A Different Kind of Stress
From the Radiology Department Newsletter, Editor: Mary McAllister


Why was it that some patients who came to the emergency room with chest pain still had the pain after a battery of tests declared them negative for a myocardial infraction or coronary artery disease? This was the question that intrigued Dr. Jens Vogel-Claussen, who decided to look into this problem using a different kind of imaging that he thought might provide the answer.


Dr. Jens Vogel-Claussen

“I noticed that these patients still had significant pain, and I wondered what might be causing it since all the tests showed normal results,” he says. He decided to perform a pilot study of patients with chest pain who came into the emergency room at Bayview, and who underwent all the standard tests to rule out myocardial ischemia, including a nuclear Single Photon Emission Computed Tomography (SPECT) stress test. As part of the study, the patients consented to receiving a special kind of MRI exam—an adenosine stress perfusion scan.

“In the group of 30 patients we tested the adenosine stress perfusion and it allowed us to see microvessel disease," Dr. Vogel-Claussen explains. "This test provides a higher resolution than comparable cardiac nuclear imaging tests, which makes it possible to detect the disease.” 

"What was interesting about these patients was that, since with nuclear cardiac SPECT, there is no absolute quantification of flow, you might call such a study ‘normal,’ and not realize there is significant underlying triple vessel disease," he adds. "At the same time, cardiac MRI is a valuable tool for the diagnosis of not only significant coronary artery disease, but also other possibly coexisting pathologies." He plans a follow-up study that will include more patients.

“The beauty of this method is that this is a one-stop technique that can pinpoint the diagnosis, and define other possible etiologies that might explain the continued chest pain," he says. "For example, we can tell whether the patient is suffering from valve disease, pulmonary hypertension, or alcoholic cardiomyopathy. Even non-ischemic etiologies can be seen with an MRI, and so, an accurate diagnosis is now possible with this one test." The results of his studies will be presented to the Radiological Society of North America (RSNA) this year. His goal is to see this test used routinely in emergency rooms to more accurately diagnose and treat patients with chest pain.

Dr. Vogel-Claussen is now also studying scleroderma and rheumatoid arthritis patients to determine whether these patients are at risk for microvascular disease. His research endeavors add to his already busy schedule, which includes giving clinical cardiac MR rounds twice a week to teach radiology and cardiology fellows as well as mentoring two research fellows in his lab, Dr. Mona Shehata and Dr. Jan Skrok.

Originally from Germany, Dr. Vogel-Claussen came to Hopkins as a visiting medical student in 2000, and then, in 2002, was matched for a residency here. He did an MR/cardiovascular fellowship supported by the RSNA, and stayed on as faculty. “I found the teaching to be excellent here, and I worked with Dr. David Bluemke from my second year of residency on, and I have really enjoyed it,” he says. In his limited spare time, he enjoys sailing and horseback riding.