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Personalised Multi-Factorial Clinical Decision Making in Complex Surgical Interventions: Right Ventricular Failure Risk Prediction in Patients Referred for Left Ventricular Assist Device Implantation (RiVeR)
Universita degli Studi di Palermo
Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT Via Ernesto Tricomi, 5, 90127 Palermo PA, Italy
Dr. Diego Bellavia
Dr. Diego Bellavia
Type of Research Project
- Clinical Project with Laboratory work
What is the background of the project?
The Data show that Heart Failure with reduced Ejection Fraction (HfrEF) affects more than 6.5 million > 50/year in Europe. Heart Transplantation (HTX), although effective, cannot be considered as the only therapeutic solution since the availability of the donors is not enough to cover completely the amount of patients in need of the organ. Continuous Flow Left Ventricular Assist Devices (CF-LVADs) could be used as a therapeutic alternative, but costs are still very high and this is partially due to related complications, such as Right Ventricular Failure (RVF).
What is the aim of the project?
The aim of the project is to define a risk model that, combining novel 3D echocardiography, cardio-specific epigenetic markers and numerical models of cardiac mechanics with the innovative machine learning approach, will be able to identify patients at high risk of Acute and Chronic Right Ventricular Failure (RVF), among those referred to Continuous Flow Left Ventricular Assist Devices (CF-LVADs).
What techniques and methods are used?
Initial risk model definition will be based on the retrospective analysis of the ongoing centralized registry pooling data from the OU1 (output) and OU2. Additional new measures, including 2 dimensional and 3 dimensional (2D/3D) volumetric and strain echocardiogram as well as cardiac Computerized Tomography / Magnetic Resonance Imaging (CT/MRI) derived numerical models of Right Ventricular (RV) fluid dynamics and mechanics will be used. Following implant, patients will be followed-up every month in the outpatients clinic, and a standard ECHO will be repeated, with a focus on signs of volume overload and/or subclinical RV impairment. The microRNA expression profiles will be investigated with advanced tool in order to predict the molecular pathway target. The miRNA modulation of these pathway will be confirmed by the analysis of cytokines and Extracellular Matrix (ECM) modulators levels expressed in myocardial biopsies obtained surgically at LVAD implant date and in circulating exosomes of patients with acute, chronic or without RVF after LVAD. Thus, we will be able to: (i)understand distinct regulatory pathways for the RV; (ii)identify specific biomarkers useful in predicting RVF; (iii) depict patients with LVAD developing pump-related reverse remodelling of both RV and Left Ventricular (LV). The patient response to LVAD will be simulated using zero-dimensional (0D) models as well as finite-element computational models with the ability to predict bi-ventricular pressure-volume (PV) loops and myocardial wall stress.
What is the role of the student?
- The student will mainly observe
- The student will observe the practical experiments but will be highly involved in the analysis of the results
- If the project includes “lab work”
- the student will take active part in the practical aspect of the project
- If the project is clinical
- the student will take active part in the clinical examination
- If the project is clinical
- the student will be allowed to work with patients
- The tasks will be done under supervision
What are the tasks expected to be accomplished by the student?
The student will follow Ventricular Assist Device (VAD) patients both during the implant and the follow up. He/she will be taking part to interviews and physical examinations, and will be included in both clinical and laboratory fields. Specifically, he/she will be taught how to properly perform an echocardiography, and how to elaborate the results obtained. Furthermore, the student will follow in the laboratory the procedures of cytokine and extracellular matrix analysis in the samples detected during the myocardial biopsy.
Will there be any theoretical teaching provided (preliminary readings, lectures, courses, seminars etc)
We will provide some preliminary readings concerning the abstract before the research project starts. Our doctors will involve the students in every step of the project, giving them theoretical and practical knowledge.
What is expected from the student at the end of the research exchange? What will be the general outcome of the student?
- No specific outcome is expected
What skills are required of the student? Is there any special knowledge or a certain level of studies needed?
Are there any legal limitations in the student’s involvement
Type of students accepted
This project accepts: - Medical students - Graduated students (less than 6 months)
- Bellavia D; Iacovoni A; Scardulla C; Moja L; Pilato M; Kushwaha SS; Senni M; Clemenza F; Agnese V; Falletta C; Romano G; Maalouf J; Dandel M. Prediction of right ventricular failure after ventricular assist device implant: systematic review and meta-analysis of observational studies. Eur J Heart Fail. 2017 Jul;19(7):926-946
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