DOPPLER-CIP

Determining Optimal non-invasive Parameters for the Prediction of Left vEntricular morphologic and functional Remodeling in Chronic Ischemic Patients

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 Obiettivo del progetto (Objective)

'Coronary artery disease (CAD) remains the primary cause of cardiovascular morbidity and mortality in Europe. In current clinical practice, patients with chronic CAD are followed using non-invasive imaging methodologies for possible adverse morphologic remodelling and functional recovery of the myocardium before the decision for invasive examinations and treatments is taken. Technological developments have brought about several newer imaging methodologies (and associated parameters) that have shown accurate prognostic results under study conditions in selected patient populations. Each of these methodologies offers intrinsic advantages and disadvantages due to the physiologic processes it tries to assess, due to the technology it requires or due to its availability (often determined by its associated cost). However, to date, no large scale studies have made a direct comparison of the different methodologies towards predicting adverse morphologic remodelling or functional recovery of the myocardium after medical therapy. The lack of such information results in a sub-optimal use of the methodologies at hand. The aim of DOPPLER-CIP is therefore to conduct a multi-centre clinical study including about 1200 patients in order to determine the optimal prognostic parameters derived from (new) non-invasive imaging for a patient presenting with suspected chronic ischemic heart disease. The modality used to extract these parameters is of secondary importance. However, as both the accuracy and the cost related to extracting a particular parameter is modality-dependent, DOPPLER-CIP will also make a cost-effectiveness analysis in order to determine which modality should preferentially be used to extract the clinically most relevant parameter.'

Introduzione (Teaser)

Comparison of the imaging modalities available for the prediction of remodelling in coronary artery disease (CAD) should help physicians make a more informed diagnostic decision.

Descrizione progetto (Article)

CAD remains the primary cause of cardiovascular morbidity and mortality in Europe. CAD is defined by arterial narrowing leading to an imbalance between myocardial oxygen consumption and supply (ischaemia) and ultimately coronary occlusion, resulting in myocardial infarction. This induces adverse changes in heart morphology and functional deterioration.

Treatment entails specific medication and often the restoration of blood flow through techniques like balloon angioplasty or a venous or arterial vessel graft to surgically bypass the stenosis. Given the associated risks of such invasive examinations and treatments, it is necessary to predict the morphologic remodelling and functional recovery of the myocardium.

A number of non-invasive imaging methodologies have been developed that could be used to predict remodelling. However, to date, no large scale studies have made a direct comparison of the different methodologies, resulting in their sub-optimal use.

The EU-funded http://www.dopplercip.be/ (DOPPLER-CIP) (Determining optimal non-invasive parameters for the prediction of left ventricular morphologic and functional remodelling in chronic ischemic patients) project conducted a multi-centre clinical study. Their objective was determining the most cost-effective imaging modality as well as the optimal prognostic parameters of each methodology.

The consortium recruited over 650 patients who undertook various examination tests during their first and follow-up visit two years later. Of these patients, over 50 % had no previous myocardial infarction, 36 % had previous infarction but preserved left ventricular function while 10 % had previous infarction and poor left ventricular function.

Analysis of the echocardiographic, the nuclear (SPECT) and the magnetic resonance imaging examinations should provide a direct comparison of the prognostic advantages of each modality.

The DOPPLER-CIP study outcomes should provide a better definition of potentially adverse conditions in CAD patients. Better prognosis of adverse morphological or functional remodelling events in cardiovascular patients should positively impact the quality of healthcare they receive.