Heart Foundation funds cardiologist

Heart Foundation funds cardiologist for innovative heart research

Newly trained Auckland cardiologist, Khang Li Looi, recently awarded a Heart Foundation Research and Training Fellowship, is set to start new research that could help to save the lives of New Zealanders with an inherited predisposition to heart muscle disease.

Khang Li, from Epsom, Auckland, will work as a cardiac electrophysiological fellow at the United Kingdom’s largest specialist cardiothoracic hospital, Papworth Hospital in Cambridge, for one year.

She’ll train to perform cardiac electrophysiology studies - the electrical activities of the heart - as well as surgical device implantations, for example pacemakers and intracardiac defribrillators, at Papworth Hospital.

“The normal electrical conduction of the heart allows efficient contraction of all four chambers of the heart, thereby allowing blood perfusion through both the lungs and systemic circulation in the body. If a person’s electrical conduction of the heart is not working effectively, this will result in the heart either beating too fast or too slow, which in the worst cases can cause sudden cardiac death,” says Khang Li, who is based at Auckland Hospital.

More specifically, Khang Li will work to identify high risk patients with dilated cardiomyopathy (DCM) who would best benefit from having an intracardiac defribrillator or ICD, an implantable device that delivers a shock to restore normal heart rhythm, used to prevent sudden cardiac death in high-risk patients.

“People with dilated cardiomyopathy have a condition in which the heart gradually becomes enlarged beyond normal limits and cannot perform as effectively as a pump. The symptoms can range from heart failure to heart rhythm disorders, commonly called arrhythmias, and some patients are unaware that they have it until something goes wrong,” says Khang Li.

“Fast heart rhythms can be particularly dangerous and cause blackouts or sudden collapse requiring resuscitations (called sudden cardiac death). Current methods to identify this group of high risk patients with DCM have low predictive accuracy.

“I want to find out which patients would benefit the most from having an ICD and also identify the most cost effective option for the New Zealand health system. To identify this I’ll use an emerging technology called Pace Ventricular Electrogram Fractionation Analysis (PEFA) – a process that studies the electrical potential of the heart that would serve as a marker for sudden cardiac death.”

Beside those patients who survive a cardiac arrest and would receive an ICD (secondary prevention), New Zealand has strict criteria for patients with heart failure treated with a prophylactic implantable cardiac defibrillator (primary prevention). This is partly because of the large number of potential candidates (possibly 14,000) and the practical constraints of limited implanting specialist resource and funding.

“There is no perfect screening tool in place in New Zealand, or the world for that matter, to help us identify these patients who are at risk of sudden cardiac death and would potentially benefit the most from an ICD,” says Khang Li.

“I want people who suffer from this disease to be able to live a normal life and contribute to New Zealand’s society and economy,” she says.

Through the findings of her research in the UK, Khang Li intends to participate in setting up a multi-national trial when she returns to New Zealand, for better management of patients with DCM. The findings of the trial will help to establish guidelines for ICD implants for this group of patients in New Zealand and potentially worldwide.

Khang Li will work alongside Dr Andrew Grace at Papworth Hospital, a renowned consultant cardiologist, who has developed one of the largest clinical practices in cardiac arrhythmia management in the United Kingdom.

“I am hugely grateful to the Heart Foundation for this fellowship, it will allow me to work in the area I am passionate about and have the potential of making a big difference in patients’ management and lives.”

More about DCM: DCM can develop at any age, in either gender and in people of any ethnic origin. In adults, it is more common in men than in women. DCM in New Zealand is commonly caused by coronary heart disease. There are other known causes including alcohol induced forms, and other idiopathic forms that may come on after a viral illness or pregnancy.

About 25% of cases were thought to be ‘idiopathic’ that is, no identifiable cause could be found. In recent years doctors have found that approximately 30% of affected individuals seem to have other family members who are also affected by the disease.

The Cardiac Inherited Disease Registry NZ, based at Auckland, maintains a database of all patients with inherited heart diseases including those with DCM. There is ongoing research in this field that may help us to understand about DCM better, with a potential of defining better management strategies for this group of patients. ICD is only one option.

ENDS

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