Advanced Heart Failure
Of the 5.7 million Americans with heart failure, ~10% will fail to respond to medical therapy and progressively worsen to develop advanced heart failure, for which the only definitive therapy is cardiac transplantation. As the supply of suitable donor hearts is limited to ~2000 per year in the US, the care of advanced heart failure patients requires therapeutic alternatives. For some patients, mechanical circulatory support in the form of a ventricular assist device (VAD) - an implantable pump - can provide short-term or long-term support and in 1-2% of VAD recipients, the heart improves to the point where the pump can be removed, termed myocardial recovery. Currently, it is not possible to predict which heart failure patients will respond to medical therapy alone, which will benefit from VAD support, and which have no potential for recovery. For VAD recipients, quantifying myocardial recovery to inform if, and when, to explant the device requires invasive testing.
Working closely with the uniquely skilled clinical team led by our collaborator Dr. Claudius Mahr at the University of Washington, our long term goals include the development of new, less-invasive strategies to quantitatively measure cardiac recovery and assist physicians in deciding if and when VAD explantation may be considered. Specifically, we are interested in cell surface markers for measuring metabolically-healthy cardiomyocytes and cardiac fibrosis, including markers that can be exploited for use in real-time patient imaging for tracking myocardial mass and structure. Moreover, we are actively pursuing the use of cell-type specific surface proteins as informative circulating biomarkers that can be detected independently of cell death (i.e. necrosis/apoptosis not required for their release) using non-invasive methods.