Clinical Cardiovascular Research Center Awarded $17M in New Grants
Friday, July 9, 2021
Ilan Goldenberg, MD; Mehmet Aktas, MD; David Tsu-Chau Huang, MD; Valentina Kutyifa, MD, PhD; Himabindu Vidula, MD, MS; Wojciech Zareba, MD, PhD
The University of Rochester Clinical Cardiovascular Research Center (CCRC) has received five new grants totaling more than $17 million over five years from both the National Institutes of Health (NIH) and Abbott. The grants will support research in treatment of atrial fibrillation (AF), device therapy for heart failure, and management of Left Ventricular Assist Device (LVAD) patients.
Led by Ilan Goldenberg, M.D., professor in the Department of Medicine, the CCRC has been involved in the design, conduct, and analysis of large scale national and international clinical research studies for more than four decades.
Faculty members who were key in securing these grants include:
- Mehmet Aktas, M.D., associate professor in the Department of Medicine
- David Tsu-Chau Huang, M.D., professor in the Department of Medicine
- Valentina Kutyifa, M.D., Ph.D., associate professor in the Department of Medicine
- Himabindu Vidula, M.D., M.S., associate professor in the Department of Medicine
- Wojciech Zareba, M.D., Ph.D., professor in the Department of Medicine
Information on each grant is as follows:
Use of LVAD for Patients with Advanced Heart Failure
NIH Grant: $3,583,000
David Tsu-Chau Huang, M.D.
The use of LVADs for patients with advanced heart failure has increased over the years. The significant improvement in survival with the current generation of LVADs is in large part due to the advances in device durability and mechanics. However, several important factors continue to limit the benefit of LVAD support and ventricular tachyarrhythmias (VTA) following LVAD implantation, such as subsequent repeat hospitalizations and increased mortality. Early study findings suggest an effective early intervention with VTA ablation peri-LVAD implantation in high-risk patients, specifically those with a history of VTA, may reduce VTA recurrence and improve clinical outcomes.
This clinical trial will evaluate the effect of prophylactic intra-operative VTA ablation at the time of LVAD implantation on post-implant total recurrent VTA events after accounting for the competing risk of death.
Factors Associated with Response to Cardiac Resynchronization Therapy in Heart Failure Patients with Non-LBBB ECG Pattern
NIH Grant: $3,426,000
Valentina Kutyifa, M.D., Ph.D.
Morbidity, mortality and health care costs of the treatment of systolic heart failure (HF) are rapidly increasing. Cardiac resynchronization therapy with a defibrillator (CRT-D) is cost-effectively reducing HF events and death in HF patients with a wide QRS and low ejection fraction. However, response to CRT-D is not unequivocally present in all patients, with less benefit in those without the presence of an ECG abnormality known as left bundle branch block (non-LBBB), posing a significant treatment challenge.
Because of the conflicting and limited data on response to CRT-D in this cohort, it is possible that we currently treat a large proportion of HF patients with non-LBBB who have limited or no benefit from the device. Therefore, better selection of patients for this expensive therapy is warranted. The primary aim of the study is to improve the selection of patients without LBB for cardiac resynchronization therapy.
Insertable Cardiac Monitor-Guided Early Intervention to Reduce Atrial Fibrillation Burden
NIH Grant: $2,914,000
Ilan Goldenberg, M.D.
More measures are needed to improve success rates following percutaneous catheter ablation (CA) treatment for drug-refractory paroxysmal and persistent AF. To date, conventional management after CA ablation has mostly been based on intervention for clinical AF recurrence. Continuous recording with insertable cardiac monitors (ICM) can now be used to detect early recurrences of subclinical AF and provide patient-triggered mobile app transmissions post-ablation.
In this clinical trial, aim one is to evaluate whether ICM-guided early intervention and symptom-triggered mobile app transmissions result in a significant reduction in AF burden. Aim two is to evaluate whether ICM-guided early intervention management will be associated with less health care utilization.
Blood Pressure and Outcomes in Contemporary LVAD Recipients
NIH Grant: $2,855,000
Himabindu Vidula, M.D., M.S.
A growing number of advanced heart failure patients are supported by a continuous-flow (CF) LVAD in the United States, but the optimal blood pressure range for patients on CF-LVAD support has yet to be fully characterized. Previous studies of patients with older LVAD technology have suggested that elevated blood pressure is associated with adverse outcomes, including increased risk of stroke and mortality.
This study will validate findings regarding the association of low blood pressure, high blood pressure and blood pressure variability, as well as the risk of stroke or death. In addition, the study will determine the optimal blood pressure range in various patient subgroups, including women and Black patients, and look into the optimal medication regimen for LVAD patients.
Confirm Rx Insertable Cardiac Monitor for Primary Atrial Fibrillation Detection in High-Risk Heart Failure Patients
Abbott Grant: $4,363,000
Ilan Goldenberg, M.D. and Mehmet Aktas, M.D.
Patients with heart failure represent a large population of patients who are at high risk for complications related to undiagnosed AF. Currently, there are limited modes for early AF detection and subsequent stroke prevention. In this study, an implantable cardiac monitor will be medically inserted into the patient and provide long term arrhythmia information via remote monitoring. Rochester is one of many institutions participating in this large randomized multicenter clinical trial in the US.