Stephenson Cardiac Imaging Centre a world leader in research

The Stephenson Cardiac Imaging Centre is a global leader in cardiovascular diagnostic imaging, clinical research, and education. The centre was founded in 2005 at the Foothills Medical Centre with the generous support of Calgary businessman, philanthropist, and cardiac patient Ken Stephenson. 

The Stephenson Centre began operations under the direction of world-class imaging scientist Dr. Matthias Friedrich, MD, a cardiologist and cardiac imaging specialist recruited from Germany. This program was the first of its kind in Canada and established Cardiac MRI as an important pillar of cardiac care in Southern Alberta.

Cardiologist and clinician-scientist, Dr. James White, MD, PhD, took over leadership of the Centre in 2013, bringing with him a new focus on exploring innovative approaches to large scale data collection, artificial intelligence (AI), and patient risk prediction. White strongly believed the Stephenson Centre held unique potential to innovate in the field of personalized cardiovascular care.

“I saw an opportunity to say, ‘What if we openly approached each and every patient that comes through our doors to go on a journey with us, to discover new ways of diagnosing and treating heart disease? I wondered if they would agree to tell us what makes them unique, how they are feeling, and combine this data with their test to predict what might happen in the future,’” says White. “Remarkably, patients were very enthusiastic to support this type of innovation.”

The Stephenson Centre has since grown to support two dedicated cardiac MRI units located at the Foothills Medical Centre and South Health Campus. The team performs about 4,500 studies per year, conducts many clinical research studies, and collaborates with basic science and clinical researchers both within Alberta and around the world.

“The Stephenson Centre is a hub of innovation for the Libin Cardiovascular Institute. It is focused on bridging the academic and clinical missions of AHS and the University of Calgary,” says White. 

“It allows for an interaction between pre-clinical innovation and clinical validation that very few places can offer. This will continue to be its legacy, to provide a true integration of research and clinical care.”

He adds that the centre’s research teams are innovating to create diagnostic and prognostic tools that will allow doctors and researchers to make better, more personalized decisions to help patients more effectively and improve outcomes.

“We are developing better ways to predict heart failure, arrhythmias, and sudden death that are personalized to each patient,” says White. 

Lake Louise Criteria

One of the early accomplishments of the centre was the development of the Lake Louise Criteria for the diagnosis of myocarditis. The Criteria has guided cardiac MRI-based diagnosis of myocarditis 2009. 

“It was a consensus meeting held in Lake Louise,” says White. “The global impact of these recommendations for diagnosing myocarditis, an inflammatory disease of the heart often caused by viruses, has really been unprecedented. It is one of the most cited recommendations globally in the field and it really did change the face of how we identify and manage patients with inflammatory heart disease.”

The Lake Louise Criteria was revised in 2018.

Cardiovascular Imaging Registry of Calgary (CIROC)

CIROC is a made-in-Calgary cardiac imaging registry that has now become an international resource for research and innovation. The registry is one of the largest patient-consented, patient-data-enriched databases of cardiac imaging in the world. 

Every set of images has been carefully linked to standardized disease descriptions, patient-reported health questionnaires, laboratory tests, pharmacy records and health outcomes. 

The registry was created by White, who has spent over a decade exploring novel ways that medical images can help predict patient outcomes.

“If patients are comfortable sharing this information, let’s provide them the opportunity to participate in research to understand and consider how gender, ethnicity, home circumstances, or daily symptoms can improve the value of medical tests” says White. “Adding this information can transform it from a simple diagnostic tool into personalized decision support.” 

White and his team have asked more than 25,000 patients with heart disease to participate in CIROC since 2015, this done using an iPAD on their arrival to any of the clinics. On average, eight out of 10 patients consent to the program. 

Data scientists can analyze this data, and using artificial intelligence methods, such as machine learning or deep learning, look for patterns in the data that are difficult to see without these advanced techniques. These patterns are helping researchers discover new ways of diagnosing certain types of rare disease; clustering individuals with similar characteristics; and develop computer models that can predict when future events will occur. 

“It’s very unique compared to other diagnostic imaging programs in Alberta because it routinely integrates real-world data collection from patients during their clinical testing,” says White.

The success of CIROC set the stage for the Libin Cardiovascular Institute’s Precision Medicine Initiative, its keystone project.

The Precision Medicine Initiative was developed to integrate and enhance access to cardiac data routinely captured across the Libin Cardiovascular Institute. Driven by an innovative data platform, and an expert team working closely with AHS, anonymized medical tests and health information is combined to support innovative research to advance personalized cardiovascular care.

“We hope to deliver a new form of personalized care for patients with heart disease across the Libin Institute. By working closely with AHS, we are able to bridge and analyze healthcare data in minutes that previously took months, improving access for personalized decision making,” says White, the inaugural director of the Precision Medicine Initiative. 

MINICOR and AID-MRI

White is also expanding his research program to establish a global network of hospitals. His team recently combined data from 12 hospitals in Canada, the US, Spain and Italy to show the value of cardiac MRI data in predicting cardiac events in patients with dilated cardiomyopathy. 

The study, published in the peer-reviewed journal Circulation: Cardiovascular Imaging in 2020, found that combining cardiac MRI with patient features can predict life-threatening arrhythmias in this group of patients. 

“One of the diseases we are particularly interested in is called dilated cardiomyopathy,” says White. “It is a common heart condition frequently leading to heart failure and higher risk of sudden death.”

“We are trying to figure out what can we learn from images and patient information to predict who is going to die suddenly and who is not. We combined our data with sites around the world and were able to present the largest study ever reported showing that a feature on MRIs, a line of scarring in the centre of the heart, can predict sudden death. If the MRI showed this feature, patients had at least a two-fold increased risk of sudden death.”

This research network, called MINICOR, seeded enrolling sites for another international study led by Dr White called AID-MRI, funded by the Canadian Institute of Health Research (CIHR).  This unique study is assessing the ability of 4D beating heart models to allow for AI-based predictions of future cardiac outcomes in patients with heart disease. 

“MINICOR and AID-MRI are both wonderful examples of how the work our teams from the Stephenson Centre, CIROC Registry, and Libin Precision Medicine Initiative have grown to deliver a scalable framework for innovation in Alberta, one capable of changing how we manage patients with cardiovascular disease on an international scale,” says White.

Read more about the Libin Cardiovascular Institute's Top 20 Achievements of the last 20 years here.