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Title: The characterisation of circulating biomarkers and body composition before and after cardiac resynchronisation therapy in patients with chronic heart failure and their role in predicting response
Author: McAloon, Christopher
ISNI:       0000 0004 7224 1305
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2017
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Heart failure is a common condition which carries a high mortality and morbidity. Despite improved medical therapy the outcomes for heart failure with a reduced ejection fraction remain poor. Cardiac resynchronisation therapy has revolutioned the treatment of patients with heart failure with a reduced ejection fraction and dyssynchrony, refactory to medical therapy, improving morbidity and mortality. Unfortunately a significant minority fail to respond to this expensive therapy, which is challenging for both the patient and society. Over the last 15 years research has focused on attempting to predict non-response. Evidence suggests wider QRS duration and bundle branch morphology on the resting electrocardiograph are the most important predictors of response and outcome following implantation of a cardiac resynchronisation device. However, the non-response rate remains unchanged despite extensive research. Molecular systems have been shown to alter with the development and progression of heart failure. Many of these systems are now utilised in the diagnosis and prognostication of heart failure. Cardiac resynchronisation therapy device implantation has been shown to alter these dysregulated molecular systems. Specific circulating biomarkers reflect these respective systems. Cardiac extracellular matrix is a dynamic support structure that has altered turnover in heart failure and is affected when cardiac resynchronisation devices are implanted. Micro ribonucleic acids have been observed recently to be important in molecular systems regulation and dysregulation has been observed in heart failure. Furthermore altered expression following cardiac resynchronisation therapy device implantation has been reported. The evidence suggests circulating biomarkers for these systems have the potential to predict response. Our prospective study examined specific biomarkers that the literature suggests has the potential to predict response, but the evidence is currently inconclusive. Moreover we utilised other important patient variables known to be predictors from the wider literature and our own retrospective cohort analysis of response to test alongside specific circulating biomarkers. We offer an informed pilot study to test important circulating biomarkers for their clinical ultility to predict heart failure patient’s ability to respond to cardiac resynchronisation therapy.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RC Internal medicine