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New method could improve heart failure detection in women
New cardiac research could save women’s lives by improving detection of heart failure
A new study has the potential to advance how heart failure is detected in women, meaning more female patients could be diagnosed at an earlier stage.
Researchers led by teams from the Universities of East Anglia (UEA), Sheffield and Leeds, have been able to fine-tune how magnetic resonance imaging (MRI) is used to detect heart failure in women’s hearts, making it more accurate.
“By refining the method for women specifically, we were able to diagnose 16.5pc more females with heart failure,” said lead author Dr Pankaj Garg, of the University of East Anglia’s Norwich Medical School and a consultant cardiologist at the Norfolk and Norwich University Hospital.
“This could have huge impact in the NHS, which diagnoses around 200,000 patients with heart failure each year. This improved method will increase early detection, meaning more women can get life-saving treatment sooner.”
UEA and the University of Sheffield have previously published research which showed how using MRI scans could be used to detect heart failure and which led to this technique being widely employed by medics.
When a heart starts to fail, it is unable to pump blood out effectively, and so the pressure in the heart rises.
“Currently, one of the best ways of diagnosing heart failure is to measure pressures inside the heart with a tube called a catheter,” explained co-author Dr Gareth Matthews of the University of East Anglia’s Norwich Medical School.
“While this is very accurate, it is an invasive procedure, and therefore carries risks for patients, which limits its use.
“For this reason, doctors tend to use echocardiograms, which are based on ultrasound, to assess heart function, but this is inaccurate in up to 50 per cent of cases. Using MRI, we can get much more accurate images of how the heart is working.”
The team was able to create an equation which allowed them to non-invasively derive the pressure in the heart using an MRI scanner.
However, previous use of this method was not as accurate as the researchers would have liked in diagnosing heart failure in women, especially in early or borderline disease.
Co-author Professor Andy Swift of the University of Sheffield’s School of Medicine and Population Health, said: “Women’s hearts are biologically different to men’s.
“Our work suggests that in heart failure women’s hearts may respond differently in response to increases in pressure.”
Heart failure can be classed differently, depending on the amount of blood squeezed out of the main chamber of the heart with every beat, known as the heart’s ejection fraction.
Women suffer disproportionately from a type of heart failure where the pumping function of the heart is preserved but the ability of the heart to relax and fill with blood is impaired.
Echocardiography struggles to diagnose this type of heart failure. The improvements in diagnosis from this new work are hoped to enable more of this particular cohort to be diagnosed more accurately and hopefully drive better treatments.
Co-author Dr Peter Swoboda of the University of Leeds’ Faculty of Medicine and Health, said: “The symptoms of heart failure, like breathlessness and fatigue, can have a devastating effect on patients’ quality of life.
“We are increasingly recognising the importance of early diagnosis and, early treatment can improve symptoms and life expectancy.
“This research will help diagnose heart failure in women more quickly and get them established on life-saving treatments sooner.”
The health and social care secretary, Victoria Atkins, added: “Heart failure is a devastating condition affecting hundreds of thousands of women in the UK, so this research is a hugely positive development that could make it possible for thousands of people to get diagnosed and treated at an earlier stage.
“For the second year of our Women’s Health Strategy for England, I have been clear that we need more research to look at the differences between how conditions affect men and women.
“I am delighted that this government-backed research has met this challenge so that we can get life-saving treatment to women faster.”
Transdermal HRT best protects bone density in women with functional hypothalamic amenorrhoea, a condition that stops periods, a review of trials has found.
The meta-analysis pooled randomised clinical trials involving 692 participants and found transdermal hormone replacement therapy and teriparatide increased bone mineral density by between 2 and 13 per cent.
Functional hypothalamic amenorrhoea can follow anorexia or intense exercise. Bone mineral density measures bone strength and the amount of mineral in bone.
Around half of women with the condition have low bone mineral density, compared with about 1 per cent of healthy women, and their fracture risk is up to seven times higher.
The research was conducted by scientists at Imperial College London and Imperial College Healthcare NHS Trust.
Professor Alexander Comninos, senior author of the study and consultant endocrinologist at the trust, said: “Bone density is lost very rapidly in FHA and so addressing bone health early is very important to reduce the lifelong risk of fractures.
“Our study provides much needed comparisons of all the available treatments from all available studies.
“Clearly the best treatment is to restore normal menstrual cycles and therefore oestrogen levels through various psychological, nutritional or exercise interventions – but that is not always possible.
“The foundation for bone health is good calcium and vitamin D intake (through diet and/or supplements) but we have additional treatments that are more effective.”
When FHA is diagnosed, clinicians first try to restore periods through lifestyle measures, including psychological and dietary support, but these can fail. Guidelines then recommend giving oestrogen, though the best form was unclear.
The team reviewed all prior randomised trials comparing therapies, including oral and transdermal oestrogen, and also assessed teriparatide, a prescription bone-building drug used for severe osteoporosis.
They found no significant benefit for oral contraceptive pills or oral hormone therapy.
A recent UK audit reported that about a quarter of women with anorexia-related FHA are prescribed the oral contraceptive pill for bone loss; the study suggests using transdermal therapy instead.
Comninos said: “Our goal is simple: to help women receive the right treatment sooner and to protect their bone health in the long-term.
“We hope this study provides clinicians with better evidence to choose transdermal oestrogen when prescribing oestrogen and so inform future practice guidelines.
“Right now, millions of women with FHA may not be receiving the best treatments for their bone health.”
An AI tool cut interval breast cancers by 12 per cent in a Swedish screening trial of more than 105,000 women.
The study also found 27 per cent fewer aggressive breast cancers detected at screening when AI was used.
Interval cancers are cancers found between routine screening appointments because they were missed at the original scan. They are often more dangerous and linked to higher death rates than cancers found at screening.
The MASAI trial is described as the first large randomised study to test whether AI can improve mammography screening, which uses low-dose X-rays to examine breast tissue for signs of cancer.
The AI tool, called Transpara Detection and developed by ScreenPoint Medical, supported radiologists in analysing mammography images.
Earlier results from the same trial showed that Transpara Detection increased cancers found by 29 per cent and reduced radiologist workload by 44 per cent compared with standard double-reading, where two radiologists independently review each scan.
The latest findings indicate higher accuracy with AI support. Sensitivity, the ability to detect cancer, was 6.7 percentage points higher in the AI group while specificity, the ability to rule out healthy cases, was maintained. Results were similar across age groups and breast density levels.
Women screened with AI had 16 per cent fewer invasive interval cancers and 21 per cent fewer large interval cancers than those in the standard screening group.
The system also helps doctors assess risk more precisely by subdividing suspicious findings into BI-RADS 4 categories A, B and C. BI-RADS (Breast Imaging Reporting and Data System) is a standardised scale that guides whether a patient needs closer monitoring, further tests or treatment.
Ageing anxiety may accelerate biological ageing in women, with fears about worsening health linked to faster epigenetic ageing, according to new research.
The study found that greater anxiety about growing old was associated with accelerated epigenetic ageing, as measured by the DunedinPACE clock, based on biological markers in blood samples.
Epigenetic changes are shifts in how genes are switched on or off without altering DNA itself, which can influence how the body ages and functions.
“Our research suggests that subjective experiences may be driving objective measures of ageing,” said Mariana Rodrigues, a PhD student and the first author of the study.
“Ageing-related anxiety is not merely a psychological concern, but may leave a mark on the body with real health consequences.”
Researchers analysed data from 726 women in the Midlife in the US study.
Participants were asked how much they worried about becoming less attractive with age, having more health issues and being too old to have children.
Blood samples were used to assess ageing with two epigenetic clocks: DunedinPACE, which estimates the pace of biological ageing, and GrimAge2, which estimates cumulative biological damage.
The study was conducted by researchers at NYU School of Global Public Health.
Worrying about declining health showed the strongest links with epigenetic ageing, while anxiety about attractiveness and fertility was not significantly associated with biological markers.
The authors suggest health worries are more common and persist over time, whereas concerns about appearance and reproduction may fade with age.
“Women in midlife may also be multiple in roles, including caring for their ageing parents,” Rodrigues said.
“As they see older family members grow older and become sick, they may worry about whether the same thing will happen to them.”
The authors caution that the study offers a snapshot in time and other factors may influence these biological changes.
When analyses were adjusted for health behaviours such as smoking and alcohol use, the link between ageing anxiety and epigenetic ageing decreased and was no longer significant.
“Our research identifies ageing anxiety as a measurable and modifiable psychological determinant that seems to be shaping ageing biology,” said Adolfo Cuevas, associate professor of social and behavioural sciences and the study’s senior author.
They call for more research to clarify how this anxiety influences ageing over time, to guide support for those experiencing ageing anxiety.
“Ageing is a universal experience.” Rodrigues said.
“We need to start a discourse about how we as a society, through our norms, structural factors and interpersonal relationships, address the challenges of ageing.”
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