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A new publication from the ongoing OxAMI study finds that patients who have had a heart attack show subtle inflammatory differences in the heart muscle unaffected by heart attack. These differences are linked to patients' long-term prognosis.

Black and white and colour MRI images of the heart

The study, published in the in the Journal of American College of Cardiology: Cardiovascular Imaging, analysed over a decade’s worth of magnetic resonance images of the heart, from patients who had been admitted to hospital because of a heart attack. The images included those obtained with a technique called ShMOLLI T1-mapping, invented at OCMR, which allows for the assessment of subtle changes in the heart muscle without using a contrast dye.

Traditionally, clinicians and researchers have focussed on the heart muscle most affected by scarring after a heart attack as the most obvious predictor of how patients go on to do.

But Dr Mayooran Shanmuganathan, the study’s first author, said “We found that patients with abnormal changes in heart muscle not scarred by the heart attack were more at risk of developing heart failure many years later.”

The researchers found that information in T1-mapping MRI images of the whole heart were better predictors of patients’ future health than traditional markers such as the size of the scarred heart muscle, tiny injuries to the heart muscle, or how efficient the heart was in pumping blood after a heart attack.

Dr Shanmuganathan added “Our results  really show that it is important to assess the changes in the whole heart after a heart attack, and that clinicians and researchers should not concentrate just on the scarred part of the heart and the overall pumping efficiency to provide the best prognosis for patients.

Clinical trials are now needed to test the benefit using T1-mapping early after a heart attack to identify patients at risk, and to find treatment strategies to prevent the development of heart failure at long-term”.

This work was conducted as part of Dr Mayooran Shanmuganathan’s DPhil study. His supervisors Professors Vanessa Ferreira, Stefan Piechnik and Keith Channon.

The authors are grateful to all the patients for volunteering to participate in this study and to the support from British Heart Foundation, National Institute for Health and Care Research and Alison Brading Memorial Graduate Scholarship from Lady Margaret Hall at University of Oxford.

Read the paper.