Building a Career in Cutting-Edge Intravascular Imaging

Growing up in Rio de Janeiro, Brazil, Daniel Chamié, MD, PhD, assistant professor of medicine (cardiovascular medicine), was immersed early in the world of interventional cardiology thanks to his father, a renowned interventional cardiologist in the structural and congenital heart diseases.

“The cath lab was a place full of energy and innovation, and rapidly became a joyful and familiar environment,” says Chamié. “Interventional cardiology became a passion that led me to pursue a career in medicine.”

After completing medical school and internal medicine and cardiology residencies, Chamié began training in interventional cardiology. Early in his training, he became fascinated by the information that intravascular imaging could provide compared to standard angiograms.

“I realized there was so much more I could see through intravascular imaging than just a regular angiogram,” says Chamié. “I decided I needed deeper knowledge in intravascular imaging because it would help me better understand the diseases I was treating, refine my technique, and ultimately be a better operator.”

Motivated by this vision, Chamié started studying intravascular imaging by himself by reading textbooks, reviewing thousands of cases from his hospital in São Paulo, Brazil, and seeking the opinion and guidance of senior colleagues. After completing his training, he moved to Ohio for a two-year research fellowship on optical coherence tomography (OCT), which, at the time, was a novel intravascular imaging modality with a higher resolution than ultrasound.

“It turned out to be a lucky moment, because after I had some clinical experience with this technology in my country, the U.S. Food and Drug Administration (FDA) cleared it for use here in the U.S.,” says Chamié. “At the time, many physicians in the U.S. were unfamiliar with the technology, but with my hands-on experience, I was able to share the practicalities and techniques for adequate image acquisition and develop methodologies to help us better analyze and interpret those images.”

After finishing his training, Chamié returned to Brazil, where he spent a decade using his imaging expertise to perform coronary interventions, continually increasing the complexity of his cases. A research organization in Brazil invited him to establish and run an OCT core lab for research to develop new methodologies to improve the analysis of diseases and treatments, which he conducted in parallel with his clinical activities.

“It was an ideal situation, because I could create new analytical methods in the core lab and develop research initiatives based on what I observed in practice, leading to valuable research advancements,” he says.

In the summer of 2022, Chamié joined Yale School of Medicine with a mission to establish the Intravascular Imaging Core Lab within the Yale Cardiovascular Research Group. He quickly built infrastructure, including investing in state-of-the-art technology and establishing standard operating procedures, methodologies, and validations. He has been active in education, recruiting fellows who learn and develop their knowledge of coronary artery disease and interventional treatments through the studies of intravascular imaging.

Chamié also set out to recruit new studies that use interventional imaging technologies. For example, he and his team serve as the intravascular imaging core lab for pivotal studies seeking regulatory approval of interventional devices, post-market studies of approved interventional therapies, and investigator-initiated research in many clinical scenarios and populations. They also help companies develop artificial intelligence (AI) software for non-invasive computed tomography (CT) scans and novel invasive intravascular imaging systems.

“CT scans usually overestimate the size of the calcification in patients’ coronary arteries, which might lead interventional cardiologists to perform more complex techniques to modify the calcification than would be necessary,” Chamié explains. “Using images from the OCT, we are guiding companies to develop a more accurate CT algorithm for the quantification of coronary calcification. It’s exciting to use our invasive imaging knowledge to inform non-invasive imaging experts to improve technology and patient care.”

Although Chamié is still working to get his credentials to provide direct patient care in the U.S., he collaborates closely with colleagues to use intravascular imaging in the clinical setting at Yale New Haven Hospital. For example, he collaborated with Jennifer Frampton, DO, assistant professor of medicine (cardiovascular medicine), and Steven Pfau, MD, professor of medicine (cardiovascular medicine), who performed the first coronary intervention in Connecticut using the new Deep-OCT system from Spectrawave. This next-generation intravascular imaging platform allows for deeper visualization of arterial wall structures essential for coronary intervention planning and uses AI to automate image analysis, improving the speed and accuracy of diagnoses right at the bedside.

In the long term, Chamié aims to build a comprehensive intravascular imaging program that includes everything from medical management to patient care, education, and research under one umbrella. He’s also focused on developing more physician-initiated research that expands into every sphere where interventional imaging can have an impact.

“We’ve only scratched the surface with interventional imaging. We can use this technology to provide researchers with valuable information about how medications affect cardiovascular disease, or whether there is any stabilization or regression of disease, and integrate these findings with individual patient data to improve risk stratification and personalize treatment strategies,” says Chamié. “Ultimately, my long-term goal is for Yale to be one of the leading imaging centers in the country—and why not in the world?”

Cardiovascular Medicine, one of 10 sections in the Yale Department of Internal Medicine, is dedicated to improving cardiovascular health by advancing groundbreaking research, training the next generation of experts in cardiology, and delivering world-class patient care to people with a range of cardiovascular issues. To learn more, visit Cardiovascular Medicine.