DOPPLER - CIP Determining Optimal non-invasive Parameters for the Prediction of Left vEntricular morphologic and functional Remodeling in Chronic Ischemic Patients Jan D’hooge on behalf of the DOPPLER-CIP consortium
Philips Healthcare GE Healthcare MedViso
Cardiac morphologic remodelling Ischemia Infarction Loading Valve disease Myopathies … Dilated (failing) heart Normal heart Irreversible process Early detection of remodelling process critically important to start treatment early Coronary Heart Disease: ~2 million deaths/year in Europe (~25% of all deaths) Better treatment primary Increasing incidence of heart failure disease Amplified by aging population
Detection of remodelling Ultrasound Magnetic resonance SPECT Which parameter and which modality has the best predictive power?
Study design 2014 2015 2009 2010 2011 2012 2013 Prep Recruitment Follow-up Stats • • 676 patients stable coronary artery disease 617 patients returned for follow-up examinations 2y after inclusion (8% drop-out) patients (i.e. one positive test for ongoing ischemia) in 6 clinical centres across Europe • Clinical data, quality of life • As many imaging exams as logistically • Imaging to determine remodelling (Echo, possible (Echo, SPECT, MRI) MRI) • Blood samples, clinical data, exercise testing, quality of life questionnaire All data analysed in a blinded, anonymized manner by core-labs
Results LV EDV Measured with MR
Predicted Probability of Remodelling Likelihood of remodeling Likelihood of remodeling LV EDV @ BL LVM @ BL Small ventricles with thick walls more likely remodel
Conclusion In this group of stable CAD patients – Morphologic remodeling is best predicted by morphologic characteristics of the LV, in particular EDV – EDV measured by MRI showed to be the most prognostic. A future cost-benefit analysis will need to demonstrate if this continues to hold when cost for the exam is taken into account. – Remodeling is frequently observed – Occurs often in normally sized ventricles! – Goes against the well-established hypothesis that the cause of remodeling is increased wall stress
DOPPLER-CIP team Linkoping Madrid Jan Engvall Pepe Zamorano Tino Ebbers Covadonga Fernandez-Golfin Luis Miguel Rincon Diaz Gidby Gunborg Lars-Ake Levin Magnus Husberg Oslo Thor Edvardsen Margareth Ribe Leuven London - KCL Sebastian Imre Sarvari Nina Hasselberg Frank Rademakers Eike Nagel Jan D’hooge Valentina Puntmann Pisa - CNR Piet Claus Uni Pisa Radmila Maksimovic Valerie Robesyn Rosa Sicari Ruta Jasaityte Luna Gargani Vitantonio Di Bello London - KCH Oana Mirea Gennaro D’Angelo Iacopo Fabiani Jens-Uwe Voigt Mauro Raciti Lorenzo Conte Kaatje Goetschalckx Mark Monaghan An Belmans Michelle Andrews Turku AMID Ana Daraban Alexandros Papachristidis Heikki Ukkonen Gianni Pedrizzetti Lieven Herbots Peter Pearson Juhani Knuuti Giovanni Tonti Tom Standaert
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