ACTA Project Grant
The Pulmonary Vascular / Right Ventricular Response to Lung Resection
Dr Ben Shelley
Each year over 5000 patients undergo lung cancer surgery in the UK. Recent trends and current guidelines suggest this figure is set to increase. It is now believed that this type of surgery affects the right-hand side of the heart (right heart). By using state of the art technologies (never previously applied to this group of patients) to examine right heart function we plan to improve understanding of these effects which in turn may lead to improved patient outcomes.
Background
Lung cancer is the second most common cancer in the UK. In suitable cases the best chance of a cure is from surgery to remove it. Patients with lung cancer often have other heart and lung diseases which increases the risks of anaesthesia and major surgery. Consequently, complication rates after lung surgery are high and have been consistently shown to increase symptoms, lengthen hospital stay and lead to increased healthcare costs. On an individual level, in some patients complications are associated with disabling shortness of breath and a poorer quality of life: 10% of patients undergoing lung surgery report being so breathless afterwards that they cannot leave their house.
The right heart pumps blood from the rest of the body to the lungs. It is believed that after lung surgery the right heart comes under significantly increased strain and that this increased strain is linked with increased complications. To date, studies of right heart function following lung surgery have been hampered by the limitations of the techniques used, in many cases leading to conflicting results.
Magnetic resonance imaging (MRI) has become increasingly available as a diagnostic technique for heart imaging; sophisticated technology facilitates high-quality cross sectional images of the heart. Cardiac MRI (CMR) is non-invasive, involves no radiation and has become the benchmark technique for assessment of right heart function. There are no previous reports of CMR assessment of patients undergoing lung surgery.
Aims
To use CMR images taken before and after lung surgery to examine the effect such surgery has on right heart function. In addition by using information derived from state of the art CMR and echocardiography (ultrasound scans of the heart) techniques we will provide increased understanding of the mechanisms of right heart failure in this context. Specifically we will be able to differentiate between primary right heart failure, global (left and right)
heart failure or the effects of changes to blood vessels within the lungs. To provide further information, blood markers of heart and blood vessel dysfunction and inflammation will be measured. The impact of right heart strain on post-operative function will be examined using questionnaires and quality of life scoring in addition to simple exercise testing (distance walked in six minutes).
Expected outcome
We anticipate that a better understanding of what happens to the right heart after lung surgery will lead to future studies implementing targeted therapies aiming to reduce right heart strain and ultimately reduce complications. This would lead to improved patient recovery, reducing symptoms and ameliorating disabling shortness of breath.
