This article is more than 5 years old. Information may no longer be current.
Cardiac MRI can aid researchers in endpoint selection for cardiac trials
Click Here to Manage Email Alerts
Cardiac MRI can be a technology that can help cardiologists to characterize myocardial tissue, particularly in patients who had a reperfused MI. A recent scientific expert panel was published in the Journal of the American College of Cardiology that provides recommendations on how best to utilize this technology when selecting endpoints for future clinical and experimental trials.
Cardiology Today spoke with Valentin Fuster, MD, PhD, director of Mount Sinai Heart and physician-in-chief of The Mount Sinai Hospital, to learn more about the potential that cardiac MRI has in this area.
Question: What are some of the takeaways from this JACC scientific expert panel?
Answer: MRI is a technology in which limit has not been reached yet. From time to time, experts need to standardize the new uses. In other words, what has happened in the last few years is a complete revolution in the way the methodology is being used. This is what has been done in this document.
Recent years have witnessed an exponential rise in the use of MRI after an MI to assess patients’ risk of future events, understand the changes taking place in cardiac tissue and evaluate the benefits of treatments. The colossal technological advances in this area have generated a plethora of new options for studying these parameters
Q: What needs to be done to standardize cardiac magnetic resonance methodologies to produce real clinical benefit?
A: While MI is the No. 1 entity today in terms of CV events, when we need imaging in vivo, it is MRI leading. In this paper, the experts of the area put together all the new information that has been obtained with MI at the time of autopsy, now in vivo with the use of MRI.
Basically, we have outlined extensive guidelines that clarify what we can and cannot see, which technology of MRI we should use and, more importantly, we have opened the field for the next guidelines. We need to be critical of the new therapies of MI because it is telling us what happens with these cells, what happens with water, what happens with molecules and then we can begin to target our therapies based on what we see in this in vivo model.
Q: What are the benefits of using cardiac MRI for post-MI tissue characterization compared with other imaging methods?
A: MRI is one of the best methods for studying the heart after an infarction. It allows the study of heart anatomy, function and tissue composition in a very precise way without exposing the patient to radiation. MRI is the ideal method for assessing the effect of new treatments. However, until now, the community has lacked consistent recommendations on the specific procedures to follow after an acute MI in order to assess the effect of these treatments.
Q: What was your first experience using cardiac MRI at autopsy?
A: I began to use MRI at autopsy over 20 years ago. The problem was, at that time, we were all concerned with the blood clot in the coronary artery. The blood clot is because something was wrong in the vessel wall. We started using MRI technology at autopsy so we could know the processes at the vessel wall. This is how it started.
Q: What would you tell researchers who are looking into cardiac MRI to focus on throughout their studies?
A: Consensus documents of this type provide guidelines to ensure consistency in the use of important tools such as this one. Currently, many clinical trials use MRI to assess a principal outcome, but it is very difficult to compare these studies because they use widely different protocols. MI affects millions of people in the world every year, and this is therefore a highly active field of research. Because of this, the implications of the new consensus document are enormous.
One of the main advices is establishing absolute infarct size as the main outcome measure to assess in the studies evaluating new treatments. Another recommendation is using magnetic resonance scans between days 3 and 7 after the infarction, as this is the period when magnetic resonance parameters are more stable and less affected by rapid changes occurring in the heart as it attempts to repair itself. This time window is also practical, since most patients remain in hospital for at least 3 days after having an MI. – by Darlene Dobkowski
For more information:
Valentin Fuster, MD, PhD, can be reached at Mount Sinai School of Medicine, Cardiovascular Institute, One Gustave Levy Place, Box 1030, New York, NY 10029; email: valentin.fuster@mountsinai.org.
Disclosures: Fuster reports no relevant financial disclosures. Please see the document for all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts