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Cardiovascular Imaging: Not Just for Cardiovascular Trials

Cardiovascular disease is the leading cause of death globally with approximately 17.3 million deaths annually. Underlying heart disease are numerous conditions such as atherosclerosis, myocardial infarction, ischemic stroke, heart failure, arrhythmias and heart valve issues.

While cardiovascular imaging (CVI) plays a key role in the assessment, diagnosis and treatment of many of these conditions it is also an important tool for collecting safety and efficacy endpoint data in many cardiovascular clinical trials. However cardiovascular disease is not the only therapeutic area in which CVI provides critical data in clinical research studies. Here at Bioclinica Medical Imaging and indeed across the industry, we are seeing growing interest in increasing understanding of the impact of new non-cardiovascular treatments on the heart and peripheral vasculature. We explore some of these non-cardiovascular therapeutic areas of research below.

Oncology

New and existing oncology therapies have shown cardiotoxic effects. For example, the impact of chemotherapy agents such as the family of anthracyclines have shown to develop cumulative dose-dependent decreases in left ventricular ejection fraction. Cardiovascular imaging modalities including echocardiography, cardiac MR and MUGA are utilized to monitor changes in LVEF, wall motion abnormalities and global longitudinal strain. And in some circumstances, strain imaging may predict the impact on cardiac function early on before symptoms appear.

Muscular Dystrophy

Cardiac disease is a common manifestation of Duchenne and Becker muscular dystrophy. Death in these patients is usually due to ventricular dysfunction, heart block or malignant arrhythmias. Early detection of heart involvement is possible via echocardiographic and cardiac MR evaluations. Assessments of strain, T1 mapping and fibrosis detection through late gadolinium enhancement are possible and may be important tools for trials evaluating safety and efficacy of new MD therapies.

Inflammation

Inflammation is a risk factor for heart disease, no matter its origin. Rheumatoid arthritis (RA), gout, lupus and psoriatic arthritis are conditions that significantly increase the risk of developing heart disease including heart failure and atherosclerosis, especially when conventional risk factors are present, i.e. high blood pressure, diabetes, high LDL and smoking.

Available medications to treat these conditions can both increase and lower heart disease risk. For this reason, it is important to consider a cardiovascular imaging modality to monitor these effects, whether it be cardiac function through echocardiography or cardiac MR, or monitoring the development of atherosclerosis through angiographic or vascular ultrasound techniques.

Diabetes

Approximately two-thirds of deaths among persons with diabetes are related to cardiovascular disease. Many imaging modalities have been evaluated for risk assessment of these patients and have shown valuable prognostic information both clinically and in clinical research studies. Cardiac MR, for instance, is highly accurate in detecting abnormal left ventricular function and tissue characteristics when delayed gadolinium enhancement is incorporated into the imaging protocol in addition to T1 mapping. These assessments are particularly useful in predicting events in asymptomatic patients and may be a useful strategy within a diabetes treatment study.

These are just a few examples of how cardiovascular imaging may benefit investigations within non-cardiovascular therapeutic areas and should be considered within treatment development programs. The imaging modality chosen for a specific application and the monitoring frequency should be discussed early in the research process. Among the key considerations are modality sensitivities, variability, availability, expertise and pre-specified endpoints such as degrees of tissue damage, myocardial dysfunction and recovery and vascular impact.

Bioclinica Cardiovascular Imaging Services has supported many studies investigating therapies in non-cardiovascular therapeutics such as Duchene’s Muscular Dystrophy, Hunter Syndrome, Fabry Disease and Oncology.

For inquires on how we may support your study, contact Tim Crowe, Director, Cardiovascular Imaging, tim.crowe@bioclinica.com.

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