The effect of CRT on the Frank Starling mechanism
Research type
Research Study
Full title
The effects of Cardiac Resynchronisation Therapy on the Frank Starling mechanism in patients with heart failure
IRAS ID
318500
Contact name
Christopher Aldo Rinaldi
Contact email
Sponsor organisation
Guys and St Thomas's NHS Foundation Trust
Duration of Study in the UK
2 years, 0 months, 2 days
Research summary
We are investigating a scientific principle called the Frank Starling Mechanism and how it relates to Cardiac Resynchronisation Therapy (CRT), a form of pacemaker therapy used in the treatment of heart failure.
The Frank Starling Mechanism is an established biological principle. The law states that the stroke volume of the heart increases in response to an increase in the volume of blood in the ventricles, before contraction, when all other factors remain constant. In other words, the law states that the more blood enters the heart, the more blood is pumped out of the heart with any given beat.
There is some evidence that in some patients with chronic heart conditions, the Frank Starling Mechanism is LESS EFFECTIVE, meaning that the heart is less able to cope with a reduction in heart pumping function over time. There is also evidence that • Treatment with CRT may IMPROVE the Frank Starling Mechanism – evidence for this has been shown in dog and mice hearts, however, has never been shown in humans.
We aim to conduct a study where subjects undergo an ultrasound scan of the heart (echocardiogram) whilst their pacemaker settings are temporarily changed. This allows us to measure the pumping function of the heart as more blood enters the heart. We will perform this test on 20 patients before and after CRT, as well as 20 patients who have pacemakers, but no heart failure. This study aims to test 3 hypotheses.
1.In patients with pacemakers, a REDUCED Frank Starling Mechanism predicts which patients go on to develop heart failure.
2.Treatment with CRT IMPROVES the Frank Starling Mechanism in patients with pacemakers and heart failure.
3.The degree of improvement of the Frank Starling Mechanism after treatment with CRT predicts which patients will respond to this treatment.REC name
London - Central Research Ethics Committee
REC reference
23/PR/0503
Date of REC Opinion
11 May 2023
REC opinion
Favourable Opinion