Abstract.We have developed a miniature integrated optical coherence tomography (OCT) ultrasound (US) probing system for intravascular imaging applications. In the OCT probe, the light coming out of a single mode fiber is focused by a gradient-index lens and then reflected by a right-angle prism from the side of the probe into the sample. It was combined with a 35 MHz PMN-PT side-viewing ultrasound transducer to obtain the ultrasound image as well. The OCT and ultrasound probes were integrated as a single probe to obtain OCT and ultrasound images simultaneously. The integrated probe has an outer diameter of 0.69 mm which, to our knowledge, is the smallest integrated OCT-US probe reported. Fast data acquisition and processing was implemented for real-time imaging. In vitro OCT and US images of human coronary artery with pathology, as well as in vivo images of normal rabbit abdominal aorta, were obtained using the integrated OCT-US probe to demonstrate its capability. C 2011 Society of Photo-Optical Instrumentation Engineers (SPIE).

Epicardial adipose tissue (EAT) has been shown to have important effects on the development of coronary artery disease (CAD) via local paracrine influences on the vascular bed. We compared a cohort of asymptomatic patients with Type II Diabetes (DM) without known CAD to an age and gender matched group of asymptomatic patients without DM from the CTRAD study in which patients underwent a cardiac computed tomography angiogram (CTA), for early detection of CAD. Mean EAT volumes of 118.6 ± 43.0 and 70.0 ± 44.0 cm3 were found in the DM and non-DM groups respectively. When stratified by presence and severity of CAD, it was found that in the DM (p=0.003) and non-DM groups (p<0.001) there was a statistically significant increase in EAT volume as the patients were found to have increasingly severe CAD. After adjusting for age, race, gender, DM, hypertension, insulin use, BMI, and coronary artery calcium (CAC) score, the presence of >120 cm3 of EAT was found to be highly correlated with the presence of significant CAD (Adjusted Odds Ratio 4.47, 95% CI (1.35–14.82)). We found that not only is EAT volume an independent predictor of CAD, but that an increasing volume of EAT predicted increasing severity of CAD even after adjustment for CAC score.

The metabolic syndrome is an emerging epidemic in developing nations, including East Asian countries such as China, Japan, and Korea. Studies examining the metabolic syndrome have used different definitions, with prevalence often highly dependent on the cut points for abdominal obesity utilized, which have been recommended by the International Diabetes Federation to be lower than standards used in Caucasians and other ethnic groups. Prevalence rates have generally varied from 8% to 13% in men and 2% to 18% in women, depending on ethnic group and definition used, and are consistently lower than most Western Caucasian populations. While recent dramatic changes in lifestyle from Westernization of dietary habits and reduced physical activity present challenges, an emphasis on healthful lifestyle changes remains the cornerstone for metabolic syndrome management. In addition, clinical management focusing on control of obesity, elevated blood pressure, dyslipidemia, and hyperglycemia, with consideration of pharmacologic therapy issues unique to certain Asian populations, remains important for reducing associated cardiometabolic risks.

Objective We examined the prognostic significance of left ventricular (LV) mass for cardiovascular disease (CVD) events in older adults with and without metabolic syndrome (MetS) and diabetes (DM). Background MetS and DM are associated with increased CVD risk, but it is unclear in these groups whether subclinical CVD evidenced by increased LV mass improves risk prediction over standard risk factors in older individuals. Methods We studied 3,724 adults (mean age 72.4 ± 5.4, 61.0% female, 4.4% African American) from the Cardiovascular Health Study who had MetS (but without DM), DM, or neither condition. Cox regression examined the association of LV mass (alone and indexed by height and body surface area [BSA]) determined by echocardiography with CVD events, including coronary heart disease (CHD), stroke, heart failure (HF), and CVD death, as well as total mortality. We also assessed the added prediction, discriminative value and net reclassification improvement (NRI) for clinical utility of LV mass over standard risk factors. Results Over a mean follow-up of 14.2 ± 6.3 years, 2,180 subjects experienced CVD events, including 986 CVD deaths. After adjustment for age, gender and standard risk factors, LV mass was positively associated with CVD events in those with MetS (hazard ratio [HR]=1.4, p<0.001) and without MetS (HR=1.4, p<0.001), but not DM (HR=1.0, p=0.62), with similar findings for LV mass indexed for height or BSA. Adding LV mass to standard risk factors moderately improved the prediction accuracy in the overall sample and MetS group from changes in C-statistics (p<0.05). Categorical-free net reclassification improvement increased significantly by 17–19% in those with MetS. Findings were comparable for CHD, CVD mortality and total mortality. Conclusions LV mass is associated with increased CVD risk and provides modest added prediction and clinical utility over standard risk factors in older persons with and without MetS, but not with DM.

OBJECTIVE -Although metabolic syndrome is related to an increased risk of coronary heart disease (CHD) events, individuals with metabolic syndrome encompass a wide range of CHD risk levels. This study describes the distribution of 10-year CHD risk among U.S. adults with metabolic syndrome. . Low-, moderate-, moderately high-, and high-risk statuses were defined as Ͻ6, 6 to Ͻ10, 10 -20, and Ͼ20% probability of CHD in 10 years (based on NCEP/ATP III Framingham risk score algorithms), respectively; those with diabetes or preexisting cardiovascular disease were assigned to high-risk status. RESEARCH DESIGN AND METHODSRESULTS -The weighted prevalence of metabolic syndrome by NCEP criteria in our study was 29.0% overall (30.0% in men and 27.9% in women, P ϭ 0.28): 38.5% (30.7% men and 46.9% women) were classified as low risk, 8.5% (7.9% men and 9.1% women) were classified as moderate risk, 15.8% (23.4% men and 7.6% women) were classified as moderately high risk, and 37.3% (38.0% men and 36.5% women) were classified as high risk. The proportion at high risk increased with age but was similar among Hispanics, non-Hispanic whites, and nonHispanic blacks.CONCLUSIONS -Although many subjects with metabolic syndrome have a low calculated risk for CHD, about half have a moderately high or high risk, reinforcing the need for global risk assessment in individuals with metabolic syndrome to appropriately target intensity of treatment for underlying CHD risk factors. Diabetes Care 31:1405-1409, 2008T he metabolic syndrome is a cluster of risk factors often linked to insulin resistance that has been shown to increase the risk for development of cardiovascular disease (CVD). Individuals with metabolic syndrome have an increased risk of coronary heart disease (CHD) and CVD mortality (1,2). Global risk assessment using Framingham risk prediction algorithms is often the initial evaluation of CHD risk in subjects with multiple risk factors, including those with metabolic syndrome (3). Although it is often assumed that individuals with metabolic syndrome have a high risk of CVD, many have only borderline elevations in risk factors and thus may actually have either a low or intermediate risk of CVD (4). Therefore, assessment of global risk of CHD in individuals with metabolic syndrome may be helpful to most appropriately target the intensity of cardiometabolic risk factor interventions for prevention of diabetes or cardiovascular disease.The aim of this article was to calculate the global risk of CHD in adults with metabolic syndrome in the U.S. to better characterize the diversity in their risk of CHD using the data from the National Health and Nutrition Examination Survey (NHANES) [2003][2004]. In addition, we will examine the global risk of CHD in individuals with metabolic syndrome across sex, ethnicity, and age-groups and examine goal attainment and distance to recommended levels for key CHD risk factors. . We defined metabolic syndrome by the modified NCEP definition if Ն3 of the following were present: 1) waist circumference Ն102 ...