Research
Cardiovascular diseases continue to be the number one cause of morbidity and mortality in the Western World. However, recent data suggests that such statistics are improving due to better and earlier diagnosis of cardiovascular diseases in addition to state-of-the-arts pharmaceutical and device interventions.

The Diagnostic CardioVascular Imaging Section (DCVI) at the David Geffen School of Medicine, UCLA, is one of the few medical centers in the world that combines the latest advances in imaging technology such as multi-detector computed tomography (MDCT) and magnetic resonance imaging (MRI), for the care of cardiac and vascular patients. This is in conjunction with traditional imaging modalities such as ultrasound, SPECT, and PET imaging. Patients benefit from the intimate collaborations between the DCVI, School of Medicine, University, and industry sponsors such as the Siemens Cardiovascular Research Collaborations Division.

The following represents a partial list of the current directions of research in the division:
Projects
MR ANGIOGRAPHY & CARDIAC MRI AT HIGH FIELD STRENGTH:
As systemic atherosclerosis continues to be the most common cause of mortality and morbidity in western countries, early diagnosis and treatment is mandatory. MRI has become established as a powerful and accurate non-invasive diagnostic modality for vascular disease and the recent introduction of advanced high-magnetic field MR systems has supported dramatic advances in this field. The DCVI's state-of-art 3.0 Tesla system (Siemens Magnetom Trio), which is equipped with 32 independent channels and a flexible receiver coil arrangement, is used to provide vascular imaging of all anatomical territories including head and neck, chest, abdomen, pelvis and the peripheral arteries. The advanced radiofrequency technology enables greatly improved performance and researchers in the DCVI section have applied this technology to create advanced imaging protocols for a variety of vascular territories.
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CORONARY IMAGING:
Coronary diseases continue to be the primary cause of heart failure, cardiac morbidity and death in the US. Currently, the gold standard for the assessment of coronary artery disease is an X-ray catheter angiogram, whereby small catheters are introduced into the groin artery and directed toward the coronary vessels. However, X-ray angiography is associated with a significant exposure to radiation, and a small risk of serious complications.
Additionally, X-ray angiography provides limited information about the functional significance of a lesion. Thus, there is a need for an alternative technique that would provide not only anatomic but also the functional information about coronary circulation in a non-invasive way.
With technical developments in the past few years, magnetic resonance imaging has developed as one such tool. Researchers at the DCVI and the Siemens Cardiovascular Research Center are working to develop new coronary angiography techniques using MRI.
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CARDIAC FUNCTION AND HEART FAILURE:
Thousands of patients in the US are afflicted with crippling heart failure each year. Yet, little is known about the mechanics of myocardial muscle in response to pharmacologic and device therapies. Recent data suggests that patients with ejection fraction <35%, prolonged conduction delays (>120 ms left bundle branch block), and class III-IV symptoms may benefit from multi-site pacing. However, up to 1/3 of patients who meet all the criteria for such a device, do not show any response. The UCLA-RESYNCH Trial is currently enrolling such CHF patients in an effort to use cardiac MRI and Echo Tissue Doppler Imaging in an effort ot statistically model the potential non-invasive predictors of responders to such device therapy. The hope is that in the near future, a non-invasive test assessing the regional myocardial performance would be highly predictive of which CHF patients will benefit (or not) from invasive device therapy, therefore, increasing survival, decreasing allocations of limited resources, and providing advanced therapy to those who may otherwise thought not to be a candidate for device therapy. Another trial, the CHF-STATIN trial, is also underway, in which the lipid-lowering class of drugs call statin are given to patients. Using advanced high-performance MRI sequences, the remodeling of the myocardium is being followed through the therapy's duration. If you are a patient or know anyone interested in enrolling, please contact our research coordinator
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ADULT CONGENITAL HEART DISEASE:
Advances in surgical techniques and a shift in paradigm toward earlier corrective surgery for neonates and children afflicted with complex congenital heart disorders have been tremendously fruitful, evidenced by the ever growing number of adult patients with a history of congenital defects. However, while these patients are living longer, they are presenting to medical centers world-wide with a challenging list of novel cardiovascular problems, such as right and left heart failure, leakiness of prosthetic valves, leakiness of grafts placed when young, and unfortunately, arrhythmias leading to sudden death. In an attempt to address the root of the growing problems, DCVI has started a trial, the UCLA MRI-Anatomic and Functional Assessment of Adult Congenital Heart Disease Trial, which enrolls specific types of adults with transposition of the great arteries, tricuspid atresia, functional single ventricles, and hypoplastic ventricle syndromes to assess via novel MRI techniques, the relationship between loading differences, altered myocardial anatomy, and fiber orientation.
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PEDIATRIC CARDIOVASCULAR RESEARCH:
One of the factors that can degrade imaging quality in MR Angiography is motion. Hence, voluntary gross body movements or breathing motion can seriously compromise the image quality of Contrast Enhanced MR angiography (CEMRA). In conscious adult patients, breath-holding can eliminate the motion artifact from CEMRA studies. However, in children and infants this issue needs to be addressed, to ensure that diagnostic image quality is obtained. The current protocol for imaging in children is carried out with either general anesthesia or deep sedation to deal with claustrophobia and eliminate gross body motion. To remove breathing motion artifact from children's angiography studies, at UCLA, we applied controlled apnea by suspending breathing through a ventilator, thus obtaining a much higher diagnostic image quality in this vulnerable group of patients.
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REMOTE SCANNING:
MR Imaging often requires specialized expertise for certain procedures, but specially trained, experienced physicians and technologists may not always be available at all centers. To address this issue we have developed a means of providing specialist scanning support via remote control from a central hub. This was successfully implemented at an in-patient MRI scanner, 0.5 miles from the hub and also at an out-patient scanner, located 6 miles from the hub. Remote controlled scanning was performed in several complex cardiovascular cases, and images with high diagnostic quality were obtained without any increase in scan duration. As this technology evolves, it seems likely that geographical separation will no longer present an obstacle to performing advanced techniques, and providing supervision and training.
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