The Cardiovascular MedTech Co-operative provides infrastructural support for a large number of projects involving clinicians and researchers embedded within the School of Biomedical Engineering and Imaging Sciences at King’s College London, extending beyond our theme leads. We believe this enables us to maximise our impact.
In addition to infrastructural support provided, we also have two dedicated staff directly working on on-going and new research projects. At present Dr Bram Ruijsink and Dr Phuoc Duong are working on a number of projects. Outlines are provided below; more details will be shown as the projects develop and results are published. Pump prime projects will be listed upon award.
MRI of Cadaveric Human Heart from Hospital Post-Mortem
The goal of this study is to get insight into the fibre structure of the heart in patients with congenital heart diseases. Fortunately, the number of child post mortems that are carried out are small, but the value of the data obtained from fibre tracking in a child’s heart with congenital heart disease is immense. Paediatric heart problems are predominantly structural as opposed to adult heart problems, which usually relate to ageing and ischaemic damage. The team are currently creating models of the heart in health and disease. These models are being used to predict response to various interventions: electrical, pharmaceutical and surgical. The current models use fibre orientation from canine hearts. It is known that small changes to these models can make big differences to the simulations, so it is imperative that the team builds up as accurate a picture as possible. Therefore, understanding the fibre structure of hearts in patients with congenital heart diseases will improve the team’s ability to make accurate assumptions about heart diseases.
MRI Sequence Development in Paediatrics
The goal of this study is to develop new MRI techniques that allow better evaluation of the heart in children with congenital heart diseases that undergo a cardiac MRI scan. Over the last decade, MRI techniques have significantly improved enabling better evaluation of heart diseases in patients with congenital heart diseases, sometimes even replacing more invasive diagnostic tests. MRI scans conventionally require patients to lay stationary for a period of time and prolonged breath-holds to reduce motion. Obtaining clear images is often more challenging with children, who are prone to more movement.
Techniques developed were implemented and validated on a clinical MRI scanner. While conventional imaging still provides better quality images, the developed methods have been used in multiple patients that underwent a clinically indicated MRI scan, awake, but have difficulties keeping still. While previously this would have resulted in bad image quality and sometimes a repeat scan with anaesthesia applied, the team has now been able to utilise real time techniques and acquire images of good enough quality for diagnostic purposes.
Further development of fast 3D imaging is currently underway within the School Biomedical Engineering and Imaging Sciences could make full awake CMR exams possible in patients that currently require anaesthesia.
The Role of Heart Rate Modulation in Fontan Circulation
In this study, the team are investigating the potential role of a new treatment for preventing/ slowing down the development heart failure in patients with a complex congenital heart disease.
In previous work, the team showed that by using dobutamine stress combined cardiac catheterisation and MRI exams that the heart of patients with Fontan circulation behaves significantly different from normal hearts, especially during stress. This abnormal behaviour is potentially a source of developing heart failure, which is very common in these patients. They now hypothesise that lowering the heart rate during the stress response improves the performance of the heart during exercise/stress response in Fontan patients, making it more efficient.
The team developed a method to obtain MRI images of the heart during exercise (Exercise Cardio Magnetic Resonance Imaging, CMR) and evaluated the physiological cardiac exercise response in healthy volunteers, compared to the response from Fontan patients. Key results of this work are currently under review in one of the leading scientific journals in the field of cardiology.
Using these studies, the team has established exercise CMR as a useful tool to investigate exercise intolerance in patients with heart diseases. In collaboration with the adult congenital cardiology team, they have been utilising this technique in several patients to answer clinical questions.
Utilizing Artificial Intelligence to improve analysis of cardiac function with CMR
Cine CMR imaging covers the whole heart and therefore holds a wealth of information about cardiac function. Currently, only cardiac volumes and ejection fraction are used clinically. Other parameters, such as ventricular shape, myocardial wall motion and filling and ejection dynamics are also available from cine CMR. These are sensitive markers of disease. However, their routine clinical use is limited, as obtaining this information from the images is time and labour intensive. Together with the group of Dr Andrew King at King’s College London (an extended member of the Cardiovascular MedTech Co-operative team), Dr Ruijsink developed artificial intelligence techniques to automatically analyse cine CMR images and obtain a range of markers within seconds. While these algorithms have great value, their use in clinical practise is limited as they currently do not have enough quality control measures to assure correct output. The team has therefore developed a range of quality control measures and built a framework for CMR analysis that includes these quality control measures, allowing automated processing of CMR scans, while assuring accurate output and flagging of suspicious images or results for clinician review. This tool has been validated in both patients and healthy subjects.
The team is currently working towards translation of this technique to apply it on large scale in different institutions. An article about this work is currently under review by a scientific journal.