We carry out thousands of studies with the aim of:
- developing the field of nuclear cardiology, with a particular interest in myocardial perfusion imaging, hibernating myocardium, and pharmacological stress
- assessing the relative role of all imaging techniques in cardiology with a particular interest in strategies of investigation and cost-effectiveness
- assistint national and international programmes of training and quality control in cardiac imaging techniques
The EMPIRE study
Economics of myocardial perfusion imaging in Europe
A multi-centre European study has been completed, comparing the cost-effectiveness of diagnostic and management strategies in centres that do and do not use myocardial perfusion scintigraphy routinely. This is the first study to test a decision model in clinical practice in this area, and it has confirmed that centres routinely using scintigraphy obtain a diagnosis more cheaply and more reliably than centres that do not. In addition, management costs are the same or lower and clinical outcomes are the same or better. The findings have important implications for clinical practice world-wide.
The ROBUST study
A comparison of thallium, MIBI and tetrofosmin in routine clinical practice
A collaborative study with University College London recruiting 2500 patients over one year. Patients are randomised to one of three commercially available myocardial perfusion imaging agents, and the clinical utility of the three agents will be compared, The findings will allow a logical choice of imaging agent for the future.
The Detection of Hibernating Myocardium
Imaging techniques have a unique role to play in the detection of myocardium that may improve in function following revascularisation ("hibernating myocardium"). This can redirect some patients from transplantation to coronary bypass grafting, and it can improve symptoms and longer-term outcome in patients with advanced ischaemic heart disease. We have used a combination of thallium scintigraphy and magnetic resonance imaging and have completed a study of 30 patients with hibernating myocardium. The imaging findings have been compared with histological and ultrastructural findings in operative myocardial biopsies, and with post-operative clinical outcome.
The Christmas study
Carvedilol hibernation reversible ischaemia trial: marker of success
This is a UK based international multi-centre study of carvedilol in heart failure. Approximately 1000 patients will be screened for the presence of hibernation using myocardial perfusion scintigraphy and echocardiography. 200 patients with hibernation and 200 without will be recruited and each group will be randomised to carvedilol or to placebo therapy for four months. The primary end-point is change in LVEF as determined by radionuclide ventriculography, and the study will allow the assessment of the role of medical treatment of hibernation. It will also provide data for a number of sub-studies. We are providing a core laboratory for the analysis of the nuclear cardiology data.
Pharmacological stress during myocardial perfusion scintigraphy
We have completed a study of 500 patients randomised to receive adenosine alone, or with submaximal exercise or maximal exercise during myocardial perfusion scintigraphy. The combination of adenosine with exercise reduced the incidence of side effects and of arrhythmias, and it is now in routine use in this and in other centres. The reliability of routine studies, particularly in patients unable to exercise, has benefited significantly.