AGH doctors tout potential of MRI as predictor of which heart failure patients will benefit most from transplantation or LVAD therapy.

An innovative cardiovascular magnetic resonance imaging ( MRI ) technique being investigated at Allegheny General Hospital (AGH) in Pittsburgh may provide physicians with a critical new tool for helping determine which patients with advanced heart failure will benefit most from heart transplantation or implantation of a left ventricular assist device (LVAD).

The AGH study is being presented today at the American College of Cardiology's 59th Annual Scientific Sessions by Robert Biederman, MD, Director of AGH's Cardiovascular MRI Center and AGH cardiovascular fellow Jose Venero, MD.   The program is part of the AGH Gerald McGinnis Cardiovascular Institute.

Drs. Biederman and Venero evaluated 18 patients suffering from dilated cardiomyopathy, a condition in which the heart becomes weakened and enlarged, to see if combining an intravenous contrast agent with MRI could show the extent of affected heart muscle and accurately determine risk stratification. The contrast agent shows up on the MRI scan as a distinct stripe in the compromised heart muscle.

Ten out of the 18 patients evaluated by the AGH team in the study had a contrast stripe on MRI and six of those required either transplant or LVAD therapy.

Patients without an MRI detected stripe, while no different in other clinical variables, did not require urgent intervention. Among these patients, there was stabilization and more often improvement in their objective clinical signs and symptoms, Dr. Biederman said.

No patient in the study died, but the presumption is that in those who urgently required heart transplantation or LVAD would have imminently died without it.

"Risk stratification among patients with advanced dilated cardiomyopathy is a significant challenge. Though more study is needed, MRI appears to offer us a unique, non-invasive crystal ball that could enhance our ability to conservatively manage low risk patients and aggressively care for those at high risk," Dr. Biederman said. "The potential benefits of incorporating such a technique into routine clinical practice would be enormous."

Source: WPAHS

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