With heart and circulatory diseases on the rise, the Norfolk and Norwich University Hospital at Norwich Research Park has become the first in the UK to implement a cutting-edge technology that creates 4D flow images of the heart. UEA associate professor of cardiovascular medicine Dr Pankaj Garg has his finger on the pulse.

Each month, those working at the pioneering heart of Norwich Research Park tell us how their work is shaping the world we live in. Read their stories here.

What does your role entail?

In my academic role I conduct research and teach students at Norwich Medical School at Norwich Research Park and in my clinical role I look after patients with heart failure. As a consultant cardiologist specialising in cardiac imaging, that includes echocardiography and cardiac magnetic resonance imaging (MRI), my role is to further our innovation to deliver better patient care.

My aim for the next five years is to focus on delivering research on a new 4D flow MRI scan technology funded by the Wellcome Trust.

How do these heart scans work?

Heart MRI scans provide complementary information to routine ultrasound imaging methods to understand what disease processes are happening in the heart muscle. The existing technology is ultrasound-based echocardiography, which works by sending sound waves back and forth. Hence, it records flow information in only one direction.

Given the complex geometry of the heart, flow cannot be accurately visualised by these old methods – because flow is actually happening in three dimensions.

Eastern Daily Press: A heart MRI with 4D flow. Coloured lines show the direction of flow inside the heart and areas of low pressure, where a vortex formation can be seen – like a thunderstormA heart MRI with 4D flow. Coloured lines show the direction of flow inside the heart and areas of low pressure, where a vortex formation can be seen – like a thunderstorm (Image: Pankaj Garg)

The novel technology I'm working on is 4D flow MRI, which integrates computer modelling technology with radio waves and magnetic fields to acquire precise information quickly and intelligently while creating detailed images inside the body – with time being the fourth dimension.

The Norfolk and Norwich University Hospital (NNUH) is the first in the UK to introduce this technique clinically. With it, we can accurately recognise disease by noticing flow changes and heart valve leaks occurring in the heart.

Why is your work with this technology so innovative?

One of the most immediate clinical benefits is in precise flow quantification for valvular heart disease assessments. On average, we take 12,000–18,000 images per patient. Historically, it would take more than an hour in the scan to acquire this breadth of data for the whole heart, but with significant advancements in the last five years we can now do this in less than eight minutes with no ionising radiation. For the patient the scan involves nothing more than lying down inside the magnet.

We are about to publish a case study in The Lancet about a patient with severe mitral regurgitation who was referred for open heart surgery to repair the mitral valve. We decided to conduct a heart MRI, which showed the patient’s condition to be mild and therefore surgery was unnecessary. We then came to an entirely different diagnosis, which completely changed the course of treatment. That gives you an idea of how this technology can revolutionise patient management.

Why did you decide to pursue a career in science?

As a teenager, I used to buy the New Scientist magazine, which triggered a lot of questions in my head. And when I was a junior doctor, I was asking a lot of questions to my consultant colleagues during routine care, which inspired me to pursue a clinical academic career – mainly to try to answer some of the questions which had been disturbing me.

But the more answers I got, the deeper I wanted to go. So I ended up asking more questions. That's the beauty of research: once you've answered one question, you're likely to end up with thirty more to explore.

What’s the best thing about working at Norwich Research Park?

After I arrived in November 2020, everybody was so enthusiastic. Working with scientists at a healthy and nurturing environment like this has been a great experience. The management team at Norwich Research Park and NNUH are very open to moving forward with meaningful clinical translational research, which will be critically important to benefit patients and raise the work happening on the Park to the next level.

But my favourite thing about working on the Park is simply going for a coffee with my students and collaborators. Everybody knows one another, which encourages a very cohesive and collaborative environment.

Eastern Daily Press: Pankaj’s favourite pastime is going to the beach and having fish and chips with his familyPankaj’s favourite pastime is going to the beach and having fish and chips with his family (Image: Pankaj Garg)

What do you get up to when you are not working?

I’m a gamer and like to play first-person shooters like Call of Duty on Sony PlayStation 5. I have two daughters, Roshni and Jasmine, who are also into gaming.

Since lockdown has eased, we've been exploring the Norfolk region. Our favourite pastime as a family is going to the beach and having fish and chips, which we absolutely love to do.

Dr Pankaj Garg is associate professor of cardiovascular medicine at UEA. You can follow him on Twitter @HEARTinMagnet