Experts discuss new directions in coronary care

The CIMIT Forum on Dec. 4 focused on “Advances in Intracoronary Diagnostics and Therapeutics,” and several heart specialists said that research must continue if the number of deaths from cardiovascular disease is going to diminish.

Speaking were Sahil Parikh, MD, Clinical and Research Fellow, Brigham and Women’s Hospital; and James Muller, MD, who is chief executive officer of InfraReDx, Inc., a company he helped create to provide better diagnostic tests to identify cardiovascular disease. Introducing the program was Ahmed Tawakol, MD, co-program leader, CIMIT Cardiovascular Disease Program; co-director, Cardiac MR-PET-CT Program; and associate director, Nuclear Cardiology, Massachusetts General Hospital.

Each year more than 1 million Americans suffer heart attacks. In many cases, the event is the first indication of heart disease, and is often fatal.

Experts say the cause of most heart attacks is rupture of a plaque in the coronary arteries followed by formation of a clot that blocks the flow of blood to the heart muscle.

Dr. Parikh said that until recently, use of drug-eluting stents (DES) has been a key strategy in treating such conditions. But a concern about toxicity has prompted cardiologists to be more cautions in recommending DES. He said that several years ago, cardiologists would call for a drug-eluting stent 90-95 percent of the time. Now doctors are recommending DES in about 75 percent of (appropriate) conditions.

Dr. Muller said that despite progress in dealing with heart disease, predicting serious heart attacks is still difficult. The company he founded, InfraReDx, Inc., is focused on providing improved diagnostic testing in predicting coronary episodes.

Dr. Muller, who once was closely involved with CIMIT, said that his company is working with the Food and Drug Administration in an attempt to receive approval for an improved tool for testing. Then the company will launch a large study to prove cost effectiveness.

 

Coronary heart disease is the leading cause of death in the United States, and 1.2 million fatal and non-fatal heart attacks occur each year.  Of these heart attacks, 700,000 occur in patients with no documented history of heart problems.  That more than half of all heart attacks occur without warning represents a major diagnostic failure and implies that new diagnostic techniques are needed.

Myocardial infarctions often occur when a lipid-rich plaque ruptures and causes an artery-clogging clot to form.  Unfortunately, current diagnostic methods are largely incapable of identifying lipid-rich plaques before they rupture.  With this problem in mind, researchers are exploring new ways to identify lipid-rich plaques.  Intravascular magnetic resonance imaging (MRI), which uses a magnetic coil small enough to fit inside an artery, presents one possibility; and optical coherence tomography (OCT) provides another.  At the moment, however, both of these techniques are hampered by blood, so both require arterial occlusion.  In contrast, near-infrared (NIR) spectroscopy, which characterizes a chemical mixture based on its absorption of NIR light, works even if the spectroscopic catheter is surrounded by blood.  NIR spectroscopy can differentiate between the fat in plaques and the fat in surrounding tissue, and early results indicate that the technique can be used to effectively identify lipid-rich plaques.  

Doctors may soon be able to make treatment decisions, such as whether to use a bare-metal stent or a drug-eluting stent in a given patient, based on the type of plaque that the patient has.  Hopefully, “personalized stenting” based on tissue type will be the method of the future.  Non-invasive molecular imaging techniques will also hopefully be developed to help doctors make informed diagnostic decisions.

   

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