Project 20

Cardiac Imaging (MRI and CT)

The advanced cardiac imaging group is a joint initiative by the departments of cardiology and radiology and collaborates with several (pre-) clinical departments within the Erasmus MC. In 2017 research activities were a direct continuation of our work in assessment of several technological innovations and new clinical applications, i.e. computational fluid dynamics, stress myocardial perfusion imaging to assess the hemodynamic significance of obstructive coronary disease; PET-CT to diagnose endocarditis, CT in the follow-up of patients after Bentall surgery and 4D flow cardiac MRI in assessment of valve disease as well as the role of CT prior to cardiac surgery.
Together with the University of Tübingen the Erasmus MC has started a multicentre validation study (SPECIFIC trial) of dynamic stress perfusion CT for which enrolment commenced in 2016 and is ongoing. Other ongoing investigations include the implementation of cardiac CT in patients with stable angina (fast-track chest pain clinic).

Results of two clinical multicenter trials including the CRESCENT 2 trial investigating the use of CT myocardial perfusion imaging in stable chest pain and the IsoCOR trial which compares the effectiveness of two different contrast media for coronary imaging) were publishes. Both represent a collaboration between various Dutch centers, Furthermore, we  continued to participate in the ADVANCE registry in which patients with angina that underwent CT FFR (Heartflow) are enrolled and are actively followed-up.

In 2017 we continued and consolidated the "Endocarditis team" meetings. A team of cardiologists, radiologists, cardiac surgeons, nuclear physicians and infectious disease specialists provides consultation for patients with (suspected) endocarditis. During a single day, patients undergo echocardiography, cardiac CT and PET-CT. Results are discussed the same day by the team and used to provide a treatment advice. Experiences gained were included in a comprehensive article on prosthetic valve endocarditis published in the European Heart Journal. We completed our analysis of a large study on PET-CT in prosthetic heart valve endocarditis together with colleagues from UMCG, Haga, UMCU, MUMC and UMCN.

CT has an important role in the follow-up of patients that underwent thoracic aortic surgery or interventions. We assessed the normal and abnormal CT findings at different intervals after surgery in a large cohort of patients that underwent Bentall surgery and stenting of aortic coarctation.

For cardiac MRI, 4D flow imaging has been investigated in particular for patients with congenital heart disease. In 2017 several ongoing projects were performed with this new technique. A study is finalized in which shunt fraction is assessed with 4D flow in patients with atrial septum defect. Furthermore, the 3-year follow-up is started in bicuspid aorta valve and Turner patients in which also 4D flow is performed. Finally, we started a study in patients with hypertrophic cardiomyopathy to look at intra-cardiac flow.The group also supports several research projects including a study focussing on reduction of myocardial infarct size in ST-elevation myocardial infarction patients, risk stratification in patients with hypertrophic cardiomyopathy using cardiac MRI, and the effect of renal denervation on pulse wave velocity.

Principal Investigators

RPJ Budde, A Hirsch
Co-InvestigatorsA Bogers, M Dijkshoorn, A Dedic, EA Dubois, TW Galema, MGM Hunink, WJ Niessen, JW Roos-Hesselink
PhD candidatesM Arslan, S Boccalini, A Coenen, MM Lubbers, FMA  Nous, RG Chelu, T Springeling, LE Swart, N vd Velde