Clinical Research Directory

Harnessing ECG Artificial Intelligence for Rapid Treatment and Accurate Interpretation

HEART-AI is a pragmatic randomized trial currently active at Montreal Heart Institute, with planned multicenter expansion testing whether an artificial intelligence (AI) score from a routine 12-lead electrocardiogram (ECG) helps clinicians identify structural heart disease sooner. Structural heart disease includes reduced heart pumping function, valve disease, pulmonary hypertension, thickened heart muscle and fluid around the heart. The study plans to enroll 5,700 adults seen in outpatient clinics or ambulatory emergency departments who have no known structural heart disease. Patients are assigned equally to standard care with or without the EchoNext AI risk score and echocardiography recommendation. For high-risk patients, EchoNext recommends a transthoracic echocardiogram (TTE, an ultrasound of the heart) within 2 to 4 weeks, no later than 30 days. Low-risk patients receive routine care, with TTE when clinically indicated. Clinicians retain responsibility for all care decisions. The score is calculated in both groups but shown only in the AI group. The main outcome is the proportion of patients with structural heart disease documented on a clinical TTE within 30 days of their first study ECG. Other outcomes include diagnoses within 12 months, time to TTE and diagnosis, imaging use, management changes and model performance.

Stereotactic Ablative Radiotherapy for the Treatment of Refractory Ventricular Tachycardia

Ventricular tachycardia (VT) is an abnormal rhythm arising from the bottom chambers (ventricles) of the heart. The hearts of most patients who develop VT have been previously damaged by a myocardial infarction (heart attack) or other heart muscle diseases (cardiomyopathies). The damage produces scar or fatty deposits that conduct electrical impulses slowly allowing VT to occur. Recurrent episodes of VT can compromise heart function and increase mortality. VT is prevented by special drugs but these are not always effective and can have many side effects. Most patients with VT will also have a specialised device called an implantable defibrillator (ICD) implanted. The ICD treats VT by either stimulating the heart rapidly or delivering a shock to it. ICDs are very effective but the shocks are painful and have a big impact on quality of life. If VT occurs despite optimal drug treatment, patients undergo an invasive procedure called catheter ablation. Here, wires are passed into the heart from the blood vessels in the leg and the damaged heart muscle causing the VT is identified whilst the heart is in VT. An electrical current is passed down the wire making its tip heat up allowing discrete burns (ablation) to be placed inside the heart. The ablated heart muscle doesn't conduct electricity which stops the VT and prevents it recurring. Some patients are so frail that ablation cannot be performed safely. A recent clinical trial has shown that VT can be treated in such patients using radiotherapy, which is usually used to treat tumours with high energy radiation. This approach is non-invasive, painless and requires no sedation or anaesthesia. This study will test whether VT can be successfully treated using stereotactic ablative radiotherapy. This can deliver high dose radiotherapy very precisely, whilst minimising the risk of damage to healthy tissues.

Prince of Wales Hospital Structural Heart Registry

Structural heart disease refers to a group of cardiac defects other than coronary artery disease. Structural heart intervention is a rapidly growing field in cardiology. In the past decade, there has been paradigm shift in the management of structural heart disease from conventional open-heart surgery to transcatheter interventions. With increasing evidence supporting structural heart interventions including transcatheter aortic valve implantation or transcatheter edge to edge repair, there has important updates in recent guidelines in treating structural heart disease. Besides, new device innovations bloomed over the past few years and had expanded the possible treatment options for high surgical risk patients. Some breakthrough devices had been approved recently by the US Food and Drug Administration and some other devices are occasionally used on compassionate ground. However, there has been lack of data in structural heart interventions in Asia Pacific regions outside Japan \[8\]. In this study, we would like to analyze the epidemiological trends, patient characteristics, procedural outcomes and clinical outcomes of structural heart interventions, and compare them with historical cohorts, matched cohort receiving medical therapy and matched cohort receiving open heart surgeries.

REgiStry-based Cardiovascular qUality improvEment Research

The goal of this registry-based observational study is to establish a comprehensive management plan, which focus on medical therapy, cardiac rehabilitation and active post-market surveillance of medical devices, in patients with cardiovascular diseases (CVD). Patients with CVD mainly refers to four groups of patients：1) post-percutaneous coronary intervention (post-PCI) patients; 2) patients with heart failure (HF); 3) patients with cardiometabolic diseases (CMD); 4) patients with structural heart disease (SHD), and the detailed definition of each group can be found in "Eligibility" section. The main questions this study aims to answer are: * the effectiveness of exercise-based cardiac rehabilitation in improving cardiac function, reducing CVD recurrence and mortality, and promoting quality of life for patients with CVD; * the feasibility of registry-based active post-market surveillance of high-risk medical devices used in cardiovascular surgeries, such as PCI, heart valve replacement, and cardiac resynchronization therapy (CRT); * the utilization of multiomics datasets to identify and dissect cardiovascular heterogeneity in both healthy and diseased populations and to guide precision medicine in patients with CVD; * the analysis and evaluation of the prescription patterns and drug response in patients with CVD.