How does the microscopic arrangement of a person’s heart cells affect their long-term heart health?
It’s the question researchers at Royal Brompton & Harefield NHS Foundation Trust and Imperial College London are hoping to determine, thanks to almost £1.5 million in funding from the British Heart Foundation (BHF).
Scientists have known for years that the cells of the heart are aligned in a spiral that goes in one direction on the outside of the heart and in another on the inside. However, no one has yet been able to work out how this factors into understanding how the heart pumps or how it affects those with heart defects.
People born with certain heart defects have an increased risk of developing heart failure, but little is known about why some people do and others don’t.
With this funding, Professor Dudley Pennell (pictured) and his team hope to find out whether the heart’s microstructure can help to explain these different outcomes.
What ‘s been discovered so far
The research team have already begun to reveal the microstructure of the heart in greater detail than was previously possible using cutting-edge scanning techniques.
They have recently discovered that, in some people with hypertrophic or dilated cardiomyopathy (inherited conditions that cause the heart to become thickened or enlarged), the heart muscle cells are arranged chaotically.
They’ve also found unusual cell patterns in people born with a rare condition called dextrocardia, where the bottom of the heart is on the right side of the chest instead of the left. But it’s not known exactly how these cell patterns develop or how common they are in other congenital and inherited heart conditions.
Professor Pennell’s theory is that hearts with a disordered microstructure might be more likely to suffer damage from high blood pressure or a heart attack, which could lead to heart failure further down the line.
“If this is the case, we might be able to identify people at high risk of heart failure many years in advance, and offer them treatment to reduce their blood pressure and cholesterol, or other drugs to help protect against heart failure.”
A new scanning technique
To test his theory, Professor Pennell is using a new type of heart scan called diffusion tensor cardiovascular magnetic resonance (DT-CMR).
Until recently, this type of scan, which tracks the movement of water molecules, had only been used in research in animals, and on human hearts after death, but Professor Pennell’s team has developed the technique to study hearts in living people.
“It is particularly difficult to do this in a moving heart, but by demonstrating it works routinely in patients, we’ve moved from the impossible to the possible.”
The researchers will scan the hearts of patients with congenital heart conditions and inherited diseases of the heart muscle. They will then follow their health over time, to find out whether patients with an unusual microstructure are more likely to develop heart failure.
They also want to make the scanning process easier and faster: currently patients need to be in the scanner for an hour to allow researchers to collect the necessary images and carry out complex calculations.
“If our research shows there’s a benefit to these scans, we think it could be introduced into routine care within five years,” Professor Pennell explains. “We hope that by revealing how the heart functions at a microscopic level, we can improve the way patients are treated and help them to stay healthier for longer.”
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*A version of this article originally appeared in Heart Matters, the British Heart Foundation’s patient magazine.