Cardiovascular diseases impose a heavy socioeconomic burden on European healthcare systems.  In the five largest European countries, France, Germany, Italy, Spain, and the United Kingdom, a total of $110 to $115 billion is spent annually for the management of cardiovascular disorders.  Of this total, approximately $40 billion is spent for treating coronary heart disease, more than $15 billion for stroke, $12 billion for hypertensive disease, and approximately $8 billion for congestive heart failure.  Cardiovascular diagnostic product sales, including electrocardiography, noninvasive imaging, and intravascular techniques, generated more than $1.4 billion in 1999 for the five major countries of Europe. 

Reimbursement has historically led to significantly different competitive product profiles and pricing across Europe.  With the impact of greater regulatory harmonization, reduced trade barriers, the euro, and European regulations, new ways of positioning products across Europe to ensure profitability are necessary.  This report from Medtech Insight analyzes the technologies, products, current and forecast markets, competitors, and opportunities in this dynamic market.

Major topics in this report from Medtech Insight include:  angiography catheters, guidewires & sheaths; cardiovascular-related intravascular imaging agents; computed tomography systems; electrocardiography systems; electrophysiology diagnostic catheters; intravascular ultrasound catheters; magnetic resonance imaging systems; nuclear medicine systems; ultrasound systems; and x-ray-based angiography & electrophysiology imaging systems.

TABLE OF CONTENTS

EXECUTIVE SUMMARY

     i. European Healthcare Indicators

     ii. European Incidence and Prevalence of Cardiovascular Disorders

     iii. Cardiovascular Diagnostic Products Markets

     iv. Electrocardiography Products

     v. Noninvasive Imaging Systems

     vi. Imaging Contrast Media and Radiopharmaceuticals

     vii. Endovascular Diagnostic Systems

1. EUROPEAN MARKET OVERVIEW

     1.1 European Healthcare Reforms

     1.2 Reimbursement Climate

     1.3 European Union Developments

          1.3.1 Medical Device Regulations

     1.4 Healthcare Profiles of Major European States

          1.4.1 France

          1.4.2 Germany

          1.4.3 Italy

          1.4.4 Spain

          1.4.5 United Kingdom

2. ETIOLOGY AND EPIDEMIOLOGY OF CARDIOVASCULAR
     DISORDERS

     2.1 Circulatory Disorders

          2.1.1 Hypercholesterolemia

          2.1.2 Atherosclerosis

          2.1.3 Ischemic Heart Disease

          2.1.4 Angina Pectoris

          2.1.5 Myocardial Infarction

          2.1.6 Stroke

          2.1.7 Aortic Aneurysm

          2.1.8 Deep-Vein Thrombosis and Pulmonary Embolism

     2.2 Arrhythmia Disorders

          2.2.1 Supraventricular Tachycardia

          2.2.2 Atrial Fibrillation

          2.2.3 Ventricular Tachycardia

          2.2.4 Ventricular Fibrillation

     2.3 Myocardial Diseases

          2.3.1 Congestive Heart Failure

          2.3.2 Valvular Disorders

          2.3.3 Congenital Heart Defects

          2.3.4 Rheumatic Heart Disease

3. DIAGNOSTIC TECHNIQUES AND PROCEDURES

     3.1 Non-Imaging Diagnostic Techniques

          3.1.1 Resting Electrocardiogram

          3.1.2 Holter Monitor Studies

          3.1.3 Trans-Telephonic Event Recording

          3.1.4 Signal-Averaged Electrocardiography

          3.1.5 Exercise Stress Testing

     3.2 Noninvasive Imaging in Cardiovascular Diagnostics

          3.2.1 Computed Tomography  

                  3.2.1.1 Spiral Computed Tomography

                  3.2.1.2 Computed Tomography Angiography

                  3.2.1.3 Electron Beam Computed Tomography

                  3.2.1.4 Computed Tomography Procedure Volumes

          3.2.2 Magnetic Resonance Imaging

                  3.2.2.1 Magnetic Resonance Angiography        

                             3.2.2.1.1 Time-of-Flight Magnetic
                                          Resonance Angiography

                             3.2.2.1.2 Phase-Contrast Magnetic
                                          Resonance Angiography

                             3.2.2.1.3 Contrast-Enhanced Magnetic
                                          Resonance Angiography

                  3.2.2.2 Echo Planar Magnetic Resonance Imaging

                  3.2.2.3 Magnetic Resonance Imaging Procedure Volumes

          3.2.3 Nuclear Medicine

                  3.2.3.1 Gamma Camera Cardiovascular Imaging

                             3.2.3.1.1 First-Pass Radionuclide Angiography

                             3.2.3.1.2 Gated Blood Pool
                                          Radionuclide Angiography

                             3.2.3.1.3 Myocardial Perfusion Studies

                  3.2.3.2 Positron Emission Tomography

                  3.2.3.3 Nuclear Medicine Procedure Volumes

          3.2.4 Diagnostic Ultrasound

                  3.2.4.1 Clinical Applications of Echocardiography

                  3.2.4.2 Types of Echocardiography

                             3.2.4.2.1 M-Mode Echocardiography

                             3.2.4.2.2 Two-Dimensional Echocardiography

                             3.2.4.2.3 Doppler Imaging

                  3.2.4.3 Contrast Enhanced Ultrasound

                  3.2.4.4 Tissue Harmonic Imaging Ultrasound

                  3.2.4.5 Tissue Doppler Imaging

                  3.2.4.6 Transcranial Doppler Ultrasound

                  3.2.4.7 Diagnostic Ultrasound for Peripheral
                            Vascular Disease

                             3.2.4.7.1 Ultrasonic Duplex Scanning

                  3.2.4.8 Diagnostic Ultrasound Procedure Volumes

     3.3 Invasive Imaging Techniques

          3.3.1 Angiography

                  3.3.1.1 Coronary Angiography

                  3.3.1.2 Peripheral Angiography

                  3.3.1.3 Angiography Procedure Volumes

          3.3.2 Intracoronary Angioscopy

          3.3.3 Intravascular Ultrasound

                  3.3.3.1 Intravascular Ultrasound Procedure Volumes

          3.3.4 Electrophysiology Studies

                  3.3.4.1 Electrophysiology Study Procedure Volumes

4. CARDIOVASCULAR DIAGNOSTIC PRODUCTS MARKETS

     4.1 Electrocardiography Systems

          4.1.1 Market Forecast

          4.1.2 Competitive Analysis

     4.2 Imaging Platforms

          4.2.1 Computed Tomography Systems

                  4.2.1.1 Market Forecast

                  4.2.1.2 Competitive Analysis

          4.2.2 Magnetic Resonance Imaging Systems

                  4.2.2.1 Market Forecast

                  4.2.2.2 Competitive Analysis

          4.2.3 Nuclear Medicine Systems

                  4.2.3.1 Market Forecast

                  4.2.3.2 Competitive Analysis

          4.2.4 Ultrasound Systems

                  4.2.4.1 Market Forecast

                  4.2.4.2 Competitive Analysis

          4.2.5 X-Ray-Based Angiography and Electrophysiology
                  Imaging Systems

                  4.2.5.1 Market Forecast

                  4.2.5.2 Competitive Analysis

     4.3 Cardiovascular-Related Intravascular Imaging Agents

          4.3.1 X-Ray Contrast

          4.3.2 Nuclear Medicine Radiopharmaceuticals

          4.3.3 Cardiovascular-Related Ultrasound Contrast

     4.4 Transcatheter Cardiovascular Diagnostic Systems

          4.4.1 Angiography Products

                  4.4.1.1 Angiography Catheters

                  4.4.1.2 Guidewires

                  4.4.1.3 Diagnostic Sheaths

                  4.4.1.4 Product Suppliers

                  4.4.1.5 Market Forecast

                  4.4.1.6 Competitive Analysis

          4.4.2 Intravascular Ultrasound Systems

                  4.4.2.1 Market Forecast

                  4.4.2.2 Competitive Analysis

          4.4.3 Electrophysiology Diagnostic Catheters

                  4.4.3.1 Market Forecast

                  4.4.3.2 Competitive Analysis

5. COMPANY PROFILES

     5.1  Acuson Corporation

     5.2  ADAC Laboratories, Inc.

     5.3  C.R. Bard, Inc.

     5.4  Boston Scientific Corporation

     5.5  Bracco Diagnostics, Inc.

            5.5.1 Esaote SPA

     5.6  Cook, Inc.

     5.7  DuPont Pharmaceuticals Company

     5.8  Endocardial Solutions, Inc.

     5.9  EndoSonics Corporation

     5.10 General Electric Company

            5.10.1 GE Medical Systems

     5.11 Hewlett-Packard Company

            5.11.1 Agilent Technologies, Inc.

     5.12 Hitachi LTD

            5.12.1 Hitachi Medical Systems Europe GmbH

     5.13 Johnson & Johnson

            5.13.1 Cordis Corporation

     5.14 Mallinckrodt, Inc.

     5.15 Marconi Medical Systems/Marconi PLC

     5.16 Medtronic, Inc.

     5.17 Nycomed Amersham PLC

     5.18 Royal Philips Electronics NV

            5.18.1 Philips Medical Systems

     5.19 Schering AG

     5.20 Schiller AG

     5.21 Siemens AG

            5.21.1 Siemens Medical Engineering Group

     5.22 Toshiba Corporation

            5.22.1 Toshiba Medical Systems Europe

COMPANY LISTING

LIST OF EXHIBITS

Exhibit ES-1:   1998, Healthcare Indicators for the Major European Countries 

Exhibit ES-2:   Incidence, Prevalence, and Mortality of Selected Cardiovascular Disorders 

Exhibit ES-3:   1999, Cardiovascular Diagnostics, Procedure Volumes, by Country 

Exhibit ES-4:   Cardiovascular Diagnostics, Procedure Volumes Forecast, 1999-2005 

Exhibit ES-5:   Cardiovascular Diagnostics, Market Forecast, 1999-2005 

Exhibit ES-6:   Cardiovascular Diagnostics, Market Forecast, by Country, 1999-2005 

Exhibit ES-7:   Electrocardiography, Market Forecast, by Country, 1999-2005 

Exhibit ES-8:   Noninvasive Imaging Platforms, Market Forecast, by Country, 1999-2005 

Exhibit ES-9:   Contrast-Based Cardiovascular Diagnostics, Procedure Volumes Forecast, 1999-2005 

Exhibit ES-10:  Cardiovascular Diagnostic Contrast Media, Market Forecast, by Country, 1999-2005 

Exhibit ES-11:  Catheter-Based Cardiovascular Diagnostics, Market Forecast, by Country, 1999-2005 

Exhibit 1-1:     1998, Healthcare Indicators for the Major European Countries 

Exhibit 1-2:     1998, Healthcare Indicators for France 

Exhibit 1-3:     1998, Healthcare Indicators for Germany 

Exhibit 1-4:     1998, Healthcare Indicators for Italy 

Exhibit 1-5:     1998, Healthcare Indicators for Spain 

Exhibit 1-6:     1998, Healthcare Indicators for the United Kingdom 

Exhibit 2-1:     1998, Prevalence and Mortality of Ischemic Heart Disease 

Exhibit 2-2:     1998, Incidence and Mortality of Acute Myocardial Infarction 

Exhibit 2-3:     1998, Incidence and Mortality of Stroke 

Exhibit 2-4:     1998, Incidence and Prevalence of Aortic Aneurysms 

Exhibit 2-5:     1998, Incidence and Prevalence of Deep-Vein Thrombosis and Incidence and Mortality of Pulmonary Embolism 

Exhibit 2-6:     1998, Incidence and Prevalence of Pacing Disorders 

Exhibit 2-7:     1998, Incidence of Congestive Heart Failure 

Exhibit 2-8:     1998, Incidence of Valvular Disorders 

Exhibit 3-1:     1999, Cardiovascular Diagnostics, Procedure Volumes, by Country 

Exhibit 3-2:     Cardiovascular Diagnostics, Procedure Volumes Forecast, 1999-2005 

Exhibit 3-3:     Cardiovascular Diagnostics, Procedure Volumes Forecast for France, 1999-2005 

Exhibit 3-4:     Cardiovascular Diagnostics, Procedure Volumes Forecast for Germany, 1999-2005 

Exhibit 3-5:     Cardiovascular Diagnostics, Procedure Volumes Forecast for Italy, 1999-2005 

Exhibit 3-6:     Cardiovascular Diagnostics, Procedure Volumes Forecast for Spain, 1999-2005 

Exhibit 3-7:     Cardiovascular Diagnostics, Procedure Volumes Forecast for the United Kingdom, 1999-2005 

Exhibit 3-8:     Diagnostic Electrocardiography, Procedure Volumes Forecast, by Country, 1999-2005 

Exhibit 3-9:     Cardiovascular Computed Tomography, Procedure Volumes Forecast, by Country, 1999-2005 

Exhibit 3-10:   Cardiovascular Magnetic Resonance Imaging, Procedure Volumes Forecast, by Country, 1999-2005 

Exhibit 3-11:   Cardiovascular Nuclear Medicine, Procedure Volumes Forecast, by Country, 1999-2005 

Exhibit 3-12:   Cardiovascular Ultrasound, Procedure Volumes Forecast, by Country, 1999-2005 

Exhibit 3-13:   Angiography, Procedure Volumes Forecast, by Country, 1999-2005 

Exhibit 3-14:   Intravascular Ultrasound, Procedure Volumes Forecast, by Country, 1999-2005 

Exhibit 3-15:   European Electrophysiology Studies, Procedure Volumes Forecast, 1999-2005 

Exhibit 4-1:     Cardiovascular Diagnostics, Procedure Volumes Forecast, 1999-2005 

Exhibit 4-2:     Cardiovascular Diagnostics, Market Forecast, 1999-2005 

Exhibit 4-3:     Cardiovascular Diagnostics, Market Forecast, by Country, 1999-2005 

Exhibit 4-4:     1999, Electrocardiography Installed Base, by Country 

Exhibit 4-5:     Electrocardiography, Market Forecast, 1999-2005 

Exhibit 4-6:     Electrocardiography, Market Forecast, by Country, 1999-2005 

Exhibit 4-7:     Electrocardiography, Market Forecast for France, 1999-2005 

Exhibit 4-8:     Electrocardiography, Market Forecast for Germany, 1999-2005 

Exhibit 4-9:     Electrocardiography, Market Forecast for Italy, 1999-2005 

Exhibit 4-10:   Electrocardiography, Market Forecast for Spain, 1999-2005 

Exhibit 4-11:   Electrocardiography, Market Forecast for the United Kingdom, 1999-2005 

Exhibit 4-12:   1999, Electrocardiography Systems Market, Share by Supplier 

Exhibit 4-13:   Noninvasive Imaging Systems, Market Forecast, 1999-2005 

Exhibit 4-14:   Noninvasive Imaging Systems, Market Forecast for France, 1999-2005 

Exhibit 4-15:   Noninvasive Imaging Systems, Market Forecast for Germany, 1999-2005 

Exhibit 4-16:   Noninvasive Imaging Systems, Market Forecast for Italy, 1999-2005 

Exhibit 4-17:   Noninvasive Imaging Systems, Market Forecast for Spain, 1999-2005 

Exhibit 4-18:   Noninvasive Imaging Systems, Market Forecast for the United Kingdom, 1999-2005 

Exhibit 4-19:   Selected Computed Tomography Systems 

Exhibit 4-20:   Computed Tomography, Market Forecast, by Country, 1999-2005 

Exhibit 4-21:   1999, Computed Tomography Market, Share by Supplier 

Exhibit 4-22:   Selected Magnetic Resonance Imaging Systems 

Exhibit 4-23:   Magnetic Resonance Imaging, Market Forecast, by Country, 1999-2005 

Exhibit 4-24:   1999, Magnetic Resonance Imaging Market, Share by Supplier 

Exhibit 4-25:   Selected Nuclear Medicine Systems 

Exhibit 4-26:   Nuclear Medicine, Market Forecast, 1999-2005 

Exhibit 4-27:   Nuclear Medicine, Market Forecast, by Country, 1999-2005 

Exhibit 4-28:   1999, Nuclear Medicine Market, Share by Supplier 

Exhibit 4-29:   Selected Diagnostic Ultrasound Systems 

Exhibit 4-30:   Diagnostic Ultrasound, Market Forecast, by Country, 1999-2005 

Exhibit 4-31:   1999, Ultrasound Market, Share by Supplier 

Exhibit 4-32:   Selected X-Ray Systems 

Exhibit 4-33:   X-Ray Systems, Market Forecast, by Country, 1999-2005 

Exhibit 4-34:   1999, Angiography/Electrophysiology Imaging Systems Market, Share by Supplier 

Exhibit 4-35:   Contrast-Based Cardiovascular Diagnostics, Procedure Volumes Forecast, 1999-2005 

Exhibit 4-36:   Contrast-Based Cardiovascular Diagnostics, Procedure Volumes Forecast for France, 1999-2005 

Exhibit 4-37:   Contrast-Based Cardiovascular Diagnostics, Procedure Volumes Forecast for Germany, 1999-2005 

Exhibit 4-38:   Contrast-Based Cardiovascular Diagnostics, Procedure Volumes Forecast for Italy, 1999-2005 

Exhibit 4-39:   Contrast-Based Cardiovascular Diagnostics, Procedure Volumes Forecast for Spain, 1999-2005 

Exhibit 4-40:   Contrast-Based Cardiovascular Diagnostics, Procedure Volumes Forecast for the United Kingdom, 1999-2005 

Exhibit 4-41:   Cardiovascular-Related Imaging Contrast and Radiopharmaceuticals, Market Forecast, 1999-2005 

Exhibit 4-42:   Cardiovascular Diagnostic Contrast Media, Market Forecast, by Country, 1999-2005 

Exhibit 4-43:   Cardiovascular-Related X-Ray Contrast, Market Forecast, by Country, 1999-2005 

Exhibit 4-44:   Radiopharmaceuticals, Market Forecast, by Country, 1999-2005 

Exhibit 4-45:   Ultrasound Contrast, Market Forecast, by Country, 1999-2005 

Exhibit 4-46:   Catheter-Based Cardiovascular Diagnostics, Market Forecast, by Country, 1999-2005 

Exhibit 4-47:   Average Device Usage per Angiographic Procedure 

Exhibit 4-48:   Angiography Products, Market Forecast, 1999-2005 

Exhibit 4-49:   Angiography Products, Market Forecast, by Country, 1999-2005  

Exhibit 4-50:   Angiography Products, Market Forecast for France, 1999-2005 

Exhibit 4-51:   Angiography Products, Market Forecast for Germany, 1999-2005 

Exhibit 4-52:   Angiography Products, Market Forecast for Italy, 1999-2005 

Exhibit 4-53:   Angiography Products, Market Forecast for Spain, 1999-2005 

Exhibit 4-54:   Angiography Products, Market Forecast for the United Kingdom, 1999-2005 

Exhibit 4-55:   1999, Angiography Products Market, Share By Supplier 

Exhibit 4-56:   Selected Intravascular Ultrasound Catheters 

Exhibit 4-57:   Intravascular Ultrasound Catheters, Market Forecast, by Country, 1999-2005 

Exhibit 4-58:   1999, Intravascular Ultrasound Catheters Market, Share By Supplier 

Exhibit 4-59:   Selected Electrophysiology Diagnostic Catheters 

Exhibit 4-60:   Electrophysiology Diagnostic Catheters, Market Forecast, by Country, 1999-2005 

Exhibit 4-61:   1999, Conventional Electrophysiology Diagnostic Catheters Market, Share by Supplier 

Exhibit 4-62:   1999, Advanced Electrophysiology Diagnostic Catheters Market, Share by Supplier 

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