The Department of Cardiology at the University Medical Center Groningen is a dynamic department that carries out quality research. Cardiovascular diseases are the leading cause of death no. 1 and most of them are caused by coronary artery disease. The "ischemia" research group has extensive experience in conducting research into the cause and treatment of coronary artery disease and heart attacks. In recent years, we have carried out small hypothesis generating projects as well as large clinical trials. This has led to publications in leading journals such as The New England Journal of Medicine, The Lancet, Circulation, JACC, Nature and Nature Genetics. We have successfully supervised more than 30 student projects at several levels (bachelor, master, MD/PhD). We are currently investigating early detection of cardiovascular disease using sophisticated noninvasive imaging techniques. This research takes place in close cooperation with the Center of Medical Imaging and Radiology Department of the UMCG. Cardiovascular disease is the leading cause of death in Europe and most other industrialized countries. It is still very difficult to early identify individuals who are at high risk of developing cardiovascular disease such as myocardial infarction and heart failure. Cardiac MRI is the current reference standard for assessing functional and structural changes of the heart.(1) We currently have MRI scans and baseline characteristics of 8,000 subjects aged 40-69 years old available for retrospective analysis. This is by far the largest number of CMR scans ever made in a single study. (2) Besides retrospective analysis, there is also the possibility of involvement in two large prospective studies. CT evaluation of coronary artery calcium (CAC) is the emerging superior method for identification of people at high risk for heart disease.(2,3) In high-risk patients (CAC>400) the yearly event rate is increase by ~10-fold. The optimal strategy for early diagnosis of severe coronary artery disease (CAD) has not been investigated. A multicenter trial will soon start, aiming to include 830 asymptomatic individuals with a high CAC score (>100). These patients will undergo a perfusion MRI scan using adenosine. A considerable proportion of costs related to the management of CAD is due to invasive coronary angiography, indicated in high-risk patients. Imaging techniques show promising potential to replace a large proportion of invasive coronary angiography.(4-6) A prospective observational study will soon start, aiming to include 440 symptomatic patients at high risk of CAD and referred for invasive coronary angiography. Patients will undergo a diagnostic algorithm consisting of a coronary CT angiogram and perfusion MRI scan before invasive coronary angiography, with a second perfusion MRI scan only when the patient received a coronary intervention.
Our general aim is to investigate the value of (novel) cardiac imaging biomarkers to predict the existence of significant coronary artery disease, development of heart failure, cardiovascular events and mortality. The large amount of available data provides for a broad range of problem definitions arising from our general aim. You are encouraged to suggest a specific topic of interest that you want to investigate. Examples of possible problem definitions are:
1. Efficiently extract as many quantitative cardiac MRI biomarkers as possible from a large set of individuals.
2. Discover novel, specific cardiac imaging biomarkers to identify individuals that will remain healthy.
3. Discover novel, specific cardiac imaging biomarkers to identify individual that are at high risk for developing cardiovascular diseases (e.g. heart failure, myocardial infarction, atrial fibrillation or valvular dysfunction).
4. Determine the diagnostic accuracy of noninvasive imaging techniques compared to invasive coronary angiography.
5. Predict the effect of revascularization, using change in perfusion pre- and post-revascularization.
6. Establish a diagnostic and prognostic algorithm for the use of noninvasive imaging techniques in high risk CAD patients.