Cardiometabolic disease in South Asians: A global health concern in an expanding population.

Cardiovascular disease (CVD) is one of the main causes of mortality and morbidity worldwide. As an emerging population, South Asians (SAs) bear a disproportionately high burden of CVD relative to underlying classical risk factors, partly attributable to a greater prevalence of insulin resistance and diabetes and distinct genetic and epigenetic influences. While the phenotypic distinctions between SAs and other ethnicities in CVD risk are becoming increasingly clear, the biology of these conditions remains an area of active investigation, with emerging studies involving metabolism, genetic variation and epigenetic modifiers (e.g., extracellular RNA). In this review, we describe the current literature on prevalence, prognosis and CVD risk in SAs, and provide a landscape of translational research in this field toward ameliorating CVD risk in SAs.

Is magnetic resonance imaging the 'reference standard' for cardiac functional assessment? Factors influencing measurement of left ventricular mass and volumes.

PURPOSE: MRI is considered reference standard for the assessment of left ventricular (LV) volume and mass measurements. There are few accepted guidelines for uniform assessment of cardiac function with MRI. We sought to investigate different confounding factors influencing LV measurement results. MATERIAL AND METHODS: In 60 diabetic type-II patients (group A) we compared intra-/inter-reader variability of MRI for cardiac function measured twice at a 3 month interval by one MRI trained reader and one untrained. In 20 patients (group B) two different techniques were compared for determining the epicardial and endocardial LV-borders. RESULTS: Bland Altman analysis showed excellent intra-observer measurement agreement for the trained reader 1 for EDM (mean = -2.3 (-23.6-19)), EDV (2.9(-9.2-15.0)), ESV (3.3(-5.8-12.4)) and EF (1.2(-3.3-5.7)). Untrained reader 2 measurement agreement was considerably less appropriate for EDM (mean = -8.2 (-25.8-9.5)), EDV (7.8(-5.1-20.7)), ESV (5.3(-8.0-18.6)). Only for EF (0.8 (-6.5-8.1)) results were comparable to reader 1. Inter-observer measurement in the beginning was poor for EDM (-13.5(-55.6-28.6)) and EDV (7.3(-61.9-76.6)), whereas agreement for ESV (2.1(-29.9-34.2)) and EF (-0.9(-11.6-9.9)) was good. After 3 months, measurement agreement for EDM (-5.3 (-46.4-35.8)) was considerably improved, for EDV (0.4(-67.0-66.2)) was excellent, whereas agreement for ESV (3.1(-34.4-28.1)) and EF (-1.7(-13.0-9.6)) was similar. Using different techniques for determining the epicardial and endocardial borders, only end-diastolic volume was unchanged whereas all other parameters were significantly different using the two methods (p < or = 0.03). CONCLUSION: Intra- and inter-reader variability, analyst experience as well as different techniques for determining the boundaries of the left ventricle significantly affect MRI parameters for cardiac function. These results suggest a need for developing commonly accepted standards for cardiac MRI evaluation.

Noninvasive assessment of coronary stenosis.

Invasive coronary angiography (ICA) has been the gold standard in the diagnosis of coronary artery disease (CAD) for a long time and angiographic procedures performed annually in the United States have steadily increased during the last 25 years. The unmatched temporal and spatial imaging resolution, the high level contrast between the coronary lumen and the adjacent structures, and the ability to concurrently perform percutaneous coronary interventions (PCI) are the technical advantages of coronary angiography. However, the isolated intraluminal imaging, the relatively high financial cost of the procedure, and the risks associated with catheterization may be limitations to its use. Moreover, a better selection of patients really in need of ICA and PCI is necessary since many patients referred for ICA are found not to have significant CAD. Therefore, a remarkable technical progress has been achieved by both cardiac magnetic resonance and cardiac computed tomography in this regard for the noninvasive detection of coronary stenoses.