FYI from the NHLBI Index
January 2010: Vol. 10, Issue 3
In the News
News from Capitol Hill
Science Advance from the NHLBI
- Advanced Imaging May Improve Management of Coronary Artery Disease
News from Capitol Hill
Health Care Reform
At the time of publication of the FYI from the NHLBI, the final details of health care reform legislation
are uncertain. One area of particular interest to the NHLBI is Comparative Effectiveness Research (CER). The
NHLBI has been a leader in this area for many years and has funded a number of new CER projects under the
American Recovery and Reinvestment Act. The Senate version of the bill would establish a private non-profit
entity to oversee CER, while the House version would establish a Council with oversight by the Department of
Health and Human Servicesí Agency for Healthcare Research and Quality. The NIH would be a member of this
Council. Both the Senate and House versions would prohibit exclusion of coverage for care delivered as
part of participation in clinical trials.
Fiscal Year 2010 Funding for NHLBI
The Consolidated Appropriations Bill was signed into law by the President on December 16, 2009. It
contained six appropriations bills, including funding for the NIH. The bill provides $3,096,916,000 for
the NHLBI for FY 2010, reflecting an increase of $81.2 million over FY 2009 (+2.69%) and an increase
of $46.5 million above the Presidentís request.
Recent Advance from the NHLBI
Advanced Imaging May Improve Management of Coronary Artery Disease
Identification of atherosclerotic plaques that are vulnerable to rupture remains an elusive goal,
due in large part to the limited resolution of existing imaging techniques. Optical coherence tomography (OCT) is a
high-resolution intracoronary imaging modality that can visualize and quantify coronary plaque microstructures, including
thin fibrous caps, collagen, thrombi, macrophages, and stent coverage. Despite its substantial promise in plaque
imaging, OCT has limited clinical application because blood severely attenuates its signal. Obtaining a clear image
requires temporarily interrupting blood flow through the vessel, which is undesirable because it can cause myocardial
ischemia and vessel injury.
To address this shortcoming, an NHLBI-supported team has developed a second-generation form of OCT,
called optical frequency domain imaging (OFDI), which can acquire images at much higher frame rates, enabling higher
resolution and rapid 3-dimensional imaging of long coronary segments after a brief, non-occlusive saline purge. This
new methodology was used successfully in 3 patients after intracoronary stent placement to identify a diverse range
of microscopic findings, including thin-capped fibroatheroma, calcium, cholesterol crystals, macrophages, and bare
stent struts. The investigators reported the first human experience with intracoronary OFDI and demonstrated its
ease of use and potential diagnostic value. Although this was a proof-of-principle study with few patients, the
results are very promising.
OFDI may become a powerful tool for studying human coronary artery disease and in personalizing
its management, but first it must be evaluated in larger patient samples to determine its clinical utility in identifying
vulnerable plaques in high-risk patients.
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