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A gentle glance at the heart

In patients with chest pain and suspicion of stable coronary heart disease (CHD), therapy depends primarily on narrowing of the coronary arteries (coronary arteries). This is often studied by inserting a cardiology catheter. In case of doubt, pressure in the coronary arteries is further measured. The combination of both methods is currently the accepted standard for treatment decisions. A promising alternative to non-invasive and directly susceptible cardiac blood flow is Cardiovascular Magnetic Resonance (MRI).

Unlike CT tomography, MR does not require ionizing radiation and, moreover, provides more accurate blood flow measurement than usual techniques. Eike Nagel, director of the Institute for Experimental and Translational Cardiovascular Imaging at Goethe University, has demonstrated this. In the MR-INFORM study, 918 patients with cardiac catheterization indicators investigated whether the MR scan provided the same results as current invasive technique.

For this purpose, the patients were randomly divided into two groups. One group received standard heart catheterization with additional measurement of pressure in the coronary arteries, while the other group was noninvasively tested by MRI. When the MRI showed a weakened blood flow to the heart, the researchers planned to follow the catheter examination.

In each test arm, narrowed coronary arteries were dilated when shown in the study. During next year, doctors documented how many patients died, suffered a heart attack, or needed a new vascular dilax. They also noted whether heart problems are still present.

Result: In the MRI group, less than half of the patients needed a diagnostic heart catheter and fewer patients had vascular dilation (36% vs 45%). This means that modern MRI scans can save heart catheter screening for diagnostic and therapeutic purposes. However, both groups did not differ in terms of persistent complaints or the appearance of new complaints, complications, or deaths.

"This allows patients with stable chest pain, who have previously received a cardiologic catheter, to be examined alternately with blood flow metering using MRI," concludes prof. Eike Nagel. "The results for the patient are just as good, but the MRI scan has many advantages: It lasts less than an hour, patients receive only a small cannula in their arms and are not exposed to radiation." Hope the physician is now using a gentle review as a first-choice method and can thus store heart rate catheter reviews.

Unlike the United Kingdom, where the MRI heart rate is paid by the National Health Insurance Fund (NHS), it is still often difficult in Germany and usually negotiated individually. Nagel also hopes that the study on recognizing soft diagnostics will contribute to and improve care.

Financial support, inter alia, is provided by the British National Institute for Health Research (NIHR) through the Biomedical Research Center (BRC) at the Guy & St. Thomas, by the German Center for Cardiovascular Disease Research (DZHK) and Bayer AG Germany.

Download pictures can be found at: http://www.uni-frankfurt.de/78920068

Title: Measurement of heart muscle circulation by magnetic resonance (above). The dark area of ​​the heart muscle (arrows) indicates a marked circulation disorder. The cardiac catheterization of the same patient (below) shows clearly narrowing in the artery.
Copyright: Eike Nagel, Goethe University

scientific contact:
Information: Prof. Eike Nagel, Institute for Experimental and Translation Cardiovascular Imaging, Department of Medicine, Campus Niederrad, Tel: 0151 4197 4195, eike.nagel@cardiac-imaging.org

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

idw 2019/06