Heart Failure and Cardiovascular Magnetic Resonance Imaging – pathophysiological mechanisms, improved diagnosis and new treatment.

Heart failure affects about 40 million people worldwide, equating to 2% of all adults and 6-10% of people over 65 years of age. Once diagnosed, heart failure leads to 50% mortality within 5 years, which is poorer survival than for most cancers. This equates to a large patient group with a sizable burden of hospitalisation and premature death.

Professor Martin Ugander’s latest research partially funded by Heart Research Australia¬†focuses on developing and using state-of-the-art cardiovascular magnetic resonance imaging (MRI) to better understand, diagnose, and evaluate treatment in heart failure. The research specifically focuses on the challenges related to:

  • Identifying and treating inefficient filling of the heart (diastolic dysfunction),
  • Thick walls of the heart (left ventricular hypertrophy),
  • A reduction in blood flow to the smallest vessels of the heart (coronary microvascular dysfunction)

 

1. Inefficient filling of the heart:

Evaluating inefficient filling of the heart requires accurate measurement . Professor Ugander and his team have developed new MRI methods to provide accurate measurement of the speed of movement of the heart during filling, and blood pressure in different chambers of the heart.  These movements and pressures will be evaluated via new non-invasive MRI measures compared to reference measurements in patients.

Through his research, Professor Ugander has found that surgical reduction in the size of the left atrium of the heart may improve the efficiency of filling. As a result, this latest research will also evaluate the ability of this new surgical treatment to improve filling efficiency in patients undergoing open-heart surgery.

2. Thick walls of the heart:

Professor Ugander and his team have developed new methods to better diagnose thick walls of the heart by both MRI and the electrical activity of the heart using electrocardiography (ECG). The accuracy and utility of these new methods will be evaluated in patients.

3. Small vessel disease

Throughout the research project the accuracy of a new ECG method to diagnose small vessel disease, as shown by MRI, will be evaluated.

 

The development and evaluation of these new diagnostic methods and treatment will establish their utility for use in every day care in patients with heart failure who otherwise currently may be incorrectly diagnosed and have a lack treatment options available to them.

The research from Professor Ugander and his team uses internationally unique, boldly novel, and state-of-the-art methods to address currently unmet clinical needs with regards to methods for the diagnosis and treatment of heart failure. This is highly clinically relevant with a large potential clinical impact.

The results of this research will potentially benefit all patients being evaluated for known or suspected heart failure. More accurate diagnostic methods lead to earlier detection, earlier treatment, decreased morbidity and mortality, and ultimately decreased costs for the healthcare system. Importantly, this represents a disease panorama that disproportionately affects indigenous groups who have a higher burden of diabetes, hypertension, and obesity. The detection of cardiac involvement manifested as left ventricular hypertrophy and coronary microvascular dysfunction by advanced ECG is particularly valuable since these new methods are software-based, do not require new ECG hardware, and can readily be made accessible in rural areas.

All patients with known or suspected heart failure would potentially benefit from the results of this research. In these patients, accurate diagnosis is needed to confidently confirm or exclude the presence of heart failure, and this research seeks to improve these methods, and evaluate a bold new treatment option. Also, aside from the impact of direct clinical utility, the new methods will provide an important ability to accurately and non-invasively study the effects of new treatments for heart failure, which ultimately will come to clinical use. This indirect clinical role as an improved tool for scientific evaluation of new therapies should not be underestimated.

To help support the work undertaken by Professor Ugander and his team, please consider a donation to Heart Research Australia.