Current CIRT Projects
The Cardiac Imaging Research Team (CIRT) is dedicated to fighting heart disease by developing powerful new diagnostic methods that can recognize at-risk individuals and evaluate atherosclerosis years or even decades before catastrophic events can occur.
CURRENT STUDIES:
PROJECT DESCRIPTIONS:
Cardiac Imaging Research Registry
Principal Investigator: Daniel S. Berman, MD
IRB Approval Number: 1752/4424
Contact: Nancy Zambrana (310) 423-3763
Status: Enrolling
The Cardiac Imaging Research Registry is an organized system of information derived from historical, demographical, clinical, imaging, and outcomes data from patients undergoing cardiac imaging procedures including nuclear cardiology SPECT and PET, cardiac CT, and cardiac magnetic resonance imaging at Cedars-Sinai Medical Center for use in ongoing and future research that will help advance the field of cardiac imaging focused around the following general aims:
1) to investigate technical questions such as issues related to the acquisition parameters, image processing, and quantitative analysis,
2) to investigate diagnostic capabilities to detect disease and assess risk compared to other assessments,
3) to investigate prognostic value to predict adverse outcomes of cardiovascular disease (CVD) and all cause mortality, and
4) to investigate the usefulness of the testing to guide clinical decision making and monitor therapy with the goal of preventing adverse outcomes.
CT-Based Coronary Plaque Feature Detection for Predicting Myocardial Ischemia (NIH funded)
Principal Investigator: Victor Cheng, MD
IRB Approval Number: 21458
Contact: Nancy Zambrana (310) 423-3763
Status: Enrolling
The purpose of this research study is to evaluate whether the appearance of coronary artery plaque (collection of cholesterol, cells, and debris) predicts changes in blood flow to the heart muscle.
There is evidence indicating that processes contributing to loss of blood flow to the heart may change the appearance of plaque on diagnostic imaging. Improving our ability to identify changes caused by these processes can help doctors better identify important coronary artery blockages and learn why some blockages cause more loss of blood flow than others. Information obtained from this study can potentially help heart doctors improve use of diagnostic tests and treatment options for coronary artery disease.
Subjects invited to take part in this study will have had a non-invasive coronary computed tomographic angiography (CCTA) that showed a significant blockage from plaque in at least one coronary artery, and are scheduled to undergo catheter-based (invasive) coronary angiography with fractional flow reserve measurement (measurement of fluid pressure in the coronary artery) for possible angioplasty. Prior to angiography, each subject will undergo PET myocardial perfusion imaging used to measure blood flow delivery to the heart muscle. During the angiography, blood will be collected from the aortic root to evaluate blood fat, cholesterol, and viscosity (a measure of "stickiness") levels, all factors that can affect blood flow to the heart muscle.
Automatic Quantitative CT Imaging of Pericardial Fat: A Novel Ischemia Predictor (NIH funded)
Principal Investigator: Damini Dey, PhD
IRB Approval Number: 13964
Contact: Damini Dey, PhD (310) 423-1517
Status: Data analysis only
The major goal of this project is to develop fully automated, accurate, new computer software for quantitation of pericardial fat from cardiac CT images acquired for routine assessment of coronary calcium to better identify patients who are “vulnerable” to sudden myocardial infarction.
Every year, 1 million people in the US will experience a heart attack or sudden cardiac death. A large percentage of these patients have no prior symptoms of any kind but suffer from silent heart disease (ischemia), which may cause a heart attack at any time. Currently there is no reliable screening method to identify people who may have silent heart disease and therefore are at risk of "heart attack". We seek to extract additional data from a non-invasive cardiac CT scan acquired for coronary calcium screening (commonly used in most imaging centers), which will improve cardiovascular risk assessment.
Principal Investigator: Victor Cheng, MD
IRB Approval Number: 19554
Contact: Victor Cheng, MD (310) 248-7964
Status: Enrolling
The purpose of this research is to improve our current ability to predict whether a patient with atrial fibrillation (heart rhythm abnormality) will receive sustained benefit from a procedure called "ablation". Radiofrequency ablation, a procedure that involves directing heat energy at specific regions inside the atria by manipulating a catheter, is often performed to eliminate atrial fibrillation and relieve symptoms when medications don’t work. However, ablation is not successful in everyone, and atrial fibrillation returns in approximately 30% of patients soon after the procedure.
Investigators will evaluate whether integrating data from imaging (cardiac CTA) and measuring electrical activity “mapping” of the left atrium will improve prediction of patients likely to fail ablation, when compared to imaging alone or electrical mapping alone. Improved identification of patients in whom atrial fibrillation recurs will help doctors better select appropriate patients for ablation and tailor techniques used during ablation to increase the chance of a positive outcome.
Principal Investigator: Daniel S. Berman, MD
IRB Approval Number: 22066
Contact: Nancy Zambrana (310) 423-3763
Status: Enrolling
This is a minimal risk, multi center trial to validate the use of a low-dose cardiac imaging protocol with a high-efficiency cardiac dedicated camera (D-SPECT) to detect myocardial perfusion (blood flow) abnormalities during myocardial perfusion single photon emission computed tomography (SPECT).
The standard SPECT procedure is performed with the Anger scintillation camera (A-SPECT) and requires the patient to lie immobilized on a table for 10-20 minutes and requires separate rest and stress images, taking 3-4 hours of patient time. The D-SPECT camera, a new nuclear imaging camera design allows very rapid images to be obtained. Shortening imaging time and reducing patient radiation exposure have become important challenges of nuclear cardiology over recent years.
Patients undergoing clinically indicated A-SPECT will be asked to have an additional ultra-low dose D-SPECT imaging study. Images from the two cameras will be compared with respect to presence/extent of perfusion defects and image quality.
Principal Investigator: Victor Cheng, MD
IRB Approval Number: 16182
Study Contact: Victor Cheng, MD (310) 423-4216
Status: Enrolling
The purpose of this research study is to evaluate whether the combination of specialized cardiac positron emission tomography (PET) and coronary CT angiography can reliably identify areas of inflamed coronary plaque (the potentially harmful build-up of cholesterol and cells along artery walls) in patients. The majority of heart attacks are caused by the sudden breakdown of inflamed coronary artery plaque. The ability to reliably detect such plaques would be a big step in helping physicians and patients prevent future heart attacks. This research study is designed to evaluate the computer software used to combine cardiac PET and CT scans in patients expected to have inflamed coronary plaque(s).
To qualify for this study, a patient must have been diagnosed with acute or chronic coronary disease and have undergone successful angioplasty and/or stent placement. After angioplasty, the patient will undergo specialized research heart PET and heart CT scans. Investigators will try to determine whether the combination of FDG PET and 64-slice CCTA can discern expected differences in plaque inflammation between those causing acute coronary syndrome and stable coronary disease. The investigators will merge images from the heart PET and heart CT scans to create a “hybrid scan” to determine the location of each inflamed coronary plaque. This information will be compared to results from the invasive coronary angiogram.
Principal Investigator: Daniel S. Berman, MD
IRB Approval Number: 24593
Contact: Nancy Zambrana (310) 423-3763
Status: Enrolling
The purpose of this study is to evaluate the use and safety profile of flurpiridaz F-18 imaging injection, in patients with a history of or suspected CAD, to determine if flurpiridaz F-18 injection PET imaging is better than the single photon emission computed tomography (SPECT) imaging currently used for this purpose. Flurpiridaz F-18 represents a new generation cardiac perfusion (blood flow) imaging agent that may have superior characteristics to currently used agents.
Participants in this study have had, or are scheduled to have, a clinical coronary angiogram, the gold standard for the detection of significant coronary artery disease. Research procedures include a screening visit and an imaging visit during which the subject will undergo rest/stress PET cardiac imaging using Flurpiridaz F-18.
PET has several technical advantages over SPECT that may account for improved image quality leading to increased diagnostic certainty when evaluating for coronary artery disease.
Principal Investigator: Daniel S. Berman, MD
IRB Approval Number: 3351/3974
Contact: Nancy Zambrana (310) 423-3763
Status: Data analysis only
Cardiac CT scanning has been shown to be useful in detecting subclinical coronary atherosclerosis, however the relative usefulness of cardiac CT findings, clinical, and biochemical assessments in predicting outcomes in coronary artery disease has not been fully explored. The Early Identification of Subclinical Atherosclerosis using NoninvasivE Imaging Research (EISNER) Study integrates the imaging (cardiac CT and nuclear cardiology), preventive cardiology, and basic cardiology aspects to improve the outcomes for coronary artery disease.
Study 1: CSMC Community (IRB# 3351)
The primary purpose of this prospective, randomized study is to determine if a particular combination of assessments (medical history and risk factor information, clinical and biochemical tests, and a cardiac CT scan) can predict future clinical outcomes (e.g. progression of atherosclerosis, heart surgery) in patients who have had no symptoms of coronary artery disease or other heart disease.
Study 2: Patients with Nuclear Cardiology Studies (IRB# 3974)
The primary purpose of this study is to determine if the information from a coronary calcium CT scan adds value to the information from a nuclear cardiology study in helping physicians make medical decisions.
Automated Quantitative Plaque Characterization with Coronary CT Angiography
Principal Investigator: Damini Dey, PhD
IRB Approval Number: 19424
Contact: Damini Dey, PhD (310) 423-1517
Status: Data analysis only
The investigators have developed a preliminary fully automatic volumetric analysis capable of accurate, rapid quantitation and characterization of atherosclerotic plaque lesions from standard coronary CT angiography and propose to refine, validate and evaluate the prognostic value of this approach. This goal will be accomplished through two specific aims: 1) validation of the developed methods by comparison to expert human observers and invasive “gold standard” modalities; and 2) assessment of the prognostic value in prediction of cardiac death.
Optimization of Image Quality and Radiation Dose in CT Angiography and CCS
Co-Principal Investigators: Daniel S. Berman, MD; Damini Dey, PhD
IRB Approval Number: 23737
Contact: Damini Dey, PhD (310) 423-1517
Status: Data analysis only
Recent developments in CT technology have made imaging of the coronary arteries possible at high resolution and speed. Strategies to reduce the radiation dose, while maintaining diagnostic image quality, are imperative for cardiac CT. The overall aim of this proposal is to improve image quality and minimize radiation dose for cardiac CT with the dual-source CT (DSCT) Siemens Definition scanner, currently operational at the Cedars-Sinai Medical Center.
Our specific aims are 1) to optimize radiation dose for coronary calcium scoring by combining lower x-ray tube voltage and tube current and 2) to optimize radiation dose in cardiac CT using new iterative reconstruction techniques.
The results of this research can be directly applied to clinical practice. Although developed for the dual-source CT scanner, results can be generalized to other CT scanners.
Principal Investigator: Daniel S. Berman, MD
IRB Approval Number: 25170
Contact: Nancy Zambrana (310) 423-3763
Status: Approval pending
Study contrast osmolality (a measurement of solution concentration) has long been considered to be one of the most important characteristics of X-ray contrast media leading to the sensations of coldness, heat and pain during injection. This randomized study will evaluate and compare the overall patient comfort profile between iodixanol (an iso-osmolar contrast medium) and iopamidol (a low-osmolar contrast medium) in patients undergoing contrast-enhanced CT (CECT) imaging of the abdomen/pelvis.
Immediately after administration of either iodixanol or iopamidol, subjects will be asked to rate discomfort that is temporally associated with the injection/infusion of the contrast medium. Other safety assessments include follow-up for adverse events will be made.
Awareness of the likelihood of patient discomfort based on contrast medium type can position health care personnel to select the appropriate medium to improve both patient satisfaction and overall diagnostic quality.
