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Vincent Aquino, M.D., F.A.C.C.

aquino1Vincent Aquino, M.D., F.A.C.C. is an interventional cardiologist and recognized leader in cardiovascular medicine serving the North Houston and Woodlands communities. He was born in Brooklyn, New York and educated at Florida State University. Dr. Aquino received his medical degree from the University of Florida College of Medicine, Gainesville, Florida. Following Internal Medicine training at the University of Texas-Houston Health Science Center, Dr. Aquino completed his cardiovascular fellowship at the University of Texas-Houston affiliated teaching hospitals, Hermann Hospital, and St. Luke’s Texas Heart Institute. Dr. Aquino has been in practice since 1985.

Dr. Aquino is certified by the American Board of Internal Medicine in the Subspecialty of Cardiovascular Disease, is a diplomat of the American Board of Internal Medicine, and is a Fellow in the American College of Cardiology. He has further board certification in Interventional Cardiology. Dr. Aquino has been involved in clinical investigations and has published several clinical reports and basic research articles in peer-review journals, including the prestigious Circulation and New England Journal of Medicine. He has received numerous recognitions as one of Houston’s Top Doctors and is listed in Top Doctors in America.

Historically, Dr. Aquino was instrumental in developing the North Houston Division of the American Heart Association (AHA). He served as president of the Houston Cardiology Society in the year 2000. Professional appointments have included Chief of Staff at Houston Northwest Medical Center (1999) as well as Medical Director of Cardiovascular Services (1995-1997). He also served as Director of Cardiology at Memorial-Hermann Hospital-The Woodlands (1986-1988). More recently he was appointed Chief of Staff at the St. Luke’s Community Medical Center-The Woodlands. Dr. Aquino has been a catalyst in the development of cost-effective practice guidelines and measures that will continue to assure the highest quality of care for all patients in this community.

As a member of the Woodlands North Houston Heart and Vein Center, Dr. Aquino has led the development of one of Houston’s most progressive and respected cardiology groups. His personal areas of clinical interest and expertise include interventional cardiology in the treatment of coronary artery disease and the management of congestive heart failure. Currently, Dr. Aquino is developing a heart attack prevention program based on the application of modern day imaging in early identification of coronary obstruction coupled with an aggressive disease management program.


We gratefully acknowledge the following authors of this article:

Clinical Investigation and Reports

Severity of Coronary Artery Calcification by Electron Beam Computed Tomography Predicts Silent Myocardial Ischemia

  1. John J. Mahmarian, MD

Author Affiliations:


  1. From the Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College, Beijing, China (Z.-X.H.); Baylor College of Medicine, Houston, Tex (T.D.H., C.M.P., M.S.V., R.R., J.J.M.); and North Houston Heart Center, Houston, Tex (V.A.).

Abstract

Background—Detection of subclinical coronary artery disease (CAD) before the development of life-threatening cardiac complications has great potential clinical relevance. Electron beam computed tomography (EBCT) is currently the only noninvasive test that can detect CAD in all stages of its development and thus has the potential to be an excellent screening technique for identifying asymptomatic subjects with underlying myocardial ischemia.

Methods and Results—Over 2.5 years, we prospectively studied 3895 generally asymptomatic subjects with EBCT, 411 of whom had stress myocardial perfusion tomography (SPECT) within a close (median, 17 days) time period. SPECT and exercise treadmill results were compared with the coronary artery calcium score (CACS) as assessed by EBCT. The total CACS identified a population at high risk for having myocardial ischemia by SPECT although only a minority of subjects (22%) with an abnormal EBCT had an abnormal SPECT. No subject with CACS <10 had an abnormal SPECT compared with 2.6% of those with scores from 11 to 100, 11.3% of those with scores from 101 to 399, and 46% of those with scores ≥400 (P<0.0001). CACS predicted an abnormal SPECT regardless of subject age or sex.

Conclusions—CACS identifies a high-risk group of asymptomatic subjects who have clinically important silent myocardial ischemia. Our results support the role of EBCT as the initial screening tool for identifying individuals at various stages of CAD development for whom therapeutic decision making may differ considerably.

Key Words:

The detection of subclinical coronary artery disease (CAD) before the development of life-threatening cardiac complications has great potential clinical relevance. However, currently available noninvasive techniques, such as exercise treadmill testing (ETT) and myocardial single photon emission computed tomography (SPECT), can identify only patients with advanced CAD who manifest myocardial ischemia.1 2 Although the presence and extent of left ventricular ischemia can accurately identify individuals at high risk for cardiac events,3 4 5 6 7 8 the low prevalence of a positive test result among asymptomatic subjects with cardiac risk factors mitigates against this approach.7 8 9

Electron beam computed tomography (EBCT) is a new noninvasive technique that can detect coronary atherosclerosis even at its earliest stages on the basis of the presence and severity of coronary artery calcification.10 Although calcification severity predicts the presence of significant anatomic CAD,11 12 there is little information as to whether the coronary artery calcium score (CACS) can identify asymptomatic individuals at high risk for having myocardial ischemia among a larger, asymptomatic, heterogeneous population with cardiac risk factors.12 This is clinically important because the presence and extent of left ventricular ischemia predict outcome beyond that provided by coronary angiographic findings alone.4 513

Accordingly, the purpose of this study was to determine whether EBCT could identify subjects with scintigraphic ischemia on the basis of CACS severity and thereby define its role as a primary screening technique for identifying subjects with a broad spectrum of CAD.