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Cardiovascular Institute

Research

A major focus of the Cardiac MRI Center is to advance non-invasive modalities that might complement, supplement or, ideally, replace certain other more invasive clinical tests. Such investigations include non-invasive assessment of the coronary arteries, evaluation of heart muscle blood flow, heart valve assessment, long-standing elevated blood pressure (hypertension) effects on the cardiovascular system, and effects before and after certain advanced surgical bypass procedures. In general, these investigations have immediate translation for clinical benefit.

Other avenues of research have more indirect or less immediate clinical implications but are addressing the mechanism or physiology of the disease. These studies add information for the clinician in terms of increasing our general understanding of the physiologic process yielding insights that can be directed to others in the future. For example, such investigations lead Cardiologists to better understand the effects of new drugs used in heart failure or hypertension, diagnosing women with chest pain, post-surgical results, and the assessment of complex valve disease.

The Cardiac MRI Center has the distinction of offering the only MRI research studies of its kind in Western Pennsylvania. For these studies, various aspects of the cardiovascular system are evaluated by cardiac MRI. These studies are performed free of charge to eligible patients. Various compensation strategies are available, and may include monetary compensation, parking, and/or medications.  Occasionally, these studies can be performed following a study ordered by your physician. The Institutional Review Board at Allegheny-Singer Research Institute reviews, approves, and oversees all research studies performed at the Cardiac MRI Center. These studies are also HIPPA compliant in the use and disclosure of Protected Health Information.

To inquire about your voluntary participation (or that of a family member or friend) in the studies listed below, or other studies at the Cardiac MRI Center, please call 412-359-6498 to speak to one of our staff physicians or Saundra Grant, RN, Clinical Research Nurse Coordinator. You may also e-mail us at sgrant@wpahs.org.
 


We are conducting research in the following areas:

 

Hypertension Study

A study for patients with enlarged and thickened hearts that ensues after years of high blood pressure (hypertension). Patients are randomized to certain medications with the MRI used to evaluate the hearts geometry and regression of muscle thickness after therapy. Medications are provided for a one-year evaluation.

Myocardial Viability Study

An MRI myocardial viability study (a study that shows blood perfusion to your heart or heart muscle) to evaluate a patient’s heart following a heart attack. The technique of imaging for potentially viable heart muscle following a heart attack has been shown by many throughout the world, including our Center, to be the ideal and most accurate test currently available to clinicians. Choosing the most appropriate intervention (medication, surgery or angioplasty) is critically dependant upon the results of such investigations.

Carotid Plaque Morphology Study

An MRI study evaluating carotid plaque morphology (composition of atherosclerotic plaque in the carotid arteries) in those with carotid disease but not on statins (a class of medications that inhibit cholesterol production that takes place in your liver). Patients eligible for the study receive free medications for one year. Evaluation of blood flow characteristics within the arteries is performed using MRI before and after one year of medication designed to favorable improve risk of strokes. Patients with lesions > 50% on either or both of their neck arteries are eligible for participation if they are not on cholesterol reducing agents or have only recently started them.

Non-Invasive Coronary Artery Imaging Study

A study to evaluate non-invasive coronary artery imaging. This study develops rapid cardiac MRI imaging for detection of coronary artery disease without the use of X-ray imaging or contrast injections. This is a major direction for use of cardiac MRI and has already been shown to be the reference standard for anomalous (not typical) coronary arteries.

Pulmonary Arterial Hypertension Study

The pulmonary hypertension patients are studied with cardiac MRI to evaluate the functional and morphological characteristics of the right ventricle and the pulmonary arteries. This study will assess the utility of MRI on cardiac remodeling in pulmonary hypertension patients prior to and following medical treatment. It will explore the correlation between the change in cardiac MRI derived parameters and the change in typical patient assessments for pulmonary hypertension. The goal is to distinguish patients into primary and secondary pulmonary hypertension based on the MRI imaging characteristics.

“Virtual Aneurysm” Model Study

The study reconstructs the 3D CT images to generate "virtual aneurysm" models (a 3-D picture of an aneurysm constructed using computer modeling) and/in combination with images/data from MRI to obtain intra-aneurysm flow predictions of aortic wall stress estimates for individual patients utilizing fluid flow conditions.  Completion of the study will allow the prediction of certain patient specific dynamic flow-induced and biomechanical forces on the aneurysm wall, which may be used as a pre-surgical planning technique and/or to evaluate the success of such surgery.

Diastolic Heart Function Assessment Study

Evaluation of diastolic heart function by cardiac MRI to demonstrate its feasibility as compared to echocardiography for its detection in those with preserved heart function but with symptoms of heart failure. This is a unique effort by the MRI research team and is one of the first to be attempted using MRI. It may offer the ability to serve as the reference standard for diastolic assessment as MRI now performs for the evaluation of systolic heart function.

Sleep Apnea Study

In those with obstructive sleep apnea, right heart function is often markedly impaired but often not well detected by current imaging strategies. Current efforts in the laboratory are directed at understanding the role of the heart as symptoms of sleep disturbance and central apnea progress and how they might improve with intervention (CPAP). Pre- and post-MRI's are performed following CPAP therapy for one-year.

Women with Chest Pain but No Coronary Artery Disease

Woman with chest pain but normal coronaries is a focus of interest that has received periodic support from major national funding agencies such as the NIH/NHLBI. We have demonstrated that MRI may be more sensitive to certain abnormalities than standard imaging. Work continues to explore the underlying abnormalities within the cardiovascular system to explain this important syndrome, as well to identify effective treatment strategies.

Safety and Efficacy of Inhaled Nitric Oxide during PCI to Decrease Heart Attack Size

A study to evaluate the safety and efficacy of inhaled nitric oxide to decrease heart attack size performed in conjunction with standard percutaneous coronary intervention (angioplasty or stent placement). This study seeks to determine if improved efficiency of the coronary blood flow may offer an advantage to standard therapy in those with an acute heart attack using the MRI as the detector of heart salvage.

CMR and Defibrillators in Evaluation of Heart Attack Damage and Risk of Sudden Death

CMR is the 'gold standard' for the detection of heart attack size. Patients who have had a heart attack in the past (recent or remote) may be eligible for a clinically indicated CMR and if their heart function is low they will be followed in a national database for certain clinical outcomes. If the heart attack is large but the heart function is preserved, the eligible patient may be eligible for an FDA approved, clinically indicated insertion of a defibrillator at no cost. The premise of this study is that the risk of sudden death may be more related to size of heart attack scar as determined by CMR then the traditionally determined ejection fraction (EF) as recent CMR studies have suggested. Two manners of entry into this study are possible: 1) a clinically indicated evaluation of their heart function and scar size as referred by their physician; 2) we have received special funding from the NIH to offer completely free scans to many patients who are interested on their own in participation.

Stem Cell Study in Heart Attacks

Ongoing studies utilizing human mesenchymal stem cells (HMC) during heart attacks are being studied using CMR to detect the amount of heart muscle that is salvaged after HMC administration. This is the first stem cell infusion study in the city of Pittsburgh to be used in humans in attempt to further reduce the substantial risk of death and complications following a heart attack. Patients who are interested are eligible, upon meeting certain criteria, and will receive a single 40 minute IV infusion of HMC's. Eligible patients may receive the therapy at up to 8 full days following their heart attack (only a one time infusion).  The first such randomized stem cell infusion took place in early November 2009 in a patient with a moderately large heart attack with return of heart function to nearly normal. There is no cost of participation for study related expenses for the interested patient.

LV Balloon Pump Assist during a Heart Attack

Ongoing CMR studies in conjunction with the Interventional Cardiology Department are investigating further methods to reduce heart attack size. Patients who meet certain criteria will have the opportunity to undergo simultaneous angioplasty and coordinated balloon inflation therapy. This technique takes advantage of the known advantages of reducing heart work by allowing a balloon to inflate/deflate to assist heart contraction thereby potentially reducing the surviving heart muscle's likelihood for further deterioration and death as it otherwise attempts to compensate for the dead muscle.

Eligible patients would have to be at AGH shortly after their heart attack for prompt angioplasty (and study inclusion) as is the standard for the treatment of all heart attacks. As always, there is no cost of participation for study-related expenses for the interested patient.

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