A new £13 million research centre aims to improve the early treatment of heart attack and strokes by understanding more about what is happening in the patient's heart or brain tissue at the time of the attack.
The University of Oxford Acute Vascular Imaging Centre (AVIC) at the John Radcliffe Hospital offers the latest technology for imaging and diagnostics during a heart attack or stroke, and will be officially opened in Oxford on Monday 15 October.
'AVIC will help doctors understand much more precisely what is actually happening in the patient's heart or brain at those crucial times during the heart attack or stroke, when such information is needed the most,' says Professor Robin Choudhury of Oxford University, who is Clinical Director of AVIC.
'We believe AVIC is unique worldwide in emergency medicine in having both a fully equipped suite for treating blocked arteries and an MRI scanner, where patients can be transported smoothly and rapidly between the two. This is done almost at the push of a button, thanks to a mechanised system and rails laid in to the floor.
'It means the patient isn't disturbed from their position on the table, it saves time and it makes it more streamlined for doctors to get all the imaging information they need.'
Importantly, the clinical research centre is joined to the Emergency Department and is next to the Oxford Heart Centre at the John Radcliffe Hospital. As a result, AVIC is embedded in the hospital environment: patients can be moved into AVIC with no loss of time and full support from specialised hospital care teams is ensured.
Funding for the centre has come predominantly from the Medical Research Council, British Heart Foundation (BHF), Department of Health and the National Institute for Health Research Oxford Biomedical Research Centre.
'When we first see a patient with a heart attack, the first steps are to talk to the patient, to get a case history and take an ECG – a 100 year old technology that is an indirect measure of electrical activity in the heart,' says Professor Choudhury, who is also an interventional cardiologist at John Radcliffe Hospital, part of the Oxford University Hospitals NHS Trust.
'The ECG provides really superficial information when we want to be able to make critical decisions quickly about the patient. It tells us little about the precise causation, the nature and extent of tissue damage or, importantly, how much the heart tissue is likely to recover and repair itself. A similar set of problems exists in stroke medicine.'
This is where the state-of-the-art imaging technologies available in AVIC can provide doctors with detailed and precise information soon after the time of the heart attack.
Professor Choudhury says: 'We are now able to characterise the heart in more detail and to determine the nature of the injury that the heart has sustained, enabling research on treatment approaches that are tailored for particular patients.'
He explains: 'Most cases of heart attack are due to blockage of an artery that supplies the heart with blood. In a stroke, the blockage is in an artery that supplies the brain. Treatment often involves the removal of the blood clot and insertion of a balloon or stent to correct the blockage. In Oxford, we typically achieve this within 20-25 minutes of a patient's arrival at the hospital. Those patients taking part in research consent to further detailed blood, physiological and imaging measures as well.
'After the patient has stabilised the next day, they may go to AVIC for more imaging tests and come back again 6 months later to learn more about their recovery. All of this allows the underlying processes in the patient’s heart and brain to be characterised in order to inform development of more sophisticated approaches to treatment.'
AVIC has both a state-of-the-art catheter lab and an MRI scanner separated only by a set of hydraulic doors. Rails in the floor allow patients to be transported smoothly between the two, rather than having to get patients up, onto a trolley and transported somewhere else.
The catheter lab offers X-ray imaging of the blood vessels causing the heart condition or stroke while treatment is targeted to the narrowed or blocked artery.
The 3 Tesla MRI scanner offers newer imaging techniques that can show the blood flow in different blood vessels for better diagnosis and characterisation of the problem. Research at Oxford University and elsewhere is rapidly advancing these techniques and their use in cardiovascular medicine.
The new centre is a good example of how the University of Oxford and the Oxford University Hospitals NHS Trust work in partnership, leading to benefits for patients and providing a clear example of translational medicine – the process of bringing innovation from research to the patient’s bedside.
AVIC is a university research centre with around 20 university and NHS investigators currently carrying out 12–15 separate clinical studies in heart disease and stroke. It is located on the John Radcliffe site and patient care is fully integrated and supported by NHS staff and resources.
'Heart attack and stroke patients in Oxfordshire – and further afield – will benefit from the high-end imaging available in AVIC,' says Professor Alastair Buchan, head of medical sciences at Oxford University, who will be using AVIC in the course of his own research. 'Patients can know they are receiving the best care from specialist NHS staff at the John Radcliffe, while taking part in research that could guide future care in this country and elsewhere.'
'NHS patients are benefiting from this unique service which is embedded within the John Radcliffe Hospital. It is another example of how the partnership between the research expertise of the University of Oxford and the clinical expertise of the Oxford University Hospitals is translated into improved care for patients with heart attack and stroke,' says Professor Ted Baker, Medical Director of Oxford University Hospitals NHS Trust.
Professor Jeremy Pearson, Associate Medical Director at the BHF, which co-funded the building and equipment for the new centre, said: 'We are delighted to be supporting this truly world-leading facility, which is already breaking new ground in the fight against heart disease. Thanks to the donations of our supporters, these scientists are pushing the boundaries of what's possible in heart research.
'Doctors at the centre will use state-of-the-art scanners to take detailed heart images in that crucial window just after a heart attack. This will give us new clues about how to improve future care, and help us all in our efforts to find new and better ways to diagnose and treat heart disease.'