By Dr. Jonathan Shurlock
The Michael Davies award is run annually to recognise researchers (both clinical and non-clinical) who have begun to establish an independent research profile and are developing outstanding investigative practice in the field of cardiovascular medicine. This year’s award was presented to Dr Thomas Treibel, associate professor of cardiology at University College London and Consultant Cardiologist at Barts Heart Centre. He is also a British Heart Foundation Intermediate Clinical Research Fellow.
Building on previous work demonstrating the role of myocardial damage caused by myocardial fibrosis as a determinant of outcome after valve replacement, Dr Treibel’s work has focussed on the role of multi-modal imaging in these patients.
One study explores the association of the left ventricular Stroke Volume index (SVi) as defined by cardiovascular magnetic resonance (CMR) with myocardial remodelling and mortality in patients with severe aortic stenosis after valve replacement. This cohort study enrolled patients undergoing surgical or transcatheter aortic valve replacement (TAVR) who subsequently underwent preprocedural echocardiography and CMR. The results demonstrated an independent association of low SVi with increased cardiovascular mortality (HR, 1.64; 95% CI, 1.08-2.50; P = .04). The authors also found that SVi as defined by CMR was independently associated with focal scar and cardiac remodelling (LV mass and LA volume).
In a similar study which enrolled patients with severe aortic stenosis awaiting TAVR, as a part of the ATTRact-AS (The Role of Occult Cardiac Amyloid in the Elderly with Aortic Stenosis) study. Eligible patients underwent quantification of extracellular volume using Computed tomography (ECVCT). 112 patients were eligible for ECVCT assessment. In this group, 27 deaths occurred over a follow-up period of 21 months. ECVCT was found to be a univariate Cox regression predictor and on multi-variate Cox regression analysis medium-term mortality (>1.5 years) doubled on each 2% increase in ECVCT.
The clinical application of the above research findings is clear in both the pre- and post-valve replacement period for patients with aortic stenosis. Prior to intervention, these forms of imaging can be used to optimise timing and nature of intervention. Post-intervention, the imaging findings can be used for risk stratification and planning further treatments or monitoring.
Congratulations Dr Treibel, for winning the Michael Davies early career award and for the ongoing production of impactful research.
- Thornton GD, Musa TA, Rigolli M, Loudon M, Chin C, Pica S, Malley T, Foley JR, Vassiliou VS, Davies RH, Captur G. Association of myocardial fibrosis and stroke volume by cardiovascular magnetic resonance in patients with severe aortic stenosis with outcome after valve replacement: The British Society of Cardiovascular Magnetic Resonance AS700 Study. JAMA cardiology. 2022 May 1;7(5):513-20. https://jamanetwork.com/journals/jamacardiology/article-abstract/2790671
- Scully PR, Patel KP, Klotz E, Augusto JB, Thornton GD, Saberwal B, Haberland U, Kennon S, Ozkor M, Mullen M, Lloyd G. Myocardial Fibrosis Quantified by Cardiac CT Predicts Outcome in Severe Aortic Stenosis After Transcatheter Intervention. Cardiovascular Imaging. 2022 Mar 1;15(3):542-