Experts discuss cardiac issues as Forum reconvenes

The CIMIT Forum re-opened for learning and networking on Sept. 11 following an August hiatus with a discussion of issues relating to cardiac care.

After the session, CIMIT staff and guests adjourned for a reception to toast the 10th anniversary of the Forum.

One presenter was Patrick O’Gara, MD, vice chairman, clinical affairs, Department of Medicine at Brigham and Women’s Hospital. His session was moderated by Ahmed Tawakol, MD, co-director, Cardiac MR-PET-CT Program, and associate director, nuclear cardiology, Massachusetts General Hospital; and co-leader of the CIMIT Cardiovascular Disease Program.

Also presenting were Matthew Jolley, MD, of Children’s Hospital Boston, and Jeroen Stinstra, PhD, of the SCI Institute Utah. Moderator was Ron Kikinis, MD, director, Surgical Planning Laboratory of the Department of Radiology, BWH and Harvard Medical School, and professor of radiology, Harvard Medical School; and co-leader of the CIMIT Image Guided Therapy Program.

The title of Dr. O’Gara’s presentation was “Application of cardiac non-invasive imaging in clinical decision-making.”

He said challenges to the institutionalization of cardiovascular imaging include cost, safety (in relation to doses of radiation), quality of images, competence and appropriateness.

Dr. O’Gara said that clinicians have been challenged to understand the appropriate application in cardiovascular imaging, and to collaborate more effectively with imaging experts. Training programs have been developed but much work remains.

“Advances in CV imaging have been nothing short of fantastic,” Dr. O’Gara said. “In many ways they have preceded our ability to know how to use the technologies appropriately and cost-effectively. Issues about safety (radiation/contrast exposure) are still present. There are many more advances to come, particularly in the area of molecular imaging. But how will these impact treatment decisions and outcomes?”

Dr. Jolley spoke on the topic of “Modeling of optimal ICD electrode placement in children and adults.” He said that implantable defibrillators have become standard practice in large adults, but there is a reluctance to place them in the bodies of growing children. He stated that studies must continue to determine when and how such devices can be placed inside a youngster - or adults who would not normally be considered candidates for such technology.

Dr. Jolley is developing data with Dr. Stinstra, a software specialist who is based in Utah. Dr. Jolley credited CIMIT Fast Forward grants with providing the two (and their laboratories) with the resources (including financial support for transportation) to continue their work even though separated by many miles.

 

The cardiologist’s chief task is often not to make a diagnosis but to weigh the risks of a heart condition and to determine how aggressively it should be treated.  Over the past decades, imaging techniques have proved vital to cardiologists seeking to make these decisions.  As expensive new imaging methods proliferate, however, it has become important that physicians understand when each is warranted.  Dr. Patrick O’Gara, a noted cardiologist from Brigham and Women’s Hospital, suggests that imaging techniques should be cost-effective and safe and that they should provide results that are visually familiar, accurate, and reproducible.

The cost of imaging has become a major concern for both clinicians and insurers.  In a few cases, private practitioners have been suspected of recommending unnecessary imaging to increase revenue.  In more cases, patient care has probably suffered due to the lack of clear guidelines specifying when certain imaging techniques are and are not appropriate. 

The question of how best to reap the benefits of imaging technology will only become more pronounced as new procedures are developed.  One area of active research involves using molecular biomarkers to shed light on a patient’s cardiac health.  Such techniques may soon be used to detect early signs of ischemia and to identify dangerous arterial plaques.  These methods may someday allow cardiologists to diagnose heart problems before they clinically manifest themselves.       

Cardiologists are slowly moving toward a more personalized approach to medicine.  In addition to clinical data, scientists are beginning to use gene expression profiles and proteomics to assess risk.  With new techniques, however, come new challenges.  Costs can be high, and care providers sometimes lack the training to correctly interpret results.  If the potential of modern imaging is to be fully realized, the training that cardiologists receive will have to be altered.

   

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