Manganese-enhanced Magnetic Resonance Imaging (MEMRI) in Heart Failure With Preserved Ejection Fraction

Summary

Heart failure with preserved ejection fraction (HFpEF) is a condition in which the heart cannot fill with blood effectively. As a result, people with HFpEF suffer fatigue, breathlessness, and develop swollen limbs. The condition often requires multiple admissions to hospital and is associated with a marked loss of lifespan.

Despite being so common, very little is known about why people develop HFpEF and there are hardly any known treatments. Type 2 diabetes (T2D) is a major risk factor for HFpEF, and people with both HFpEF and diabetes are at a heightened risk of hospitalisation and premature death. It is unclear why the combination of diabetes and HFpEF is particularly harmful. This may be related to the hearts of people with type 2 diabetes being unable to take up the mineral calcium properly, as well as due to their hearts being less energy efficient. Both of these are vital to heart muscle pumping and filling, but until recently it has not been possible to assess these in humans.

New advances in heart MRI scans, with dedicated scanner techniques and dyes (manganese contrast), now allow extremely detailed pictures of heart structure, function, calcium uptake and energy efficiency, all during the same scan. The investigators will enlist 40 volunteers with HFpEF (20 with T2D and 20 without T2D), and up to 20 healthy volunteers, to undergo a heart MRI scan with manganese contrast to assess calcium uptake and energy efficiency. This will allow the comparison of people with HFpEF with and without T2D, to see how their hearts are different to healthy volunteers.

Conditions

• Heart Failure With Preserved Ejection Fraction
• Type 2 Diabetes

Interventions

DIAGNOSTIC_TEST

Manganese-enhanced MRI and 31-P magnetic resonance spectroscopy

Using a 3-Tesla scanner, 31P magnetic resonance spectroscopy will be performed to obtain information regarding cardiac energetics. An intravenous infusion of manganese dipyridoxyl diphosphate (mangafodipir, MnDPDP) will be commenced at a rate of 1mL/min using a dose of 5µmol/kg (0.1mL/kg).

DIAGNOSTIC_TEST

Cardiovascular magnetic resonance scan

Scan including adenosine stress perfusion

OTHER

Minnesota Living with Heart Failure Questionnaire

Self-administered, validated questionnaire to assess symptoms of heart failure

DIAGNOSTIC_TEST

Echocardiogram

Resting transthoracic echocardiogram to exclude valvular pathology and the assess indices of systolic and diastolic function and speckle tracking for strain

DIAGNOSTIC_TEST

Six-minute walk test

Standardised, objective assessment of exercise capacity

DIAGNOSTIC_TEST

Blood tests

Full blood count, Urea and electrolytes, Liver function tests, Glucose and HbA1c, Insulin and C-peptide, NTproBNP, High sensitive troponin I, storage of plasma for future analyses

Sponsors & Collaborators

• University of Leicester

  lead OTHER

Principal Investigators

• Gerry P McCann, MD · University of Leicester

• Abhishek Dattani, MBBS · University of Leicester

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2024-10-10

Primary Completion

2026-11-30

Completion

2036-02-29

Countries

• United Kingdom

Study Locations