Non-invasive view into the heart

June 24, 2019

For patients with chest pain and presumably stable coronary heart disease (CHD), therapy depends primarily on how constricted the arteries that support the heart are (coronary arteries). This is often determined using an invasive procedure called cardiac catheterization. If necessary, the pressure in the coronary arteries is also measured. The combination of these methods is the currently the recognized standard for making therapy decisions. Cardiovascular magnetic resonance imaging (MRI) is an alternative for directly measuring the blood flow in the myocardium.

In contrast to cardiac catheterization, MRI is non-invasive, works without ionising radiation, can be done in 40 minutes and delivers direct measurements of the blood flow to the heart. The team headed by Professor Eike Nagel, Director of the Institute for Experimental and Translational Cardio Vascular Imaging at Goethe University was able to demonstrate that MRI measurements are as safe to guide decision-making as the currently used invasive procedure. Within the international MR-INFORM study, they examined 918 patients with an indication for cardiac catheterization to see if decision-making by an MRI scan led to the same results as the current invasive method.

Patients were randomly assigned to two groups. One group received the standard diagnostic investigation with cardiac catheterization and pressure measurement of the coronary arteries. The other had the 40 minute MRI scan of the heart to decide whether to send the patient on for invasive angiography.

In each study arm, constricted coronary vessels were dilated when indicated by the examination. In the following year, the physicians documented how many patients died, suffered a heart attack or required a repeated vascular dilation. In addition, they recorded whether the heart symptoms continued.

The result: in the group of patients examined by MRI, less than half required a diagnostic cardiac catheterization and fewer patients received a vascular dilation (36% vs 45 %). This means that with a fast and non-invasive MRI examination as the first test, both diagnostic and therapeutic cardiac catheterizations can be reduced. Importantly, the two groups did not differ in terms of continuing symptoms, the development of new symptoms, complications, or deaths.

"This means that patients with stable chest pains who previously would have received cardiac catheterization can alternatively be examined with MRI," concludes Professor Eike Nagel. "The results for the patients are just as good, but an examination by MRI has many advantages: the procedure takes about 40 minutes, patients merely receive a small cannula in their arm and are not subject to radiation." The physician hopes that the less invasive method will now be used as a method of first choice, reducing the need for cardiac catheterizations.

In contrast to Great Britain, where an MRI scan of the heart is paid for by the National Health Service (NHS), reimbursement is often difficult in Germany and usually has to be negotiated individually. In this regard, Nagel also hopes that the study will contribute to the acceptance of the non-invasive procedure and improve its availability.
-end-
Financial support was provided primarily by the British National Institute of Health Research (NIHR) via the Biomedical Research Centre (BRC) at Guy's & St. Thomas' Hospital, the German Centre for Cardiovascular Research (DZHK) and the company Bayer AG Deutschland.

A picture can be downloaded here: http://www.uni-frankfurt.de/78920068

Caption: Measuring blood flow in the myocardium with magnet resonance imaging (top). The dark area in the myocardium (arrows) shows a pronounced reduction of blood flow. The cardiac catheterization of the same patient (bottom) shows a clear constriction of the artery.

Credit: Eike Nagel, Goethe University

Publikation: Magnetic Resonance Perfusion or Fractional Flow Reserve in Coronary Disease
Eike Nagel, et al., N Engl J Med 2019;380:2418-28.
DOI: 10.1056/NEJMoa1716734

Further information: Professor Eike Nagel, Institute for Experimental and Translational Cardiovascular Imaging, Faculty of Medicine, Niederrad Campus, Tel.: +49 151 4197 4195, eike.nagel@cardiac-imaging.org.

Current news about science, teaching, and society can be found on GOETHE-UNI online (http://www.aktuelles.uni-frankfurt.de)

Goethe University is a research-oriented university in the European financial centre Frankfurt am Main. The university was founded in 1914 through private funding, primarily from Jewish sponsors, and has since produced pioneering achievements in the areas of social sciences, sociology and economics, medicine, quantum physics, brain research, and labour law. It gained a unique level of autonomy on 1 January 2008 by returning to its historic roots as a "foundation university". Today, it is one of the three largest universities in Germany. Together with the Technical University of Darmstadt and the University of Mainz, it is a partner in the inter-state strategic Rhine-Main University Alliance. Internet: http://www.uni-frankfurt.de

Publisher: The President of Goethe University Editor: Dr. Anne Hardy, Science Editor, PR & Communication Department, Theodor-W.-Adorno-Platz 1, 60323 Frankfurt am Main, Tel: -49 (0) 69 798-13035, Fax: +49 (0) 69 798-763 12531, hardy@pvw.uni-frankfurt.de.

Goethe University Frankfurt

Related Blood Flow Articles from Brightsurf:

Brain regions with impaired blood flow have higher tau levels
In Alzheimer's disease, impaired blood flow to brain regions coincides with tau protein buildup.

3D ultrasound enables accurate, noninvasive measurements of blood flow
A 3D ultrasound system provides an effective, noninvasive way to estimate blood flow that retains its accuracy across different equipment, operators and facilities, according to a new study.

Blood flow recovers faster than brain in micro strokes
Work by a Rice neurobiologist shows that increased blood flow to the brain is not an accurate indicator of neuronal recovery after a microscopic stroke.

Exercise improves memory, boosts blood flow to brain
Scientists have collected plenty of evidence linking exercise to brain health, with some research suggesting fitness may even improve memory.

3D VR blood flow to improve cardiovascular care
Biomedical engineers are developing a massive fluid dynamics simulator that can model blood flow through the full human arterial system at subcellular resolution.

MRI shows blood flow differs in men and women
Healthy men and women have different blood flow characteristics in their hearts, according to a new study.

Brain blood flow sensor discovery could aid treatments for high blood pressure & dementia
A study led by researchers at UCL has discovered the mechanism that allows the brain to monitor its own blood supply, a finding in rats which may help to find new treatments for human conditions including hypertension (high blood pressure) and dementia.

Blood flow monitor could save lives
A tiny fibre-optic sensor has the potential to save lives in open heart surgery, and even during surgery on pre-term babies.

Changes in blood flow tell heart cells to regenerate
Altered blood flow resulting from heart injury switches on a communication cascade that reprograms heart cells and leads to heart regeneration in zebrafish.

Blood flow command center discovered in the brain
An international team of researchers has discovered a group of cells in the brain that may function as a 'master-controller' for the cardiovascular system, orchestrating the control of blood flow to different parts of the body.

Read More: Blood Flow News and Blood Flow Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.