Guide Cardiac Resynchronisation Therapy - Guide CRT

Lead Research Organisation: King's College London
Department Name: Imaging & Biomedical Engineering

Abstract

Cardiac Resynchronisation Therapy (CRT) has been shown to be a safe and effective treatment option in patients with
advanced drug-refractory Heart Failure (HF), systolic dysfunction and ventricular dyssynchrony. However, up to one-third of
patients implanted with a CRT device show no improvement in symptoms and up to half of patients show no improvement
in cardiac function. These non-responders are a strong burden to healthcare systems by causing considerable
unnecessary costs, e.g. for devices, implantations, recurring follow-up visits as well as hospitalisations for acute HF
decompensation The aim of this project is to develop a single platform which integrates all stages of the CRT pipeline,
referred to as the "Guide CRT", to improve response rate. The main components of this include MR clinical imaging
protocols dedicated to HF patients, tailored image processing tools (segmentation of the heart morphology, myocardial scar
and coronary sinus, as well as analysis of left ventricle (LV) wall motion), fused visualisation for improved patient selection
and planning of LV lead placement, and the image-based guidance technologies to support CRT device implantation.
Guide CRT will be evaluated on a cohort of 50 patients. Through the proposed joint efforts between leaders in their
respective industrial, academic and clinical fields, we aim to demonstrate that integrating comprehensive multimodal
imaging data and tools can help to provide answers to the great challenges of CRT, namely identification of patients who
are likely to respond and guiding LV lead placement to maximise this reponse.

Planned Impact

1. Patients with heart failure - CRT can be a life-changing treatment for patients that respond. Similarly, patients that are
likely to be non-responders will benefit from not having an invasive treatment and being triaged to more appropriate
therapy. The project, by improving outcome of patients with heart failure, will lead to improved quality of life for these
patients. This impact will occur once the prototype developed in this project has been commercialised and this is
anticipated to begin approximately 1 year after the end of the project, i.e. 2017.
2. The National Health Service, other international healthcare providers - better selection of patients for CRT and improved
outcome for those undergoing CRT will result in cost-savings for healthcare providers. These cost-savings can then be
better utilised for other high-priority healthcare issues. This impact will occur after the beginning of development of the
commercial version of the Guide CRT application in 2017.
3. UK economy - this project will directly create employment in the UK and strengthen the UK's standing in high-end
technology research and development. Sales of Siemens' products through the UK will generate income for the UK
government. This impact will occur from the beginning of the project.
4. Academic researchers - novel scientific knowledge is likely to be generated by the project that will have applications in
other types of cardiovascular disease. This impact will occur from within the first year of the project and continue thereafter.
5. Those employed on the project - at least 3 new researchers will be employed on this project. The researchers will gain
new skills during the course of the project that will be beneficial for career development. This impact will occur during the
course of the project.
6. Other imaging technology manufacturers - it is quite common in the commercial imaging sector for manufacturers to release competitive technologies based on first-to-market systems. The commercial electrophysiology sector has a large
degree of technology convergence and the leading manufacturers tend to offer similar systems to remain competitive. It is
likely that similar systems to Guide CRT will be released within 2 to 3 years of first commercial release.
7. The project partners - Siemens will use the developed software prototypes as basis to produce a novel product and will
strive to be first-to-market to capture market share. The electrophysiology sector is very technology-dependent specialty
and new technologies tend to be rapidly taken up even faster than in other clinical fields. This will have a positive economic
impact on Siemens. KCL will publish scientific papers in leading journals and conferences, create technology that has
potentially high impact and carry out a landmark clinical study. These are all important when academic institutions are
assessed. New IPR is likely to be generated during the project and this will be jointly protected by the project partners. The
project has already had an impact on the partner since writing of the proposal has already fostered a new partnership and
this will continue at least throughout the course of the project.

Publications

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Karim R (2018) Image Data Analysis for Quantifying Scar Transmurality in MRI phantoms for Cardiac Resynchronisation Therapy. in Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference

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Mountney P (2017) A Planning and Guidance Platform for Cardiac Resynchronization Therapy. in IEEE transactions on medical imaging

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Panayiotou M (2018) LV function validation of computer-assisted interventional system for cardiac resyncronisation therapy. in International journal of computer assisted radiology and surgery

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Panayiotou M (2016) Dynamic mapping of ventricular function from cardiovascular magnetic resonance imaging. in Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference

 
Description Using magnetic resonance images of a patient with heart failure can be useful for guiding pacemaker implants
Exploitation Route We are developing a commercial software solution to help with pacemaker implants and this will allow other clinical centres to carry out clinical studies. Furthermore, some of the algorithms that we have developed can be used for other types of heart disease.
Sectors Digital/Communication/Information Technologies (including Software),Healthcare

 
Description The software developed as part of this project has assisted in the placement of pacemaker devices in patients.
First Year Of Impact 2015
Sector Healthcare
Impact Types Societal

 
Description i4i Product Development Award
Amount £624,000 (GBP)
Funding ID II-LB-1116-20001 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 04/2018 
End 03/2020
 
Description Siemens Healthcare 
Organisation Siemens Healthcare
Country Germany 
Sector Private 
PI Contribution Co-development of software with Siemens Healthcare employees that are located on our premises
Collaborator Contribution Co-development of software and access to clinical data
Impact Co-developed software
Start Year 2014