PREDICT-VF
Research type
Research Study
Full title
PREDICTING RISK USING ECVUE: DETECTION OF ACTIVATION CHANGES DURING PHYSIOLOGICAL STRESS THAT INDICATE A CRITICAL SUBSTRATE FOR VENTRICULAR FIBRILLATION
IRAS ID
152681
Contact name
Prapa Kanagaratnam
Contact email
Sponsor organisation
Imperial College
Research summary
Research Summary:
Abnormal fast heart rhythms can unexpectedly occur in the young and have been associated with adverse outcomes. These are often due to heart conditions that are inherited, but our understanding of how the genetic information results in these rhythms is incomplete. In addition, invasive tests which involves passing catheters into the heart are needed to make a diagnosis and inform us who is at risk. Unfortunately, during these tests we cannot mimic the situations under which these fast heart rhythms start and this compromises their reliability.In this study, we will be trying to understand whether it is possible to predict if a person is going to get fast heart rhythms using tests that do not involve passing catheters into the heart. We will use a novel vest which can detect the electrical conduction of the heart, and by exposing the study subject to typical situations that can trigger rhythm disturbances such as exercise and relaxation, we hope to understand the differences between people that develop heart rhythms and those who do not. We will focus our work on two types of inherited heart conditions: Brugada Syndrome and Hypertrophic Cardiomyopathy.
We will also be taking blood samples that will be used to grow individual heart cells, in order to understand how the behaviour of these heart cells compares with what we see from the vest in the whole heart. Ultimately, we hope that such blood tests can be used to predict people at risk of dangerous fast heart rhythms.
Summary of Research:
141 people took part in our studies – ranging from people with a family history of cardiac conditions to those surviving cardiac arrest. Each volunteer performed an exercise test with a state-of-the-art electrical sensor vest and underwent a 3D X-ray scan (computerized tomography, CT) of the chest. Volunteers also kindly provided us with their personal and family history as well as clinic investigations to help us make sense of the data we collected.Were there any problems?
One patient had a fast abnormal heart rhythm after exercise, but this resolved after less than a minute of resting without any significant symptoms or medical intervention. We expected to find problems in the lungs from CT scans unrelated to our study – this happened in five patients who all received a referral to the relevant expert at our centre.
What were the results of the study?
We discovered several new aspects of our field from the data:
The electrical recovery patterns of the heart change with exercise differently if you have survived a cardiac arrest. https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbSu94g-2Fw7XUVx4K3PFSk7eu-2Fj7RgW-2F2zCt5y7glUSzUJJ5e2_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YIrf7NiD4k5gfmy-2FwWglP8t5F3-2Bo0cJjPum1gp-2Fxl9kTkXl-2F0jDz2YZbjiDq88EfuPFrXwa3V-2FjB1AkAMWeuRv-2FpndhyGf9kevhqauUQjDTWCTTi7a-2F1TyZO6jjEn10s1qT1w-2B493w64FrOs-2B2xC1lSMK3Pxn7xbH6kg8mkMF1t0w-3D-3D&data=05%7C01%7Cfulham.rec%40hra.nhs.uk%7C3d8a79b39c874b74b6e708dbac49c322%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638293205025549072%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=i05m2dLwsRDExEarqDWqIXltGqXW6H11qu1wuWymroI%3D&reserved=0
Stability of electrical patterns of the heart can be measured and given a score out of 100 – our group created the software to make this possible and named it Ventricular Conduction Stability (V-CoS). https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbYmQsGrKhqntA-2FbTU5g6kdGA4mzJWSntSm75v4tbQACezW-P_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YIrf7NiD4k5gfmy-2FwWglP8tagfQoMlZ9uzhbGQVqRphzBBrSJei59odx2dKYznPH-2Ba530Go1RZFcSYKRo0X1kdkFfPKQZljBfEEE0ozcWPJP5jfK9vpMpbZn1H2tbPOqsWB6kOYn2q83VTBQKcEBpGDGeXEXOFM63iXuqN-2F8GcaUw-3D-3D&data=05%7C01%7Cfulham.rec%40hra.nhs.uk%7C3d8a79b39c874b74b6e708dbac49c322%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638293205025549072%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=sFeqYhhzVCoRZepbscVDjV2T1EePgxzpqaaICYxyLgE%3D&reserved=0
This V-CoS test can successfully tell the difference between cardiac arrest survivors and patients who have not experienced such lethal arrhythmia even when all other cardiac tests are normal. https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbYmQsGrKhqntA-2FbTU5g6kdHPbTRRCjDbK-2B1In0bxBgVWFBqzAse-2BN-2BsPyaMNMMd5EQ-3D-3DG4SD_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YIrf7NiD4k5gfmy-2FwWglP8tJTUjgii0ZR-2Bwjt5p9zkloVY1P3E845eax-2BF0H4I060XqwZxJyGaKeU-2FpWWhcAWl2n5Z1EKtOVbzZy99ComfWmSCFxWfFOh4N-2FOmVpX-2Bn3O26m4iZSn1GQIOZn-2FR8c5tMQsuoVzdl6xPkLQtDXAgO2g-3D-3D&data=05%7C01%7Cfulham.rec%40hra.nhs.uk%7C3d8a79b39c874b74b6e708dbac49c322%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638293205025549072%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=p1rN8WHvMciP1vhf0wBoyUsXsdEUom5KzENLQPFPGMw%3D&reserved=0
Performing the V-CoS test repeatedly shows that there is a regular pulsation in electrical changes after exercise that is seen in cardiac arrest survivors. https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbbdJugJLCLZfQYimqdLU2ypjWBvFUJgwau1CRdOHJ2P-2FEAAaVX2rTGOu1B0mk3bHwL7VPpW7GA7OO-2Bmj0TPhUkc-3DKg2m_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YIrf7NiD4k5gfmy-2FwWglP8tgYD4sP7xUEz3clVCavaVH3S5KC5LpDfrHAkyy7dK5vC-2Fp9aBwiYioK8-2FnEC64u1Ll9CaEHYDjZehwkx3yxAxa0XWdVPUDa3mTHw-2FoqqwZyLhz490VUORRDBS5j-2B5Nr0wdQF-2F8yjcylv-2BvhTSAROw8Q-3D-3D&data=05%7C01%7Cfulham.rec%40hra.nhs.uk%7C3d8a79b39c874b74b6e708dbac49c322%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638293205025549072%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=GCsbgD%2F%2BViIhDP%2FAM99Z0%2BETIyC9QcC2MvcQYQQyDQQ%3D&reserved=0 page S466.
The V-CoS test can tell the difference between Brugada syndrome patients and their unaffected relatives even when the standard ECG heart tracing is apparently normal. https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbfc0AJp3txhrRMgW2idGNToCAzMfhGGqDV0GMCs9741rz1H6mjxsN37j5YcYXPVrbA-3D-3DQbs5_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YIrf7NiD4k5gfmy-2FwWglP8tKCfxo3gUniTae1Mead4kPQOdMv6HHefKNpdc797PcAHtqf46vIS3aBQtOrUZSc4Ljd6tXr3Fgi-2FUoIgV5QTxPhS09fM7EOnoJoDWWeWtVkhZHXDblYLEMWGvmhM2RTN1azG7b9GtmuHDJT80BfGeuA-3D-3D&data=05%7C01%7Cfulham.rec%40hra.nhs.uk%7C3d8a79b39c874b74b6e708dbac49c322%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638293205025549072%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=K3cPnPJ6bTfvhXJSXwPQCQn3CxYOI3mGyEcCRAxlhpY%3D&reserved=0 Abstract 07-17
Other electrical measurements can be combined to pick out cardiac arrest survivors from other patients with thickened heart muscles (hypertrophic cardiomyopathy) who have never had serious rhythm abnormalities. https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbbdJugJLCLZfQYimqdLU2ypjWBvFUJgwau1CRdOHJ2P-2FEAAaVX2rTGOu1B0mk3bHwIkFA1p3CU1haOqYyHruwH0-3DbT1k_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YIrf7NiD4k5gfmy-2FwWglP8tl7YJoCds-2FqqX-2FSRfDUYr4rJV7PQSLQEaGE0mwOI0ZyofmGt4s13SA9ROL5-2Fp1ZggYRUI-2BwpHKwuOVM3zOi3ovMTBe3umNqmBRnqeTmzfTNvxh41u5YN3ovZRTfJpAQsWqV4-2BND4XjVvHJbeosxY6oA-3D-3D&data=05%7C01%7Cfulham.rec%40hra.nhs.uk%7C3d8a79b39c874b74b6e708dbac49c322%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638293205025549072%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=dhTr6w%2FQsruc%2BdhN3kTMBhhueGtCetqk6REPmAqvRbY%3D&reserved=0 page S31.
How has this study helped, and what is next?
We now have a better understanding of the electrical problem that leads to cardiac arrest and the tools we might be able to use to pre-empt it. This study has revealed several new ideas that can be tested in clinical trials to see whether they make a difference in a wider population.
All the research done in these studies was looking back at patients with previously known cardiac arrest to see if this could be measured electrically compared with unaffected volunteers – known as ‘retrospective’ measurement. To understand whether these measurements will work as a mainstream clinical tool, researchers must study the numbers in a group of people who have not had a cardiac arrest yet but might do in the future – this is called ‘prospective’ testing.
We have set up another study called PREDICT-VF2 – which will look at 200 patients with hypertrophic cardiomyopathy who have never had a cardiac arrest. We will manage them according to modern guidelines to ensure they receive the best known treatments, but also make electrical measurements at the start of their 5 year follow-up to see if these would have been better predictors than the current guideline-backed tools.
So far we have recruited 67 out of the target 200 volunteers and expect to release our final results in 2027.
REC name
London - Fulham Research Ethics Committee
REC reference
14/LO/1318
Date of REC Opinion
29 Aug 2014
REC opinion
Further Information Favourable Opinion