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Topics: Five Questions, Funding
Can Advanced Imaging Solve the ‘New’ Heart Disease?
Six Questions with cardiologist and ‘imaging nerd’ Diana Lopez.

Diana Lopez, MD, is a self-proclaimed imaging nerd. She’s been that way since med school, when she got to revise the cardiovascular imaging chapter of a prominent cardiologist’s textbook revision, a gig that set her on a mission to pick the brains of every expert she could get access to in the field.
The assignment sparked a love affair with cardiac imaging that continues in earnest a decade later, in the lab of one of the experts she interviewed, Marcelo Di Carli, MD, at Brigham and Women’s Hospital (BWH). Now, Lopez is leading the edge of cardiac imaging closer to clinical utility to keep up with the changed landscape of cardiovascular disease.
An instructor in medicine at BWH, Lopez was supported with a two-year faculty fellowship from Harvard Catalyst from 2023 to 2025. We caught up with her as she was wrapping up the pilot clinical trial that was the object of her funding.
For decades, cardiovascular outcomes have been improving in step with advances in stenting, surgeries, and cholesterol-lowering drugs. What clinical problem does your research seek to address in this changing landscape?
All these tools have really changed the paradigm of severe, unstable plaque rupturing and causing massive heart attacks. That was what everyone was trying to prevent, and as a field, we’ve gotten really good at it. Even in my clinical practice, we don’t see these large, scary heart attacks as often, thankfully. When people do have heart attacks, because of how quickly we intervene and the medical therapies available, they generally have better outcomes. Few require ICU stays, whereas everyone did decades ago. It’s still very serious, but it’s a very different landscape.
The problem is that in the background of all these huge advancements, obesity is on the rise. Diabetes, hypertension, and chronic kidney disease are all on the rise. Everyone was waiting for the point where cardiovascular mortality would start to rebound because of these higher comorbidities. That signal has started to go up: Heart failures are on the rise again.
“We’re seeing an increase in less severe, not as dramatic heart attacks that nonetheless increase the chance of heart failure and death. We’re trying to figure out why.”
So if people are not having major heart attacks, what is happening? We’re seeing an increase in less severe, not as dramatic heart attacks that nonetheless increase the chance of heart failure and death. We’re trying to figure out why.
You’ve employed advanced PET imaging in that effort. What’s the advantage of this approach?
We can look under the hood more easily than we used to. With these imaging tools, the bar for interrogating someone’s coronary vascular system has been lowered. Now we’re able to learn that maybe you don’t have a big blockage in your artery, but you have diffuse plaque, or your microvasculature is not working efficiently because of diabetes or kidney disease. We know from work in our research lab and many others that microvascular disease increases your risk of future heart attack, heart failure, and death.
We want to use cardiovascular imaging to help us better understand how cholesterol-lowering medications work so that we can target the right population. If one person has primarily microvascular disease with no large calcium deposits in their artery and someone else has a lot of calcium deposits but their microvasculature is better, does it make sense to treat them the same way? Probably not, right? But right now, we don’t have that level of detail.
I focused on cardiac PET specifically because it’s currently the most validated way to measure and interrogate microvascular disease. It’s highly reproducible, widely available, and scalable, in contrast to the old-school way of sending someone to the cath lab.
How might this research change clinical cardiology practice?
That’s part of the fun of being an imaging specialist. With these modalities, we can visualize the spectrum of these conditions and use that to improve diagnosis. And, as we’ve started to validate the prognostic significance of these different modalities, we’re better able to risk-stratify patients. The next frontier is using these tools to better manage and treat our patients.
In collaboration with academia and pharma, we’re trying to figure out how to use advanced imaging to make us better clinicians. How can we integrate the information better to achieve more personalized, individualized management? That’s the goal.
You see this approach in oncology: they sequence the tumor so they know exactly the right chemo for that person. They’ve made all these advances and are fine-tailoring treatments. That’s what we’re trying to do in cardiology, to really get into the weeds so we can tailor things appropriately to each person. I think cardiac imaging is going to help us get to that level.
As a cardiologist, I don’t just want to identify people who have severe blockages. I also want to find people who already are showing signs of accelerated atherosclerosis or accumulating a bunch of plaque. The advantage of the PET is that we can identify earlier components of atherosclerotic disease.
“As a cardiologist, I don’t just want to identify people who have severe blockages. I also want to find people who already are showing signs of accelerated atherosclerosis or accumulating a bunch of plaque. The advantage of the PET is that we can identify earlier components of atherosclerotic disease.”
What’s the benefit to patients?
I’ve noticed that with cardiovascular imaging I can actually show patients what their heart or microvasculature looks like, so it’s no longer an abstract concept. It becomes a very concrete condition.
Women tend to have more nonobstructive CAD – it just happens to be disproportionately more dominant in women. In the old days, women would come in with chest pain, get a routine nuclear test–not PET–and be told nothing’s wrong because no major blockage was detected. But if you do the same study with PET, you may find microvascular dysfunction. Then you can start to target women earlier.
Amgen supplied the drugs for your study but is not a sponsor. What has your experience been working with the pharmaceutical industry?
It’s a symbiotic relationship, right? We as academic investigators have questions we want to dive into, and they have their own motivations, so it works out for both of us. I want to interrogate the microvasculature and see which drugs are going to actually help. They are amenable because they can then figure out how best to market their drug. These drugs cost thousands of dollars, and it’s really hard to use them in a clinical study without this kind of collaboration.
I think academia is definitely changing in that more partnerships are happening. Thankfully, Massachusetts General Hospital (MGH) has very clear relationship guidelines laid out for researchers about how to collaborate with industry without posing any conflict of interest.
How did you end up on this career track?
I’m such an imaging nerd. It’s funny how it all came about. In med school, I was so excited when my cardiology professor, who authored a very well-known cardiology textbook for medical students, asked me if I wanted to help him work on the new edition. I was like, “Of course!” At the time I didn’t really have a sense of what I wanted to specialize in within the broad field of cardiology. I ended up getting the cardiovascular imaging chapter to revise, and through that I had to interview multiple people at Beth Israel Deaconess, MGH, and BWH, including my current senior mentor, Marcelo di Carli, MD, who is the Steven E. Seltzer, MD, Professor of Radiology at BWH.
It was fun to talk to cardiac imaging specialists. Marcelo told me to reach out if I ended up staying here for residency, which I did, and it’s been a long, long research relationship ever since. He’s been a research mentor, clinical mentor, research sponsor, and just a good friend.
Everybody in the lab is like family. My resident when I was a med student is in the lab; my chief resident during residency is in the lab – all people that I love. It doesn’t feel like a coincidence. We support each other. It’s just nice to be around people who are so highly motivated, but also care deeply about what they’re doing. Especially right now.