This is the fifth volume in this series on quantitative coronary arteriography (QCA) published over the last nine years. Research and applications in this exciting, field are covered in a total of 26 chapters by world renowned experts. This book is subdivided into a total of 6 parts, each emphasizing the latest progress in these respective fields. In Part One a comprehensive overview is given of the current knowledge and research in endothelial function, which is of eminent importance for the further understanding of the pathophysiology of coronary artery disease in patients. Fortunately, the use of QCA tools is not limited anymore to leading research institutes; over the last several years these tools have been installed in many cardiology centers world wide. To understand the current possibili ties, limitations and future expectations of QCA, several relevant topics are presented in Part Two. First of all, the questions about why and how QCA systems should be validated both at the development site and at the appli cation sites, and whether data from different vendors and core laboratories can be pooled, are discussed. As the X-ray cardiovascular world steadily moves into the digital imaging era, differences and similarities between the conventional cinefilm and the modern digital approaches are presented. Cur rently. the widespread use of digital imaging is still hindered by the lack of proper archival and exchange media. Requirements and possible solutions for this problem are handled in this section as well.

A unique overview of all major angiographic lipid intervention trials, presented by their principal investigators. Basic mechanisms and methodological aspects, including biochemical as well as angiographic aspects, are discussed by experts in these fields. A careful comparison of all available data permits an analysis to be made of what may currently be considered proved, which aspects merit further investigation, and which hypotheses should be rejected. Audience: Clinicians involved in the practice of lipid lowering and investigators involved in lipid-lowering clinical trials. Scientists involved in other areas of lipid research and investigators conducting coronary angiographic trials designed to study the influence of different interventions will find a wealth of information and practical guidelines in this book.

This is the first monograph to focus exclusively on coronary radiology. It is particularly timely, given that the emergence of computed tomography and magnetic resonance imaging, coupled with improvements in both hard- and software, has made reproducible non-invasive coronary imaging a practical reality. A wide range of topics is addressed, including: quantitative angiography, intravascular and quantitative ultrasound, multislice and electron beam computed tomography, magnetic resonance coronary angiography and use of the coronary calcium score as an independent risk factor. All of the latest developments, such as non-invasive intracoronary thrombus imaging, are covered. Particular care has been taken to consider the common questions confronted in asymptomatic patients. The text is supported by high-quality color images of the coronary and cardiac anatomy.

What's New in Cardiovascular Imaging is a bibliographical "image" of a Symposium held June 22-24, 1998 in Leiden, the Netherlands. At this Symposium all the major advances in car diovascular imaging in all the cardiovascular imaging modalities (X-ray, (intravascular) ultra sound, magnetic resonance, scintigraphy and CT) were addressed by the leading authorities in this field. Based on the presentations of the invited Faculty, this book consists of a compi lation of manuscripts related to most of the topics discussed at this particular meeting. We express our gratitude to all authors and coauthors for having made great efforts in preparing their superb up-to-date chapters under a great time pressure, so that this book was available at the time of the Symposium. The authors are all excellent investigators in one or more fields of cardiovascular imaging and they have stimulated progress in cardiovascular imaging with the aim to improve patient care and clinical research. This book consists of a total of 32 chapters subdivided into seven Parts. Each part describes a particular field in cardiovascular imaging. These Parts are: Coronary quantitation by QCA and intracoronary ultrasound (QCU), angiographic trials, progress in intravascular ultrasound, magnetic resonance (MR) coronary and vascular imaging, nuclear cardiovascular imaging, echocardiography, and cine and spiral CT coronary imaging. In general, each Part begins with a chapter that provides a broad overview of the advances in the field described in that particular Part, as well as a view towards the future.

In recent years there have been tremendous advances in cardiac imaging techniques covering the complete spectrum from echocardiography, nuclear cardiology, magnetic resonance imaging to contrast angiography. With respect to these noninvasive and invasive cardiac imaging modalities, marked technological developments have allowed the cardiologist to visualize the myocardium in a far more refined manner than conventional imaging was capable of. Echocardiography has extended its domain with intravascular ultrasound, cardiovascular nuclear imaging has added positron emission tomography to its line of research, magnetic resonance imaging has been broadened with magnetic resonance angiography and spectroscopy, and finally contrast angiograp hy has widened its scope with excellent quantitation programs. For all these imaging modalities it is true that the application of dedicated quantitative analytic software packages enables the evaluation of the imaging studies in a more accurate, reliable, and reproducible manner. It goes without saying that these extensions and achievements have resulted in improved diagnostics and subsequently in improved patient care. Particularly in patients with ischemic heart disease, major progress has been made to detect coronary artery disease in an early phase of the disease process, to follow the atherosclerotic changes in the coronary arteries, to establish the functional and metabolic consequences of the luminal obstructions, and to accurately assess the results of interventional therapy.

In the past, coronary arteriography was the only modality available to provide high quality images of the coronary anatomy. Quantitative coronary arteriography (QCA) was developed, implemented, validated and extensively applied to obtain accurate and reproducible data about coronary morphology and the functional significance of coronary obstructions. Over the last few years extensive basic technological research supported by clinical investigations has created competing modalities to visualize coronary morphology and the associated perfusion of the myocardial muscle. Currently, the following modalities are available: X-ray coronary arteriography, intracoronary ultrasound, contrast- and stress-echocardiography, angioscopy, nuclear cardiology, magnetic resonance imaging, and cine and spiral CT imaging. For all these imaging modalities, the application of dedicated quantitative analytical software packages enables the evaluation of the imaging studies in a more accurate, reliable, and reproducible manner. These extensions and achievements have resulted in improved diagnostics and subsequently in improved patient care. Particularly in patients with ischaemic heart disease, major progress has been made to detect coronary artery disease in an early phase of the disease process, to follow the atherosclerotic changes in the coronary arteries, to establish the functional and metabolic consequences of the luminal obstructions, and accurately to assess the results of interventional therapy. Aside from all these high-tech developments in cardiac imaging techniques, the transition from the analogue to the digital world has been going on for some time now. For the future, it has been predicted that the CD-R will be the exchange medium for cardiac images and DICOM-3 the standard file format. This has been a major achievement in the field of standardization activities. Since these developments will have a major impact on the way images will be stored, reviewed and exchanged in the near future, an important part of this book has been dedicated to DICOM and the filmless catheterization laboratory. Cardiovascular Imaging will assist cardiologists, radiologists, nuclear medicine physicians, image processing specialists, physicists, basic scientists, and fellows in training for these specialties to understand the most recent achievements in cardiac imaging techniques and their impact on cardiovascular medicine.

In this fourth book in the series on quantitative coronary arteriography (QCA) with the earlier three volumes published in 1986, 1988 and 1991, the latest developments in this exciting field are covered. Both the methodolog ical and clinical application aspects of these advances are presented in a comprehensive manner in a total of 37 chapters by world renowned experts. The book is subdivided into a total of eight parts, beginning with the more methodological issues, such as QCA and other modalities (3 chapters), cine film versus digital arteriography (3 chapters), quality control in QCA (4 chapters), and coronary blood flow and flow reserve (3 chapters). Since QCA has been well established as the technique for the assessment of regression and progression in atherosclerotic disease, and of restenosis after recanaliz ation procedures, major clinical trials in both groups are described extensively by their principal investigators in a total of 11 chapters. In addition, the QCA results after the application of various recanalization techniques are presented in another eight chapters. In the last part the experiences with various intracoronary prostheses with the emphasis on QCA are discussed in five chapters. This large increase in application oriented chapters means that QCA is well alive and gaining momentum. Although the accuracy and precision of the analytical methods steadily improve with the increasing complexity of the algorithms, there is still always the human factor involved in these processes in terms of frame selection, segment definition, etc.

Catheter ablation is widely accepted as an effective and safe form of therapy for cardiac arrhythmia. In many instances this curative procedure is considered as the first line of therapy if not the ultimate treatment of choice. With the use of radiofrequency (RF) modality; which has revolutionized the technology from a barotraumatic, potentially injurious procedure using high voltage, direct-current (DC) shock to a safe and relatively painless one; catheter ablation procedure now carries a very low risk and is extremely effective for certain types of arrhythmia. Its efficacy rate in curing supraventricular tachycardia involving an accessory pathway or dual atrioventricular nodal pathways has been near perfect and its application for certain types of atrial and ventricular arrhythmia have also been very satisfactory. However, conventional RF ablation has several well known limitations, most notably is its ability to only produce relatively small, point lesions; rendering it effective only for an arrhythmia with a small and/or a superficial target. It was soon recognized that the technology would not likely to have significant utility in arrhythmia with a more widespread target such as atrial fibrillation or those which involve scarred and deep myocardial tissue such as ventricular tachycardia. Indeed, the application of conventional RF technology in these complex but common arrhythmia has yielded unsatisfactory results.

According to Schopenhauer problems are usually passing through three stages: - in the first stage they are ignored or just smiled at, - in the second stage they are fought, and in the third stage they are considered to be self-evident, just taken for granted. Whereas digital subtraction angiography (DSA) has obviously reached stage three of that scale, i.e. routine use in radiology, digital angiocardiography, in particular imaging the heart and coronary circulation, is still on its way to the final goal: the filmless heart catheterization laboratory for all invasive and interventional procedures. A few pioneers have already completely abandoned the conventional cine coronary and angiocardiographic technique, others - as we do -still combine both digital and conventional methods in clinical routine, but most cardiol ogists up till now stay sceptically aside. We hope that at least some of the articles published in this volume may convince more and more cardiologists that digital imaging procedures are the method of choice, in particular if quantitative assessment of the anatomical or functional status of the cardiovascular system is required (pre- and post operations or pre-and post-interventions). Such a critical control of all therapeutic procedures, be it by surgical, catheter-or medical 'interventions', is indeed an urgent and widely under estimated or neglected requirement.

Recent, rapid advances in mathematical engineering and applied mathematics have opened the door to solving complex problems in angiography imaging. For the first time, this book presents the different medical imaging modalities--MR, CT, x-ray, and ultrasound--for performing angiography and its analysis. Pioneers from a variety of relevant disciplin