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TAYLOR ET AL., 34th BETHESDA CONFERENCE: Can Atherosclerosis Imaging Techniques Improve the Detection of Patients at Risk for Ischemic Heart Disease?
J Am Coll Cardiol 2003;41:11:1855-917

BETHESDA CONFERENCE REPORT
34th Bethesda Conference: Can Atherosclerosis Imaging Techniques Improve the Detection of Patients at Risk for Ischemic Heart Disease?1

Allen J. Taylor, MD, FACC, Conference Co-Chair
C. Noel Bairey Merz, MD, FACC, Conference Co-Chair
James E. Udelson, MD, FACC, Conference Co-Chair

This Conference, sponsored by the American College of Cardiology, was held at Heart House, Bethesda, Maryland, October 7, 2003.

Participants

JONATHAN ABRAMS, MD, FACC
Professor of Medicine (Cardiology); Univ. of New Mexico School of Medicine; Div. of Cardiology, Ambulatory Care Ctr.; 2211 Lomas Blvd., NE, 5th Floor; Albuquerque, NM 87131-0001

C. NOEL BAIREY MERZ, MD, FACC
Director; Cedars-Sinai Medical Center; Preventive & Rehabilitative Cardiac Ctr.; 444 S. San Vicente Blvd., Suite 901; Los Angeles, CA 90048-4174

ROGER S. BLUMENTHAL, MD, FACC
Director, Preventive Cardiology; Associate Professor of Medicine; Johns Hopkins Hospital; Carnegie 538 - Cardiology; 600 N. Wolfe Street; Baltimore, MD 21287

THOMAS J. BRADY, MD
Director, Cardiac Imaging; Department of Radiology, MGH; Vice Chairman, Radiology Research; L.L. Robbins Professor of Radiology; Harvard Medical School; CIMIT; 100 Charles River Plaza, Suite 400; Boston, MA 02114

B. GREG BROWN, MD
Professor of Medicine/Cardiology; University of Washington; Health Science Building, Room A-509; 1959 NE Pacific Street; Seattle, WA 98195-0001

ALLEN P. BURKE, MD, FACC
Armed Forces Institute of Pathology; Department of Cardiovascular Pathology; Building 54, Room 2005; 14th Street and Alaska Avenue, NW; Washington, DC 20306-0001

GREG BURKE, MD
Professor and Chair; Department of Public Health Sciences; Wake Forest Univ. School of Medicine; Medical Center Blvd.; Winston Salem, NC 27157-1063

MICHAEL H. CRIQUI, MD, MPH
Professor and Vice Chair; Department of Family & Preventive Medicine; University of California, San Diego; 9500 Gilman Drive, Mail Code 0607; La Jolla, CA 92093-0607

ROBERT DETRANO, MD, PHD, FACC
Professor of Medicine; Harbor-UCLA Research & Education Institute; 1124 W. Carson Street, Bldg. E 5; Torrance, CA 90502-2006

ZAHI FAYAD, PHD
Associate Professor of Radiology and Medicine (Cardiology); Mt. Sinai School of Medicine; Box 1234
New York, NY 10029

ZORINA GALIS, PHD
Associate Professor of Medicine; Biomedical Engineering and Biology; Emory University School of Medicine; Division of Cardiology; 1639 Pierce Drive, WMB 319; Atlanta, GA 30322

PHILIP GREENLAND, MD, FACC
Harry W. Dingman Professor and Chair; Department of Preventive Medicine; Northwestern University Medical School; 680 N. Lake Shore Drive, Suite 1102
Chicago, IL 60611-4407

CHRISTIAN C. HAUDENSCHILD, MD, FESC
Head, Department of Experimental; Pathology; Jerome H. Holland Laboratory; American Red Cross
15601 Crabbs Branch Way; Rockville, MD 20855

PAUL A. HEIDENREICH, MD, FACC
VA Palo Alto Health Care System; 111 C Cardiology
3801 Miranda Avenue; Palo Alto, CA 94304-1207

DAVID M. HERRINGTON, MD, MHS, FACC
Department of Internal; Medicine/Cardiology
Wake Forest University School of Medicine; Medical Center Blvd.; Winston Salem, NC 27157-1045

NANCY HOUSTON-MILLER, RN, BSN
Associate Director; Stanford Cardiac Rehabilitation Program; 780 Welch Road, Suite 106; Palo Alto, CA 94340-1516

DONALD B. HUNNINGHAKE, MD
Director of Heart Disease Prevention; University of Minnesota Health, Box 192; 401 East River Road; Minneapolis, MN 55455-0368

MICHAEL S. LAUER, MD, FACC
Director of Clinical Research; Department of Cardiovascular Medicine; Cleveland Clinic Foundation; 9500 Euclid Avenue, F-25; Cleveland, OH 44195-0001

JOAO A. C. LIMA, MD, FACC
Associate Professor of Medicine; Cardiology Division, Blalock 569; Johns Hopkins Hospital; 600 North Wolfe Street; Baltimore, MD 21287

DANIEL B. MARK, MD, MPH, FACC
Professor of Medicine; Duke Clinical Research Institute; P.O. Box 17969; Durham, NC 27115

IRA S. OCKENE, MD, FACC
Director, Preventive Cardiology Program
Associate Director, Division of Cardiovascular Medicine; Department of Medicine; Univ. of Massachusetts Medical School; University Campus, 55 Lake Avenue; North Worcester, MA 01655-0002

CHRISTOPHER J. O’DONNELL, MD, FACC
Associate Director; Framingham Heart Study; 73 Mount Wayte Avenue, #2; Framingham, MA 01702

PATRICK G. O’MALLEY, MD, MPH
Chief, Division of General Internal Medicine; Walter Reed Army Medical Center; 6900 Georgia Avenue, NW; Washington, DC 20307-5001

RICHARD C. PASTERNAK, MD, FACC
Director; Preventive Cardiology & Cardiac Rehabilitation; Massachusettes General Hospital; 55 Fruit Street; Boston, MA 02114-2620

THOMAS A. PEARSON, MD, PHD, FACC
Albert D. Kaiser Professor and Chair; Dept. of Community & Preventive Medicine; University of Rochester Medical Center; 601 Elmwood Avenue, Box 644; Rochester, NY 14642-0001

RODERIC I. PETTIGREW, MD, PHD, FACC
Director, National Institute of Biomedical Imaging and Bioengineering; National Institutes of Health; 31 Center Drive, MSC 2077, Rm. 1B-37; Bethesda, MD 20892

WENDY S. POST, MD, FACC
Assistant Professor of Medicine; Cardiology Division, Carnegie 568; Johns Hopkins University Hospital; 600 N. Wolfe Street; Baltimore, MD 21287-0001

PAOLO RAGGI, MD, FACC
Professor of Medicine; Tulane University Medical Center; 1430 Tulane Avenue, SL 48; New Orleans, LA 70112-2699

RITA F. REDBERG, MD, FACC
Associate Professor of Medicine; Research Director; UCSF National Center of Excellence in Women’s Health; School of Medicine, Div. of Cardiology; 505 Parnassus Avenue, M1180; San Francisco, CA 94143-0124

MARY J. ROMAN, MD, FACC
Professor of Medicine; Weill Medical College of Cornell University; 525 East 68th Street; New York, NY 10021

LESLEE J. SHAW, PHD
Associate Professor of Medicine; Director, Outcomes Research; Atlanta Cardiovascular Research Institute; 5665 Peachtree Dunwoody Road,
Suite 225; Atlanta, GA 30342

LYNN A. SMAHA, MD, PHD, FACC
Senior Vice President, Academic Affairs; Guthrie Health; 1 Guthrie Square; Sayre, PA 18840-1625

SIDNEY C. SMITH, JR., MD, FACC
Professor of Medicine; Director Center for Cardiovascular Science and Medicine; University of North Carolina School Medicine; CB&7075, Burnett-Womack Building; Chapel Hill, NC 27514-6560

JAMES H. STEIN, MD, FACC
Associate Professor of Medicine; University of Wisconsin Medical School Section of Cardiology; H6/315 Clinical Science Center; 600 Highland Avenue; Madison, WI 53792-0001

ALLEN J. TAYLOR, MD, FACC
Director, Cardiovascular Research; United States Army Cardiology Service; Walter Reed Army Medical Center; WRAMC Building 2, Room 4A; 6900 Georgia Avenue, NW; Washington, DC 20307-5001

JAMES E. UDELSON, MD, FACC
Associate Professor of Medicine; Tufts-New England Medical Center; 750 Washington Street, Box 70; Boston, MA 02111-1526

RENU VIRMANI, MD, FACC
Chairperson; Cardiovascular Pathology; Armed Forces Institute of Pathology; 14th Street and Alaska Avenue, NW; Washington, DC 20306-0001

ROBERT A. VOGEL, MD, FACC
Professor of Medicine; Director, Clinical Vascular Biology; University of Maryland Hospital; 22 S. Greene Street, Room S3B06; Baltimore, MD 21201-1544

PETER W. F. WILSON, MD
Boston University School of Medicine; 715 Albany Street, Evans E204; Boston, MA 02118

NATHAN D. WONG, PHD, FACC
Associate Professor & Director; Heart Disease Prevention Program; University of California at Irvine
C240 Medical Sciences 1; Irvine, CA 92697-0001

Conference Steering Committee
ALLEN J. TAYLOR, MD, FACC, Conference Co-Chair
C. NOEL BAIREY MERZ, MD, FACC, Conference Co-Chair
JAMES E. UDELSON, MD, FACC, Conference Co-Chair
JONATHAN ABRAMS, MD, FACC
RICHARD C. PASTERNAK, MD, FACC
ALLEN P. BURKE, MD, FACC
RENU VIRMANI, MD, FACC
RITA F. REDBERG, MD, FACC
ROBERT A. VOGEL, MD, FACC
SIDNEY C. SMITH, JR, MD, FACC
PETER W.F. WILSON, MD
DANIEL B. MARK, MD, MPH, FACC
LESLEE J. SHAW, PHD

Staff
American College of Cardiology
CHRISTINE W. MCENTEE, Chief Executive Officer
EVA GRACE, Project Coordinator
SYLVIA POLK-BURRISS, Project Coordinator

TABLE OF CONTENTS

Executive Summary—Can Atherosclerosis Imaging Techniques Improve the Detection of Patients at Risk for Ischemic Heart Disease?

Task Force #1—Identification of Coronary Heart Disease Risk: Is There a Detection Gap?

  1. Scope of the Problem
  2. Presentation of CHD in the Population
  3. Detection
  4. Atherosclerosis Detection From Other Tests
  5. Identifying the High-Risk Asymptomatic Patient: Global Risk Assessment
  6. Novel, Predisposing, and Conditional Risk Factors
  7. Current Barriers to Risk Assessment
  8. The Detection Gap
  9. Future Directions
  10. References

Task Force #2—What Is the Pathologic Basis for New Atherosclerosis Imaging Techniques?

  1. Components of Atherosclerosis That Form Targets for Atherosclerosis Imaging
  2. General Issues Related to Detection of Plaque Components by Atherosclerosis Imaging
  3. Considerations of Individual Plaque Components
  4. Plaque Calcification
  5. Inflammatory Activity
  6. Correlation of Risk Factors and Plaque Types, and Relevance to Screening Strategies
  7. Putting it All Together: Vulnerable Plaque Scoring System? Is the Sun Greater Than the Parts?
  8. Future Directions
  9. References

Task Force #3—What Is the Spectrum of Current and Emerging Techniques for the Noninvasive Measurement of Atherosclerosis?

  1. Spectrum of Imaging Methods
  2. Definition of an Abnormal Calcium Score
  3. Emerging Technologies: Nuclear Imaging of Vulnerable Plaque
  4. Is There a Clinical Hierarchy of Atherosclerosis Imaging Tests?
  5. Atherosclerosis Measurement in Special Populations
  6. Imaging Horizons
  7. Future Directions
  8. References

Task Force #4—How Do We Select Patients for Atherosclerosis Imaging?

  1. Schema for Risk Evaluation and Utility
  2. Potential Benefits of Atherosclerosis Screening
  3. Matching Modalities to Specific Patient Populations
  4. Potential Disadvantages of Atherosclersis Screening
  5. How Should Tests Be Accessed?
  6. Future Directions
  7. References

Task Force #5—Is Atherosclerosis Imaging Cost Effective?

  1. Defining the Effectiveness of Diagnostic Tests for Economic Analysis
  2. Principles of Economic Analysis Relevant to Cardiac Imaging
  3. Lessons From Screening for Preclinical Cancer
  4. Cost Effectiveness of Preclinical Atherosclerosis Imaging: Current Evidence
  5. Health Policy Implications and Conclusions
  6. Future Directions
  7. References

1 The recommendations set forth in this report are those of the Conference participants and do not necessarily reflect the official position of the American College of Cardiology.

When citing this document the American College of Cardiology would appreciate the following citation format: Can Atherosclerosis Imaging Techniques Improve the Detection of Patients at Risk for Ischemic Heart Disease. Presented at the 34th Bethesda Conference, Bethesda, Maryland, October 7, 2002. J Am Coll Cardiol 2003;41:1855–917.

This document is available on the American College of Cardiology Web site at www.acc.org. Single copies of this document are available for $5.00 each by calling 800-253-3636 (U.S. only) or by writing the Resource Center, American College of Cardiology, 9111 Old Georgetown Road, Bethesda, Maryland 20815.

 

Copyright © 2003 by the American College of Cardiology

 

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