Cardiovascular Research: opportunities and challenges

Cardiff & Vale University Health Board

Research & Development Inaugural Conference

City Hall, Cardiff. June 2013

Zaheer Yousef BSc MBBS MD FESC FRCP

Consultant Cardiologist & Senior Research Fellow Heart Muscle Diseases & Heart Failure Devices

University Hospital of Wales & Cardiff University

Conflicts: St Jude Medical, Medtronic, Servier, Takeda, Pfizer, Novartis, Astra Zeneca

Heart Function Services: UHW

weekly team-HF multi-disciplinary team meetings

Heart Function Services: academic profile

Heart Function Services: academic profile

Resynchronisation Devices: background

Atrio-Ventricular Intra-Ventricular Inter-Ventricular

PET AET

Resynchronisation: optimisation study

echo marker

Intra-ventricular

dyssynchrony

Ts-12, Ts-6, Ts-2

Direct

LV function

LVOT-VTI

Indirect

LV function

p/t-MR

Inter-ventricular

dyssynchrony

PET AET

APD

Atrio-ventricular

dyssynchrony

DFT, MV/AV-VTI

Select optimal echo marker at each AV (80180msec) and VV (-40+40msec)

Optimisation: increased responders

Non-responders at 3 months

0

50

100

150

QoL 6MWT VO2 peak

% change

from

baseline

3 months

6 months

p=ns

p<0.05

p<0.01

50% non-responders

Thomas DE et. al. Eur J of Heart Failure 2009;11:779

Responders

echo optimisation

• International meetings

• “Cardiff functional response index”

• Protocol incorporated into clinical practice

• Improved patient outcomes

High Risk Cardiac Surgery: Bi-V pacing

Russell SJ et. al. Eur J of CT Surgery 2012;42:146

•Recently published

•Weekly downloads

•Clinical practice at UHW

•Improved patient

outcomes

Cancer Survivors: background

Clinical Case

•23yr male: urogenital lymphoma aged 8yrs

•Extensive surgery , radiotherapy, and chemotherapy: “cured”

•Presents 15yrs later: end-stage heart failure; EDD 9cm, EF 5%

• heart transplant 4 years ago.

Why do only some patients

develop LVSD?

Can we predict which

patients will develop LVSD?

Can we alter prognosis in

high risk patients?

NISCHR clinical fellowship

Cancer Survivors: cardio-oncology group

Newly Diagnosed

Cancer Therapy

Post-Therapy

Evaluation

Long-Term

Surveillance

6weeks - 3months

>10yrs

Cancer Survivors: pre-clinical disease

Study Protocol: work in progress!

• 30 anthracycline recipients (>1yr) with preserved LV systolic function

• Ethics/R+D, funding, local collaborations, research environment

• Can we identify pre-clinical disease?

LV Mechanics

Arterial Pulse Wave

Ventriculo-Arterial coupling

@ rest and exercise

Academic Outputs: 5 years

Local Collaborations:

• Cardio-Oncology, Cardio-Thoracic (Cardiff + Swansea), Cardio-Renal

• Cardiff University, Cardiff Metropolitan University

Doctoral Degrees and Publications:

• X2 completed (MD), x1 MD in progress, x1 PhD in progress

• Senior/First author: x5, Others: x7, In progress: x5

Grants + Portfolio Studies:

• Grants: MEDIA (Euro 500,000), ESPRC (£340,000), Unconditional Grants (£200,000)

• Portfolio Studies: x4 (cardio-oncology x2, cardio-renal x2)

Commercial Studies:

• Local PI: x9 clinical trials (UK top recruiter for x2 studies)

• UK Chief Investigator: MORE-CRT (2nd highest recruiter World-Wide) + acute HF trial

• Income: >£150,000

R + D activities: challenges & opportunities

Manpower

• Heavy clinical burden

• Single HF specialist

• X2 academic sessions (NISCHR)

• Research nurse, clinical fellow

Research Environment:

• Bureaucracy and paperwork

• Cath Lab space

• Clinic Capacity

• Off-site activities

• Consultant expansion

• R+D directorate funding streams

• R + D timelines

• Outstanding clinical material

• Excellent collaborative links

• Research governance protocols

• Clinical research facility

questions?

zaheer.yousef@wales.nhs.uk