Methods for imaging the molecular or cellular profile of tissue are being developed for all forms of non-invasive cardiovascular imaging. It is thought that these technologies will potentially improve patient outcomes by allowing diagnosis of disease at an early-stage, monitoring disease progression, providing important information on patient risk, and for tailoring therapy to the molecular basis of disease. Molecular imaging is also already assuming an important role in science by providing a better understanding of the molecular basis of cardiovascular pathology, for assessing response to new therapies, and for rapidly optimizing new or established therapies. Ultrasound-based molecular imaging is one of these new approaches. Contrast-enhanced ultrasound molecular imaging relies on the detection of novel site-targeted microbubbles (MB) or other acoustically active particles which are administered by intravenous injection, circulate throughout the vascular compartment, and are then retained and imaged within regions of disease by ligand-directed binding. The technique is thought to be advantageous in practical terms of cost, time, and ease of use. The aim of this review is to discuss the molecular participants of cardiovascular disease that have been targeted for ultrasound imaging, general features of site-targeted MB, imaging protocols, and potential roles of ultrasound molecular imaging in cardiovascular research and clinical medicine.
Cardiovascular Diseases ; Clinical Medicine ; Diagnosis ; Disease Progression ; Humans ; Injections, Intravenous ; Methods ; Microbubbles ; Molecular Imaging* ; Pathology ; Ultrasonography*

Clinical imaging creates visual representations of the body interior for disease assessment. The role of clinical imaging significantly overlaps with that of pathology, and diagnostic workflows largely depend on both fields. The field of clinical imaging is presently undergoing a radical change through the emergence of a new field called molecular imaging. This new technology, which lies at the intersection between imaging and molecular biology, enables noninvasive visualization of biochemical processes at the molecular level within living bodies. Molecular imaging differs from traditional anatomical imaging in that biomarkers known as imaging probes are used to visualize target molecules-of-interest. This ability opens up exciting new possibilities for applications in oncologic, neurological and cardiovascular diseases. Molecular imaging is expected to make major contributions to personalized medicine by allowing earlier diagnosis and predicting treatment response. The technique is also making a huge impact on pharmaceutical development by optimizing preclinical and clinical tests for new drug candidates. This review will describe the basic principles of molecular imaging and will briefly touch on three examples (from an immense list of new techniques) that may contribute to personalized medicine: receptor imaging, angiogenesis imaging, and apoptosis imaging.
Apoptosis ; Biochemical Processes ; Biomarkers ; Cardiovascular Diseases ; Diagnosis ; Precision Medicine* ; Molecular Biology ; Molecular Imaging* ; Pathology

Along with the aging process, the spectrum of liver disease changes greatly. Nonalcoholic fatty liver disease (NAFLD) in elderly people lead to low liver function and is also the major cause of extrahepatic diseases, such as cardiovascular disease and malignant tumor. This review provides an overview of the morphological structure and function of the liver in aged people, and discusses the characteristics of weakness, malnutrition and limited movement in the elderly, as well as the current status of multiple diseases and multiple drug use. Finally, this article puts forward some appropriate regimens for the diagnosis and treatment of NAFLD in elderly people to provide a reference for clinical practice.
Aged ; Cardiovascular Diseases ; Humans ; Liver ; pathology ; Malnutrition ; Neoplasms ; Non-alcoholic Fatty Liver Disease ; diagnosis ; pathology ; therapy ; Risk Factors

The risk of cardiovascular disease is known to be increased in obstructive sleep apnea syndrome (OSAS). Its mechanism can be explained by the observation that the sympathetic tone increases due to repetitive apneas accompanied by hypoxias and arousals during sleep. Heart rate variability (HRV) representing cardiac autonomic function is mediated by respiratory sinus arrhythmia, baroreflexrelated fluctuation, and thermoregulation-related fluctuation. We evaluated the heart rate variability of OSAS patients during night to assess their relationship with the severity of the symptoms. We studied overnight polysomnographies of 59 male untreated OSAS patients with moderate to severe symptoms (mean age 45.4+/- 11.7 yr, apnea-hypopnea index [AHI]=43.2+/-23.4 events per hour, and AHI >15). Moderate (mean age 47.1+/-9.4 yr, AHI=15-30, n=22) and severe (mean age 44.5 +/-12.9 yr, AHI >30, n=37) OSAS patients were compared for the indices derived from time and frequency domain analysis of HRV, AHI, oxygen desaturation event index (ODI), arousal index (ArI), and sleep parameters. As a result, the severe OSAS group showed higher mean powers of total frequency (TF) (p=0.012), very low frequency (VLF) (p= 0.038), and low frequency (LF) (p=0.002) than the moderate OSAS group. The LF/HF ratio (p=0.005) was higher in the severe group compared to that of the moderate group. On the time domain analysis, the HRV triangular index (p=0.026) of severe OSAS group was significantly higher. AHI was correlated best with the LF/HF ratio (r(p)=0.610, p<0.001) of all the HRV indices. According to the results, the frequency domain indices tended to reveal the difference between the groups better than time domain indices. Especially the LF/HF ratio was thought to be the most useful parameter to estimate the degree of AHI in OSAS patients.
Adult ; Cardiovascular Diseases/*diagnosis/pathology ; Electrocardiography/methods ; *Heart Rate ; Humans ; Male ; Middle Aged ; Oximetry ; Oxygen/metabolism ; Plethysmography ; Polysomnography/methods ; Sleep ; Sleep Apnea, Obstructive/*diagnosis/pathology

OBJECTIVETo detect the levels of serum amyloid A (SAA) and explore the pathogenesis of cardiovascular diseases in patients with obstructive sleep apnea syndrome (OSAS).

METHODSPolysomnography was performed in 80 patients with OSAS and 20 control subjects matched for age and body mass index. The patients with OSAS were divided into mild OSAS group (n=22), moderate OSAS group (n=23) and severe OSAS group (n=35) according to the apnea hypopnea index (AHI). Serum amyloid A levels were measured in all the subjects by enzyme-linked immunosorbent assay for correlation analysis.

RESULTSSerum amyloid A levels in mild OSAS group (1.66-/+0.73 microg/ml), moderate OSAS group (2.72-/+1.12 microg/ml) and severe OSAS group (4.08-/+1.85 microg/ml) were significantly higher than those in the control group (0.66-/+0.59 microg/ml) (P<0.05). SAA levels also differed significantly between the 3 OSAS groups (P<0.01), increasing with the severity of OSAS. Correlation analysis indicated that SAA level was positively correlated to AHI (r=0.649, P<0.01) and TSaO(2)<90% (r=0.491, P<0.01), but inversely yo miniSaO(2) (r=-0.499, P<0.01). After 3 months of nCPAP therapy, SAA levels were significantly decreased in the 20 patients with severe OSAS (4.13-/+2.27 microg/ml vs 5.14-/+2.30 microg/ml, P<0.01).

CONCLUSIONSAA levels are elevated in OSAS patients in close correlation to the severity of OSAS, which may contribute to the vulnerability of the patients to cardiovascular diseases. nCPAP therapy help reduce the risk for cardiovascular diseases in OSAS patients.

Adult ; Aged ; Cardiovascular Diseases ; complications ; pathology ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; Serum Amyloid A Protein ; metabolism ; Sleep Apnea, Obstructive ; complications ; diagnosis ; metabolism

BACKGROUND: The diagnostic criteria for bathtub drownings are not standardized, and the risk factors associated with bath-related deaths are unclear. METHODS: We analyzed a Korean nationwide database of bath-related deaths that occurred between January 2008 and December 2015. Eighty-four cases were enrolled after reviewing 31,123 autopsy records. RESULTS: The subjects' ages ranged from 18 to 91 years, with a mean age ± standard deviation of 61.3 ± 16.0 years. Bath-related deaths in the winter were approximately 4.6-fold greater than those in the summer. Of the 84 subjects, the primary cause of death in 57 (67.9%) was drowning in the bath; 24 (28.6%) drowned of other causes such as natural diseases, and 3 (3.6%) died of acute alcohol intoxication. We analyzed water-inhalation signs to establish criteria for bathtub drowning diagnosis. There were significantly higher incidences of hyperinflated lungs, water in the sphenoid sinus and stomach/duodenal contents, and Paltauf's spots (subpleural hemorrhage) in bathtub-drowned subjects compared to non-drowned individuals (P < 0.01). Multiple signs of water inhalation were significantly associated with bathtub drowning (P < 0.01). The two leading contributory causes of bath-related death were cardiovascular diseases and alcohol intoxication (binge drinking before bathing). CONCLUSION: The diagnosis of bath-related deaths could present considerable medico-legal problems; therefore, a comprehensive autopsy with a thorough scene investigation can clarify the cause of death in these situations. Preventive strategies for reducing such deaths should target alcohol drinking before bathing and long soaking times in bathtubs, especially among elderly individuals with preexisting cardiovascular diseases.
Aged ; Alcohol Drinking ; Autopsy ; Baths ; Cardiovascular Diseases ; Cause of Death ; Diagnosis ; Drinking ; Drowning ; Forensic Pathology ; Humans ; Incidence ; Inhalation ; Korea* ; Lung ; Risk Factors ; Sphenoid Sinus ; Water

OBJECTIVETo analyze the cardiac manifestations of mitochondriopathy patients.

METHODSWe retrospectively analyzed the clinical (Electrocardiogram, Holter monitoring, echocardiogram and laboratory examinations) and pathological data of 90 mitochondriopathy patients diagnosed within recent 20 years. The cardiac involvement data from these patients were summarized.

RESULTSHypertrophic cardiomyopathy was found in 2 patients and dilated cardiomyopathy in 3 patients Mitochondriopathy diagnosis was made in 1 patient two years after heart transplantation due to heart failure resulting from previously diagnosed hypertrophic cardiomyopathy with noncompaction. The prevalence of cardiomyopathy is 5.6% (5/90). The prevalence of various arrhythmias was 22.2% (20/90). Four patients received permanent pacemaker because of Adams-Stokes attack or bradyarrhythmias (mitochondriopathy diagnosis was made 1-3 years post pacemaker implantation in 3 cases). History of syncope, respiratory failure, RBBB, atrial fibrillation and episodic ventricular tachyarrhythmias were presented in 1 patient with mitochondriopathy, another mitochondriopathy patient developed atrial tachyarrhythmias. Arrhythmia were present in 14 mitochondriopathy patients including RBBB, bifascicular block, intraventricular block, Wolff-Parkinson-White syndrome and short PR interval syndrome. The mtDNA 3243A-G mutation was detected in 8 patients.

CONCLUSIONSIncidence of cardiomyopathy, heart failure and severe arrhythmias is high in patients with mitochondriopathy. Therefore, young cardiomyopathy patients with severe conduction block disorders should undergo relevant etiologic and genetic screening for mitochondriopathy and patients with diagnosed mitochondriopathy should regularly receive electrocardiogram and echocardiography examinations for possible cardiac involvement.

Adolescent ; Adult ; Aged ; Cardiomyopathy, Hypertrophic ; diagnosis ; etiology ; Cardiovascular Abnormalities ; diagnosis ; etiology ; Child ; Child, Preschool ; Female ; Heart Block ; diagnosis ; etiology ; Humans ; Infant ; Male ; Middle Aged ; Mitochondrial Diseases ; complications ; diagnosis ; pathology ; Prognosis ; Retrospective Studies ; Young Adult

microRNA (miRNA or miR) is a small single stranded non-coding RNA (21-25nt) that regulates gene expression in almost creatures. Currently, plenty of researches on how miRNA affects human cardiovascular disease have been reported. This review highlights recent findings about the role of miRNA in heart tissue and circulation correlated with human cardiovascular disease and explores the application of miRNA in sudden cardiac death in forensic science.
Animals ; Biomarkers/blood* ; Cardiomyopathy, Dilated/metabolism* ; Cardiovascular Diseases/metabolism* ; Cause of Death ; Death, Sudden, Cardiac/pathology* ; Forensic Sciences/methods* ; Gene Expression Profiling ; Gene Expression Regulation ; Heart Failure/metabolism* ; Humans ; MicroRNAs/metabolism* ; Myocardium/pathology* ; Pulmonary Embolism/diagnosis* ; Up-Regulation

Arterial and cardiac involvement of Behcet's disease is a rare but life threatening complication. The rupture of an arterial aneurysm might result in sudden death. We report a 54-year-old man with an established diagnosis of Behcet's disease who presented with multiple cardiovascular complications that eventually lead to his death. He presented with extensive venous occlusions, and sequentially developed right ventricular thrombosis with multiple pulmonary thromboembolisms, and a pulmonary artery aneurysm. We report this unusual sequence of cardiovascular complications in a patient with Behcet's disease.
Aneurysm, Dissecting/*etiology ; Behcet Syndrome/*complications ; Cardiovascular Diseases/diagnosis/*etiology/ultrasonography ; Fatal Outcome ; Hemoptysis ; Humans ; Male ; Middle Aged ; Pulmonary Artery/*pathology ; Pulmonary Embolism/*etiology ; Risk Factors ; Rupture/etiology ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Warfarin and aspirin are commonly used to prevent cardiovascular diseases. Aspirin was recently found to have chemopreventive effects on colon cancer and polyps by inhibiting cyclooxygenase-2. Therefore, we evaluated whether the symptoms of bleeding related with aspirin or warfarin could be a clue in early detection of colon cancer. We also assessed the effect of aspirin on the development of synchronous polyps. METHODS: A total of forty-one and 16 patients diagnosed as colon cancer, taking aspirin or warfarin respectively were enrolled. In addition, 171 patients with colon cancers were age and gender matched as a control group. We investigated the difference of clinical features and laboratory findings among three groups. RESULTS: The incidence of bleeding was 81.3% (warfarin), 53.7% (aspirin), 40.4% (control). Among three groups, location and size of cancer, number of lymph nodes involvement and stages were not different, but the number of patients in Duke stage D in warfarin group (n=1, 6.3%) were less than that of the control (n=44, 25.7%) (p=0.049). The extent of circumferencial involvement by cancer was lower in aspirin group (67%) than in the control group (80%) (p=0.035). The percentage of patients with synchronous polyps and mean number of synchronous polyps in aspirin group (34.1%, 0.68, respectively) was lower than that of control group (53.6%, 1.69, respectively) (p=0.029, 0.008, respectively). CONCLUSIONS: Bleeding related with aspirin or warfarin usage had no effect on the early diagnosis of colon cancer. However, lower incidence of Duke stage D in warfarin group might be related to anti-metastatic effect of warfarin. In addition, aspirin may have a role in suppressing the development of synchronous polyps.
Aged ; Anticoagulants/adverse effects/therapeutic use ; Aspirin/adverse effects/*therapeutic use ; Cardiovascular Diseases/prevention & control ; Colonic Neoplasms/*diagnosis/pathology ; English Abstract ; Female ; Gastrointestinal Hemorrhage/chemically induced ; Humans ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/adverse effects/*therapeutic use ; Warfarin/adverse effects/*therapeutic use