Cardiac Magnetic Resonance Imaging for the Assessment of Myocardial Angiogenesis.

Research in biology and applications of growth factors in coronary artery disease (CAD) has progressed considerably over recent years. Vascular endothelial growth factor and fibroblast growth factor-2 have been more successful in animal models of myocardial ischemia and Phase I studies than in placebo-controlled trials. However, cardiac magnetic resonance (CMR), with its higher sensitivity and specificity indices for identification of CAD, has not been extensively used in trials of angiogenic therapies. Data in animals and in patients suggest that CMR can reliably identify collateral vessels. Therefore, we hypothesize that CMR may depict collateralization induced by angiogenic therapy better than currently used nuclear perfusion imaging modalities. Versatility of the assessment of myocardial function and perfusion in one imaging session, combined with the noninvasive nature of the test, may considerably lower the cost of clinical trials. Use of CMR-derived surrogate end points may provide better risk stratification and assessment of efficacy in patients receiving growth factor therapy.