The goal of this career development award project is to develop the research skills of Michael Salerno MD, PhD to become an independent investigator involved in patient-oriented research in the field of cardiovascular imaging. The necessary mentorship in clinical investigation will be provided by his clinical mentor, Dr. Christopher Kramer MD and engineering mentorship will be provided by his co-mentor Dr. Craig Meyer. His career will be further enriched by an advisory committee which includes experts in the development of rapid pulse sequences for myocardial perfusion imaging, quantification of perfusion, and the statistical design and analysis of clinical trials. The University of Virginia wll provide the ideal combination of resources necessary for Dr. Salerno to become an independent investigator. This career development proposal includes didactic training necessary to design, perform and analyze multi-center imaging trials which will be instrumental to his long term success in the field of cardiovascular imaging. This training will lead to a Masters degree in Statistics with a concentration in biostatistics and clinical trials. Dr. Salerno's ultimate plan t to utilize his unique interdisciplinary combination of engineering and clinical expertise in cardiovascular imaging to translate new CMR techniques into clinical practice. His likelihood for success in this endeavor will be significantly increased by further development of his clinical research skills by both his didactic training and mentorship interactions resulting from this caree development award. Adenosine stress perfusion CMR is becoming a promising modality for the evaluation of coronary artery disease with multiple advantages as compared to other imaging techniques including a lack of ionizing radiation, high-spatial resolution, and the ability to accurately quantify myocardial perfusion and ischemic burden. Current CMR first pass perfusion techniques are limited by "dark-rim" artifacts which may be mistaken for true perfusion abnormalities resulting in false positive studies with visual analysis, and may impede accurate quantification of myocardial perfusion for quantitative methods. Furthermore, these techniques are still limited in their temporal resolution, spatial resolution and ventricular coverage. We hypothesize that spiral pulse sequences will be robust to these artifacts, while having the efficiency to provide full ventricular perfusion quantification with high temporal and spatial resolution. Additionally, we hypothesize that these techniques will result in a robust clinical protocol for adenosine stress CMR which will have high specificity.
The specific aims of this project are: (1) To develop spiral based-perfusion pulse sequences to perform absolute quantification of myocardial perfusion with whole heart coverage. (2) To evaluate adenosine stress CMR using spiral trajectories for both qualitative and quantitative assessment of myocardial perfusion in patients with an intermediate probability of CAD to determine the sensitivity and specificity using FFR as a functional gold standard. As nearly 40% of the greater than 1 million heart catheterizations which are performed annually in the US do not demonstrate obstructive CAD, improving the accuracy of non-invasive stress testing techniques could significantly reduce health care costs resulting from patients undergoing expensive and often unnecessary invasive procedures. Improved techniques would also reduce repeated testing for equivocal studies and reduce the number of incorrect diagnoses. Thus, this project has the potential to reduce health care expenditures while improving patient care.

Public Health Relevance

This proposal seeks to create highly innovative quantitative spiral cardiac magnetic resonance pulse sequences to improve adenosine stress CMR. As nearly 40% of the greater than 1 million heart catheterizations which are performed annually in the US do not demonstrate obstructive CAD, improving the accuracy of non-invasive stress testing techniques could significantly reduce health care costs resulting from patients undergoing expensive and often unnecessary invasive procedures. Improved techniques would also reduce repeated testing for equivocal studies and reduce the number of incorrect diagnoses. Thus, this project has the potential to reduce health care expenditures while improving patient care.

Agency
National Institute of Health (NIH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HL112910-03
Application #
8700494
Study Section
Special Emphasis Panel (ZHL1)
Program Officer
Scott, Jane
Project Start
Project End
Budget Start
Budget End
Support Year
3
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Virginia
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
City
Charlottesville
State
VA
Country
United States
Zip Code
22904
Hamirani, Yasmin S; Wong, Andrew; Kramer, Christopher M et al. (2014) Effect of microvascular obstruction and intramyocardial hemorrhage by CMR on LV remodeling and outcomes after myocardial infarction: a systematic review and meta-analysis. JACC Cardiovasc Imaging 7:940-52
Salerno, Michael (2014) Seeing the unseen fibrosis in heart failure with preserved ejection fraction. JACC Cardiovasc Imaging 7:998-1000
Salerno, Michael; Taylor, Angela; Yang, Yang et al. (2014) Adenosine stress cardiovascular magnetic resonance with variable-density spiral pulse sequences accurately detects coronary artery disease: initial clinical evaluation. Circ Cardiovasc Imaging 7:639-46
Kuruvilla, Sujith; Adenaw, Nebiyu; Katwal, Arabindra B et al. (2014) Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: a systematic review and meta-analysis. Circ Cardiovasc Imaging 7:250-8
Salerno, Michael; Kramer, Christopher M (2013) Advances in parametric mapping with CMR imaging. JACC Cardiovasc Imaging 6:806-22
Brooks, Jeremy; Kramer, Christopher M; Salerno, Michael (2013) Markedly increased volume of distribution of gadolinium in cardiac amyloidosis demonstrated by T1 mapping. J Magn Reson Imaging 38:1591-5
Lipinski, Michael J; McVey, Courtney M; Berger, Jeffrey S et al. (2013) Prognostic value of stress cardiac magnetic resonance imaging in patients with known or suspected coronary artery disease: a systematic review and meta-analysis. J Am Coll Cardiol 62:826-38