Brian P. Shapiro, M.D., specializes in advanced cardiovascular imaging using cardiac magnetic resonance imaging (cMRI) and cardiac computerized tomography (CT). Using these noninvasive modalities, Dr. Shapiro hopes to further the ability to detect and characterize various diseases, including pulmonary hypertension and heart failure.
- Heart failure with preserved ejection fraction (HFpEF). Dr. Shapiro's early publications focused on the pathophysiology and potential therapeutic targets of HFpEF. Using a novel, elderly disease model of severe systemic hypertension, Dr. Shapiro utilized hemodynamic catheterization to characterize ventricular pressure and volume loops, immunohistochemistry and various assays to demonstrate the pathophysiologic abnormalities (such as interstitial fibrosis, advanced glycation end products and derangements of ventricular-arterial coupling) that contribute to this disease. This research yielded various publications and presentations that helped to characterize potential therapeutic targets such as aldosterone blockade and reversal of advanced glycation end products. It also provided a basis for enhanced detection of HFpEF using cMRI, which culminated in a large, prospective, observational study using cMRI in HFpEF patients.
- Echocardiography. Echocardiography maintains a critical role in the diagnosis of pulmonary arterial hypertension (PAH), but its prognostic role remains less well-elucidated. There are a variety of techniques to quantify right ventricular size, systolic function and right-sided noninvasive hemodynamics. Dr. Shapiro seeks to better characterize the accuracy and prognostic importance of these measurements using a database of pulmonary arterial hypertension patients to analyze all echocardiograms for right-sided variables. Through collaboration with pulmonary medicine and the echocardiography lab, Dr. Shapiro demonstrated that greater right atrial size and estimated right atrial pressure (via inferior vena cava characteristics) are highly predictive of cardiovascular events in PAH patients. A simple and highly reproducible scoring system aids in prognostication in this cohort. These studies will be further translated to a prospective observational study utilizing more advanced right ventricular parameters.
- Cardiac magnetic resonance imaging. Cardiac magnetic resonance imaging (cMRI) measures the phasic changes (pulsatility), of the main pulmonary artery. Dr. Shapiro's work will provide further evidence that earlier disease could be noninvasively detected by cMRI and will lead to further research determining whether cMRI measurements could accurately detect and follow the disease course of those with mild PAH.
Significance to patient care
Dr. Shapiro aims to use advanced, noninvasive imaging to better understand pathophysiologic mechanisms of cardiac disease. The use of simple techniques for earlier detection may render earlier treatments and better outcomes for diseases such as pulmonary hypertension and heart failure.