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CARDIOVASCULAR GENOMIC MEDICINE

New Paradigms in Cardiovascular Medicine

Emerging Technologies and Practices: Perioperative Genomics

Mihai V. Podgoreanu, MD^_*,_* and Debra A. Schwinn, MD^_*,,,

^_* Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
Department of Pharmacology/Cancer Biology, Duke University Medical Center, Durham, North Carolina
Department of Surgery, Duke University Medical Center, Durham, North Carolina
Center for Genomic Medicine, Duke Institute for Genome Science and Policy, Durham, North Carolina.

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.

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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