CARDIOVASCULAR GENOMIC MEDICINE: STATE-OF-THE-ART PAPER
New Paradigms in Cardiovascular Medicine
Emerging Technologies and Practices: Perioperative Genomics
Mihai V. Podgoreanu, MD**,* and
Debra A. Schwinn, MD*, , ,
* Anesthesiology
Pharmacology/Cancer Biology
Surgery, Duke University Medical Center, Durham, North Carolina
Center for Genomic Medicine, Duke Institute for Genome Science and Policy, Durham, North Carolina. Supported in part by grants AG17556 and HL075273 (to Dr. Schwinn) from the National Institutes of Health and grant 0120492U (to Dr. Podgoreanu) from the American Heart Association.
Manuscript received June 21, 2005;
revised manuscript received August 5, 2005,
accepted August 17, 2005.
* Reprint requests and correspondence: Dr. Mihai V. Podgoreanu, Box 3094, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710
(Email: mihai.podgoreanu{at}duke.edu).
Considerable progress has been made in understanding the pathophysiology of perioperative stress responses and their impact on the cardiovascular system; however, researchers are just beginning to unravel genetic and molecular determinants that predispose to increased risk for postoperative cardiovascular adverse events. A new field, coined perioperative genomics, aims to apply functional genomic approaches to uncover the biological reasons why similar patients can have dramatically different clinical outcomes after surgery. For the perioperative physician, such findings may soon translate into prospective risk assessment incorporating genomic profiling of markers important in inflammatory, thrombotic, vascular, and neurologic responses to perioperative stress, with implications ranging from individualized additional pre-operative testing and physiological optimization, to perioperative decision-making, choice of monitoring strategies, and critical care resource utilization. We review current knowledge regarding genomic technologies in perioperative cardiovascular disease characterization and outcome prediction, as well as discuss future trends/challenges for translating integrated "omic" information into daily clinical management of the surgical patient.
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Abbreviations and Acronyms
| | ACE = angiotensin-converting enzyme | | AF = atrial fibrillation | | APOE = apolipoprotein E | | AR = adrenergic receptor | | CABG = coronary artery bypass grafting | | CAD = coronary artery disease | | CPB = cardiopulmonary bypass | | FVL = factor V Leiden | | HSP = heat shock protein | | IL = interleukin | | MACE = major adverse cardiac events | | PAI-1 = plasminogen activator inhibitor-1 | | PMI = perioperative myocardial infarction | | PoAF = postoperative atrial fibrillation | | SNP = single nucleotide polymorphism |
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