<International Circulation>: Detecting the early signs of coronary artery disease presumably is an effective method of promoting cardiovascular health. What are the latest developments in the early identification of myocardial dysfunction?

    Dr Liu: In terms of early myocardial dysfunction， we are fortunate to have some new markers that have been developed and some currently in development. The imaging modalities are certainly also helping. It is known that approximately one in five individuals will develop and succumb to heart failure. Classically the symptoms occur very late while the heart is remodeling. We can begin to identify those at risk by identifying the classic risk factors – diabetes， high blood pressure and so on. These also need to include family history as there are genetic forms of heart failure transmitted in families. With this risk identification， one can begin to apply the various blood-based markers which include brain natriuretic peptide. This is easily measured in blood， is readily available at this time and has a reasonable sensitivity to identifying patients at risk. Another marker is high-sensitivity troponin. The traditional troponin we use is to detect a patient with acute myocardial infarction， but the high-sensitivity troponin can pick up tiny levels of troponin which are released in response to the presence of the risk factors or high blood pressure in those patients who run an increased likelihood of developing heart failure in the future. This can be complemented by some newer markers currently in development coming from areas of inflammation and areas of angiogenesis， and these are presently being validated. These can be used in conjunction with the newer approaches in imaging such as three-dimensional echo imaging combined with spectral tracking for example. Collectively， these techniques are giving us a better indication of who is at risk for developing heart failure. There are treatments available to then interrupt the process and avoid the complications.