Aortic function: from the research laboratory to the clinic.

For many years, much of the pioneering research on aortic function was carried out by a small group of investigators frequently working away from the clinical environment in the research laboratory. The evaluation of aortic function using aortic pulse wave velocity, aortic distensibility, or other practical indices had yet to reach clinical threshold. It was necessary for the clinicians to take over and to apply these indices to the clinic. In this Odyssey, the work by the basic scientist was important to define the fundamental mechanisms of aortic function; however, it was the vision of the clinical investigator who recognized the importance of aortic function and introduced it into clinical practice. In the near future, the clinical investigator will introduce aortic function in daily clinical practice as the measurement of left ventricular function is used today. A close collaboration between the clinical and the basic investigator will be necessary in order to define the molecular mechanisms related to aortic wall synthesis and degradation of collagen and elastin. Application of these findings by the clinical investigator may help to delay or prevent aortic dysfunction related to aging or other conditions and diseases.

Coronary Atherosclerosis: Pathophysiologic Basis for Diagnosis and Management.

Coronary atherosclerosis is a long lasting and continuously evolving disease with multiple clinical manifestations ranging from asymptomatic to stable angina, acute coronary syndrome (ACS), heart failure (HF) and sudden cardiac death (SCD). Genetic and environmental factors contribute to the development and progression of coronary atherosclerosis. In this review, current knowledge related to the diagnosis and management of coronary atherosclerosis based on pathophysiologic mechanisms will be discussed. In addition to providing state-of-the-art concepts related to coronary atherosclerosis, special consideration will be given on how to apply data from epidemiologic studies and randomized clinical trials to the individual patient. The greatest challenge for the clinician in the twenty-first century is not in absorbing the fast accumulating new knowledge, but rather in applying this knowledge to the individual patient.