João A. C. Lima, MD Professor of Medicine and Radiology Johns Hopkins Hospital

Transcription

1 CARDIOVASCULAR MRI Tower Health, Reading, May 12, 2018 João A. C. Lima, MD Professor of Medicine and Radiology Johns Hopkins Hospital

2 Disclosures Cannon Medical Systems Grant Funds Contracted Research Medimmune Grant Funds Contracted Reseach May 11,

3 Quantification and Reproducibility The Main Strengths of CMR Kim R et al. Circulation 1999 Nature, May 2016 Eng J. et al. Radiology, 2015 May 11,

4 Multi-Ethnic Study of Atherosclerosis (MESA) Study of 6814 participants ages free of CV disease at baseline Purpose: evaluate novel subclinical disease markers that may predict the development of clinical cardiovascular disease (MI, CHF, death) Markers: blood serum/ chemistry, gene banking, BP, diet/psychosocial questionnaires, ABI Advanced Imaging: especially EBCT/ MDCT + carotid ultrasound, cardiac MRI, endothelial function

5 Collaborating Centers in MESA Univ of Washington Univ of MN U of Vermont Univ of WI Madison New Engl Med C Northwestern Columbia Johns Hopkins UCLA Wake Forest Chinese 12%, African-American 28%, Hispanic 22%, White 38%; 53% women Mean age 62 yrs at study entry

6 Heart failure risk prediction in the Multi-Ethnic Study of Atherosclerosis Harjit Chahal, David A Bluemke, Colin O Wu, Robyn McClelland, Kiang Liu, Steven J Shea, Gregory Burke, Pelbreton Balfour, David Herrington, Pei Bei Shi, Wendy Post, Jean Olson, Karol E Watson, Aaron R Folsom, Joao A C Lima Independent predictors for HF: AUC = 0.87 Age (1.30 (1.10 to 1.50) per 10 years). Male gender (2.27 (1.53 to 3.36). Current smoking (1.97 (1.15 to 3.36). Body mass index (1.40 (1.10 to 1.80) per 5 kg/m2. Systolic blood pressure (1.10 (1.00 to 1.10) per 10 mm Hg. Heart rate (1.30 (1.10 to 1.40) per 10 bpm. Diabetes (2.27 (1.48 to 3.47). NT probnp - (2.48 (2.16 to 2.84) per unit log increment. LV Mass - (1.40 (1.30 to 1.40) per 10 g/m2. Conclusions A clinical algorithm based on risk factors readily available in the primary care setting can be used to identify individuals with high likelihood of developing HF without pre-existing cardiac disease. HEART 2014

7 Cumulative CHD Event Rate Model Adjusted HR P value LV mass (per 10%) LV volume (per 10%) LV mass/ volume (g/ml)

8 Compressed Sensing, Radial Imaging Spuentrep et al, Radiology, 2004 Feng et al, Magn Res Med, 2015 Pang et al, Magn Res Med, 2014 May 11,

9 Myocardial Scar and Infarct Quantification Transmurality Phase-Sensitive MRI Lima et al. Circulation 1995; 92 May 11, Kellman et al. MRM 2000; 47 Kim et al. NEJM 2000; 343

10 Hypertrophic Cardiomyopathy Young et al. Circulation 1994; 9 MRI guided therapy Ho et al. N Eng J Med 2010; 363 O Hanlon et al. JACC 2010; May 11, Maron M. JCMR 2012; 14

11 Dilated Cardiomyopathy Sarcoidosis Prognostic value of fibrosis in DCM Pre-treatment Ankur Gulati et al. JAMA 2013; 309 Post-treatment de Waha et al. SCMR Cases of the Week; White et al. Circulation 2013; 127 Myocarditis Chagas disease Rochitte et al. JACC 2005; 46 Friedrich et al. JACC 2009; 53 May 11,

12 Sudden Death and Afib Substrate Grey zone VT arising from scar and surrounding area Ischemic Non-Ischemic Schmidt et al. Circulation 2007; 115 Wellens H.J., et al. Circulation, (2): p Soejima K et al. J Am Coll Cardiol. 2004; 43(10): Hsia HH et al. Circulation. 2003; 108(6): Ashikaga H.., et al. Circulation Research, 2007 May 11,

13 Afib substrate and the left atrium Oakes et al, Circulation, 2009 Inoue, J Amer. Heart Assn 2015 May 11,

14 Myocardial Perfusion Imaging Wang et al. JACC 2006; 48 Greenwood et al, Circulation, 2013 Mordini et al. JACC: Cardiovascular Imaging, Vol 7, No 1, 2014: May 11,

15 Myocardial Tissue Characterization Messroghli DR et al. Magn Reson Med 2004, 52: 141 Mewton N et al. JACC 2011 May 11,

16 Myocardial Fat Imaging Mahmod et al., Circulation, 2013 Kellman et al, Magn Res Med, 2009 Castillo et al, Radiology, 2004 May 11,

17 Coronary Imaging Manning et al. JMRI 1993; 3 Coronary artery endothelial function MRI Hays et al. JACC 2010; 56 Kim et al. NEJM 2001; 345 May 11,

18 Peripheral Vascular Disease Volunteer PAD Patient Isbell et al. JMRI 2007; 25 Ambale Venkatesh et al. Am Heart J 2017;183 18

19 Vascular Structure and Function MESA COPD: Markl & Ambale AJR, 1984 May 11, 2018 Redheuil A. Artery Research 2014;8(2):

20 MRI Safety - Contrastless CMR Ultrashort TE technique BOLD imaging De Jong et al. J Mol Cell Cardiol 2011; 51 Contrastless Angiography Courtesy of BA Venkatesh Journal of Magnetic Resonance Imaging Volume 35, Issue 1, pages 1-19, 15 DEC 2011 DOI: /jmri May 11,

21 Tagged MRI Osman et al, Magn Res Med, 1999 Ambale-Venkatesh et al, EHJCI, 2014 Rosen et al, AJP-HCP, 2004 Zerhouni et al, Cardiac Radiology, 1988 Dougherty Choi and et al, Axel, EHJ, Radiology, Clark, Reichek, et al, Circulation, 1991 May 11,

22 CMR Spectroscopy Rijzewijk et al, J Amer Coll Cardiol, 2008 May 11,

23 CV Imaging Beyond Hydrogen Sodium imaging Myocardial BOLD MRI Rochitte et al. Circ Res 2000; 87 Potassium imaging Fieno et al. Circ Res 1999; 84 Friedrich et al. Circulation 2001;108 May 11,

24 MRI Extended to Large Cohort Studies Turkbey et al, JAMA, 2015 Unger et al, JAMA. 2012;308(9): May 11,

25 Thank You