Background

In patients with stable coronary artery disease (CAD), the atherosclerotic process can induce a host of coronary functional and anatomic abnormalities that eventually affect myocardial performance. A number of factors likely contribute to this process, including procoagulant tendencies, inflammation, metabolic abnormalities, coronary microcalcification, oxygen radicals, and oxidized lipids. The treatment is usually multitargeted, frequently focused on clinical presentation of ischemia. The relevant biomarker might target coronary flow limitations and/or abnormalities; expression of ischemia, such as perfusion, myocardial metabolism, or left ventricular function; or factors involved in CAD. Ischemia can be assessed directly by myocardial metabolic assessment (P31 or other techniques), indirectly by perfusion techniques, such as nuclear imaging or MRI, or by ECG changes (ambulatory ECG).

Targeted Topics: Asymptomatic Coronary Artery Disease, Chronic Ischemic Cardiomyopathy, Peripheral Artery Disease

Electron Beam Computerized Tomography
Douglas P. Boyd, Ph.D., University of California, San Francisco
Nathaniel Reichek, M.D., Medical College of Pennsylvania and MCP Hahnemann University

Angiography, Vascular Reactivity, and Flow
Steven Reis, M.D., University of Pittsburgh Medical Center

ECG Monitoring
Peter H. Stone, M.D., Brigham and Women’s Hospital
Bernard Chaitman, M.D., St. Louis University Medical Center

Plasminogen Activator Inhibitor Type 1 (PAI-1) and Vasculopathy
Burton E. Sobel, M.D., University of Vermont
Paul M. Ridker, M.D., Brigham and Women’s Hospital
Edwin L. Alderman, M.D., Stanford University Medical Center

Clinical Trial Challenges
Janet Wittes, Ph.D., Statistics Collaborative

Summation and Recommendations

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