A breakthrough in computational medicine is helping one University of Houston professor pave the way to uncover a ticking "time-bomb" in the heart.
Ioannis A. Kakadiaris, an associate professor of computer science at UH and director of the Computational Biomedicine Laboratory (CBL), and doctoral student Sean O'Malley are collaborating with Dr. Morteza Naghavi and other leading cardiologists from the Association for Eradication of Heart Attack (AEHA) in this research effort. With cardiovascular disease accounting for twice as many deaths as all cancers in the United States, this group has developed computer technology to alert physicians to heart attack risk.
"This 'time-bomb' is called 'vulnerable plaque,' and the unaware, healthy-looking person with the 'bomb' in his or her heart is the 'vulnerable patient,'" Kakadiaris said. "These 'vulnerable patients' bear a very high risk of having a heart attack in the next 12 months."
To support this effort to defuse these "time bombs," Kakadiaris has been awarded a three-year, $566,350 grant from the Division of Information and Intelligent Systems of the National Science Foundation (NSF).
"This is exactly the outcome we had hoped to foster when we funded this project," said James C. French, NSF program director whose support was instrumental for the project to come this far. "The Science and Engineering Information Integration and Informatics program at NSF seeks to fund core computer science research in a domain context that has the potential for high impact in science and engineering domains. Kakadiaris' expertise in computer vision to aid in the identification of vulnerable patients has the potential for broad impact in health care. I am delighted to see that his group is achieving that potential."
The method developed by the CBL takes advantage of the tendency for vasa vasorum – the small arteries distributed around the walls of blood vessels – to proliferate around areas of inflammation in human blood vessels. Using ultrasound inside blood vessels, known as intravascular ultrasound (IVUS), along with micro- and nano-sized contrast agents, Kakadiaris' lab has developed a new software tool that can generate cross-sectional images of a patient's arteries, highlighting areas with dense vasa vasorum and potential inflammation. For the first time, this new imaging technology will provide doctors with the ability to detect "inflamed plaque" that represents regions of blood vessels prone to future rupture and sudden blockage. Its early detection is essential in the practice of cardiology in order to reduce the number of fatalities occurring every year due to unpredicted heart attacks.
"The case of former President Clinton, who last year unexpectedly experienced a heart attack and underwent quadruple bypass surgery, demonstrates that even a former president with access to the best available medical care can have undiagnosed heart disease," Kakadiaris said. "Clinton himself blamed 'insufficient vigilance' and stressed the importance of repeated testing as a means of heart disease prevention."
Supporting this line of thinking – now called the "Clinton Syndrome" – AEHA's mission is to identify "vulnerable patients" by advancing the science and practice of heart attack prevention, detection and treatment. Additionally, a non-profit initiative sponsored by AEHA, Screening for Heart Attack Prevention and Education (SHAPE), presents a practice guideline for doctors to implement public screening of at-risk populations, calling for men 45 and older and women 55 and older to undergo a comprehensive vascular health assessment.
"Recent discoveries and major advances in diagnostic and therapeutic areas have set the stage for translating new science, such as Kakadiaris' work, into a new practice of preventive cardiology," said Naghavi, president of AEHA. "While further studies are warranted, we are making steady progress toward eradicating heart attack. Considering the large amounts of data the SHAPE program will produce, there is an urgent need for computational tools to assist in screening for the conditions that underlie sudden cardiac events."
Kakadiaris' lab is part of the Ultimate IVUS Collaborative Project at UH, along with a number of other physicians and scientists. Also involved in these clinical and preclinical studies are Drs. Manolis Vavuranakis and Christodoulos Stefanadis from the University of Athens Medical School, Drs. Stephane Carlier and Roxana Mehran from the Cardiovascular Research Foundation and Columbia University Medical Center, Erling Falk from Aarhus University in Denmark, Dr. Craig Hartley from Baylor College of Medicine in the Texas Medical Center, and Ralph Metcalfe, mechanical engineering professor in UH's Cullen College of Engineering.
"Americans suffer approximately 1.5 million heart attacks annually and about half of them prove fatal," Kakadiaris said. "Despite a host of new public health initiatives targeting heart disease and its aggravating factors, such as diabetes, inadequate physical activity and obesity, sudden cardiac death is a major concern with the majority of deaths occurring in apparently healthy people."
About the University of Houston
The University of Houston, Texas' premier metropolitan research and teaching institution, is home to more than 40 research centers and institutes and sponsors more than 300 partnerships with corporate, civic and governmental entities. UH, the most diverse research university in the country, stands at the forefront of education, research and service with more than 35,000 students.
About the Association for Eradication of Heart Attack
Originating in the Texas Medical Center, AEHA is a non-profit organization that promotes education and research related to mechanism, prevention, detection and treatment of heart attacks. The organization is committed to raising public awareness about recent discoveries that revealed arteriosclerosis as an inflammatory disease, opening new avenues in preventing heart attacks, such as vaccination strategies. AEHA's mission is to eradicate heart attacks.
To view a multimedia demonstration of vasa vasorum imaging from Kakadiaris' lab, visit http://www.cbl.uh.edu/CARDIA/gallery/demos.html.
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