Nav: Home

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:

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.
Researchers closer to new Alzheimer's therapy with brain blood flow discovery
By discovering the culprit behind decreased blood flow in the brain of people with Alzheimer's, biomedical engineers at Cornell University have made possible promising new therapies for the disease.
In vitro grafts increase blood flow in infarcted rat hearts
Advances in stem cell research offer hope for treatments that could help patients regrow heart muscle tissue after heart attacks, a key to patients achieving more complete recoveries.
Balloon-guided catheters provide better blood flow following stroke interventions
Patients who have experienced a stroke as a result of blockages of the arteries in the brain have better outcomes with the use of balloon-guided catheter surgery as compared to having a conventional guided catheter procedure.
Scientists developed new contactless method of measuring blood flow in hands
Russian researchers proposed a new contactless method for measuring blood flow in the upper limbs.
Researchers investigate correlation between blood flow and body position
For the first time ever, an international research group detected alterations in capillary blood flow around the face caused by body position change.
Restoring blood flow may be best option to save your life and limb
Amputation for severe blockages in the lower limbs has a lower survival rate than other treatment options that restore blood flow.
Blood flow in the heart revealed in a flash
Researchers at Linköping University have for the first time been able to use information from computer tomography images to simulate the heart function of an individual patient.
More Blood Flow News and Blood Flow Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#540 Specialize? Or Generalize?
Ever been called a "jack of all trades, master of none"? The world loves to elevate specialists, people who drill deep into a single topic. Those people are great. But there's a place for generalists too, argues David Epstein. Jacks of all trades are often more successful than specialists. And he's got science to back it up. We talk with Epstein about his latest book, "Range: Why Generalists Triumph in a Specialized World".
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.