For Volcano Therapeutics Inc (Laguna Hills, CA), it all started one evening in 1993, when co-founder Dr Ward Casscells (University of Texas School of Medicine, Houston, TX) was ministering to his son, who had an ear infection, according to Gower: "Using a special infrared thermometer, Casscells had discovered that the boy's inflamed ear was one degree hotter than the healthy one. He started to wonder: could a thermometer also detect inflammation in the arterieswhich some of his more daring colleagues were starting to say was the true cause of heart attacks?"

Casscells spent the rest of that night striking matches and burning the skin of his inner left arm. "Using the same thermometer, he learned that it was possible to tell his burns from uninjured flesh simply by taking their temperature," wrote Gower. "By dawn he was convinced that finding hot spots in the cardiovascular system just might help prevent the leading cause of death in the Western world."

"It was a great day in my life, that's for sure," Casscells told Gower, as he sat in his Houston office 9 years later, "rolling up a pinstriped sleeve to reveal a cluster of souvenir scars," and it led to Volcano's current project; the development of miniature heat-seeking sensors designed to be guided into the arteries with a catheter, as previously reported by heartwire. The company is also testing a catheter device on animals that delivers heat to the inflamed lesions, "based on Casscells's theory that warming the lesions could have the paradoxical effect of shutting down inflammation."

Other companies focus on light instead of heat. Catheter developer InfraReDx (Cambridge, MA) uses lasers "to create a kind of topographical map of fatty deposits in arterial walls," according to Gower. Another firm, LightLab (Westford, MA), makes catheters that fire light in all directions within the artery to create a cross-sectional image, showing how much is absorbed and reflected by the surrounding tissue.

Still another company, Pharmacyclics (Sunnyvale, CA), makes light-tipped catheters designed to cure as well as diagnose. After a patient took motexafin lutetium (Antrin® - Pharmacyclics)a drug already used successfully in photoangioplasty trials, as previously reported by heartwirethe doctor would insert the catheter into the arteries. The light would "search and destroy" the inflamed lesions, which have absorbed the drug.

The problem with the catheter method of detection, say some doctors, it that it is difficult to convince asymptomatic patients to undergo the procedure in the first place. "You're not going to volunteer to shave your groin and have someone stick a needle into an artery and rummage around in your heart for nothing," Dr Peter Libby (Chief of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA) told Gower.

Libby's preferred method for diagnosing inflammation is already available: blood tests for C-reactive protein (CRP). As previously reported by heartwire, several studies have shown a correlation between elevated CRP levels and increased cardiovascular risk, even in patients with normal cholesterol levels.

Catheter proponents argue, however, that it is not enough to know the patient has inflamed arteries. "You must find the exact spots where vulnerable plaque lurks if you want to treat it effectively," Gower writes, and be able to determine whether the lesions have thin or thick caps, to be treated with stents and/or statins.

You're not going to volunteer to shave your groin and have someone stick a needle into an artery and rummage around in your heart for nothing.

Meanwhile, Dr Valentin Fuster (Director, Cardiovascular Institute, Mt Sinai School of Medicine, New York, NY) has commissioned a team of engineers led by Dr Zahi Fayad (ex-University of Pennsylvania) to create a more plaque-sensitive MRI. "Fayad's team of 10 engineers and technicians has been working with Siemenswhich manufactures the MRI machines Mount Sinai usesto rewrite software and tweak hardware to produce sharper images," Gower writes. "Fayad also developed a technique known as 'black blood' imaging that overcomes a problem with standard MRI technology, which shows both blood and vessel walls as white. Fayad's innovation allows him to see where the vessel wall has thickeneda marker for vulnerable plaque."

At the Texas Heart Institute, Dr Morteza Naghavi (Center for Vulnerable Plaque Research, Houston, TX) is studying ferrous nanoparticles that mark inflamed areas when injected into a patient, and Phillips Medical Systems is working with scientists at Washington University in St Louis on similar marking particles that cause fibrin, a protein produced during blood clotting, to show up during an MRI scan, Gower notes: "And GE Medical Systems distributes a product developed by Surgi-Vision, a Gaithersburg, MD companya tiny, antennalike wire that's threaded into a blood vessel and enhances the ability of MRIs to diagnose certain circulatory diseases; it also shows promise as a plaque hunter."

All these developments with MRIs, Gower writes, are still in the experimental stages and aren't due to be in regular use for another 3 to 5 years. Moreover, DNA testing may have progressed by that time to the point where not only can patients with genetic predispositions toward MI be identified, there may even be at-home testing available as well as vaccines, according to Naghavi.

Gower closes with the following advice to his readers: "At your next checkup, ask your doctor about a CRP test. It's worth talking about statins too. In the meantime, exercise, don't smoke, and really, really try to like tofu."