Research fields of interest

Research areas of interest

1) Cardiac energetics

Cardiac energetics is a major research focus of the groups led by Profs. Neubauer, Clarke and Watkins. The failing heart is an engine out of fuel, and altered energetics are likely to play a major role in the pathophysiology of contractile dysfunction in heart failure, diabetes and obesity. Energy compromise is also a new paradigm for hypertrophic cardiomyopathy. At OCMR, we are pursuing various lines of clinical investigation into the role of cardiac energetics, both at rest and stress. Energy metabolites can be measured non-invasively in patients with 31P-MR spectroscopy. By measuring cardiac function, perfusion, tissue oxygenation and fibrosis simultaneously with CMR imaging, we are able to dissect primary vs. secondary roles of energetic changes in these disease states. Therapy studies aimed at optimising cardiac energetics are also a major focus of the group.

For more info: stefan.neubauer@cardiov.ox.ac.uk

2) Cardiomyopathies

Multi-modal magnetic resonance imaging in patients with LV hypertrophy, such as hypertrophic cardiomyopathy, hypertrophic cardiomyopathy phenocopies, athlete’s heart, LV non-compaction, hypertensive heart disease and dilated cardiomyopathy is a research focus of a group led by Profs Watkins and Neubauer, Dr. Petersen and Dr. Hudsmith. We are investigating the interrelationships of myocardial hypertrophy, myocardial regional and global function, myocardial fibrosis and myocardial blood flow in such conditions to shed light into various pathophysiological aspects.

For more info: steffen.petersen@cardiov.ox.ac.uk

3) CMR assessment of Revascularisation Injury, Myocardial Hibernation and Myocardial Ischemia

Our work has evaluated the role of cardiac magnetic resonance (CMR) imaging in the characterisation of myocardial injury, in coronary artery disease patients, in a variety of clinical settings. In a randomised trial, CMR was used to study the rate and severity of both reversible (myocardial stunning) and irreversible myocardial injury (myocardial necrosis) in patients undergoing two different techniques of coronary artery bypass surgery (CABG)-off pump surgery vs. conventional (on pump) surgery. We found that off pump surgery results in significantly better left ventricular function early after surgery most likely by reducing global myocardial stunning and that both surgical techniques result in a similar degree of CMR defined irreversible myocardial injury despite off-pump surgery producing less post-operative biochemical marker release. Separate clinical studies have evaluated the mechanisms and functional significance of cardiac troponin rise in the setting of percutaneous coronary intervention (PCI) by correlating changes in DE-MRI obtained both pre PCI and post PCI, with angiographic and procedural variables in a population of CAD patients undergoing complex PCI.

We have also used quantitative first pass perfusion imaging techniques to investigate resting blood flow changes in myocardial hibernation, and have recently completed a study comparing the utility of 1.5T vs. 3T CMR perfusion imaging for the diagnosis of suspected coronary artery disease. Ongoing work is centered on high-field (3T) perfusion and blood-level oxygenation imaging (BOLD) in microvascular and macrovascular coronary disease.

For more info:stefan.neubauer@cardiov.ox.ac.uk

4) The Effects of Uncomplicated Obesity On the Cardiovascular System

The obesity epidemic is escalating worldwide and, if present trends continue, is set to supersede smoking as the primary cause of morbidity and mortality in the next decade. Obesity had been implicated in many cardiovascular diseases, e.g. hypertension, coronary artery disease, and heart failure. Most studies into the effect of obesity are done on obese subjects who have concomitant diabetes, insulin resistance or hypertension- pathologies that exert independent cardiovascular effects. However, there is evidence that a significant number of obese people have none of these complications. Uncomplicated obesity is associated with abnormal cardiovascular function and energetics and with hyperleptinaemia, but the mechanisms underlying this phenotype are incompletely understood.We are investigating the effect of obesity per se on cardiovascular function and metabolism, using rest and stress cardiovascular magnetic imaging and spectroscopy techniques.

For more info: stefan.neubauer@cardiov.ox.ac.uk

5) MR Development

The cardiac MR physics group is developing a number of acquisition and analysis methods that enable higher quality research and clinical examinations.  Projects are split between analysis (primarily the analysis of vascular images) and data acquisition.  We are fortunate to be one of the few groups with good access to 3T scanning for cardiac work.  Work at 3T follows two distinct themes, incremental work that takes proven 1.5T methods and applies these at 3T, these require small changes to protocols and workflow but can validate 3T against the 1.5T gold-standard as a clinical device.  The second area exploits the higher SNR of 3T to make feasible exams that were previously impossible, such as 31P exercise physiology, high resolution cardiac 31P, cardiac BOLD imaging.  Our work benefits from very close links with our clinical research colleagues, and the methods that we develop are focused towards real clinical problems.

EPSRC Vascular Analysis Project

For more info: Matthew Robson (email: matthew.robson@cardiov.ox.ac.uk)

6) Vascular MRI

Work in the Vascular Group is directed towards development and application of MRI to characterize atherosclerosis and vascular disease.   The aim is to use these techniques to provide insights into the pathophysiology of atherosclerosis and its complications; to obtain earlier and more refined diagnosis and to quantify the response to therapeutic interventions.  To these ends, researchers in OCMR have developed methods to measure vascular function (aortic compliance, brachial artery flow-mediated vasodilatation and pulse wave velocity) and structure (aortic and carotid atherosclerosis) in a single examination.  The precision of MRI for measurement of vascular parameters allows the effects of therapies to be quantified in small numbers of patients over short time frames.  The group works closely with colleagues in cardiology, & cardiac and vascular surgery.  Clinical trial work is supported by dedicated Research Nurses and a Clinical Trials Administrator embedded within Cardiovascular Medicine.

For more info: robin.choudhury@cardiov.ox.ac.uk

7) Valve disease

Assessing the clinical utility of CMR quantification in valve disease. The optimal timing for valve replacement surgery is unclear, as irreversible left ventricular (LV) dysfunction may develop while asymptomatic, with a reduction in long-term prognosis. Predicting irreversible post-operative function is thus important for the timing of surgery, and accurate quantification of cardiac parameters with CMR may enable this. CMR may also predict the onset of symptoms and/or the need for valve surgery in asymptomatic, conservatively managed patients, and improve the timing of surgery in this group. Both of these outcomes would have a major impact on clinical management, and could improve long-term prognosis in addition to improving our understanding of the mechanisms of LV dysfunction in valve disease.

For more info: saul.myerson@cardiov.ox.ac.uk