Imaging Cardio-Mechanical Health

Heart failure (HF) and coronary heart disease (CHD) are major clinical conditions affecting an estimated 2.7M people in the UK alone. Both of these conditions result in a fundamental reduction in the ability of heart muscle to effectively pump and deliver blood to the body. While this deficiency in the heart is easily detected using medical imaging, dissecting the causes of reduced heart performance in terms of its implications for muscle health remain an open challenge for the treatment of heart failure and evaluation of patient treatment.

The Imaging Cardiomechanical Health (ICMH) project aims to address this need by directly measuring the health of the heart muscle through the development of cardiac Magnetic Resonance Elastography (cMRE). Using state-of-the art magnetic resonance imaging and biomechanical modelling, this project will provide a novel noninvasive modality (cMRE) for directly measuring the alterations in muscle properties, determining the mechanical pathophysiology behind reduced function. Integrating new imaging sequences with biomechanical processing software, this project will aim to systematically develop, verify and validate these tools using 3D printed and ex vivo animal heart models. Building on these engineering developments, cMRE tools developed through the ICMH project will be applied in patients and volunteers to illustrate the potential of this new modality.

The central aim of this project is the development of robust clinical tools for the in vivo measurement of the intrinsic active and passive biomechanical properties of cardiac tissue using magnetic resonance elastography (MRE) in conjunction with advanced biomechanics. Delivery of cMRE technology would provide a new mode for assessing muscle health in clinical treatment and biomedical research, presenting pathways for improving clinical outcomes and reducing economic costs.

Impact in the Clinic: Current assessment of heart health is based on echocardiography or MRI surrogates of pump function. These analyses inherently measure the health of the cardiovascular system as a whole and are nontrivially modulated by multiple factors - e.g. vascular hypertension, microvascular disease, and preload failure - that may obscure the health of the myocardium itself. While cardiac pressure catheterisation permits a more thorough and direct assessment of the heart muscle, the invasiveness of the method often means its use is delayed until patients show significant heart failure symptoms. Due to the associated risks, the catheterisation process is only repeated in specific patients post-treatment, limiting the assessment of patient-specific treatment efficacy. Development of our cMRE technology would alter each step of this process. The non-invasive nature of our technique would allow its safe use at early disease stages, providing a clear assessment of tissue health distinct from the rest of the cardiovascular system. This complementary information could be integrated into clinical diagnosis procedures, improving patient stratification as well as focusing therapies to address problems identified within the muscle of the heart. Further, the procedure could be safely repeated, allowing re-assessment of tissue health during treatment. This would enable low-risk, longitudinal guidance for adjusting therapy through time. These improvements would also come at significantly reduced cost (£350 / 1hr MRI scan time) compared to pressure catheterisation (£1250 / procedure, equipment and in-patient time).

Impact in Clinical / Basic Research: A core outcome of this project is a novel tool for assessing the properties of the heart - and other tissues - non-invasively. This would provide a valuable tool for research in both clinical and basic science arenas as explained in Academic Beneficiaries and Academic Impact sections. Realizing this potential, the developments in this project - which require interdisciplinary input - extend to a broad range of potential end users, enabling the cross-pollination of ideas through training workshops and education programmes (see Pathways to Impact).

Economic Impact: The economic impact of the proposed work will be realised through commercial opportunities stemming from the project (see National Importance). Development and dissemination of these tools will require commercialisation to absorb costs associated with device manufacturing, installation and CE marking. Our team at KCL has experience in these development procedures, being currently involved with the European Union-funded PICTURE project, where new transducer technology for the assessment of breast tumours has entered into the patent process. These initial efforts in development of MRE transducer design and reconstruction has already generated interest from 12 clinical sites worldwide as well as interest from imaging companies (Siemens and Philips). Use of our technology would require specific, engineered wave transducer technologies (current devices in our lab have been designed for brain, heart, liver and cells) as well as installation of our sequences and FEM-based reconstruct tools. Delivering these solutions to clinical, experimental and engineering end-users would necessitate commercialisation (see Pathways to Impact).