euHeart to personalise care

The computer analysis technique used to visualise how a vehicle would deform during a crash could determine the best treatment for patients with heart murmurs.

That is the aim of an EU-funded research project called euHeart, which is looking to provide more effective care for not only heart rhythm disorders, but also conditions such as heart failure, coronary artery disease and congenital heart defects.

The euHeart consortium includes partners from 16 academic, industrial and medical organisations in the UK and five other European countries. The group is developing advanced computer models of the human heart that can be personalised to a specific patient's conditions using clinical data from sources such as computed tomography (CT) and magnetic resonance imaging (MRI) scans.

These measurements will give the geometry of a patient's heart that can be represented numerically using finite element analysis (FEA), which is then fed into computer simulation models.

'Mathematics and computation are tools engineers have used over the past 50 years, primarily to analyse [civil] structures in the 1960s and 1970s and automotive and aerospace applications in the 1980s and 1990s,' said Nicolas Smith, euHeart's scientific coordinator. 'What this project does is take that kind of approach and apply it to medicine and physiology with all the same kinds of benefits.'

The computer models will integrate the behaviour of the heart and aorta at molecular, cellular, tissue and organ level. Smith said it will create a clear 3D image of the heart that clinicians can rotate, try different procedures on and look at the effects before performing real treatments on the patient.

One example where this technology could be helpful is for heart rhythm disorders. Doctors treat this with a minimally invasive procedure known as radio-frequency ablation. A catheter is inserted into the patient's heart and the tissue responsible for propagating abnormal electrical signals through the heart muscle is destroyed using heat from a radio-frequency field generated at the tip of the catheter.

'You can scar the tissue or burn tracks into it to force the electrical wave to straighten out and conduct in a smooth way, which causes that piece of tissue to contract properly,' said Smith, who is also a lecturer in computational biology at Oxford University. 'It's a procedure which is effective in 60 to to 70 per cent of patients, but there is still a large percentage of patients who don't properly respond.'

The problem is that the shape and electrical activity of each patients' heart is subtly different. 'What we can do is build a computer model of the particular person's atria and look at the way their electrical wave is being conducted and look at the best ways of straightening it out by putting scars into the tissue,' said Smith.

More information can be gathered about a patient's heart by including other clinical data into the model such as measurements of bloodflow and blood pressure in the coronary arteries (which feed the heart muscles) and electro- cardiograms (ECGs). This information can show how cardiovascular disease disturbs the correct functioning of the heart.

The euHeart project, which has a budget of €19m (£15m) of which €14m is from the EU's 7th Framework Programme, is expected to last four years. First, the consortium will fully develop simulation tools before clinical trials which are to be led by King's College London. It is expected the project will complement the recently announced, Philips-led HeartCycle project focusing on the long-term management of chronic heart disease patients.

After four years the consortium hopes to have developed a series of computer simulation software packages clinicians can use to determine the best treatment for patients with heart conditions. Smith said industry project partner Royal Philips Electronics has a strategy for including such technology within current imaging software that already comes with its medical scanners.

Olivier Ecabert, senior scientist at Philips Research and project leader of euHeart, said he hopes the project can make a big difference in the way heart disease is treated throughout the world.

'Cardiovascular disease is the number one killer in western countries and it is now spreading to developing countries so there is a requirement to reduce the impact of this disease,' he said. 'We think a better understanding of the heart and physiology will achieve this objective.'

Siobhan Wagner