In this section
We are delighted to be involved in a number of different research projects. Our research not only helps to advance cardiac scientific practice but also helps to keep our staff engaged and at the forefront of new technological advances.
Cardiac Physiology research is vital to ensure that our service is continuously updated and focussed on evidence-based best practice. Some of our recent research commitments include:
Accolade
A multicentre prospective study investigating how to avoid cardiac toxicity in lung cancer patients treated with curative-intent radiotherapy to improve survival.
Radiotherapy plays a major role in the treatment of lung cancer and recent advances in radiotherapy have led to better cure rates. However, the radiotherapy dose needed to destroy the cancer cells can unfortunately also damage the surrounding organs, such as the heart. The precise mechanism of damage and which areas of the heart are more sensitive to radiation is not currently known. This project uses the analysis of large amounts of existing radiotherapy treatment data to determine this. Establishing detailed radiotherapy dose limits for the heart and the heart’s sub-structures will lead to the delivery of heart-sparing radiotherapy, where possible, in lung cancer patients treated in Yorkshire and Greater Manchester. The investigators estimate that this should lead to an improvement in one-year survival of approximately 10%.
BHF Protect-TAVI
This prospective, randomized study was designed to analyse the difference of cerebral embolization in patients undergoing transcatheter aortic valve implantation with balloon-expandable vs. self-expandable valves by using a cerebral protection system (Sentinel™ Device).
BIO-WOMEN
The purpose of the CMR GUIDE HF research study is to evaluate whether a specific group of patients with heart failure will benefit from receiving an implantable cardiac defibrillator. Under current guidelines patients with mild-moderate heart failure are ineligible to receive these cardiac defibrillators.
BIO WOMEN is a study designed to compare the CRT response rate in a heart failure population with an equal distribution of men and women. 27 sites in 8 countries (Austria, Belgium, Germany, Israel, Italy, Netherlands, Spain, UK). Primary endpoint is magnitude of CRT response measured as a function of increase in left ventricular ejection fraction (LVEF) at 12 month follow up.
BSE N-STEP
The programme builds on the CCRF’S EVAREST research programme, which has established a vast hospital network of academic stress echocardiography centres across the UK, generating a database of 8000 patients. The BSE N-STEP has been created based on this experience and aims to continue to recruit patients referred for stress echocardiograms across the country. The results will help better understand how protocols are used among different Trusts and the resources involved, as well as the clinical pathway and outcome of patients. Findings from the study should generate important insights into standards of stress echocardiography clinical practice across the NHS.
CMR-GUIDE HF
The purpose of the CMR GUIDE HF research study is to evaluate whether a specific group of patients with heart failure will benefit from receiving an implantable cardiac defibrillator. Under current guidelines patients with mild-moderate heart failure are ineligible to receive these cardiac defibrillators.
Heart failure weakens the heart muscle which results in reduced “pump” function (the heart is unable to effectively pump oxygenated blood throughout the body). This can also result in dangerous heart rhythms, which can result in either a blackout or even sudden death. An implantable cardiac defibrillator (ICD), which looks similar to a pacemaker, is a special device which sits just under the skin at the front of the chest, and has a lead running from it into the heart via a large vein. It can identify dangerous heart rhythms and then send an electrical “shock” through the heart in an attempt to restore a person’s normal rhythm. Currently, defibrillators are only inserted into patients who have either had dangerous heart rhythms, or have a heart pump that is severely reduced in function. Deciding which patients will benefit from a defibrillator is difficult as there is no perfect way to predict who will develop these dangerous heart rhythms. Recent studies have shown that the amount of scarring in the heart (detected on MRI) may better predict who will develop these dangerous rhythms. However, under current guidelines, patients with mild or moderate reduction in heart pump function are not eligible for a defibrillator, even if scarring is present. Professor Joseph Selvanayagam, an expert in heart failure and MRI will be overseeing the trial which aims to assess whether the amount of scarring in participants with less severe reductions in pump function, can better predict who will experience life threatening events from a dangerous heart rhythm and whether there is a role for ICDs in this group of participants. People will be recruited in the UK, Germany and Australia for this study. Funding for the study has been provided to the Investigator from a device company (Biotronik) in the form of a research grant. Biotronik is also providing all of the devices for the study as in kind support.
CRAFT
Atrial flutter and atrial fibrillation are believed to share the same initiating triggers in the form of pulmonary vein ectopy. Cavo-tricuspid isthmus-dependent atrial flutter almost always results from short bursts of antecedent atrial fibrillation. Radiofrequency (RF) ablation of the cavo-tricuspid isthmus (CTI) is the current accepted first-line treatment for atrial flutter, although post-ablation atrial fibrillation commonly occurs, even in the absence of pre-existing atrial fibrillation.
Cryoballoon Pulmonary Vein Isolation (PVI) has become an established treatment for atrial fibrillation. In patients with both atrial flutter and fibrillation, PVI alone has been shown to control both types of atrial arrhythmia, with no benefit derived from supplemental RF CTI ablation.
This study aims to demonstrate that standalone cryoballoon PVI for typical atrial flutter without RF CTI ablation will lead to a significant difference in preventing recurrence of atrial arrhythmia compared to radiofrequency ablation of the CTI, and should be offered as first-line therapy.
Optimise
PREEMPT-HF
The goal of the PREEMPT-HF study is to collect CIED and clinical event data to evaluate extended applications of the HeartLogic™ Heart Failure Diagnostic (HeartLogic) in a broad spectrum of heart failure (HF) patients with a compatible implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D). The study will use commercially approved Boston Scientific CRT-D and ICD devices that contain the HeartLogic feature.
Revived
Triage-HF
UK TAVI trial
The goal of the trial was to evaluate transcatheter aortic valve replacement (TAVR) compared with surgical valve replacement (SAVR) among patients with symptomatic severe aortic stenosis.
Our department was the core lab for echocardiographic assessment post TAVI during this trial.