Cardiac Imaging Unit
Justification
Comprehensive assessment of the heart, including both its structure and function, is a fundamental objective when evaluating the effect of cardiovascular therapies. Because of its close correlation with patients’ long-term prognosis, the scientific evidence generated over the last 50 years has consolidated the use of measures based on cardiovascular imaging techniques as surrogate endpoints in clinical trials of cardiovascular medicine. In addition, patient inclusion criteria in clinical trials are usually established according to determined cut-off points for different indices of the overall assessment of the heart.
Furthermore, drug safety studies in other disciplines increasingly require an assessment of their potential cardiotoxicity. Thus, the pharmacological development of biological therapies, particularly in the field of oncology, has increased the demand for comprehensive cardiac assessment in the context of multiple clinical research protocols.
Because of its availability, portability and low cost, echocardiography is the initial technique of choice for assessing the heart comprehensively and monitoring its progress following a given therapeutic intervention. Nevertheless, cardiac magnetic resonance currently provides more accurate and reproducible parameters for obtaining measurements of ventricular size and function. As measurement variability is lower compared with other techniques, cardiac MR has been shown to make it possible to reduce the sample size of studies that use structural and functional characterisation of the heart
Cardiovascular risk stratification based exclusively on clinical criteria has proved insufficient in a large number of patients, usually those within the "intermediate risk" spectrum. In addition, pharmacological intervention in clinical contexts involving chronic inflammation may have a direct effect on patients’ cardiovascular risk. In this context, non-invasive measurement of atherosclerotic burden and intima-media thickness using carotid ultrasonography provides a well-validated surrogate index of a given patient’s cardiovascular risk.
In recent years, coronary cardiac CT has become established as an essential tool in the overall cardiac assessment. Its ability to detect the presence and extent of coronary lesions accurately and non-invasively makes it a highly valuable complementary technique alongside echocardiography and cardiac magnetic resonance. This information is particularly relevant in the context of new oncological, immunological and radiotherapy treatments, which may induce or accelerate the formation of atheromatous plaques and modify patients’ cardiovascular risk. Likewise, ruling out coronary artery disease using CT is essential before initiating certain therapies that may affect the cardiovascular system. For all these reasons, cardiac CT has notably increased its importance and availability in the overall assessment of the heart in research and clinical practice.
On this basis, the Cardiac Imaging Unit’s mission is to provide services to research groups within and outside IiSGM that may benefit from comprehensive assessment of the heart using echocardiography, magnetic resonance and/or CT, or from assessment of atherosclerotic risk using carotid ultrasonography.
Description of the facilities
Echocardiography examinations and Carotid Ultrasound in support of research are performed in the Echocardiography Laboratory, located on the Ground Floor of the Surgical Centre of the HGUGM. It has high-end equipment dedicated to conducting research studies, acquired by the IiSGM.
Magnetic Resonance Imaging is performed using specific equipment acquired by the IiSGM, with a primary research focus on cardiac MRI. It consists of a Philips Achieva system with a 1.5 T magnet installed in the MRI area located on the Basement Floor of the Oncology Pavilion. This equipment is equipped with complete cardiovascular imaging software and integrated into the Hospital's Information System.
Cardiac CT is performed using equipment belonging to the Cardiology Department, an Apex Revolution system by General Electric, located on Floor -1 of the General Hospital. This latest-generation equipment enables the acquisition of images of the coronary arteries and the entire heart, with high resolution and a significant reduction in radiation dose and excellent diagnostic quality. It is fully integrated into the hospital's information system.
The Cardiac Image Analysis Unit of the Cardiology Department is divided into two complementary sections.
The first consists of a team of engineers assigned to the Cardiology Department, with exclusive dedication to research, based at LITEC (Translational Research Laboratory in Cardiology).
The second is made up of a group of senior radiodiagnostic technicians, also with exclusive dedication to research projects, who carry out their work in the Cardiology Imaging Laboratory, in close contact with clinical cardiologists.
Both teams work together in a coordinated manner, forming a highly specialised unit for the processing, analysis and advanced quantification of cardiovascular parameters. The Cardiology Image Analysis Unit has state-of-the-art computer equipment with high capacity for archiving and processing all types of data, as well as validated systems for the quantitative assessment of cardiovascular parameters, which are described in the following section.
Service Portfolio
Image Acquisition and Obtaining
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Echocardiography (transthoracic and/or transoesophageal) |
Acquisition of 2D, 3D, tissue Doppler, Colour Doppler, continuous-wave and pulsed-wave valvular Doppler images in parasternal, apical, subcostal and suprasternal views. |
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Carotid Ultrasound |
Acquisition of B-mode and Doppler images of the common carotid artery, carotid bulb and internal carotid artery using a linear probe. |
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Functional cardiac MRI without contrast |
Acquisition of sequences to assess biventricular function in cine mode in short-axis views with complete coverage from the base to the LV apex, 2-chamber, 4-chamber and 3-chamber views. 1.5‐T system (Philips Achieva, software package release 9). |
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Functional cardiac MRI with contrast |
Following administration of a 0.2 mmol/kg bolus of gadolinium contrast, a first-pass multiplanar perfusion sequence will be performed, followed by a 3D inversion-recovery late-enhancement sequence. The inversion time will be adjusted using the Looklocker tool. The images will be acquired 15 minutes after contrast administration. 1.5‐T system (Philips Achieva, software package release 9). |
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Cardiac CT |
Acquisition of studies using the Apex Revolution (General Electric) system, which incorporates spectral technology, a volumetric detector, advanced iterative reconstruction and electrocardiographic synchronisation (ECG-gating). This system enables cardiac studies to be performed, including calcium scoring, coronary angiography and advanced assessments such as myocardial perfusion studies and iodine maps. |
Measurement and Quantitative Analysis
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Conventional echocardiography measurement (transthoracic or transoesophageal) (per study) |
Measurement of biventricular function from two-dimensional images, measurement of mitral inflow and LV outflow tract Doppler velocities, estimation of pulmonary pressures and measurement of tissue Doppler at the level of the mitral and tricuspid annuli (syngo.via - Intelligent Imaging Software, SIEMENS). |
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Advanced echocardiography measurement (transthoracic or transoesophageal) (per study) |
Measurement of biventricular function from 3D LV images (syngo.via - Intelligent Imaging Software, SIEMENS) and 3D RV images (4D-RV function; TomTec Imaging Systems). Measurement of LV longitudinal and circumferential strain. Measurement of 3D LV strain (syngo.via - Intelligent Imaging Software, SIEMENS) |
| Carotid Ultrasound Measurement (per study) |
Measurement of intima-media thickness at the level of the common carotid artery, carotid bulb and internal carotid artery (IMT software, Q-Lab software, Philips or ImageJ software, adaptable according to the imaging provider's manufacturer). |
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Cardiac MRI measurement (per study) |
Biventricular function, quantification of segmental contraction ("Wall Motion Analysis"), assessment of intracardiac flows, quantification of late enhancement (Medis® Cardiac MR QMass® and QFlow®). Adaptable system for the quantification of both clinical and preclinical imaging studies in large or small animals. |
| Cardiac CT measurement (per study) |
Quantification of atheromatous lesions, with morphometric and volumetric analysis, determination of plaque composition (calcified, mixed and non-calcified) and assessment of the coronary and aortic valvular calcium score. |
Procedure for requesting a specific service
4. Procedure for requesting a specific service
The Hoja de Encargo IM-SPE-7 form of the IiSGM will be used. The Hoja de Encargo consists of 5 parts:
- SAI identification
- Applicant identification
- Details of the required service and budget*
- Comments: Indicate whether it is a self-invoice or not**
- Signatures
*Details of the services requested: (tick as applicable)
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Service |
Image Acquisition and Obtention |
Measurement and Quantitative Analysis |
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Transthoracic echocardiography |
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Transoesophageal echocardiography |
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Carotid ultrasound |
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Functional cardiac MRI without contrast |
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Functional cardiac MRI with contrast |
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Quantitative coronary CT angiography |
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Coronary CT calcium scores (Agatson) |
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Cardiac CT for pre-TAVI planning (including vascular access) |
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Cardiac CT for assessment of morphology and function |
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Cardiac CT of the aorta/pulmonary artery |
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Cardiac CT for myocardial perfusion |
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Cardiac CT iodine maps |
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Cardiac CT with non-invasive FFR-CT calculation |
NOTE: The Image Unit is responsible for sending samples
The procedure to be followed is as follows:
- Issue the study protocol whose parameters are to be analysed
- Once the protocol has been studied by the staff of the Image Unit (UI), the CRFs specially designed for that study are sent to the centre carrying out the study
- The study personnel send the image studies to be analysed, together with their corresponding CRFs, to the UI.
- Perform the analysis
- The results are sent to the centre carrying out the study
- The image studies are archived in the UI for 1 year in order to reanalyse the studies or analyse other parameters if necessary
SAI Rates Cardiac Imaging Unit
Contact persons
Dr. Javier Bermejo Thomas
Head of Cardiology Department, 5th floor. Area 5100
Cardiology Department
Hospital General Universitario Gregorio Marañón Calle Doctor Esquerdo 46
28007 Madrid
E-mail: javier.bermejo(ELIMINAR)@salud.madrid.org
Tel. 91 426 58 82
Dra. Ana González Mansilla
Coordinator, Non-Invasive Cardiology Area
Cardiology Department
Hospital General Universitario Gregorio Marañón Calle Doctor Esquerdo 46
28007 Madrid
E-mail: agmansilla(ELIMINAR)@salud.madrid.org
Tel. 91 586 88 15
Dr. Pablo Martinez-Legazpi Aguiló
Translational Cardiology Research Laboratory
Cardiology Department
Hospital General Universitario Gregorio Marañón Calle Doctor Esquerdo 46
28007 Madrid
E-mail: legazpi.pablo(ELIMINAR)@ccia.uned.es
Jennifer Gutierrez Galvez
Imaging Unit Coordinator
Cardiology Department
Hospital General Universitario Gregorio Marañón Calle Doctor Esquerdo 46
28007 Madrid
E-mail: jeniffer.gutierrez(ELIMINAR)@iisgm.com