| Backgrounder: | ||
| June 15 Press Conference | Speaker Biographies/Remarks | |
Remarks: This week marks the official opening of the NIH-Suburban MRI Center: A Heart and Stroke Research and Care Program. The opening of the Center represents the beginning of a unique alliance between one of the world's top biomedical research centers and a community hospital committed to the best in cardiovascular diagnosis and care.
The collaboration will have profound benefits for the millions of people all over the world who, each year, are felled by stroke or heart attack. Equally important, the patients at Suburban Hospital will benefit immediately by having prompt access to research and treatment protocols that are second to none in the world.
Remarks: According to the National Center for Health Statistics, there were 952,000 cardiovascular (CV) deaths in the United States in 1997. Heart attack and stroke are responsible for most of these fatalities.
Despite an encouraging drop of 36% in age-adjusted CV mortality between 1977 and 1997, the absolute death rate from cardiovascular disease has been flat in recent years because of an aging population.
Both prevention and treatment of CV disease require accurate diagnosis of those who are at risk of developing the disease and accurate sub-grouping of those experiencing heart attack or stroke. Seriously ill persons require a different approach than the more mildly afflicted.
Suburban Hospital admits approximately 200 patients with heart attack and 200 patients with stroke each year. An additional 300-400 patients are admitted with chest pain without evidence of heart damage.
Beginning in the next several months, Suburban patients with these disorders will have the opportunity to participate in NHLBI and NINDS research protocols that will attempt to define the role of MRI in diagnosis of these maladies. MRI promises to be a valuable technique for the evaluation of these complications of atherosclerosis.
I believe that this research effort will quickly define the place of MRI in the early diagnosis of CV disease and will result in improved treatment and perhaps better prevention in those of us destined to fall ill with this disorder.
Robert Balaban, Ph.D., is Chief of the
Laboratory of Cardiac Energetics at the National Heart, Lung,
and Blood Institute of the National Institutes of Health. He has
a B.S. degree in chemistry and biology from the University of
Miami and a Ph.D. in physiology and pharmacology from Duke University.
He was a NATO fellow at Oxford University in biochemistry. His
research targets the complex physiological control networks that
regulate the energy metabolism of the heart, and focuses on the
use of non-invasive techniques to better understand these processes
in isolated enzymes, organelles, cells and humans. Currently,
he is studying the application of MRI to the study of the heart.
He has co-authored 190 peer-reviewed papers, and more than 600
abstracts.
Remarks: Magnetic resonance imaging or MRI is a noninvasive technique that can be used for rapid diagnosis of heart disease. Timing is critical in the treatment of heart attack and heart disease -- and a quick, accurate diagnosis leads to faster treatment. As you will soon hear from Dr. Arai, we hope that this new study will define MRI's potential to more quickly and accurately identify heart attacks so patients can benefit from earlier treatment.
Magnetic resonance imaging or MRI uses magnetic fields to take pictures of the inside of the body from any angle or orientation. This produces a practically ideal view of the anatomy of the heart and the blood vessels.
Over the last 3 years, engineers and technical staff at the NHLBI have worked to improve the technology of the scanner. The new MRI now has adequate speed to freeze the motion of the heart and to capture dynamic information about how well the heart beats.
Cardiac MRI also provides unique methods that accurately measure or quantify regional function in small areas of the heart.
These new developments in MRI have quickly reached the level where clinical evaluation is appropriate. We hope that the close collaboration between the clinical staff at NIH and Suburban Hospital combined with extensive technical expertise at the NHLBI will quickly adapt this tool for routine clinical use.
Andrew Arai, M.D., is an investigator
in the Section on Cardiovascular Imaging of the Laboratory of
Cardiac Energetics at the National Heart, Lung, and Blood Institute
of the National Institutes of Health. He received his B.S. degree
in 1982 from Cornell University and his M.D. in 1986 from the
University of Illinois, College of Medicine. He is a board-certified
cardiologist. His research focuses on the clinical application
of cardiovascular magnetic resonance imaging and the development
of non-invasive methods to study cardiac anatomy, perfusion, function
and viability in the human heart.
Remarks: Diagnosis of heart disease frequently requires information about cardiac anatomy, heart pump function, regional heart blood flow, and blockages in the coronary arteries.
To acquire all of this information in a given patient currently requires several medical tests.
MRI has the ability or potential to acquire all of this information in a single test. People have said that MRI could be a "one stop shop" for the diagnosis of heart disease.
These tools are applicable to the majority of patients with any form of heart disease, including angina, coronary artery disease, heart attacks, heart failure, valvular heart disease, and other less common diseases.
Managing patients with coronary artery disease, the leading cause of death in this country, requires us to detect small blockages in the coronary arteries. These blockages cause abnormal blood flow to some parts of the heart and, in the most severe form, cause a heart attack.
Recent developments here at the NIH have allowed us to image areas of the heart that have inadequate blood supply.
These new MRI diagnostic tools capture this information very quickly in less than 2 minutes.
The reason this speed is important relates to the irreversible damage that occurs during a heart attack. When the blood flow to a part of the heart is blocked by a blood clot in the coronary artery, that part of the heart starts to die within about 15 minutes. During longer periods of inadequate blood flow, more and more permanent damage to the heart muscle occurs.
We now have very effective treatments to stop a heart attack and prevent further damage. These blood thinning treatments or balloon treatments save lives and prevent further heart damage. All of these treatments work better the faster they can be started. So a rapid diagnosis is critically important. Only about 40 percent of patients coming into a hospital emergency room with chest pain can be immediately diagnosed with heart attack using standard testing. Most patients must have additional tests or further hospitalization before they can be diagnosed.
In this new study, MRI will help us triage those emergency room patients who cannot be immediately diagnosed and must wait for additional test results. Patients with milder chest pain such as possible angina will be evaluated with MRI and with traditional clinical evaluation. Of course, patients who have a definite heart attack will be treated with current therapies such as a clot
busting drug or balloon angioplasty. MRI evaluation of these patients will occur after stabilization. Scanned images from this study and the stroke component you will hear about in a moment will be archived into a database to keep track of patient results and to use as a source of clinical information for future studies.We believe MRI is well suited to making the critical measurements to diagnose these patients. This will be the first use of this form of high technology anywhere in the world to improve the assessment of patients directly out of the emergency room. The high image quality provided by this equipment will translate to improved diagnosis of patients with the most common heart disease in the country.
Steven Warach, M.D., Ph.D., is Chief
of the newly formed Section on Diagnostics and Therapeutics in
the Stroke Branch of the National Institute of Neurological Disorders
and Stroke (NINDS). He earned his B.S., M.A. and Ph.D. degrees
from Michigan State University in psychology and neuroscience.
He received his M.D. degree, completed residency in neurology,
and MRI fellowship training at Harvard Medical School, where he
had been on the faculty in the Neurology and Radiology Departments
prior to his recruitment by NIH. He is internationally recognized
for his pioneering research in the use of new MRI methods for
the diagnosis and study of neurological disease, particularly
stroke. His most recent work has focused on better ways to develop
and test new stroke therapies with MRI, and he has played a major
role in designing several international clinical trials evaluating
new medicines to treat stroke by using MRI.
Remarks: Every 43 seconds another person suffers a stroke. Every three and a half minutes someone dies from a stroke. Stroke is the 3rd leading cause of death, and the leading cause of long term disability in adults. The cost of caring for stroke patients is approximately 40 billion dollars per year. It was three years ago that the clot-busting drug, tPA, after an NINDS sponsored study, became the first medicine approved to help patients suffering stroke, and, as recently reported, this benefit is lasting. However, three years have passed and tPA is still the only FDA approved therapy for stroke, it is only the first step, and we need to find ways to treat those people for whom tPA is not the answer. Attempts over the last several years to develop other safe and effective therapies for stroke patients have not been successful. We need a new approach to finding therapies for stroke patients. This program embodies that new approach.
Stroke is a process not an event. It does not mean immediate, irreversible damage. The newer MRI scanning methods--called diffusion MRI and perfusion MRI--have shown us that the stroke process evolves over hours and days and that injured parts of the brain can be prevented from progressing to permanent damage if treated with appropriate drugs. Research in patients with the new MRI methods has already improved the early diagnosis of stroke, and has given us a picture of the ongoing brain injury during stroke. The MRI will allow us to evaluate new therapies at Suburban hospital by seeing if they reduce the brain damage caused by an ongoing stroke. Medicines that reduce the amount of brain damage are the ones most likely to make patients better. Our goal is to identify new types of therapies that reduce permanent brain damage. Once identified, a potential therapy can be tested in a larger group of patients across the nation to determine if it is safe and if improves the function of the stroke patient --if it helps them to better walk, talk, and lead independent lives.
The research program will be integrated with a new comprehensive multidisciplinary stroke care program at Suburban Hospital, which will begin this fall. Over this summer we will bring all of the elements of the program together to be able to offer to stroke patients who come to Suburban Hospital the expertise and systematic care of a team of emergency physicians and nurses, neurologists, internists, intensive care physicians, rehabilitative therapists as well as the NIH treatment and research team. This team will be always on call to offer the highest quality of care and to offer patients the opportunity to participate in research to discover new and better ways to improve recovery from stroke.
Wayne Olan, M.D., is the Director of
Neuroradiology and MRI Services at Suburban Hospital in Bethesda,
Maryland. He completed his medical education at the University
of Health Science of the Chicago Medical School and his residency
at Bronx-Lebanon Hospital Center, an Albert Einstein-affiliated
hospital in New York. Prior to joining Suburban Hospital in 1998,
he served as Chief of the Neuroradiology Section at George Washington
University Medical Center in Washington, DC. He continues as a
clinical associate professor of radiology and neurological surgery
at George Washington University and also serves as a consulting
physician for the Department of Radiology/Section of Neuroradiology
at the National Institutes of Health. He is certified by the American
Board of Radiology and is a senior member of the American Society
of Neuroradiology. He has published a dozen articles dealing with
stroke, aneurysms and other neurological conditions, and has presented
more than 60 case studies and abstracts at conferences throughout
the world.
Remarks: Suburban Hospital is the only community hospital, and one of fewer than 50 facilities in the world, with this level of imaging technology. This offers extraordinary benefits to the health of our community. Heart attacks and strokes are emergency situations where time is of the essence. The majority of these events tend to occur in the community setting where people live or work.
When a patient is stricken with symptoms of a stroke or heart attack, the community hospital must be able to offer the most advanced diagnosis and treatment options to provide the best opportunity for survival. This unique alignment between a leading research center and a community hospital brings cutting-edge medicine to local areas where it can be most beneficial
This project promises to change the way medicine is practiced with regard to these catastrophic events by providing faster, more precise diagnoses and treatment. It will allow for marked decrease in morbidity and the greatest chance for elimination of debilitating symptoms all together.
The alignment of multiple arms of the community-based emergency system is crucial to the success of this project. The efforts encompass the entire delivery system including the EMTs in the field, emergency room staff and the NIH and Suburban Hospital medical staff directly involved in the project. Additionally, the project will incorporate extensive community education to reinforce the need for immediate action in dealing with symptoms of heart attack or stroke.In addition to the research aspects focusing on stroke and heart attack, the state-of-the-art MRI Center will also provide the full range of routine clinical imaging services for patients throughout Suburban Hospital, offering countless benefits in diagnostic clarity and quality.
Contacts. . . for more information on the NIH-Suburban MRI Center, A Heart & Stroke Care program:
NHLBI Communications Office, (301) 496-4236 NIH Clinical Center, Communications, (301) 496-2563 NINDS, Margo Warren, (301) 496-5751 Suburban Hospital, Ronna Borenstein-Levy, (301) 896-2598 MRI Program home |CC | NIH updated 6/99