Quantitative Cardiovascular Physiology – Jannike Nickander's team

We combine quantitative cardiac magnetic resonance (CMR) imaging with proteomic and biomarker analysis to understand coronary microvascular dysfunction and ischemic heart disease in patients without obstructive coronary artery disease. By integrating advanced imaging biomarkers with omics data, we aim to improve diagnostic precision and uncover the mechanisms behind these common but underdiagnosed conditions, translating findings into better-targeted clinical care.

Part of the:
Small vessel disease in young patients with Wilson’s disease
Blood platelets and proteins slide down blood vessels. Illustration. Photo: Getty Images

Small vessel disease in young patients with Wilson’s disease

A new study from Karolinska University Hospital and Karolinska Institutet in collaboration with Uppsala University Hospital and Uppsala University shows suspected small vessel disease in young patients with Wilson’s disease. The study was recently published in Journal of Cardiovascular Magnetic Resonance.

Small vessel disease in long-term follow-up of severe COVID-19
An elderly worried woman in glasses sits and holds her chest. Photo: GettyImages,Getty Images

Small vessel disease in long-term follow-up of severe COVID-19

Patients hospitalized for severe COVID-19 exhibit cardiac systolic dysfunction and small vessel disease at long-term follow-up. This is according to a new study from Karolinska Institutet and Karolinska University Hospital published in Jama Network Open.

Researchers in clinical physiology receive millions in research funding
A group picture of seven researchers in hospital environment Photo: Stefan Zimmerman

Researchers in clinical physiology receive millions in research funding

We congratulate the research group Clinical Physiology at the Department of Molecular Medicine and Surgery, where a total of five researchers were granted millions from the Swedish Research Council and the Heart-Lung Foundation 2022.

New study shows sex differences in the physiology of the heart
Jannike Nickander and Martin Ugander Photo: N/A

New study shows sex differences in the physiology of the heart

Thanks to new technology, researchers at the Clinical Physiology group, Department of Molecular Medicine and Surgery, Karolinska Institutet, have been able to show that females have higher myocardial perfusion, blood volume and extracellular volume in the heart compared to males. These findings were recently published in the journal Scientific Reports.

Our research

Coronary microvascular dysfunction (CMD) and myocardial infarction with non-obstructive coronary arteries (MINOCA) are increasingly recognized causes of chest pain and ischemic heart disease, yet remain underdiagnosed — particularly in women. Quantitative cardiac MRI provides a unique, non-invasive window into myocardial perfusion, tissue characterization, and microvascular function, allowing us to detect disease mechanisms that conventional angiography cannot capture.

Led by Jannike Nickander, our research combines state-of-the-art quantitative CMR (including stress perfusion imaging, T1/T2 mapping, and extracellular volume quantification) with proteomic profiling to build a more complete picture of the pathophysiology underlying CMD and MINOCA. We are a part of the research group for Clinical Physiology at Karolinska Institutet and Karolinska University Hospital, and collaborate across cardiology, radiology, and laboratory medicine to bridge mechanistic imaging findings with clinical translation.

Research vignettes

Coronary microvascular dysfunction and quantitative stress perfusion CMR

Coronary microvascular dysfunction is a key contributor to ischemic symptoms in patients with angina but no obstructive coronary artery disease. Using quantitative stress perfusion CMR, we characterize microvascular blood flow reserve non-invasively, aiming to refine diagnostic criteria and better identify patients at risk of adverse cardiovascular outcomes.

Sex differences in cardiac imaging biomarkers

Women are disproportionately affected by MINOCA and CMD, yet diagnostic imaging thresholds have historically been derived from male-predominant cohorts. Our work has demonstrated sex differences in myocardial blood volume, perfusion, and extracellular volume at rest and during vasodilator stress, providing mechanistic insight that is now informing sex-specific reference values in quantitative CMR.

Follow-up and long-term outcomes in MINOCA

Patients with myocardial infarction with non-obstructive coronary arteries often lack a clear mechanistic diagnosis at the time of the acute event. Through comprehensive follow-up CMR, we investigate the evolution of myocardial injury, microvascular function, and clinical outcomes in this population to guide more precise long-term management.

Integrating proteomics with cardiac imaging

By combining high-throughput proteomic platforms (e.g., Olink) with quantitative imaging biomarkers, we aim to identify circulating protein signatures associated with microvascular dysfunction and myocardial tissue changes, opening avenues for novel non-invasive biomarkers and a deeper mechanistic understanding of ischemic heart disease without obstructive coronary disease. 

Publications

All publications from group members

Funding

  • Swedish Heart Lung Foundation
  • Swedish Society of Medicine
  • Region of Stockholm (ALF)
  • Karolinska Institutet
  • Magnus Bergvalls stiftelse

Staff and contact

Group leader

All members of the group

Alumni

  • Raman Vashishtha
  • Abdumalek Al-Hashimi
  • Rebecka Vesterlund
  • Ivan Bekhali
  • Esra Mohamed
  • Bilal Blbisi 

Contact 

For more information, research opportunities, student projects, or collaborations please contact the team leader:

Jannike Nickander; jannike.nickander@ki.se

Postal address

K1 Molekylär medicin och kirurgi 
K1 MMK Klinisk fysiologi
SE-171 76 Stockholm

Visiting address

Eugeniavägen 3, Karolinska University Hospital, A8:01, 17176 Stockholm