EH 4_2015

Safe and Efficient BIOTRONIK Home Monitoring provides early detection of clinically relevant events – improving patient outcomes and therapy efficiency. BIOTRONIK Home Monitoring® www.biotronik.com CARDIOLOGY EUROPEAN HOSPITAL  Vol 24 Issue 4/15 10 Continued from page 9 PET/MR is promising in cardiology Researchers hope they will be able to use PET/MR in many more applications. Bucciarelli-Ducci: ‘The ambition for PET/MR is that it rep- resents a one-stop shop where you can measure precisely myocardial function, but also viability assess- ment with FDG, which is the gold standard on top of tissue revascu- larisation and weak cardiac MR.’ Simultaneous acquisition by PET/ MR studies is another advantage, since it facilitates workflow and image registration significantly. Choosing PET/MR over PET/CT leads to a dose reduction of 80% by leaving CT alone – a strong argu- ment in they system’s favour, espe- cially in child imaging. Although data on PET/CT or PET/ MR for cardiac applications is almost non-existent, a paper published by Catalano et al. in Radiology in 2013, can be used as a reference. The study compared the use of the two hybrids in cancer patients and concluded that data found by PET/ MR revealed additional findings not similar to PET/CT in 41% of the patients. ‘It’s very relevant because it did impact on clinical management in about 18% of patients, and influ- enced decisions on whether they should receive additional chemo- therapy and surgery or not’ she points out. Despite numerous promises, a series of very real weaknesses continue to restrain development of the new hybrid. First, the price of the modal- ity is dissuasive and means doctors will have to justify the cost. Then, PET/MR equipment is scarce, and only very few centres worldwide do cardiac PET/MR. Siemens recently published a map of its Biograph mMR (which enables to do 3-T) global distribution; Even if they were present on four continents as of January 2015, they only had about 60 machines in total. Additionally, the level of exper- tise demanded by the modality is very high and remains an obstacle to its widespread use among cardi- ologists. ‘Once you do PET/CT, it’s Part of a healthy heart cell with a T-tubule ‘bicycle spoke’ structure Part of a heart cell following a heart attack, where T-tubules have been lost. A ‘super-tubule’ (cyan) compared with healthy T-tubule (pink) Report: Mark Nicholls Images revealing the ‘bicycle spoke’ structure of a heart cell may hold key clues to reducing damage from a heart attack. Research conducted by Dr Ashraf Kitmitto and colleagues at the University of Manchester provides new information as to why some cells do not work properly follow- ing a heart attack. Their findings – illustrated with striking 3-D nano- images – were presented at the British Cardiovascular Society (BCS) Conference in Manchester in June in the session ‘Unravelling the struc- tural basis of cardiovascular disease through the application of advanced imaging techniques’. Using serial block face scanning electron microscopy (SBF-SEM), Kitmitto and her team produced the 3-D images of a healthy heart cell at nanoscopic scale, which shows that part of their structure is arranged like spokes on a wheel. During her talk, ‘3-D views of myocyte remodelling in heart failure and MI’, Ashraf Kitmitto discussed how the spoke-like structures, called T-tubules, carry an electrical sig- nal from the outside the cell to the inside and are necessary for the coordinated transmission of the electrical impulse through the cell, enabling cardiac cells to contract and thus the heart to pump blood around the body. However, following myocardial infarction, the T-tubules are lost in many areas and the electrical signal cannot be carried properly through the cells. The cardiac myocyte death triggers a healing response and dangerous irregular heartbeats. The next step is to find out why this process happens following a heart attack and develop strategies to intervene to stop it from happening, for improved outcomes. With an estimated 550,000 people in the UK living with heart failure following a heart attack, Kitmitto said: ‘We’ve made major advances in treating people following a heart attack, so more people are surviv- ing, but the treatments don’t address changes to the structure of the heart.‘ For the first time, we’ve been or remodelling with extracellular matrix, fibrous tissue deposition within the surviving myocardium. The remaining T-tubules appear to fuse and clump together form- ing very large, but distorted, ‘super- tubules’. Funded by the British Heart Foundation (BHF), the research has offered what Kitmitto described as ‘the most detailed images of the T-tubule network to date’ – promis- ing new insights into the structural changes that may contribute towards the development of heart failure Brilliant ‘bicycle spoke’ images may hold clues to myocardial infarction Advanced imaging techniques reveal T-tubules Source:Dr.F.Nensa&Dr.T.Schlosser,UniversityHospitalEssen,Germany Siemens’ Biograph mMR provides MR and PET data as one dataset – molecular MR acquisition data. Although this machine was not developed for cardiac imaging, but rather oncology, its potential in the cardiac field represents an opportunity

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