Heart of the matter

CHRIS SIMNETT
AHS Communications

Dr. Matthias Friedrich first began exploring the idea of using MRI to diagnose heart inflammation 11 years ago.

Now, the German-born Friedrich, who came to Alberta five years ago as the director of the Stephenson Cardiovascular Magnetic Resonance Centre in Calgary, is the world leader in the field.

Friedrich was the first to propose and apply the techniques that eventually led to the Lake Louise Criteria, the now global standard for the use of Cardiac Magnetic Resonance (CMR).

"I consider this as the significant achievement of my work - the awareness of doctors for inflammation of the heart definitely is higher now," Friedrich says.

"I was able to introduce a method that is now used worldwide, because it is not only safer for the patient and more efficient in terms of diagnostic decision-making, but also better for the health-care system. That is what our group can be proud of. You do not do these things alone. It is always a team effort."

It took 17 authors and two-and-a-half years to assemble this series of protocols and guidelines. It was published in April in the Journal of the American College of Cardiology.

"The main message in all of this is: Here in Alberta - not just in this centre - we have people who are really working on the cutting edge of health research," Friedrich says.

"In looking at inflammation of the heart, we have developed and refined the most accurate diagnostic tool available today."

He says inflammation of the heart isn't uncommon and can be caused by viral infection, severe flu or severe diarrhea. The good thing, he says, is the inflammation usually goes away by itself.

"But we know about one out of 10 patients experience a more severe form (of inflammation) that may even leave some scars on the heart, which stay there forever. If this happens repeatedly, there is a buildup of scar tissue and the patient could suffer from heart failure."

Although myocarditis is such a common disease, it has been very difficult to diagnose. Symptoms such as weakness, fatigue, palpitations and shortness of breath could be associated with many other ailments. Before using MR technology, doctors used what is called exclusion to diagnose cardiac inflammation.

"You excluded all the possible diseases and, if you couldn't find anything, then inflammation was the most likely," says Friedrich.

"There was only one way to definitely diagnose it, and it's still considered the gold standard, and that's a biopsy. You wouldn't do that with a patient with atypical symptoms. That's why we think CMR and biopsy actually go very well together. The biopsy now would only be required if the patient has a clinical suspicion for the disease and if the MRI study shows evidence of inflammation. With CMR as a gatekeeper, you can then triage the right patients for the more invasive biopsy."

Using the MR scanner, a patient can be diagnosed in less than 30 minutes, saving time and frustration and saving the health system money and resources.

Friedrich began doing CMR four years ago when the Stephenson CMR Centre opened and is extremely proud of what he's accomplished.

"We get approached by doctors and researchers from Australia, Europe and Asia - they know about the Stephenson CMR Centre, they know about the Lake Louise Criteria and they are using them," he says. "Our centre has really become one of the leading centres in the world and a very high authority.

"When I came here, the challenge for me was to bring the technique of heart MRI to Canada and to form a centre of excellence in applying this technique. That's what we have done here. The research we are doing here has also been successful because of the good collaborations we have here, within Calgary, nationwide and also international."