A Novel Automated & Comprehensive Approach for Ventricular Function Assessment in Heart Failure
Condition: Heart Failure
MeSH terms: Heart Failure
Study type: Observational

Summary: 
      Heart failure is a major health care burden. It can occur with either normal or reduced LV
      ejection fraction, depending on different degrees of ventricular remodelling. The
      investigators recently published a new method, curvedness-based imaging. The investigators
      have also reported the diagnostic utility of curvedness-based imaging in various cardiac
      diseases. The investigators now propose to prospectively assess curvedness-based imaging for
      diagnosis of heart failure with normal ejection fraction and with reduced ejection fraction,
      and examine left ventricular systolic and diastolic function and predicts the prognosis in a
      cohort of HF patients.
    

Detailed description: 
      Heart failure imposes major global health care burden on society and suffering for the
      individual.In the US, HF affects 5.7 million patients, and is the leading cause of
      hospitalization for people over 65 years, with 25% to 50% rate or hospital readmission within
      6 months.In Singapore, between 1991 and 1998, it accounted for 4.5% of all hospital
      admissions and 2.5% of mortality in the geriatric age group.It confers an annual mortality of
      10%.

      The early diagnosis and identification of the underlying etiology of HF is of paramount
      importance; some causes require specific treatment and may be correctable. From updated
      American College of Cardiology/American Heart Association guidelines, some questions must be
      addressed for suspected HF patients: Is the left ventricular ejection fraction preserved or
      reduced? Is the structure of the LV normal or abnormal? Are there other structural
      abnormalities such as right ventricular (RV) abnormalities that could account for the
      clinical presentation? Is there LV global and regional dysfunction and to what extent? Is the
      etiology ischemic or non-ischemic?

      Cardiac imaging is important both for HF diagnosis and monitoring of progress. Impaired pump
      function, expressed reduced left ventricular ejection fraction is often used as a marker of
      HF. About 50% of HF have preserved EF.In this situation, more intricate and comprehensive
      imaging involving measurement of multiple diastolic and systolic parameters, usually using
      echocardiography, may become necessary to address the questions mentioned above.

      Our solution is expected to result in a significant cost saving for HF patients. HF diagnosis
      is still very challenging, consisting of assessment of medical and family histories, a
      physical exam and diagnostic imaging tests. The investigators compare the cost difference in
      traditional way against our proposed solution. The traditional diagnostic tests include chest
      x-ray, BNP blood test, echocardiography, nuclear heart scan and cardiac catheterization. In
      this project, the investigators estimate the cost of echocardiography, nuclear heart scan and
      cardiac catheterization for HF diagnosis. Based on clinical experience, among 1000 patients
      undergoing echocardiography, 50% will be referred to nuclear heart scan and 30% will be
      referred to invasive cardiac catheterization. The cost of the whole workup is estimated to be
      $1.95 million. If 1000 patients undergo our proposed CBI solution directly, the cost
      estimated at $1.4 million. The cost saving is estimated at S$400 per patient.

      Hence, the investigators will be exploring the following for this study:

      Primary aim: Assess LV systolic and diastolic function from curvedness-based imaging in 120
      HF patients with reduced ejection fraction and normal ejection fraction.

      Secondary aim: Evaluate the utility of curvedness-based imaging for the diagnosis of etiology
      of HF, against gold standard gadolinium enhanced CMR in subgroup of HF patients.

      Exploratory aim: Evaluate the utility of curvedness-based imaging for the prediction of
      prognosis during 6 month follow up, where clinical outcome include death, CV death and HF
      re-admission.
    

Intervention name(s): Cardiovascular Magnetic Resonance; Echocardiogram
Intervention type(s): Other; Other
Intervention description(s): For the evaluation of left ventricular volumes, function and mass. This is also for the assessment of myocardial fibrosis based on delayed enhancement imaging technique.; For the assessment of diastolic and systolic function as well as valvular and cardiac function. Ventricular-arterial coupling will also be performed.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients presented to hospital with a primary diagnosis of Heart Failure or are attending a
        hospital clinic for management of Heart Failure within 6 months of an episode of
        decompensated heart failure, which either resulted in a hospital admission (primary
        diagnosis) or was treated in out-patient clinic