Research base for clinical exploration of heart failure.
Research base for heart failure, PN-II Project/Capabilities
CARDIOLOGIC RESEARCH BASE FOR ACUTE HEART FAILURE
Cardiovascular conditions are the main cause of mortality and morbidity in Romania. Thus, with a mortality of 700 / 100,000 inhabitants, Romania is on top of countries in Europe. Among these, heart failure has the most somber forecast. The acute causes determining the heart failure can not be correctly evaluated unless with portable echographs, available at patient bed, in Critical Care Units.
In Emergency University Hospital Bucharest, in cardiology sections, there is a Cardiovascular Research Unit with expertise in cardiac and vascular echography. The development of the existing research base, aiming the complex and complete evaluation of acute heart failure, is crucial. Such development of the research base would lead to the possibility to expand the existing projects and to open opportunities related to the national and especially international co-operation, while raising Romania's visibility on international scientific field. The current projects aims:
SCIENTIFIC AND TECHNICAL DESCRIPTION OF THE PROJECT
Overview of accomplishments in the mentioned ST domain, at national and international level.
Heart failure is the main cause of cardiovascular mortality in Romania. This could be acute and chronic. Most of the fundamental clinical, epidemiological, clinical or imaging evaluation studies (for example, echocardiographic) have included patients with chronic heart failure. The acute heart failure was less systematically studied, although it is an important public health problem and it has a high mortality. Thus, approx. 5% from the emergency admissions are due to acute heart failures. In United States, 10% from the expenses assigned to cardiovascular conditions are consumed by acute heart failure. In the severe form of acute heart failure, the acute pulmonary edema, the intra-hospital mortality is above 10%, and that at 1 year is 30%.
The acute heart failure has numerous mechanisms, such as: global systolic dysfunction, global diastolic dysfunction, longitudinal dysfunction and dynamic mitral regurgitation. The current level of knowledge does not allow the detail description of each mechanism's role in the genesis of acute cardiac decompensation. Also, the role of intraventricular interaction (right ventricle – left ventricle) is unknown in acute heart failure. Additionally, the interaction between the left ventricle and big arteries (ventricle-arterial), as well as the role of acute endothelial dysfunction, were not evaluated in acute heart failure.
Echocardiography is the main evaluation method of the cardiac structure and function. Thus, the new echocardiography methods, such as Tissue Doppler, three-dimensional (3D) echography, achieved either transthoracically or transoesophageally, could bring important information regarding the occurrence mechanisms of acute heart failure. In the same time, the over time monitoring of the cardiac function, along with corroborating the data with the degree of functional cardiopulmonary dysfunction (measured through effort test on treadmill, along with determining the cardiopulmonary function) and with the frequency, type and severity of arrhythmias (evaluated through Holter monitoring) could bring important data about the mechanisms of progression to chronic heart failure. The main limit in performing such studies is the availability of conventional echocardiographs at patient bed in Critical Care Units. Thus, the echocardiographic evaluation during the most severe acute heart failure phase (acute pulmonary edema) is mainly based upon a single study done on 38 patients and published in 2001 in New England Journal of Medicine. Other studies have included patients during the recovery phase after an acute cardiac decompensation, thus only bringing indirect data about the mechanisms of acute heart failure. Moreover, these studies have used only conventional transthoracic echocardiographic methods. As a consequence, the existence of a portable echocardiograph, equipped with transthoracic, transoesophageal and vascular probe, capable to use the new echocardiographic methods, such as Tissue Doppler, for evaluating the heart failure, is of important scientific interest. Additionally, the possibility to quantify the cardiopulmonary function would be extremely useful for long term evaluation of the patients.
The general and specific objectives of the project.
The primary objectives of the project are:
The secondary objectives of the project are:
The project lead:
Emergency Universitary Hospital Bucharest will have the following contributions and objectives of scientific research:
How the project's results will be used (estimating the expected results, forecasted benefits), potential beneficiaries.
Based on the investment project for the development of Cardiologic Research Base for Acute Heart Failure (CARDIO-HF) study protocols will be elaborated, especially in echocardiography (cardiac and vascular) domain of this pathology. Also, based on the current collaborations between our Research Base and the foreign cardiologic research bases (United Kingdom, Italy, France), new multi-center research projects will be elaborated, while attracting international funds. The scientific results will be analyzed within partnership and disseminated at national and international level. Therefore, taking into account the relative short of scientific information in this research field, scientific works will be elaborated, that could be published in ISI-rated magazines and within other international databases. The results will also be disseminated through participations to European and World Cardiology Congresses and sub-specialties related to the studied subject. The results obtained from the further research projects of acute and chronic heart failure could fundament the evaluation of new targeted and efficient therapeutic methods. These could lead to a better evaluation and to a better treatment of patients with heart failure condition, as well to cut the costs raised by their care, by optimizing the resource flows. The equipment dedicated to the development of the Research Base will be the property of the institution leading the project (Emergency Universitary Hospital Bucharest). The access to the use of the purchased materials will be free for the future co-partners that will participate to the scientific research programs to be performed based on this investment project.
The dissemination of the results, the conditions of access for third parties (access program, available documentation, access conditions/costs, personnel providing the usage etc.).
The dissemination of the results will be done through publications, presentations at national and international congresses, dedicated Website. The access to the use of the Base will be free for the future co-partners that will participate to the scientific research programs to be performed based on this investment project.
How the investment will lead to the involvement into European projects.
By development and modernization of the Research Base, there is the potential to elaborate research projects in partnership with similar research centers, in United Kingdom, Italy and France; such collaborations already exist. Therefore, the collaboration with Wales Heart Research Institute, University of Wales College of Medicine, Cardiff, United Kingdom, that has started over 10 years ago, already materialized into multiple common research projects and inter-clinical studies, including on the subjects proposed to be approached within this project. Also, the collaboration with San Gaudenzio Cardiology Clinic, Novara, and with Institute of Clinical Physiology - Cardiovascular Research, Pisa, Italia materialized into experience exchanges and scientific research projects. There already are new possibilities of collaboration with other departments, such as the one from Leicester, United Kingdom, and Decode Laboratories from Island (for the study of genetic determinants of cardiac dysfunction and the application to a FP7). Thus, this project opens new perspectives for the reconsolidation of the already existing collaboration and for the development of new international common research projects.
THE IMPACT GENERATED BY THE PROJECT
The technological/scientific impact: The contribution of the project to the national research, the novelty and complexity degree of the proposed solutions related to the investment done (the features of the acquisitioned equipment/developed laboratory).
The most subjects approached in the future research projects, which will be based on the equipment acquisitioned through this program within the Base will research scientific subjects that were insufficient approached until now. Thus, the scientific project further elaborated will not have the objective to verify the results in the special literature, but the innovate research within the complex cardiology imaging evaluation of heart failure, especially the acute one. These data could be essential for a better knowledge of this pathology and for the future development of new efficient prevention and treatment methods. The forecasted economic and benefic impact is the output that could allow the optimization of the evaluation and treatment of patients in heart failure condition. Also, the project will contribute to the consolidation of the existing partnership between our Research Base and other research centres at national and international level, within other university institutions, from other hospitals within the domestic health network; this partnership will lead to the accomplishment of new competitive products and services.
The main aim of the current project is to consider thoroughly research directions started within the National Project CARDIOSCREEN.
Results. Final report 5 jun 2009
The project title: CARDIOLOGIC RESEARCH BASE OF ACUTE HEART FAILURE
Contract Nr: 135/19.09.2007
The characteristics of the acquired equipment/lab: are specified on the web page and Annex I. 2.
Project Director: Prof. Dr. Dragos Vinereanu. (email@example.com)
Research Fellows directly involved in project:
Access conditions: (access schedule, available documentation, conditions/access costs, etc.):
ST services offered by the lab:
ST services quality offered by the new lab: Performance indices of the lab: high performance in the research field – reference provided firms, like (General Electric, Burdick, Quinton, Xerox), with training and assistance services assurance;
Personal quality – performance, high level specialized (training periods in Wales Heart Research Institute, Cardiff, UK; San Gaudenzio Clinic Novara Italia, etc)
Known beneficiars: (including possible partners)