Dr. Mihai Strachinaru received his PhD this month at Erasmus MC for his research into "shear wave echocardiography", a study that combines cardiology with super-fast imaging techniques. With this research he lays the foundation for a new research method into heart failure. A method that can also prevent serious heart failure through early detection. And that is necessary: ​​it is expected that by 2025 in the Netherlands 195,000 people will be diagnosed with heart failure.

Strachinaru's research is part of the Medical Delta UltraHB scientific program: Ultrafast ultrasound for the heart and brain. In this program, cardiologists and doctors from Erasmus MC and LUMC work closely with image physicists from TU Delft and Erasmus MC. Strachinaru's research has been funded by NWO-TTW and the Hartstichting (the Dutch Heart Foundation).

The originally Romanian cardiologist left his homeland twelve years ago ‘to make a difference’ and now seems to be doing so.

Congratulations, Mihai. Was it a successful day?

"Absolutely. A very special successful day. It didn't really feel like an exam. Not because the questions I received were so easy, but mainly because there was a real exchange of expertise. Each committee member posed a question from his own field. As a result, the committee members, the promoters and I got into a fascinating conversation about the application of the technique.”

Do you want to tell something about that technique?

“The research is about a new way of looking at our heart, namely with echocardiography. Echo as we know it, displays about 50 images per second. We are now able to make echo films of 500 and 1,000 and even 5,000 frames per second. As a result, we have been able to capture a previously unknown phenomenon, which we are now beginning to understand.”

What is that phenomenon?

“They are a kind of waves that run along the paths of the heart after the valves are closed. That closing is what everyone knows as the sound of a heartbeat. When the valves close it gives a blow to the heart muscle which causes a wave. That wave cannot be compared to a sound wave, but are more like the waves of an earthquake. Their special characteristic is that the wave movement is related to the stiffness of the heart muscle. A stiff heart muscle is the cause of 50% of heart failure. Our greatest discovery is that this allows us to measure the stiffness of the heart muscle.”

How big is the impact of this discovery?

“Half of the heart failure cases are diastolic in nature. That means it is caused by a problem in the relaxation phase of the heart. In the relaxation phase of the heart it can fill up, after which the blood can be pumped again. With a stiff heart muscle, the heart cannot relax enough and therefore does not fill up sufficiently. We were previously able to view this principle only through indirect factors. In addition, the heart is positioned deep and behind the ribs, which makes it even more difficult to visualize.

We see a lot of future in this new way of measuring, supported by studies in Trondheim and Paris. There too, clear differences are seen between the waves of healthy people and heart patients. The next step is to investigate whether it is progressive. When we can see that, we achieve early detection. Then you can examine people with dubious heart complaints for the stiffness of the heart muscle.”

I accidentally discovered how I could increase the frame rate of an echo machine.

Why is early detection important?

“Heart failure is a huge domain in cardiological pathology. You can compare it with deadly cancers. Regardless of the type of heart failure, 20% of patients die within one year of discharge from the hospital. After five years, that percentage is 40 to 48%. Treatment is, at most, life-prolonging and focused on comfort. If I express it in euros, heart failure in 2017 cost around € 817 million. In 2007 that was € 455 million, so you can also see the costs are rising rapidly. Fact is our population is getting older and subsequently the risk of heart failure increases.

Because healing is not possible, our hope lies in early detection. Early detection gives more chance to delay the progression of the disease. This ensures a better quality of life, fewer complications and it prolongs life. With adequate treatment, some forms of heart failure may also be reversible.

The research took place within Medical Delta, in collaboration with companies and doctors. How did that collaboration go?

"It was a national and international collaboration. My role was to bring all knowledge together and I hope I played that role well. For example, physics is involved. If you don’t have a background in physics, it is very difficult to understand. So you need each other. Years ago I accidentally discovered something that I could use to increase the frame rate of an echo machine. Within this collaboration I was able to further investigate the patterns that are required for this. The great thing is that you come up with new ideas and applications within the collaboration.”

What was that accidental discovery years ago?

“I was working as a cardiologist in Brussels at the time. On a busy day - people were waiting for their ultrasound - I examined a patient and after some quick actions I suddenly had a very sharp picture. It was my mistake, but one that I wanted to be able to reproduce. Maybe it was something. I contacted the supplier's engineers, who initially told me it was impossible. "We make this," they said. They were certain they knew what the device can and cannot do. But when I sent them the video, they were convinced.”

That was the start of this investigation?

“I am a Romanian cardiologist and I am proud of that. But I wanted to make a difference and I knew I couldn't do that there. That is why I first went to Paris, then to Brussels. At one point I had a conversation with a friend who told me: "ultrasound is dead. It is an old technique, 60 years old and it does not evolve." It triggered my interest and I thought that it might be my ‘distinctiveness’.” Not long after that conversation, I made that mistake with the device and another month later I was at a conference, where Erasmus MC gave a lecture about high frame rate ultrasound. I told them what I had discovered. It led to a conversation with Felix Zijlstra, head of cardiology at Erasmus MC. He asked me to become a partner in the lab. It started there.”

Do you also work as a cardiologist?

"During the research I still worked as a cardiologist, even during night shifts."

Was that good for your heart?

Laughs. “I'm always looking for something new. This kind of effort makes me feel better.”