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Scarring of heart muscle can predict risk of death


Tuesday 5 March, 2013

(Embargoed until 21.00 GMT)

Experts from Royal Brompton Hospital and Imperial College London have discovered that fibrosis (scarring) of the heart is an accurate predictor for sudden cardiac death among patients with dilated cardiomyopathy (DCM). The paper "Association of Fibrosis with Mortality and Sudden Cardiac Death in Patients with Nonischemic Dilated Cardiomyopathy" is published today in the prestigious Journal of the American Medical Association (JAMA).

Dilated cardiomyopathy is a disease in which the heart is enlarged, its walls become thinned and weakened and it fails to pump properly.

Affecting more than 35,000 people, it is a leading cause of heart failure in the UK and the most common cause of the need for a heart transplant. Some patients can benefit from an implanted cardioverter defibrillator device (ICD) to prevent death from abnormal heart rhythms, but this is an expensive form of treatment, with unpredictable results.

Researchers, who studied more than 470 DCM patients over eight years, found that fibrosis, which can be detected through a cardiovascular magnetic resonance (CMR) scan, is a better predictor of death than the ejection fraction (the measure of the volume of blood expelled by the heart at each beat), which is the main measure currently used to determine risk and whether to implant an ICD.

Professor Dudley Pennell, a Royal Brompton cardiologist; director of the National Institute for Health Research Royal Brompton Cardiovascular Biomedical Research Unit and professor of cardiology at Imperial College, said: “Implantable defibrillators can be an effective treatment to prevent risk of sudden death, but we need much more evidence to know which patients would benefit from treatment. Implantable defibrillators don’t work for all patients, and this can be very stressful for patients.

“Our findings mean we can improve the selection of patients to have a device fitted – saving lives and potentially, 30 per cent in costs to the NHS for these patients.”

Royal Brompton cardiologist and Imperial College senior lecturer, Sanjay Prasad, was the lead author on the JAMA paper, and said: “Our findings fill an important and significant gap in clinical knowledge about treating dilated cardiomyopathy.

“In the past, it has been challenging to determine in advance which patients would benefit most from a defibrillator – now we know that a CMR scan for each patient to look for the presence of fibrosis can provide essential information for determining effective treatment.”

Lord Howe, Health Minister, said: “We want our patients to have access to the most effective treatments possible, especially if that treatment could help to save their lives. Research like this is incredibly important and I’m delighted we could support the work of clinicians at Royal Brompton Hospital through the National Institute for Health Research.

“Their work will ensure that patients get the most appropriate treatment, directly saving and improving lives, and help NHS funds to be used most effectively.”

The study is an international collaboration between teams at Royal Brompton Hospital, the National Heart and Lung Institute (NHLI) at Imperial College London, University of Edinburgh Centre for Cardiovascular Science and the Singapore National Heart Centre. It has been funded and supported by the National Institute for Health Research Royal Brompton Cardiovascular Biomedical Research Unit, Imperial College London, the British Heart Foundation, CORDA and Rosetrees Trust.


Notes to editors:

Royal Brompton & Harefield NHS Foundation Trust is a national and international specialist heart and lung centre based in Chelsea, London and Harefield, Middlesex. The Trust helps patients from all age groups who have heart and lung problems and is the country's largest centre for the treatment of adult congenital heart disease.

The views expressed in the paper ‘Association of Fibrosis with Mortality and Sudden Cardiac Death in Patents with Nonischemic Dilated Cardiomyopathy’ are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

About the National Institute for Health Research
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world.
For further information, visit the NIHR website: www.nihr.ac.uk

NIHR Royal Brompton Cardiovascular Biomedical Research Unit
The NIHR Royal Brompton Cardiovascular Biomedical Research Unit has several different, but interconnecting research areas enabling clinicians and health researchers to work together to undertake translational clinical research.
The BRU research is directed by Professor Dudley Pennell, and aims to combine novel imaging, cell biology and genetics techniques across a broad range of cardiac diseases to develop innovative treatments and diagnostics for the benefit of patients.
The work broadly falls into the clinical research areas of advanced heart failure, adult congenital heart disease, complex coronary artery disease and aorta and aortic valves. Additionally, there are two crosscutting science areas of advanced imagine and genetics and genomics.

About Imperial College London
Consistently rated amongst the world's best universities, Imperial College London is a science-based institution with a reputation for excellence in teaching and research that attracts 14,000 students and 6,000 staff of the highest international quality. Innovative research at the College explores the interface between science, medicine, engineering and business, delivering practical solutions that improve quality of life and the environment - underpinned by a dynamic enterprise culture.

Since its foundation in 1907, Imperial's contributions to society have included the discovery of penicillin, the development of holography and the foundations of fibre optics. This commitment to the application of research for the benefit of all continues today, with current focuses including interdisciplinary collaborations to improve global health, tackle climate change, develop sustainable sources of energy and address security challenges.

In 2007, Imperial College London and Imperial College Healthcare NHS Trust formed the UK's first Academic Health Science Centre. This unique partnership aims to improve the quality of life of patients and populations by taking new discoveries and translating them into new therapies as quickly as possible.
For further information, please visit the Imperial website: www.imperial.ac.uk

British Heart Foundation
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. For more information, please visit: www.bhf.org.uk/pressoffice

CORDA supports high quality research into the early diagnosis and prevention of heart disease and stroke, mainly through cardiovascular magnetic resonance imaging.  Since its founding in 1976 CORDA has raised funds to support research providing ground breaking new treatments at a number of leading hospitals and currently at Royal Brompton Hospital and the Institute of Neurology.
For further information, please visit: http://corda.org.uk

Rosetrees Trust
Rosetrees Trust is a substantial family foundation established in 1987 that funds life changing medical research. Rosetrees has donated millions of pounds of family money to leading researchers in all the main areas of medical research, including brain and neurological disorders, cancer, cardiovascular disease, imaging, lung damage, nano-technology, regenerative medicine, rheumatology and stroke, to create Rosetrees’ unique model. Rosetrees vision is to fund researchers whether established, or young and promising with the potential to become future leaders in their field, to achieve extraordinary improvements in human health. Since Rosetrees establishment over 25 years ago, nearly £100 million has been invested in world class research, either from Rosetrees or the major grants that followed from Rosetrees’ initial support, towards its target of £1 billion for major medical research, encouraged by Rosetrees’ entrepreneurial philanthropy.
For further information, please visit: www.rosetreestrust.co.uk

For further information, please contact:
Sharene Chatfield
Head of media relations
Royal Brompton & Harefield NHS Foundation Trust
Tel: 020 7351 8672  
Mobile: 07866 536 345
Email: s.chatfield@rbht.nhs.uk

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Read more about Professor Dudley Pennell
Read more about Dr Sanjay Prasad