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Non-Invasive Imaging

Adult Echocardiography Lab

Non-Invasive Cardiovascular Imaging Section

The Non-Invasive Cardiovascular Imaging Section is composed of separate imaging service-units (Echocardiography, Cardiovascular CT, Cardiac MRI service, Vascular Imaging Laboratory)  providing support for patient care, medical education and research, both clinical and basic. 

The Echocardiographic Laboratory

The Johns Hopkins Adult Echocardiography Laboratory is a state-of-the-art center, with a strong tradition of clinical excellence, research, education and innovation. Facilities include an outpatient and inpatient center located on the 4th floor of the Zayed Building of the Johns  Hopkins Hospital and is comprised of 10 rooms for cardiac ultrasound examinations, stress testing, transesophageal echocardiograms (TEE) and reading/interpretation. Satellite echocardiographic laboratories located at all Johns Hopkins community sites, including White Marsh, Green Spring Station, Greater Baltimore Medical Center, Odenton, Columbia, two Washington DC locations, and at the Johns Hopkins Bayview Medical Center, function in close connection with the central echocardiographic laboratory and are digitally equipped with databases linked to the main hospital. The laboratory is equipped with 20 top of the line echocardiographic systems, one of which is solely dedicated to research. It is staffed with 19 full time and 3 part time registered cardiac sonographers, and 3 full time nurses, dedicated to clinical and investigative echocardiography. The lab is nationally accredited through the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL).

Leadership

The echocardiography program, directed by Theodore Abraham, MD, FASE, brings together cardiovascular expertise from throughout the Johns Hopkins Institutions. The Cardiology echocardiography team includes Drs: Oscar Cingolani, Mary Corretti, Allison Hays, Jose Madrazo, Susan Mayer, Thomas Metkus, Erin Michos, Monica Mukherjee, James Weiss, and Katherine Wu. The administrative director of the echo lab is Susan Phillip, RCS, FASE. Members of the Echocardiography section are actively involved in imaging and patient oriented research, have active roles in many national organizations and committees, including the American Society of Echocardiography, the American Heart Association, and the American College of Cardiology, and routinely present at national and international meetings.

Research

The echocardiography lab is actively involved in multiple research projects to improve diagnostic capabilities of non-invasive imaging, with current research interests including hypertrophic cardiomyopathy, strain imaging, cardiotoxicity, transcatheter aortic replacement and infiltrative heart disease. In addition, Dr. Abraham leads the Hypertrophic Cardiomyopathy Center of Excellence.  The echocardiography core laboratory provides support for clinical trials in echocardiography and cardiovascular ultrasound. We assist with all imaging aspects of the clinical research process, including protocol development, onsite training and skilled interpretation of transthoracic echocardiograms, stress tests, and transesophageal echocardiograms. Expertly and fully staffed, the echo core lab provides strict quality assurance, fast turnaround times, and high-quality image storage.

Education

The Johns Hopkins Echo lab has a strong commitment to education in advanced cardiac imaging with an advanced echocardiography fellowship lead by Susan Mayer, MD, FASE  (smayer9@jhmi.edu) and a CAA-HEP cardiac sonographer program, which are among the most prestigious in the country. There are weekly echo lectures, sonography courses, monthly echo grand rounds and regular CME courses given throughout the year.

Procedures 

Tests performed in the Echocardiography Laboratory include 2-D and 3-D transthoracic echocardiography (TTE), stress echocardiogram, intraprocedural transesophageal echo (TEE), and 3D TEE.   Staff also provides echocardiographic guidance during complex interventions in the catheterization laboratory (interventional echocardiography). The Echocardiography Laboratory also offers strain imaging (for the improved detection of systolic dysfunction), contrast studies, optimization for left ventricular assist devices (LVADs) and specialized studies for the evaluation of hypertrophic cardiomyopathy.

Cardiac CT Program

The cardiac CT program in the Division of Cardiology at Johns Hopkins is world renowned for its exceptional clinical experience, education, and research. Johns Hopkins Medical Institutions were among the first in the nation to operate multi-detector cardiac CT scanners exclusively devoted to heart scans. Drs. Joao Lima (Director of Outreach Cardiovascular Imaging), Edward Shapiro (Director of Cardiovascular Imaging at the Johns Hopkins Bayview Medical Center), and Armin A. Zadeh (Director of Cardiac CT at the Johns Hopkins Hospital) embraced cardiac CT with its emergence in the early 2000’s and bring a wealth of experience with reading contrast enhanced scans. Dr. Michael Blaha (Director of Clinical Research at the Ciccarone Center for Prevention of Heart Disease) is a world authority on the use of coronary calcium scanning for advanced risk stratification. 

The cardiac CT program in Cardiology supports clinical service, along with a diverse array of research and educational activities at the Johns Hopkins Hospital and at Johns Hopkins Bayview Medical Center. Both campuses operate 320-slice CT scanners which acquire CT scans within less than one second of time, leading to lower average radiation doses to patients. Clinical services include evaluation of coronary heart disease in patients with acute or chronic chest pain, assessment of cardiovascular structure and function in patients with cardiomyopathy or congenital heart disease, as well as guidance of invasive procedures. The cardiac CT program at Johns Hopkins Cardiology pioneered the use of myocardial stress testing using CT and was among the first in the nation to offer this test as clinical service.

Started by Drs. David Bush and Edward Shapiro in 2006, the Cardiac CT Practicum is the longest running and most successful cardiac CT teaching course in the world. The course has educated more than 1,000 national and international trainees since. Complementing the Cardiac CT Practicum, a training course in CT Myocardial Perfusion Imaging was launched in 2014, now directed by Drs. Lima and Zadeh. Dr. Joao Lima and his team at Johns Hopkins led several multi-center international studies on the utility of cardiac CT, which were instrumental in defining the diagnostic accuracy of this technology. Both experimental and clinical studies are ongoing, including research on atherosclerotic plaque imaging, determination of coronary blood flow, and comparative effectiveness of cardiac CT for patient outcome.

The Cardiac MRI Service

The Cardiac MRI Service is jointly managed by Radiology and Cardiology, Department of Medicine. The service supports clinical studies and clinical research including the Multi-Ethnic Study on Atherosclerosis lead by Joao A. C. Lima, MD, Director of Cardiovascular Imaging and functions as the reading center for all MRI studies obtained in that large Multi-center NIH funded effort.

Activities are based in the cardiovascular magnet installed in the 5th floor of the Blalock building, the basement of Blalock and in the Zayed Building. Clinical MR research activities include:

  • Investigation of global and regional left ventricular function by MRI tissue tagging
  • Measurements of infarct size and microvascular obstruction by contrast enhanced MRI
  • Development of myocardial perfusion techniques and vascular MRI applications
  • MR Imaging for assessment of a variety of disease states including: ARVD, HOCM, HIV-related Cardiovascular Disease and infiltrative heart disease
  • MR measure of coronary endothelial function
  • MR spectroscopy to quantify myocardial fat content and evaluate myocardial energetics