Cardiac MRI Endpoints in Myocardial Infarction Experimental and Clinical Trials: JACC Scientific Expert Panel
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. ; 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. BI received funding for work in the topic of this review from the Carlos III Institute of Health–Fondo de Investigacion Sanitaria- and the European Regional Development Fund (ERDF/FEDER) (PI13/01979, DTS17/00136), the Spanish Ministry of Science, Innovation and Universities (MICINN) and ERDF/FEDER SAF2013-49663-EXP, Red Madrileña de nanomedicina en imagen molecular (RENIM-CM Ref# B2017/BMD-3867), H2020 ERA-CVD (JTC2016/APCIN-ISCIII-2016/AC16/00021), and Fundación BBVA 2016. CBD is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. RF-J is a recipient of funding from the European Union Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 707642. DGD was supported by the Instituto de Salud Carlos III, CIBERCV-Instituto de Salud Carlos III, Spain (grant CB16/11/00479), co-funded with European Regional Development Fund-FEDER contribution), and grants PIE/ 2013-00047 and PI 17/1397. DJH was supported by the British Heart Foundation (CS/14/3/31002), the National Institute for Health Research University College London Hospitals Biomedical Research Centre, Duke-National University Singapore Medical School, Singapore Ministry of Health's National Medical Research Council under its Clinician Scientist-Senior Investigator scheme (NMRC/CSA-SI/0011/2017) and Collaborative Centre Grant scheme (NMRC/CGAug16C006), and the Singapore Ministry of Education Academic Research Fund Tier 2 (MOE2016-T2-2-021). This article is based upon work from COST Action EU-CARDIOPROTECTION CA16225 supported by COST (European Cooperation in Science and Technology). CB funding from British Heart Foundation (BHF) (RE/18/6134217) and Institute of Health Efficacy Mechanism and Evaluation Programme (12/170/45). PC was supported by the RHU MARVELOUS (ANR-16-RHUS-0009) of Université Claude Bernard Lyon 1 (UCBL), within the program "Investissements d'Avenir" operated by the French National Research Agency (ANR). RD is funded by NIH (R01 HL136578 and R01 HL133407). MS received research support from Siemens Healthineers, and NIH R01 HL131919-01A1. HA was funded by the Swedish Heart-Lung Foundation, Lund University, Lund Sweden and Region of Scania, Sweden. EDA is funded by the British Heart Foundation (FS/13/71/30378). ; Sí
