This is an application for competitive renewal of our project entitled "Contrast MRI and Chronic Myocardial Injury in Humans", which yielded many of the original papers in delayed-enhancement" MRI (DE-MRI), a technique that is now considered a fundamental component of the Cardiac MRI examination and used world-wide to evaluate patients with heart disease. Despite the successes, there remain crucial limitations in the evidence base and in the technique itself. First, very few prognostic studies have been performed, and as such, there is a paucity of evidence linking DE-MRI findings with patient outcome. Yet, prognostic studies are the bedrock of evidence-based clinical medicine and these will be vital in determining the exact role of DE-MRI in assisting patient management decisions. Second, DE-MRI exhibits excellent contrast between infarcted and normal myocardium;however, the contrast between infarcted myocardium and the blood pool (both of which are bright) is frequently suboptimal. Since a large proportion of infarctions caused by coronary heart disease are subendocardial, it is often difficult to detect small infarcts or, even if detected, to assess the precise size of the infarct. Given these limitations, we have identified two important "next steps" that we will tackle as part of our continuing project. First, we will aim to establish the prognostic implications of the DE-MRI findings. We propose to study patients with left ventricular dysfunction due to cardiomyopathy, a group at increased risk for sudden death (Aim 1). We hypothesize that an assessment of myocardial scarring by DE-MRI will provide additional prognostic information compared with a traditional assessment, including left ventricular ejection fraction. Second, we have developed a novel "dark-blood" DE-MRI technique (FIDDLE), which improves the detection of subendocardial infarcts. Our goal will be to optimize this technique in an animal model of myocardial infarction (MI), and then to compare this technique with conventional DE-MRI in a study of patients with documented non-Q-wave MI, which are often small and subendocardial (Aims 2 and 3). We hypothesize that FIDDLE will improve sensitivity for detecting MI, without reducing specificity. Given the worldwide epidemic of cardiovascular disease (30% of global deaths), a noninvasive technique that could improve the detection, risk stratification, and management of patients with heart disease would represent a significant advance. Accordingly, we believe that the results of this project could have a large clinical impact.

Public Health Relevance

Delayed-enhancement MRI (DE-MRI), a technique that is now considered a fundamental component of the Cardiac MRI examination, is used world-wide to evaluate patients with heart disease. Despite the successes, there remain crucial limitations in the evidence base and in the technique itself. This project aims to establish the prognostic implications of the DE-MRI findings and proposes a new technique to improve the detection of subendocardial infarcts. Given the worldwide epidemic of cardiovascular disease (30% of global deaths), a noninvasive technique that could improve the detection, risk stratification, and management of patients with heart disease would represent a significant advance. Accordingly, we believe that the results of this project could have a large clinical impact.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL064726-10
Application #
8644842
Study Section
Special Emphasis Panel ()
Program Officer
Buxton, Denis B
Project Start
2000-04-01
Project End
2015-03-31
Budget Start
2014-04-10
Budget End
2015-03-31
Support Year
10
Fiscal Year
2014
Total Cost
$487,785
Indirect Cost
$175,102
Name
Duke University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
White, James A; Kim, Han W; Shah, Dipan et al. (2014) CMR imaging with rapid visual T1 assessment predicts mortality in patients suspected of cardiac amyloidosis. JACC Cardiovasc Imaging 7:143-56
Shah, Dipan J; Kim, Han W; James, Olga et al. (2013) Prevalence of regional myocardial thinning and relationship with myocardial scarring in patients with coronary artery disease. JAMA 309:909-18
Klem, Igor; Shah, Dipan J; White, Richard D et al. (2011) Prognostic value of routine cardiac magnetic resonance assessment of left ventricular ejection fraction and myocardial damage: an international, multicenter study. Circ Cardiovasc Imaging 4:610-9
Weinsaft, Jonathan W; Kim, Han W; Crowley, Anna Lisa et al. (2011) LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR. JACC Cardiovasc Imaging 4:702-12
Patel, Manesh R; Cawley, Peter J; Heitner, John F et al. (2009) Detection of myocardial damage in patients with sarcoidosis. Circulation 120:1969-77
Kim, Han W; Klem, Igor; Shah, Dipan J et al. (2009) Unrecognized non-Q-wave myocardial infarction: prevalence and prognostic significance in patients with suspected coronary disease. PLoS Med 6:e1000057
Senthilkumar, Annamalai; Majmudar, Maulik D; Shenoy, Chetan et al. (2009) Identifying the etiology: a systematic approach using delayed-enhancement cardiovascular magnetic resonance. Heart Fail Clin 5:349-67, vi
Shah, Dipan J; Kim, Han W; Kim, Raymond J (2009) Evaluation of ischemic heart disease. Heart Fail Clin 5:315-32, v
Thomson, Louise E J; Crowley, Anna Lisa; Heitner, John F et al. (2008) Direct en face imaging of secundum atrial septal defects by velocity-encoded cardiovascular magnetic resonance in patients evaluated for possible transcatheter closure. Circ Cardiovasc Imaging 1:31-40
Klem, Igor; Greulich, Simon; Heitner, John F et al. (2008) Value of cardiovascular magnetic resonance stress perfusion testing for the detection of coronary artery disease in women. JACC Cardiovasc Imaging 1:436-45

Showing the most recent 10 out of 30 publications