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Medical Lighting System Bologna – ITALY ph +39 051 721844 info@acem.it - www.acem.it Medical Lighting System STARLED3 NX MEDICA - DÜSSELDORF 12- 15 Nov 2014 Hall 10 Stand E 31 MEDICA - DÜSSELDORF SURGICAL LED LAMP FOR UNIVERSAL APPLICATIONS Rechargeable battery powered system on demand EUROPEAN HOSPITAL Vol 23 Issue 5/14 CARDIOLOGY The potential of cardiovascular magnetic resonance imaging Spain’s Institute for Cardiovascular Research Cardiomyopathy is a disease with many faces, a ‘chameleon’, according to Professor Jeanette Schulz-Menger. As Head of the working group Cardiac MRI at Charité, Campus Buch and head of Non-invasive Cardiac Imaging at Helios-Klinikum Buch, Berlin, she uses cardiac MRI to understand the disease better. ‘Cardiac MRI plays different roles in the diagnosis of the different forms of cardiomyopathy,’ the professor explained during our EH interview. The ‘crucial feature’ of this imag- ing modality is its ability ‘to differen- tiate possible myocardial damages’ in all forms of this cardiac disease, she pointed out, even when the pump function of the heart is intact. Even if echocardiography, for exam- ple, recorded normal cardiac per- formance in a patient, cardiac MRI can detect scar tissues and inflam- mations. Cardiac MRI is the modality of choice to record right ventricular pump function, because echocar- diography cannot handle the com- plex anatomy of the right heart. ‘The right ventricle is shaped like a backpack –it simply does not fit in any geometrical assumption,’ Prof. Schulz-Menger explained. While echocardiography tries to cut the right ventricle into many sections to be able to calculate pump function, she added, ‘MRI can generate a 3-D image of the heart, which allows us to evaluate the actual pumping performance.’ In dilated cardiomyopathy – the pathological enlargement of the heart muscle – MRI is used to identify the cause of the condition, such as perfusion problems, inflam- mations or scar tissue. ‘Scar tissue is easily visualised with contrast- enhanced techniques,’ she said. This is of utmost importance because patients with scar tissue on the myocardium are at a higher risk of sudden cardiac death or on-going weakening of the heart muscle. Moreover, cardiac MRI is increas- ingly used to examine the hearts of professional athletes, although this particular area has not yet been acknowledged in the relevant guidelines. Here, the task of cardiac MRI is to show whether a heart is enlarged due to intensive activity or due to a hypertrophic cardiomyo- pathy. While echocardiography can visualise a thickened heart mus- cle, unlike MRI it cannot unam- biguously identify cardiomyopathy. Furthermore MRI can identify heart muscle inflammation. Athletes who suffer this condition, and contin- ue training, might experience life- threatening arrhythmias, which may lead to sudden cardiac death. Professor Schulz-Menger is par- ticularly pleased that other disci- plines have begun to recognise the value of this: ‘Cardiac MRI is used for risk stratification purposes in non-cardiac diseases.’ In certain lung diseases such as sarcoidosis MRI can contribute to a more complete picture of the patient status. ‘Many young sarcoidosis patients die of sudden cardiac death due to con- duction disorders,’ she explained. Conventional diagnostic methods, however, detect only eight per- cent of cardiac involvement, while pathological studies have shown cardiac involvement in 40 percent of patients. Cardiac MRI could iden- tify these patients – ‘and,’ Professor Schulz-Menger said, ‘that’s great’. She would like to see MRI used more frequently and in a more tar- geted fashion, but that would need its benefits and the potential to be communicated better to a wider clinical audience. Close relatives of patients with hypertrophic cardio- myopathy also need to undergo an MRI scan because there could be a familial predisposition for the dis- ease. ‘If I am serious about diagnos- tics, each relative has to have a car- diac MRI,’ the professor pointed out, particularly since echocardiography is known for its poor detection of early signs of a hypertrophic car- diomyopathy. Additionally, a cardiac MRI scan is indicated when contra- dicting findings are reported, for example when an ECG yields differ- ent data than the echocardiography. Cardiomyopathy – the chameleon disease Stepping towards CD disease prevention MRI benefits and potential should be communicated better and to a wider clinical audience to be used more frequently MR image of myocarditis with fibrotic changes (white signal) MR image of hypertrophic cardiomyopathy Jeanette Esther Schulz-Menger has chaired cardiovascular magnetic resonance imaging at the Experimental and Clinical Research Centre (ECRC) in Berlin since 2008. The Max Delbrück Centre (MDC) and Charité jointly operate the centre. The professor’s research focus is on the evaluation of myocardial damage with cardiac MRI. A driving force behind the implementation of a 7T MRI scanner at MDC, she also sets great store by translating MRI research results into clinical practice. Report: Dr Eduardo de la Sota Cardiovascular disease develops in a slow and subclinical manner over decades, only to manifest sudden- ly and unexpectedly. Prevention is crucial, both before and after clini- cal appearance, and evidence is ample of the effectiveness of early detection of at-risk individuals and lifestyle modifications or pharmaco- logical approaches. However, those approaches require time, perseverance, and con- tinuous development. Special focus must be made in e.g. diet, weight control (obesity is a disease) and physical activity, among others. Led by Dr Valentín Fuster, The Spanish Institute for Cardiovascular Research (CNIC) was founded because – despite enormous advanc- es in diagnosis and treatment over the last 20 years – cardiovascular diseases remain the major cause of death in the developed world. The costs generated in economic, social and human terms are also immense. In response, the Spanish Government, through the Carlos III Institute of Health, created the CNIC to amalgamate the best Spanish cardiovascular research and provide a modern infrastructure and ample funding for biomedical research. CNIC research is grouped into three departments: • Vascular biology and inflam- mation (VBI). Here the com- plex interactions between the components of circulating blood and the vascular wall are inves- tigated, with e m p h a s i s on vessel wall re- modelling, inflamma- tion and c e l l - c e l l biology and signalling in m e t a b o l i s m and disease. • Cardiovascular development and repair (CDR). Researchers are investigating cell-cell inter- actions and signalling pathways operating during heart morpho- genesis and vascular develop- ment, the origin and mainte- nance of the pluripotent state, and the metabolic regulation and repair of the adult cardio- vascular system. • Atherothrombosis, imaging and epidemiology. This department develops non-invasive technol- ogies for molecular-resolution imaging that can identify and characterise vulnerable plaques. Combined with epidemiologic analyses, this approach pro- vides invaluable information on underlying molecular mechanisms of dis- ease, leading to tools for accurate diagnosis and targeted drug delivery. At the 19th World C o n g r e s s on Heart Disease in Boston, MA, topics ranged from clinical pathophysiology to evaluation and stratification techniques and molecular and cellular biology, including neurohumoral, immunological and genetic studies. The most relevant studies presented approached cardiovascular disease prevention and prognostic algo- rithms. These included two interest- ing Spanish studies. In the first, according to Dr R C Hermida from the University of Vigo, sleep blood pressure (SBP) is an independent predictor of cardio- vascular events. That study involved 11,255 subjects, 6,028 men/5,227 women. Dr Hermida concludes that mean SBP, but not daytime clini- cally measured BP, is a significant and independent prognostic marker of cardiovascular disease morbidity and mortality. These findings indi- cate ABPM (Asleep Blood Pressure Measurement) is a clinical necessity to accurately detect abnormal sleep- time BP and assess cardiovascular disease risk. In the second study, Dr M J Sanz from the University of Valencia), pre- sented a study to address effective strategies to treat and prevent ath- erosclerosis, using combined con- centrations of Rosuvastatin (Rosu) and bexarotene (Bex) on angio- tensin II (Ang-II)-induced arterial mononuclear cell (MC) recruitment. Research data suggest that com- bined administration of Rosu+Bex at suboptimal doses may constitute an alternative therapy to control vascular inflammation, minimising the appearance of drug-associated adverse effects. Thus, CD prevention is advanc- ing slowly, but showing clear evi- dence that physical and mental hygiene, medical controls, educa- tion and healthcare information will minimise mortality and morbidity of cardiovascular diseases, which cause much suffering, mortality and healthcare expenditure. ©private 16 ph +39051721844 info@acem.it - www.acem.it

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