History of CORDA

Donald Longmore was a cardiac surgeon in the 1960s, the early days of cardiac surgery, when the few survivors frequently had multi organ failure including the usually fatal kidney failure. Contemporary artificial kidneys were unsuitable for post cardiac surgery patients therefore he made “gentle” artificial kidneys. These took him into a new world of kidney physicians and surgeons who were successfully transplanting kidneys. It seemed logical to transplant the less biologically complex hearts. He became a pioneer of heart transplantation.

Supported with a grant from The British Heart Foundation he set up a laboratory and team to transplant hearts and lungs culminating in the application to humans.

He was convinced that themajor proportion of cardiac surgery dealt with manifestations of arterial disease and the result of failed prevention. His friend Sir John Vane had made the Nobel prize-winning discovery of Prostacyclin which promised a greater understanding of arterial disease causing blockage of arteries to vital organs ultimately causing coronary and stroke.(Vane became a supporter of CORDA and a patron until his death).

With an understanding of the disease process it was logical to see if it could be prevented or reversed.

A method of detecting the disease process long before symptoms appeared was therefore urgently needed.

Any method of detecting disease at an early stage before the subject is aware that it might be present must satisfy certain criteria: -

1. It must be safe and avoid harmful X-Rays or any other source of radiation
2. Any test must be painless and not cause any distress.
3. The results of any test must be unambiguous. There must be no “false positives” and no “false negatives”
4. The results should not require expert interpretation.
5. At the very least the test should be able to divide the subjects into three categories:-
a) Come back in two years
b) Severe Disease go to your doctor
c) Results equivocal requiring restudy in say 6 months
6. If possible the results should be in a simple form that can be shown to the subject. There is no better way to get compliance with treatment or the imposition of strict preventive measures than the immediate impact of seeing the presence of disease whereas the remote risk of a future event caused by risk factors does not usually sufficiently reinforce the preventive message.
7. Ideally the test can be taken to the community rather than requiring subjects to come to a hospital.
8. The test and preventive measures should cost substantially less than the expensive management of end-stage disease and represent demonstrable savings to the healthcare budget.

X-ray techniques showed the lumen of vessels but not the vessel walls. Magnetic Resonance could be used to produce images of organs in the body but the problem was that imaging a moving organ such as the heart was much more complex than for static bone or organs.

It would require sophisticated computers with complex software and computers were relatively new, filled a small room and were extremely expensive. Computer experts who could understand computers were even less common.

John Stephenson was in the forefront of computer development understood them intimatelyand consulted on a range of matters including their application to science and technology. Longmore contacted him to discuss his dilemma and it became clear that the only way Longmore could progress his research was with the use of advanced computer technology. He also realised that the use of the latest and most expensive equipment to provide the performance necessary Would be expensive and that unfortunately, hospital budgets could not run to the cost, of£60,000 in 1975. Stephenson was so impressed, however with the aims and enthusiasm of Longmore that he discussed the need with a close colleague, Keith Beddows, the European Technical Director for Varian Data Machines, one of the largest scientific computer manufacturers in the USA. Together with Beddows, they built a complete system from spares and this system, enclosed in an air conditioned room, became the bedrock of Longmore’s research.

It continued to do sterling work for many years by measuring the endomyocardial viability ratio continuously, a parameter capable of predicting the outcome of treatment, it also demonstrated the potential of computers to improve patient care.

The Hammersmith GEC machine was made available to Longmore and his physicist assistant David Firmin (now professor Firmin) at night and at weekends. The collaboration of these important assets enabled them to be the first to develop MR to study the heart.

Stephenson had by this time become involved in the project and approached the BHF to ask them to support Longmore’s work. He was told that the case for prevention had not been made and it was not an area to which the BHF were directing their funds at that time.

Stephenson therefore suggested to Longmore that they form a charity to fund his work together with other similar projects researching into prevention of heart disease. Longmore jumped at the idea so Stephenson, together with MacFarlanes solicitors drew up the constitution of the charity. It was registered as a company limited by guarantee in February 1976, and called HEART, an acronym for Heart Exploration and Research in Therapy. The name was subsequently changed to CORDA in September 1982 but the original articles of association remain unchanged. These objectives are:

To raise funds to sponsor research into a method of detecting the onset of cardiovascular disease by quick, painless and non-invasive means(i.e. without the need for X-rays).

They were concerned that a new charity dedicated to prevention may lack credibility among the medical profession and might struggle to survive. A strategic plan was therefore needed to attract influential people and support to the new venture. They divided the tasks between them. Stephenson and his wife Bernice set out to raise essential working capital. Longmore was able to recruit Sir Robert Carr, a skiing companion who had recently been Home Secretary (later Lord Carr), as chairman, and Stephenson became vice chairman, a position he has occupied ever since. The first meeting chaired by Lord Carr was held on the 25th May 1976. This was attended by influential people from the world of industry and commerce most of whom subsequently joined the board.

Longmore also wanted to attract distinguished medical individuals to assist the medical credibility of the proposed research and they were fortunate to obtain the agreement of three Nobel prize winners, five fellows of the Royal Society, two government advisers, the chairman of the Committee of Safety of Medicines and representatives of the Royal Colleges of Surgeons, physicians, and pathologists. These key people formed the Scientific Advisory Council (SAC) and with their aid and guidance the charity became a significant organisation in the fight against cardiovascular disease.

The First CMR

During the next two years, the charity was able to raise the 2007 equivalent of £5.6 million which was used to pay for the conversion of a derelict building in Britten Street London and, together with a DTI loan of £650,000 and a generous discount from GEC CORDA established the world’s first Cardiovascular Magnetic Resonance unit under the auspices of the Royal Brompton Hospital.

CORDA provided a further two MR Machines but it soon became clear that commercially available MR machines were not capable of sophisticated cardiovascular studies needed for the early detection of OVD therefore CORDA scientists, doctors, clinical scientists, and engineers designed and built the worlds most powerful and fastest machine. This was installed in a converted Metroliner double deck bus and used in the community to prove the practicality of population screening.

This versatile and easily programmable CORDA machine, mounted in the bus was used to develop many new advances including the accurate measurement of movement and blood flow, measurement of cardiac function, navigator interactive images to increase accuracy, early examples of coronary artery imaging, measurement of coronary blood flow and characterisation of atheromatous plaques to show whether they are dangerous “time bombs” or merely manifestations of old age.

This CORDA bus, together with the original magnetic resonance machine, which still functions, is now in the Science Museum in order that researchers of the future can see how it originated in the 1980’s.

A young John Stephenson and Donald Longmore at the Charity’s first fund raising dinner in February 1976 organised by the Thame & District Round Table and Ladies Circle. The charity was then called HEART hence the shape of the cake.