Heart failure and transplantation

The overall aim of the heart failure research program is to improve the quality of care from diagnosis to treatment of patients with heart failure which directly aligns with the core clinical goals of the clinical team. Heart failure is a major global health crisis with high morbidity and mortality and one of the most common causes of hospitalisation in Australia. Heart failure poses a threat to a person’s survival, quality of life and places a marked financial burden on patients, hospitals, and the society, highlighting the urgent need to improve the diagnosis and treatment of this common disorder.

Potential of Left Atrial stain obtained during Exercise Stress Echocardiography in the diagnosis of Heart Failure with Preserved Ejection Fraction (LASHPEF)

Lead Investigator: Dr Wandy Chan

Heart failure with preserved ejection fraction (HFpEF) accounts for ~50% of all heart failure cases. Diagnosis of HFpEF can be challenging as symptoms are often non-specific and may not be apparent at rest. Exercise right heart catheterisation (ExRHC) improves the diagnosis of HFpEF, it can unmask abnormal left ventricular filling pressure induced by exercise. However the test is invasive and is only available in expert centres which limits the access of the test and could delay a patient receiving appropriate treatment. The LASHPEF study assesses the feasibility of obtaining left atrial strain (LAs), a novel parameter of diastology during exercise echocardiography and evaluates its diagnostic potential against ExRHC, the current “gold standard”.

Development of ‘cardiac specific cell-free DNA quantitation in blood’ as a highly sensitive biomarker to detect heart failure patients most at risk of re-hospitalisation

Lead Investigator: Dr Wandy Chan

HF is a significant health problem with a high 30-day re-hospitalisation rate. It poses a huge burden to the health care system both directly and indirectly. Therefore, there is a need for a clinical tool that could better risk-stratify patients or facilitate early detection of HF deterioration, enabling earlier intervention which hopefully could halt repeated hospitalisations and reduce mortality. Cell-free DNA (cfDNA) is released systemically upon cell death, and is elevated in chronic heart failure patients compared to healthy controls. In addition, these molecules contain unique signatures that are specific to the organ they originated from. There are many yet to be answered questions prior to evaluating cardiac specific cfDNA as a candidate for prognosis or surveillance. Our project aims to address some of the fundamental questions.

Streamlined Pathway for Acute Heart Failure (SPAHF)

Lead Investigator: Dr Wandy Chan

HF is one of the top 10 reasons of Emergency Department (ED) presentations in older adults. Initial care upon ED presentation is crucial. However, HF patients often encounter excessive delays in the diagnosis and treatment due to a multitude of reasons, the delay could prolong the time spent in ED and has a knock-on effect of a longer hospital stay, further exacerbating constraints in resources and increasing health care costs. In SPAHF, we propose and evaluate if implementation of a standardised pathway to expedite early diagnostic workup and treatment for patients presenting to ED with suspected HF will reduce time spent in ED, decrease length of hospital stay, and improve patient outcomes, thus reducing pressure on ED and hospital resources.

Evaluating the Role of Urinary Sodium Guided Diuretic Therapy

Lead Investigator: Dr Maryam Khorramshahi Bayat

Natriuretic diuretics are among the most commonly used drugs for achieving euvolemia in patients with acute decompensated heart failure. They act by diminishing sodium reabsorption at different sites in the nephron, thereby increasing urinary sodium and water losses. Hence, urinary sodium concentration (UNa), both in spot samples and continuous urine collections, has been proposed as a tool to rapidly assess the response to decongestive therapy and to estimate future outcomes. In this study, we investigate the potential clinical utility of spot UNa measures in the treatment and risk stratification of patients with acute heart failure.

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