An award-winning research project, funded by the British Heart Foundation (BHF), has tested a new imaging method which could help improve how doctors predict a patient's risk of having a heart attack (1).
Scientists from the University of Edinburgh, a BHF Centre of Research Excellence, in collaboration with the University of Cambridge are the first to demonstrate the potential of combining PET and CT scanning to image the disease processes directly in the coronary arteries that cause heart attacks (2).
There are nearly 2.7 million people living with coronary heart disease (CHD) in the UK and it kills 88,000 people each year. Most of these deaths are caused by a heart attack. Each year there are around 124,000 heart attacks in the UK (3).
The research, published in the Journal of the American College of Cardiology (JACC) (4), involved giving over 100 people a CT calcium score to measure the amount of calcified or hardened plaques in their coronary arteries. This is a standard test, which is commonly used to predict CHD risk but cannot distinguish calcium that has been there for some time from calcium that is actively building up.
The patients were also injected with two tracers, special molecules that show up on certain imaging scans and can be used to track substances in the body.
One of these tracers, 18F-sodium fluoride (18F-NaF), is a molecule taken up by cells in which active calcification is occurring. The 18F-NaF can then be picked up and measured on PET scans.
The researchers wanted to see if they could identify patients with active, ongoing calcification because these patients may be at higher risk than patients in whom the calcium developed a long time ago.
The results showed that increased 18F-NaF activity could be observed in specific coronary artery plaques in patients who had many other high-risk markers of cardiovascular disease.
Dr Marc Dweck, lead author on the research paper and a BHF Clinical Research Fellow at the University of Edinburgh, said:
"Predicting heart attacks is very difficult and the methods we've got now are good but not perfect. Our new technique holds a lot of promise as a means of improving heart attack prediction although further ongoing work is needed before it becomes routine clinical practice.
"If we can identify patients at high risk of a heart attack earlier, we can then use intensive drug treatments, and perhaps procedures such as stents, to reduce the chances of them having a heart attack."
Dr Shannon Amoils, Research Advisor at the (BHF), which funded the study, said:
"For decades cardiologists have been looking for ways to detect the high-risk plaques found in coronary arteries that could rupture to cause a heart attack, but it's been difficult to develop a suitable imaging test that can focus in on these small vessels.
"This research is a technical tour de force as it allows us to assess active calcification happening right in the problem area – inside the wall of the coronary arteries and this active calcification may correlate with a higher risk of a heart attack."
The research follows on from recent work Dr Dweck did using PET/CT that provided greater insight into the aortic valve disease – aortic stenosis (5). With the support of the BHF, Dr Dweck and his colleagues at Edinburgh also intend to translate this technique into predicting a patient's risk of a stroke.
Notes to editors
1. The excellence of Dr Dweck's research was recently recognised with two academic prizes: the William W Parmley Young Author Award and the Young Investigator Award by JACC and the American College of Cardiology respectively.
2. The PET and CT scanning was carried out at Edinburgh's Clinical Research Imaging Centre into which the BHF invested £3 million in 2010.
3. Scarborough P et al (2010). Coronary heart disease statistics 2010 edition. British Heart Foundation: London.
4. Dweck M et al (2012). Coronary arterial 18F-Sodium Fluoride Uptake. Journal of the American College of Cardiology. Currently available online: http://content.onlinejacc.org/cgi/content/abstract/59/17/1539
5. Information about this research is available here: http://www.bhf.org.uk/default.aspx?page=14021
6. Scan image showing active calcification available.
The British Heart Foundation (BHF) is the nation's heart charity, dedicated to saving lives through pioneering research, patient care, campaigning for change and by providing vital information. But we urgently need help. We rely on donations of time and money to continue our life-saving work. Because together we can beat heart disease.
University of Edinburgh
Founded in 1583, the University of Edinburgh has for more than 400 years been one of the most influential centres of knowledge in the world.
Located in the Scottish capital, among the great figures who have studied at Edinburgh are naturalist Charles Darwin, philosopher David Hume, telephone inventor Alexander Graham Bell British Prime Minister Gordon Brown. Pioneering research linked to Edinburgh includes the discovery of chloroform, the TB vaccination, microchips which power iPod music players and the cloning of Dolly the Sheep. Today Edinburgh is home to nearly 28,000 students.
University of Cambridge:
The University of Cambridge's mission is to contribute to society through the pursuit of education, learning and research at the highest international levels of excellence. Cambridge's reputation for excellence is known internationally and reflects the scholastic achievements of its academics and students, as well as the world-class original research carried out by its staff. Some of the most significant scientific breakthroughs occurred at the University, including the splitting of the atom, invention of the jet engine and the discoveries of stem cells, plate tectonics, pulsars and the structure of DNA. From Isaac Newton to Stephen Hawking, the University has nurtured some of history's greatest minds and has produced more Nobel Prize winners than any other UK institution with over 80 laureates.
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