Virtual blood vessel technology could improve heart disease care

Creating 3D models of the coronary arteries to compute blood flow through the heart's arteries would have changed the way treatment was assessed and planned in over a fifth of patients, says the research presented by Sheffield Teaching Hospitals NHS Foundation Trust.

When the research team trialled the VIRTUHeartTM technology with doctors treating heart attack patients, they found that using it would have changed the treatment of more than 20 per cent of patients. In many cases, it would have led to fewer patients undergoing an invasive procedure such as having a stent fitted.

By giving doctors a clearer picture of a patient’s arteries, the research funded by the British Heart Foundation, showed that VIRTUHeartTM could help more heart patients to get the right treatment for them, free up doctors’ time and better meet demand on heart care services.

The researchers are currently investigating the impact this technology could have if it was used widely in the NHS, including the effect it might have on waiting lists. They hope that it could be in use in as little as three years.

Dr Hazel Arfah Haley, Interventional Cardiologist at Sheffield Teaching Hospitals NHS Foundation Trust, led the study. The research was presented at the British Cardiovascular Society in Manchester.

She said: “By giving doctors a better understanding of what is happening inside their patient’s blood vessels, we’ve shown that this technology has the potential to help improve how we assess and treat heart disease, ensuring patients have the treatment that best meets their needs.

“Our team are also investigating whether VIRTUHeartTM could improve treatment for people with another common heart condition called angina, helping to make sure that even more patients get the treatment they need first time around.”

There are up to 250,000 coronary angiograms performed in the UK every year1 - a test which allows doctors to look inside a patient’s coronary arteries (which supply the heart muscle with blood) and check for blockages. This is one of the first tests that patients admitted to hospital with a heart attack will undergo and helps doctors plan treatment to restore blood supply to the heart muscle.

But angiograms can be hard to interpret when an artery is only partly blocked, and this can make it challenging for treatment decisions to be made, particularly when doctors are managing patients with complex heart disease.

The innovative technology, developed by researchers at the University of Sheffield, re-creates another invasive but underused test called a Fractional Flow Reserve (FFR) in which doctors insert a special wire into arteries to calculate how well blood is flowing. FFR is underused for several reasons including time pressure, availability, complex anatomy, and operator’s familiarity.

Using only the images from a patient’s angiogram, VIRTUHeartTM works as a “virtual FFR” and creates computer models of their blood vessels, allowing doctors to calculate blood flow and find out more about the extent of blockages.

Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation, said: “There are around 100,000 hospital admissions each year due to heart attacks, mostly caused by the coronary arteries becoming narrowed and blocked by a build-up of fatty plaques.

“Technologies like VIRTUHeartTM show real promise to improve treatment as well as reducing unnecessary interventions, expense and complications and freeing up clinicians’ time to treat other patients.”

The study involved 208 patients who were admitted to hospital with an NSTEMI – a type of heart attack where the affected coronary artery isn’t completely blocked. All of the patients had their coronary arteries reconstructed using VIRTUHeartTM.After the patients had been treated, the researchers revealed the virtual blood vessel models to their doctors. They found that using the technology would have changed how doctors treated 46 patients (22 per cent). Of these, 21 patients who had an invasive procedure such as a stent would have instead been treated with medication only if the technology had been used to plan their treatment.

Overall, using VIRTUHeartTM to plan treatment would have led to 42 fewer stents being fitted – a decrease of 18 per cent.

The VIRTUHeartTM system was developed by the Mathematical Modelling in Medicine research group in the department of Infection, Immunity and Cardiovascular Disease at the University of Sheffield, in partnership with the Insigneo Institute and Sheffield Teaching Hospitals NHS Foundation Trust.