Diffusion Tensor Imaging in ST-elevation Myocardial Infarction
Research type
Research Study
Full title
Investigation of Post-Myocardial Infarction Left Ventricular Remodelling By Diffusion Tensor Cardiac Magnetic Resonance
IRAS ID
259868
Contact name
Dudley J Pennell
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
3 years, 0 months, days
Research summary
Research Summary
This research will use a novel heart scanning technique called Diffusion Tensor Cardiac Magnetic Resonance (DT-CMR) to assess changes in arrangement of heart muscle cells after a heart attack (ST-elevation myocardial infarction). The damage that occurs after a heart attack leads to heart enlargement and reduced pump function, which can result in heart failure, life threatening heart rhythm abnormalities and death. This study will examine changes in heart muscle architecture 3-5 days after a heart attack using DT-CMR, and assess whether this early measurement can identify patients who will later develop heart enlargement and reduced pump function at 4 months. These individuals are at highest risk of poor clinical outcomes. Early identification may provide opportunities to improve their treatment and reduce risk of future adverse events.
Furthermore, we will also investigate the relationship between disturbed heart muscle architecture following a heart attack, and changes in dimension and composition of heart muscle segments assessed by MRI, and blood markers of heart muscle injury. We will recruit patients treated for a heart attack from Harefield Hospital, which is a high-volume heart attack centre. Each patient will undergo a MRI scan at the CMR unit at the Royal Brompton Hospital 3-5 days and 4 months after heart attack using our new state of the art research scanner. We expect this study to occur over a 3-year period with recruitment of 75 patients.
This research will provide new insights into the mechanisms underlying changes in heart function after a heart attack and expand our understanding of the clinical utility of DT-CMR in these patients. This new knowledge may inform the development and evaluation of new treatments, and if our hypothesis is proven, it will provide the rationale for future studies to establish the role of DT-CMR in risk stratifying patients after a heart attack.
Summary of Results
This work shows that a new scanning technique, diffusion tensor cardiovascular magnetic resonance (DT-CMR) imaging:
a) identifies abnormalities in the orientation and movement of layers and spirals of cells within the heart muscle, called sheetlets, early after a heart attack, both when the heart is in a relaxed state and contracted state. This change in sheetlet function can be used to identify those patients who are at risk of developing a dilated and weakened heart muscle at 4 months after their heart attack. These changes extend beyond the area of heart muscle damaged during the heart attack and are more pronounced in patients with heart attacks which are larger and have higher risk features.
b) detects changes in sheetlet function which are linked to measures of cardiac pump function.
c) enables detection of heart attack without the need to administer special dyes (contrast agents) to identify areas of damaged heart muscle.
This work provides the rationale for future evaluation of DT-CMR as a single contrast-free scanning method for diagnosing and risk stratifying patients after an acute heart attack.
REC name
London - Harrow Research Ethics Committee
REC reference
19/LO/0434
Date of REC Opinion
20 May 2019
REC opinion
Further Information Favourable Opinion