Title: Developing MRI sequences to Assess maternal cardiac and Placental function in women with HyperteNsion in prEgnancy (DAPHNE)
Funder: The Academy of Medical Sciences

Abstract: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and infant morbidity and mortality, encompassing chronic and gestational hypertension, and preeclampsia. Studies suggest HDP includes a variety of cardiovascular phenotypes. Cardiovascular magnetic resonance imaging (CMR) is the gold standard for measuring cardiac structure and function. It provides diagnostic and prognostic insight into myocardial and vascular injury/adaptation, including inflammation, fibrosis, and tissue perfusion/oxygenation. Placentation transforms uterine microcirculation, and influences maternal cardiovascular adaptation. Simultaneous evaluation of cardiovascular and placental function may provide novel insight into HDP mechanisms, individualised risk stratification, management, intervention targets, and evaluation of novel/repurposed interventions. The project will: 1. Develop a novel imaging protocol for cardiac and placental function assessment by A) assessing feasibility and acceptability MRI to capture maternal cardiac and placental views 2. Assess cardiac and placental structure and function in HDP by MRI including a) cardiac volumes, ejection fraction, strain rate, oedema (T2), fibrosis (T1), and aortic distensibility, with paired data from echocardiography b) placental volume, diffusion weighting, and oxygenation (T2*, oxygen enhanced MRI) This will generate detailed cardiac/placental tissue characterisation pilot data for women with HDP. We may therefore begin to evaluate this protocol to: A)improve clinical phenotyping of women with HDP to guide therapy and anticipate pregnancy complication development B)assess cardiac and placental function alteration following medical therapy use for cardiovascular and placental disorders. C)Assess MRI biomarkers as surrogate obstetric clinical trial outcomes

Lay abstract: One in ten pregnant women will develop high blood pressure in pregnancy, and one in twenty women develop a dangerous problem known as preeclampsia. Preeclampsia is a problem with the placenta that can affect the mother’s heart, kidneys and liver. It can also affect the baby’s growth. Frequently doctors need to deliver a baby prematurely due to severe illness in the mother, or the baby becoming unwell. We do not fully understand what causes preeclampsia or the best way to treat it. We know that women who have had preeclampsia are more at risk of cardiovascular disease long term. About 1 in 12 stillbirths happen to women with high blood pressure, meaning about 250 babies per year die in the UK. MRI scans use magnetic fields to take pictures inside the body. They are safe in pregnancy. Techniques have developed to use MRI scans to look in detail at the heart, and more recently at the placenta. These scans give very detailed information about the health and function of the heart and placenta, and provide much more information than ultrasound measurements of the heart. For the first time, this project will use these safe magnetic scans in pregnancy to look at the heart and placenta during a single scan in women with high blood pressure. The aim is to understand the causes of preeclampsia, and to develop techniques to assess how a woman responds to treatment for her blood pressure in pregnancy.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;4.1 DISCOVERY AND PRECLINICAL TESTING OF MARKERS AND TECHNOLOGIES
Health categories: CARDIOVASCULAR;REPRODUCTIVE HEALTH AND CHILDBIRTH