title: Double jeopardy: multi-modality imaging of monozygotic "twin cap" atherosclerosis.
abstract: The investigation of asymptomatic but potentially vulnerable atherosclerosis is not yet a major focus for clinical Cardiologists. We have illustrated the contemporary investigation and treatment of such disease using a clinical case that involved monozygotic twins. One twin (T1) had unfortunately suffered a cardiac arrest whilst jogging and survived only due to bystander CPR and prompt defibrillation. His identical twin brother (T2), on subsequent investigation, harbours a compositionally identical lesion in a proximal coronary vessel that has not yet ruptured or provoked a clinical event. Following the presentation of both non-invasive and invasive images, we discuss the need for active suspicion and intensive treatment for those people with a 'genetic' risk of future myocardial infarction.
authors.affiliation: Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Critical Care Research, University of Liverpool, Liverpool, UK. Electronic address: Scott.Murray@lhch.nhs.uk.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Murray
authors.affiliation: Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Cooper
authors.affiliation: Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Appleby
authors.affiliation: Department of Cardiovascular Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: McCann
authors.affiliation: Department of Cardiovascular Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Sukumaran
authors.initials: S
authors.lastname: Binukrishnan
authors.affiliation: The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Maria D
authors.initials: MD
authors.lastname: Radu
authors.affiliation: Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Stables
mesh_terms: D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D050197:Atherosclerosis / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D003331:Coronary Vessels / Q000503:physiopathology*; D004200:Diseases in Twins; D005080:Exercise Test; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014430:Twins, Monozygotic
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin
keywords: Atherosclerosis; CT; IVUS; MRI; OCT; Twin studies; Vulnerable plaque