34th Bethesda Conference Executive summary—can atherosclerosis imaging techniques improve the detection of patients at risk for ischemic heart disease?

Abstract

This document presents the summary findings from the 34th Bethesda Conference: “Can Atherosclerosis Imaging Techniques Improve the Detection of Patients at Risk for Ischemic Heart Disease?” This conference, comprised of five writing groups, began the process of formulating report outlines and documents in January 2002. The conference, held October 7, 2002, at the Heart House in Bethesda, Maryland, allowed for open discussion, constructive commentary, and the formulation of summary comments resulting in the documents presented in this report. The purpose of Bethesda Conference 34 (BC 34) was to review the current status and controversies within the integration of atherosclerosis imaging into clinical cardiovascular medicine. Each Task Force was also specifically charged with developing recommendations on “Future Directions” for the field of atherosclerosis imaging, as appropriate within the scope of issues they considered. Although it is recognized that atherosclerosis imaging, including many different emerging technologies, may enhance the detection and treatment of patients at risk for coronary heart disease (CHD), much remains unknown about these modalities despite the fact that many are rapidly moving into broad clinical use. Further consideration of these tests as clinical tools extends prior efforts such as the Prevention V Conference of the American Heart Association, and the National Cholesterol Education Program, Adult Treatment Panel III guidelines. The latter treatment guidelines focused particular attention on the relevance of diagnosing subclinical atherosclerosis for altering lipid treatment goals by designating that aortic, peripheral, and carotid artery disease were considered to represent “Coronary Heart Disease Equivalents” because the level of CHD risk and CHD event rates associated with these conditions is approximately equivalent to the level of risk seen in stable CHD. Thus, screening for atherosclerosis in other vascular regions has been considered for CHD risk evaluation.