, diagnostic modalities and treatment regimens for IHD. The next chapter describes the deleterious effects of congenital heart diseases and the role of myocardial ischemia in these conditions, detailing the pathogenesis, diagnosis and treatment options before tacking strategies for prevention. Chapter three demonstrates the gender disparity in sudden cardiac death (SCD). SCD occurs predominantly in women often without previous symptoms or history of CVD. The mechanisms surrounding SCD are detailed followed by identification of those at risk and potential treatment strategies such as implantable cardioverter-defibrillators for high risk subjects. Chapter four reports on the significance of endothelial function and its mellitus. Damage to the endothelium is considered to be the initiation of the atherothrombotic episode; be it chemically induced by reduction in nitric oxide, oxidative stress or inflammation or by mechanical sheer stress and hemodynamic disruption. This is followed by the presentation of clinical findings in sixty patients with CHD and type II diabetes Mellitus compared to sixty eight patients with CHD but no evidence of diabetes. Using Holter ECG monitoring, echocardiography, vascular Doppler ultrasound, the vascular responses between those with and those without diabetes were measured. Furthermore, cerebrovascular reactivity testing was also assessed. Patients with CHD and concomitant diabetes demonstrate reduced endothelium-dependent vasodilation compared to those CHD patients without
CHD. As mentioned above, the economic cost of CHD is crippling healthcare budgets and contributes to loss of business revenue and national reduction in gross domestic product.
Chapter five from experts at the Centers for Disease Control and Prevention, USA surveyed inpatient admissions between 2006-8. Some 41,546 claims were made for a primary diagnosis of acute myocardial infarction (46% ST segment elevation MI; STEMI). The associated costs are highest in males than females and a geographical variation was observed.
STEMI costs were higher than non-STEMI costs and costs were highest in those undergoing surgical revascularisation by primary coronary intervention or coronary artery bypass grafting.
These data could be used to model more cost-effective AMI intervention programs. The next chapter details the biochemical tests available for the detection and diagnosis of cardiac ischemia. There are a plethora of candidate biomarkers however very few have made the transition to use in the clinical setting. Biomarkers up stream of the cardiac troponins may serve as sensitive tests, but at the cost of specificity thus reducing the overall diagnostic efficiency of the test. Malondialdehyde low-density lipoprotein, Myeloperoxidase, whole blood choline, and free fatty acids are described. The FDA cleared Ischemia Modified Albumin assay is described in detail including its clinical utility not only in acute chest pain but in those patients without acute coronary syndrome. Lastly, with the advent of sensitive cardiac troponin tests, the ischemia vs necrosis debate is challenged once again. Chapter seven discusses the role of uric acid (the end product of purine metabolism) as a risk factor for the development of CVD. Similarly, the role of magnesium and the hypomagnesaemic state and its relationship in the development of clinical disorders such as diabetes, hypertension, atherosclerosis and acute coronary syndrome are discussed in the subsequent chapter. Chapter nine investigates the process of ‘self-eating’ or autophagy, detailing the intracellular signalling
control mechanisms and its role in the maintenance of normal myocardial tissue and its cardioprotective effect during ischemia in the hypoxic myocardium. The understanding of autophagy may lead to possible therapeutic targets for IHD. The penultimate chapter is concerned with progenitor and stem cell engineering as a possible intervention to treat IHD.
This is of great interest given recent advances in understanding progenitor cell biology but also poses many considerable challenges in transferring from laboratory based science into a clinical reality. The chapter reviews recent progress in progenitor and stem cell engineering, including cell sources, scaffold free tissue construct, myocardial tissue generation using decellularised native tissue, porous scaffolding and biosynthetic polymers. The final chapter of this text discuses the role of fatty acid imaging, in which fatty acid tracers labelled with the radioisotope of iodine, 123-I is used in single positron emission computer tomography (SPECT) imaging. An overview of myocardial fatty acid metabolism is given, along with description of the iodine-labelled tracers and their myocardial tissue kinetics. This is followed by the clinical utility of the tracer in imaging post acute myocardial infarction, in those with stable chronic coronary artery disease, risk stratification and the assessment of myocardial tissue viability and probably most importantly, prediction of functional recovery. Furthermore,
its role in chronic kidney disease is discussed in light of the high prevalence of CHD in this unique population.

David C. Gaze
Dept of Chemical Pathology Clinical Blood Sciences,
St George’s Healthcare NHS Trust
London, United Kingdom


Chapter 1 Introduction to Ischemic Heart Disease 1
David C. Gaze

Chapter 2 Myocardial Ischemia in Congenital Heart Disease:
A Review 15
Fabio Carmona, Karina M. Mata, Marcela S. Oliveira and Simone G. Ramos

Chapter 3 Significance of Arterial Endothelial Dysfunction and 
Possibilities of Its Correction in Silent Myocardial Ischemia and Diabetes Mellitus 41
I.P. Tatarchenko, N.V. Pozdnyakova, O.I. Morozova, A.G. Mordovina, S.A. Sekerko and I.A. Petrushin

Chapter 4 Sex Differences in Sudden Cardiac Death 61
Anastasia Susie Mihailidou, Rebecca Ritchie and Anthony W. Ashton

Chapter 5 Costs of Hospitalizations with a Primary Diagnosis of Acute Myocardial Infarction Among Patients Aged 18-64 Years in the United States 77
Guijing Wang, Zefeng Zhang, Carma Ayala, Diane Dunet and Jing Fang

Chapter 6 Biomarkers of Cardiac Ischemia 91
David C. Gaze

Chapter 7 Is Hyperuricemia a Risk Factor to Cardiovascular Disease? 123
Magda H M Youssef

Chapter 8 Patient on ACS Pathway – Hypomagnesaemia a Contributory 
Factor to Myocardial Ischemia 133
Ghulam Naroo, Bina Nasim, Tanveer Yadgir and Omer Alskaf

Chapter 9 Cell Autophagy and Myocardial Ischemia/Reperfusion Injury 143
Suli Zhang, Jin Wang, Yunhui Du, Jianyu Shang, Li Wang, Jie Wang, Ke Wang, Kehua Bai, Tingting Lv, Xiao Li and Huirong Liu

Chapter 10 Progenitor/Stem Cell Engineering for Treatment of Ischemic Heart Diseases: Therapeutic Potentials and Challenges 163
Yuliang Feng, Yigang Wang and Shi-Zheng Wu

Chapter 11 Role of Fatty Acid Imaging with 123I- β-methyl-p-123IIodophenyl- 
Pentadecanoic Acid (123I-BMIPP) in Ischemic Heart Diseases 175
Junichi Taki, Ichiro Matsunari, Hiroshi Wakabayashi, Anri Inaki and Seigo Kinuya .

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Published by: Unknown - Sunday, February 17, 2013


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