Structures inside heart reveal heart failure risk

Having a more complex network of muscle fibres inside the heart can reduce the risk of heart failure according to new research part-funded by us.



The study – published in Nature – has uncovered a hidden role of 'strand-like' muscle structures in the heart called trabeculae which were thought to have no use beyond the heart's early development.

However, researchers from Imperial College London have now found that these structures play a key role in the pumping and electrical activity of the heart and also protect against heart failure.

This discovery could pave the way to the development of vital new treatments for heart failure, when the heart can't pump blood around the body as effectively as it should.

Trabeculae are columns of muscle fibres which form complex branching networks inside the lower chambers of the heart (ventricles). Trabeculae are an example of a fractal – a recurring geometric pattern often observed in nature.

Scientists used artificial intelligence to analyse cardiac MRI scans of over 18,000 people from the UK Biobank. Analysis of these scans showed that those with a more complex network of trabeculae had an increased capacity to pump blood.

The researchers also looked at genetic data from nearly 50,000 patients with heart failure and found that having an increased complexity of these structures directly reduced someone's risk of heart failure.

The team also looked at the genetics of the medaka fish, which has similar trabeculae to humans, and discovered several genes responsible for regulating the branching patterns of trabeculae in the heart. Understanding these genes could provide new targets for drugs to treat heart failure.

An estimated 920,000 people in the UK are living with heart failure, often caused by damage to the heart after a heart attack.

The research was funded by the British Heart Foundation (BHF), the Medical Research Council (MRC), Wellcome, National Institute of Environmental Health Sciences, and the National Institute for Health Research (NIHR).

Dr Declan O'Regan, Consultant Radiologist at Imperial College London, who led the study said:

"The fractal patterns we see in these trabeculae occur throughout nature – from snowflakes through to waves. Our research has uncovered that these branching structures play an unexpected and vital role in the function of the adult heart."

"We now know that many of the genes that determine the development of trabeculae are also important in heart failure. Our next step is to figure out exactly how trabeculae protect against heart failure and whether images of these structures could be used to predict heart failure risk. Better understanding trabeculae, their functions and the genes which control them could lead to new treatments for heart failure."

Professor Jeremy Pearson, our Associate Medical Director, said:

"Heart failure is a devastating condition, affecting a growing number of people in the UK. Despite advances in medical treatments, there is still no cure for this condition – survival rates remain poor and life expectancy is worse than for many cancers."

"Discovering the hidden importance of these muscle structures has opened up new avenues for research into heart failure. It’s early days yet, but this ground-breaking research could lay the foundations for developing new treatments to secure longer, healthier lives for people with heart failure."

Find out more about heart failure