The BRC has supported complex interventional studies of cardioprotection during PCI by both providing some of the required infrastructure and fostering a change in culture regarding clinical academic activity. The studies form a central aspect of the academic activity of one of the clinical lecturers supported by the BRC, who is now seeking to secure an intermediate fellowship to continue the studies after completion of his training.
The BRC also supports a research fellow investigating whether more detailed patient selection enhances the response to Cardiac Resynchronisation therapy (CRT ' biventricular pacing). The study recruited 210 patients attending the Wellcome Trust Clinical Research Facility before device implantation, and is a collaboration between Papworth and CUH. An interim analysis was used to inform changes in the routine care of this group of patients including adoption of more extensive pre-implantation imaging and selection of the site of left ventricular pacing, optimisation of the device immediately following implantation, and the establishment of a clinic to optimise the device using non-invasive cardiac output measurements (which have been demonstrated to be equivalent to, and much easier to perform, than detailed echocardiography). The changes in the CRT clinic evolved directly through the research programme which itself was carefully developed after a pilot study of 50 patients who assisted in the design of the larger study reported above. A measure of success is the almost complete follow-up that has been achieved at the 6-month assessment.
The framework of the BRC (including the biochemical laboratory to analyse peptides and other metabolic hormones) has also enabled experimental medicine studies to assess the utility of GLP-1 to protect the heart against stunning and ischaemic LV dysfunction. These were initially supported by an experimental medicine grant from the BHF and MRC, and after encouraging results a further recent award has been made by the MRC to continue these studies. The clinical fellow undertaking this work has collaborated closely both within the BRC cardiovascular group, and with interventional colleagues to extend the studies of cardioprotection during PCI.