Projet CMRAI : Detecting the vulnerable aorta in MRI for precision cardiovascular medicine

CMRai project: Detecting the vulnerable aorta in MRI for precision cardiovascular medicine

The aortic aneurysm is a permanent dilation of the aorta whose consequences, in the event of rupture, can be fatal. If diagnosed early enough, treatment often relies on managing high blood pressure. In other cases, surgery is considered to treat the aneurysm as soon as possible. But unfortunately the diagnosis is often late, made during the rupture, and constitutes a dramatic event associated with a mortality rate of 80-90%. It is in this context that it is necessary to better detect aortic aneurysms in the French population. So how can we better prevent aortic ruptures? This is the challenge taken up by the CMRAI project led by the IHU-ICAN and Sorbonne University and funded by EIT Health.

This project, set up at the initiative of the IHU-ICAN and coordinated by its founder Sorbonne University, brings together 9 European partners: Assistance Publique-Hôpitaux de Paris (France), the Hanover School of Medicine (Germany), the Medical University of Vienna (Austria), Vall d’Hebron Hospital (Spain), Santa Cruz Hospital (Portugal), Lisbon University of Sciences (Portugal), including 2 industrial partners: Imageens (France ) and Siemens Healthineers (Germany).

The objective of the CMRAI project is to create a platform that will make it possible to define, from the first signs of the disease, an aortic aneurysm risk score for each patient, and therefore to define a personalized follow-up and management strategy.

This project proposes to go beyond the practice based on diameter alone by proposing an evaluation of new functional parameters in MRI accounting for the elasticity of the wall of the aortic aneurysm, the shear forces applied to its wall, the pressure regime and the disturbances of the resulting blood flows.

These innovative parameters from algorithms developed by the LIB biomedical imaging laboratory (Inserm/SU/CNRS) will be studied in two populations: in patients with a thoracic aortic aneurysm as part of a clinical study in 5 European reference centers and in healthy subjects recruited from the Constances cohort (Inserm) in France in order to establish the normal values expected in the general population.

Led by Prof. Alban Redheuil, head of Cardiovascular and Thoracic Imaging (ICT) at Pitié-Salpêtrière hospital and medical manager of the ICAN Imaging platform, by Dr Nadjia Kachenoura, head of the cardiovascular imaging team ( iCV) of the Biomedical Imaging Laboratory (LIB) and by Ted Baldwin CEO of the start-up Imageens, the CMR projectAI involves several departments of the IHU-ICAN:

Expected results

CMRAI will therefore allow the screening of the aortic aneurysm, the therapeutic decision-making and the adapted and personalized care thanks to Magnetic Resonance Imaging (MRI) coupled with the automated and multiparametric analysis of the aorta.

This study contributes to the development of precision medicine in cardiometabolic diseases. This is a major project that has obtained EIT Health funding.

April 7, 2022: World Health Day: The IHU model to tackle the public health challenge of cardiometabolic diseases and accelerate medical innovation at the service of the patient.

World Health Day: The IHU model to tackle the public health challenge of cardiometabolic diseases and accelerate medical innovation at the service of the patient.

Created in 2011, the IHU ICAN (Foundation for Innovation in Cardiometabolism and Nutrition) is a center of excellence in the field of metabolic diseases: diabetes, obesity, liver diseases (steatosis), heart and vessel diseases. These pathologies represent the first cause of chronic diseases. So how does the “IHU” model make it possible to fight effectively against this scourge?

1- With teams of experts

The strength of the IHU model lies in the concentration of significant human resources on targeted public health priorities, supported by agile structures, and in bringing together clinicians, researchers and entrepreneurs in the service of patients.

IHUs represent a force for innovating and developing the paths, treatments and medical devices of tomorrow. ICAN teams accelerate discoveries on metabolic diseases and their transfer to the benefit of patients thanks to integrated procedures that demonstrate responsiveness and agility from project set-up to the valorization of the discovery.

2- With the decompartmentalization of disciplines.

Changing scale to invent the medicine of tomorrow in cardiometabolism.

Cardiovascular diseases related to diabetes, atherosclerosis, obesity or liver diseases such as NASH are grouped under the concept of cardiometabolic diseases. There are scientific bases for this concept of cardiometabolic diseases consisting of the many interfaces between metabolism and organs: microbiota, adipose tissue, immune system. Thus, we have moved from a medicine centered on an organ to a global and systemic approach to cardiometabolic diseases.

The management of patients with metabolic diseases is modified, doctors no longer reason by organ or by disease but they implement a personalized and multidisciplinary approach for a global management of the disease and its consequences on the future. patients.

For example, not all obese patients develop diabetes or serious cardiovascular pathologies, just as not all diabetic patients have heart failure. Conversely, some individuals a priori at low risk will have a myocardial infarction. It is therefore necessary to better understand the interactions between the organs and between the pathologies in order to better manage the patients and anticipate the evolutions. It is necessary to determine which patient will develop which syndrome.

New causal relationships have emerged. “NASH (non-alcoholic fatty liver disease), for example, which until then was considered an indicator of malnutrition and systemic disease, turns out to be much more than that: it has a direct impact on the vessels, the microbiota, the tissue fat and overall metabolism ». Pr Stéphane Hatem, Director of ICAN

The organs dialogue with each other, and when one of them begins to suffer from metabolic disturbances, the messages sent can domino and trigger deleterious processes at a distance.

Developing knowledge of pathophysiological links, identifying biomarkers and evaluating them in populations are key steps in understanding metabolic diseases. To do this, the IHU ICAN participates in innovative research programs on integrating the use of health data generated by new imaging or research techniques thanks in particular to the explosion of omics in health. Much work remains to be done, but advances in biology and new technologies are accelerating research innovations. Entirely dedicated to the study and understanding of metabolic diseases, the IHU ICAN is a pioneer in research on cardiometabolism.

Some examples of innovative projects for patient services carried out by the IHU ICAN:

Successful launch of the XVIVO trial

Successful launch of the XVIVO trial

Launch of the pre-CE marking industrial trial conducted by XVIVO Perfusion, in collaboration with Dr Guillaume Lebreton, thoracic surgeon in the cardio-thoracic surgery department headed by Pr Leprince, aimed at validating the performance of a new system for transporting grafts intended for heart transplantation.

This innovative method of protecting the grafts involves connecting the heart, of the donor cooled at rest, to a pump which administers a preservation solution, oxygen and nutrients throughout the duration of the transport. Unlike the standard transport method, which simply involves placing the heart in a chilled liquid, this new solution will better meet the nutritional needs of the heart and allow to increase the chances of success of the transplant, especially when the heart has to travel a long way to reach the recipient.

The Pitié-Salpêtrière site 1st recruiting center for this trial

Thanks to the joint work of the Scientific Operations teams for setting up the project and the ICAN clinical investigation platform, the Pitié-Salpêtrière hospital is the first recruiting center for this trial with 11 patients in 6 months on the 30 planned in total. Currently, 11 hospitals are involved in this innovative project. The total duration of the study is 2 years. »