Advanced Cardiovascular Imaging
Extensive state-of-the-art imaging platforms for MRI, MRS, PET, and ultrasound for experimental, translational, and clinical imaging are available to this research consortium, including newly developed sequences, coils in CMRI and hybrid-imaging (with CMRI, US, X-ray). Scientific members of the various imaging teams have been the first in Europe (and in some instances the first world-wide) to validate, introduce and optimize new imaging techniques for a range of experimental and clinical applications.Advanced imaging techniques of the heart and the vasculature, as well as cells drawn directly from the patients in the studies, are of paramount importance for this translational approach to assess the beneficial effects of flavanols on response-to-injury processes within the cardiovascular system. The scientists within this research consortium will gain unrestricted access to three levels of imaging within the Department of Cardiology and the University of Düsseldorf:
Clinical Imaging
The dedicated expert teams in clinical imaging at the Division of Cardiology include:
- Echocardiography
- Cardiovascular Magnetic Resonance, CMR
- Hybrid Imaging
- Cardiac Intervention and Imaging
Translational Imaging
These expert teams work in close collaboration with experimental and translational imaging groups from other departments within the focus research area of cardiovascular diseases:
- High-field-MRI (Flögel, Schrader)
- PET/MRI (Shah)
- MRS (Roden/Schrader)
Cellular Imaging
In addition theCenter of Advanced Imagingof the Heinrich-Heine University provides access to all modern state-of-the-art molecular and sub-cellular imaging technologies including the following:
- Several confocal laser scanning microscopes for FRET and FLIM analysis (Zeiss LSM 510, Zeiss LSM 710, Olympus Fluoview 1000, Becker&Hickl DCS-120 for Nikon Ti-E, for FLIM, Olympus Two-photon microscope)
- Various confocal microscopes and intravital microscopy facilities
Within the Department of Cardiology three major aspects of clinical imaging in cardiovascular disease are of major importance for this consortium on flavanol research and the proposed clinical studies:
CMRI:
The use of magnetic resonance imaging for depicting the heart in rapid motion is a challenge that has been met by the deployment of sophisticated imaging sequences and advanced computer technologies. This has allowed real-time imaging and has enabled CMR-guided interventions. CMR is a state of the art imaging modality in modern cardiology that unifies different examination methods in one study to provide a full volume view of the whole heart. CMR assessment of ventricular function by cine-sequences is the current gold standard. Analysis of contraction can be further intensified using dedicated sequences for myocardial tagging and strain imaging. Magnetic resonance imaging itself yields unique tissue contrast, which provides valuable information for tissue characterization in inflammation (myocarditis) and remodeling processes (myocardial infarction), and is able to precisely differentiate different types of cardiomyopathies. The use of a contrast agent in MRI further increases the scope of its use because the extent of scar tissue can be precisely identified based on its characteristic delayed enhancement; small and great vessels can also be depicted more clearly. Fast image acquisition enables us to visualize the first pass of the contrast agent as a measure of myocardial perfusion, and this can be used for the prediction of functional coronary blood supply and the detection of myocardial ischemia. In recent years, cardiovascular MRI has evolved into one of the most important non-invasive modalities for the diagnosis of cardiovascular disease and is superior to other diagnostic imaging techniques due to its high spatial resolution. We have access to cutting-edge cardiovascular MRI imaging using the most sophisticated scanner hardware and software, including the latest pulse sequence designs for myocardial function (ultra-fast two- and three-dimensional pulse sequences for image acquisition, whole heart imaging, strain rate and sensitive encoding imaging); perfusion at rest and under stress (ultra-fast two- and three-dimensional pulse sequences for image acquisition, viability (two- and three-dimensional sub-second imaging sequences); vessel (ultra-fast bolus tracking contrast enhanced angiography, high resolution non-contrast cardiac triggered angiography using three-dimensional turbo spin echo techniques); and vessel wall imaging (ultra-high resolution black blood pulse sequences).One of our current research interests relies on ultra-fast myocardial perfusion imaging for the detection of coronary heart disease and the identification of microvascular disease. The ability to differentiate between significant and non-significant coronary artery disease is crucial. Invasive coronary artery angiography involves a luminogram. Using angiography, it can be very difficult to differentiate between coronary artery stenoses that profit from treatment and those that will not. Further evaluation is often required, especially for intermediate stenoses (>50%, <70%). Thus, for decisions regarding optimal therapy (interventional versus bypass surgery versus medical treatment), a more reliable and accurate diagnostic test is required. Our research in this area aims to evaluate MRI as a reliable and accurate non-invasive imaging technique for the optimal assessment of stenoses.
Echocardiography:
Patients will be investigated using 2D and 3D echocardiography. Global and regional systolic function will be assessed by 3D transthoracic echocardiography, and diastolic function and myocardial contractility will be investigated using deformation echocardiographic imaging. Here, 2D and 3D models will be applied for the detection of wall motion abnormalities using dedicated software (speckle tracking and strain imaging). With these features, global and regional myocardial function can be assessed. Additionally, contrast echocardiography will be used to detect perfusion deficits, matching functional aspects to myocardial injury. All these modalities will be integrated in a 3D echocardiographic model to characterize the relationship between myocardial perfusion and function during ischemia. Myocardial stress testing using dobutamine stress echo and cold pressure test will be performed using the hybrid 3D echocardiographic model to demonstrate the dynamics of coronary stenosis during exercise, with a predicted reduction in systolic global and regional myocardial function, contractility and perfusion flow. The echocardiographic imaging platform will allow us to establish the proof-of-principle that flavanols are able to reduce myocardial injury and ischemia after exercise in coronary artery disease.
Hybrid Imaging:
Our research focuses on magnetic resonance in the assessment of valvular heart disease and decisions on interventional therapy using multi-modality and multi-planar image fusion and cutting edge hybrid imaging. Our institution is currently one of two centers worldwide that provides cutting-edge hybrid imaging using multiple imaging modalities involving multi-modality and multi-planar image fusion. The 3D echocardiographic heart model for systolic and diastolic regional and global myocardial function, contractility and coronary flow will be part of the hybrid 3D whole-heart model, based on inputs from all imaging modalities (XperCt, echo, cMRI). In this context, the advantages of all the imaging modalities will be combined in a hybrid segmented heart model. Using this individual virtual heart model for every patient, all parameters of myocardial function, coronary perfusion and cardiac morphology can be assessed by exploiting the advantages of each imaging modality to generate a patient-specific heart model.