| Project 1: Role of echocardiography in understanding the relationship between aortic valve diseases and ascending aorta dilatation. From genetics to biomechanics. (Project Score: 3.91/5) |
| The main objective of this project is to evaluate the relationship between ascending aorta dilation and alterations in aortic valve. There is a large body of evidence already published in the field that applicant do not cite. The study is not a novelty and even if it sounds clearly feasible, its originality suffers from its weakness. |
| Project 2: Non-Invasive measurement of systolic intraventricular pressure difference to assess acute effects of cardiac resynchronization therapy on left ventricular function: implications for patient selection and device optimization. (Project Score: 3.50/5) |
| This scientific project aims to evaluate a new echocardiographic parameter of myocardial contractility, the peak systolic ejection intraventricular pressure difference (IVPDe) between left ventricular apex and outflow tract. This new parameter has been previously correlated to invasive intraventricular pressure measurements in animals and 20 patients with dilated cardiomyopathy (Yotti R,, JACC 2004) and correlated to invasive assessment of myocardial contractility in an animal model (Yotti R, Circulation 2005). Three objectives are defined by the applicant: to establish reference values of IVPDe, the effect on left bundle branch on this parameter and the role of this parameter in order to select and optimize CRT devices. The project is well presented, although not very innovative. The study population is rather low for a 12-month programme. The objectives of this study are many (4 objectives are actually identified) in the face of a small number of subjects for each group It is actually a proof of concept but the validation of the parameter expressing myocardial contractility in the clinical setting is not clear. Indeed, this parameter has been validated as comparator to invasive intraventricular pressure measurements in a small population of 20 patients but the validation as a parameter of contractility was only performed in 9 pigs in a previous study (Yotti R, Circulation 2005). Therefore, a first step might be to evaluate the accuracy of this parameter as a new parameter of myocardial contractility in the clinical setting. Unfortunately, this step is not discussed in the project. |
| Project 3: Accuracy, reproducibility and discriminative power of rotational deformation parameters derived from 2D and 3D echocardiography. (Project Score: 2.94/5) |
| The project aims to determine accuracy of 3D speckle tracking to assess rotational deformation parameters. The main strength of the project is related to the expertise of the host institution. However, the project is not well detailed: it lacks objectives and study hypothesis and the clinical implications are not mentioned. References related to the research are not cited. The project is mostly methodological, the proposed study population is small and not very suitable for a 12-month programme. |
| Project 4: Cardiovascular mechanics in children with chronic kidney disease. (Project Score: 3.66/5) |
| This project aims to assess left ventricular function in children with chronic kidney disease. More precisely, left ventricular mechanics as assessed by speckle tracking, tissue Doppler, torsion and 3D will be studied in a population of at least 80 children with CKD and compared to age and BMI-matched children. In addition, correlation with biomarkers (BNP and hsCRP) and the relation of those abnormalities with arterial stiffness will be studied in this population. The project is interesting and well presented, although similar studies already exist. The candidate and the host Institution seem very suitable for the project. |
| Project 5 - selected: Severe aortic stenosis with low gradient despite normal ejection fraction: assessment of myocardial function and ventricular-arterial coupling. (Project Score: 4.22/5) |
| This project is focused on the physiopathology of paradoxical low-flow low-gradient AS and the possible intervention of myocardial dysfunction in addition with ventricular-arterial uncoupling in this pathology. In addition, response to exercise and evolution of myocardial function during a 2 years follow-up will be studied. The study will deal with a hot topic. However, the prevalence of low flow is rather low. Among 70 patients with severe AS we will have only 5 to 7 patients with low flow which makes difficult to provide enough inside into the physiopathology of low flow AS. This means that more patients should be examined and screened. |
| Project 6 : A novel energy conservation-based approach to non-invasive assessment of cardiac mechanical efficiecy in valve disease. (Project Score: 3.75/5) |
| The project aims to assess the feasibility of measuring energy loss associated with aortic stenosis and mitral regurgitation. The second aim is to expand the evaluation of energy loss in patients with more than 1 valve lesion. This study would be an echo sub-study of a translational research programme. The project is very interesting, although not very clear in some of its sections. One of its strength is the translational (bench-to-bedside) approach. However, a concern is that part of the project has already received a consistent grant from the Welsh Government. |
| Project 7 : Can 3D measures of left ventricular dyssynchrony predict which patients benefit from CRT optimization? (Project Score: 3.75/5) |
| The primary aim of the project is to evaluate the efficacy of 3D measures of LV function after CRT in order to predict which patients will require CRT optimization. It is a relevant and interesting clinical issue. However, no data on the number of patients who will be included in the study is given – only a statement that the authors plan to start recruitment in January 2012 and to have final results by December 2012. It’s difficult to assess potential scientific impact of this study without knowing the size of the study group. Moreover the protocol should be expanded. Suppose that 3D echo assessment of LV synchrony does not show any acute benefit resulting from Doppler-based CRT optimization – does it prove that the optimization was not beneficial? In such case it’s one technique against the other. This study would, then, require long-term clinical follow-up to substantiate the conclusions whether 3D echo can predict which patients benefit from CRT optimization. |
| Project 8 : Usefulness of real-time three dimensional echocardiography for percutaneous left atrial appenfage closure by Amplatzer Cardiac Plug (Project Score: 2.31/5) |
| The project is interesting, although rather poorly presented. - The project is too shortly exposed (1 page). The methodology, feasibility, ethic consideration, clinical implications are missing. |
| Project 9: Strain of mitral valve papillary muscles in ischemic mitral valve disease: prediction of mitral regurgitation post-revascularization: study with echocardiography and cardiac magnetic resonance. (Project Score: 4.03/5) |
| The project aims to evaluate whether strain on papillary muscles measurement is able to predict mitral regurgitation post revascularization. Strengths of the project: Expert host institution and calculation of sample size. The hypothesis of the study makes sense and the methodology is appropriately built. However, the feasibility of the study could be limited by the number of patients who need to be screened. |
| Project 10 : The diagnostic accuracy and feasibility of the latest 3D stress echocardiography technology in patients with suspected coronary artery disease (Project Score: 3.53/5) |
| This project aims to investigate whether the newest 3D echo techniques are feasible and improve diagnostic accuracy of dipyridamole stress echocardiography. The project is interesting and well presented and the clinical impact is straightforward. Patients will be referred for coronary angiography (“gold standard” in this study) based on positive stress echocardiography (presumably standard 2D stress echocardiography) – this is likely to cause a bias and influence the results. The candidate seems very promising, especially considering his young age. |
| Project 11 - selected : Dobutamine stress echocardiography to investigate apical rocking as surrogate of dynamic left ventricular dyssynchrony in ischemia and patients with dilated cardiomyopathy (Project Score: 4.22/5) |
| This project will be based on apical rocking, a parameter integrating information on regional and temporal function inhomogeneities of the left ventricle reported in a previous publication of the host institution (Voigt JU, Eur Heart J 2009). The main aim will be to determine whether a low-dose dobutamine challenge improves the predictive value of this parameter as a measure of LV dyssynchrony. The study is obviously interesting but the main issue relates to the recruitment of patients. This could limit the feasibility. |