Author + information
- Borja Ibanez, MD, PhDa,b,c,∗ (, )@Borjaibanez1,
- Anthony H. Aletras, PhDd,e,
- Andrew E. Arai, MDf,
- Hakan Arheden, MDe,
- Jeroen Bax, MD, PhDg,
- Colin Berry, MD, PhDh,
- Chiara Bucciarelli-Ducci, MD, PhDi,
- Pierre Croisille, MD, PhDj,
- Erica Dall'Armellina, MD, DPhilk,
- Rohan Dharmakumar, PhDl,
- Ingo Eitel, MDm,
- Rodrigo Fernández-Jiménez, MD, PhDa,b,n,
- Matthias G. Friedrich, MDo,p,
- David García-Dorado, MD, PhDb,q,
- Derek J. Hausenloy, MD, PhDr,s,t,
- Raymond J. Kim, MDu,
- Sebastian Kozerke, PhDv,
- Christopher M. Kramer, MDw,
- Michael Salerno, MD, PhD, MSw,
- Javier Sánchez-González, PhDx,
- Javier Sanz, MDa,n and
- Valentin Fuster, MD, PhDa,n,∗∗ (, )@CNIC_CARDIO
- aCentro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- bCIBERCV, Madrid, Spain
- cCardiology Department, IIS Fundación Jiménez Díaz Hospital, Madrid, Spain
- dLaboratory of Computing, Medical Informatics and Biomedical–Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- eLund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
- fNational Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- gDepartment of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
- hBritish Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, and Golden Jubilee National Hospital, Clydebank, United Kingdom
- iBristol Heart Institute, Bristol NIHR Cardiovascular Research Centre, University of Bristol and University Hospitals Bristol NHS Trust, Bristol, United Kingdom
- jUniversity Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
- kLeeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, United Kingdom
- lBiomedical Imaging Research Institute, Cedars-Sinai Medical Center, and Division of Cardiology, Department of Medicine, University of California, Los Angeles, California
- mUniversity Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
- nCardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York
- oDepartments of Medicine & Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
- pDepartment of Medicine, Heidelberg University, Heidelberg, Germany
- qVall d’Hebron University Hospital and Research Institute, Universtat Autònoma de Barcelona, Barcelona, Spain
- rCardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, National Heart Research Institute Singapore, National Heart Centre, Yong Loo Lin School of Medicine, National University Singapore, Singapore
- sThe Hatter Cardiovascular Institute, University College London, and The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Research & Development, London, United Kingdom
- tTecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico
- uDuke Cardiovascular Magnetic Resonance Center, Division of Cardiology, and Department of Radiology, Duke University Medical Center, Durham, North Carolina
- vInstitute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
- wDepartments of Medicine and Radiology, University of Virginia Health System, Charlottesville, Virginia
- xPhilips Healthcare, Madrid, Spain
- ↵∗Address for correspondence:
Dr. Borja Ibanez, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), c/ Melchor Fernandez Almagro, 3, 28029 Madrid, Spain.
- ↵∗∗Dr. Valentin Fuster, Mount Sinai School of Medicine, Cardiovascular Institute, One Gustave Levy Place, Box 1030, New York, New York 10029-6500.
• CMR is increasingly used for improved long-term risk stratification of post-MI patients and to initially evaluate cardioprotective interventions.
• There is a need to standardize CMR endpoints, which should rely on pathophysiology and association with hard endpoints.
• This document presents a consensus of recommendations of CMR endpoints selection in experimental and clinical trials.
• Universal standardization of CMR protocols/endpoints will accelerate the process of bringing cardioprotective interventions into clinical practice.
• Future studies should serve to introduce CMR as an indispensable tool affecting decision-making in daily practice.
After a reperfused myocardial infarction (MI), dynamic tissue changes occur (edema, inflammation, microvascular obstruction, hemorrhage, cardiomyocyte necrosis, and ultimately replacement by fibrosis). The extension and magnitude of these changes contribute to long-term prognosis after MI. Cardiac magnetic resonance (CMR) is the gold-standard technique for noninvasive myocardial tissue characterization. CMR is also the preferred methodology for the identification of potential benefits associated with new cardioprotective strategies both in experimental and clinical trials. However, there is a wide heterogeneity in CMR methodologies used in experimental and clinical trials, including time of post-MI scan, acquisition protocols, and, more importantly, selection of endpoints. There is a need for standardization of these methodologies to improve the translation into a real clinical benefit. The main objective of this scientific expert panel consensus document is to provide recommendations for CMR endpoint selection in experimental and clinical trials based on pathophysiology and its association with hard outcomes.
- area at risk
- clinical trial
- infarct size
- magnetic resonance imaging
- myocardial infarction
The CNIC is supported by the ISCiii, MICINN, and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (award SEV-2015-0505). This research was supported (in part) by the Intramural Research Program of the National Institutes of Health, National Heart, Lung, and Blood Institute. Agencies supporting the research of coauthors are acknowledged in the Online Appendix. The authors appreciate the scientific commitment of the sponsor unrelated to industrial interests. Dr. Arai has a U.S. Government Cooperative Research and Development Agreement with Siements; has a U.S. Government Cooperative Research and Development Agreement (Clinical Trial Agreement) with Bayer; and has a U.S. Government official duty (unpaid consultant) with Circle CVI (licensed software developed at the National Institutes of Health). Dr. Arheden is a shareholder in Imacor AB. Dr. Bax has received speaker fees from Abbott Vascular and Boehringer Ingelheim; and his institution has received unrestricted research grants from Medtronic, Boston Scientific, Biotronik, Edwards Lifesciences, and GE Healthcare. Dr. Berry has institutional agreements between the University of Glasgow (employer) and Abbott Vascular, AstraZeneca, Coroventis, DalCor, GlaxoSmithKline, HeartFlow, Novartis, Philips, and Siemens Healthcare. Dr. Bucciarelli-Ducci has served as a consultant for Circle Cardiovascular Imaging. Dr. Dharmakumar has a research agreement with Siemens Healthcare. Dr. Friedrich has served as a board member and advisor for Circle Cardiovascular Imaging. Dr. Kim has received an educational grant from Siemens Healthineers; and is cofounder of HeartIT LLC. Dr. Salerno has received research support from Siemens Healthineers. Dr Croisille’s institution holds a research agreement with Siemens Healthcare, Circle Cardiovascular Imaging, and Olea Medical. Dr. Sánchez-González is an employee of Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received April 17, 2019.
- Accepted May 15, 2019.
- 2019 The Authors