Heart Failure Research
Professor David Kaye and his colleagues in the Heart Failure and Transplant service are undertaking a series of studies to investigate the causes and to develop new treatments for patients with heart failure. These studies encompass national and international leading trials with groundbreaking developments in the field, including new drugs and devices on the cutting edge of research.
Medical therapy for advanced heart failure
The care of patients with very advanced heart failure represents a significant challenge with many patients having no further treatment options available due to the presence of other complicating factors. In this context, we have developed an oral formulation of a drug (milrinone) that was previously only available intravenously. Early clinical trial experience has been positive, and this research will continue to expand, with multicentre trials planned.
Diffuse (interstitial) scarring of the heart is a major feature of many forms of heart failure, contributing to both symptoms and outcomes.
The Heart Failure research group, in collaboration with the Imaging group, has worked extensively to better understand the causes of fibrosis and the potential targets for therapy. In patients with hypertrophic cardiomyopathy, we used cardiac MRI to demonstrate that although extensive fibrosis is present in the heart, the actual rate of turnover of fibrosis is low, suggesting that anti-fibrotic therapies may require long periods of administration to provide benefit.
A study to evaluate the Corvia Medical, Inc. IASD® System II to reduce elevated left atrial pressure
Currently, we are part of a clinical trial involving the implantation of an inter-atrial septal device (from CORVIA) to reduce left atrial pressure in patients with heart failure with preserved ejection fraction. Early results from pilot studies have proved promising, with a large randomised controlled trial currently under way in collaboration with the Alfred and multiple international investigators. Professor Kaye has taken this novel device and implemented it into a trial focusing on patients with AF, observing electrophysiologic and haemodynamic changes to assess the patient’s clinical status and effectiveness of device post Pulmonary Vein Isolation in patients with Atrial Fibrillation.
This is a comparative patient study utilising a novel ultrathin electrocardiogram (ECG) device, the SmartHeart, to objectively measure electrical activities generated by user’s heart during contractions continuously for 24 hours in order to compute a precise real-time heart rate and to detect any heart rhythm changes. The electrical signal measured by the ultrathin ECG device will be compared to the signals obtained from a commercially available ECG device such as a Holter monitor and/or hospital patient monitor. The study aims to function as a proof of concept study for the SmartHeart in accurately measuring user’s heart electrical activity, heart rate and detection of possible heart problems.
The objective of this First-in-Human evaluation is to assess the safety and effectiveness of catheter-based unilateral ablation of the greater splanchnic nerve in subjects having heart failure with preserved ejection fraction (HFpEF). The system is designed to safely deliver radiofrequency energy via an intravascular catheter temporarily placed into the veins adjacent to the greater splanchnic nerve in order to achieve unilateral ablation of the greater splanchnic nerve. For patients with HFpEF we expect these changes to improve shortness of breath and ability to exercise, improve quality of life, and increased responsiveness to fluid tablets.
Dr Shane Nanayakkara is a cardiologist and researcher currently completing a PhD in heart failure.
A/Prof Justin Mariani is a consultant cardiologist.