Committed to improving patient outcomes through the advancement of scientific knowledge, the NHCS has continually made remarkable strides in cardiovascular research, leading to significant advancements in the prevention, diagnosis and management of heart diseases.

With the prevalence of heart disease continuing to rise locally and globally, due to factors such as the ageing population and an increase in incidence of risk factors including hypertension, obesity and diabetes, there needs to be a greater emphasis on preventing and treating heart diseases.

Established on 5 September 2014, the National Heart Research Institute of Singapore (NHRIS) at NHCS has established itself as a premier institution for cardiovascular research in the region, with several research achievements with the potential to improve patients’ outcomes since its launch.

Breakthroughs in Research

The research at NHRIS spans a wide range of disciplines within cardiovascular medicine, encompassing both basic, translational and clinical research. Some recent major achievements include:

▸ Discovery of new treatments for heart disease by studying patient’s heart stem cells

Heart stem cells can be made from patients with heart disease and studied in a dish to better understand the patient’s heart disease and discover new treatments for that patient’s heart condition. This approach has been used in patients with a heart condition called hypertrophic cardiomyopathy (an inherited heart condition characterised by thickening of the heart muscle) and a new treatment using myeloperoxidase has been discovered, which has the potential to improve heart function and symptoms in patients with this heart condition¹.

▸ A new treatment for preventing fibrosis of heart and other organs

By studying heart tissue from patients undergoing heart surgery, a new interleukin-11 antibody treatment has been discovered for preventing inflammation and fibrosis in the heart and other organs, opening up opportunities for further new treatments for patients with heart, lung, liver diseases, conditions which are characterised by inflammation and fibrosis². This innovative new treatment is currently being tested in humans and has the potential to improve health outcomes in patients with these different conditions.

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"By embracing multidisciplinary approaches, harnessing new technologies, and engaging with our strong network of partners, we aim to accelerate progress of transformative cardiovascular research for our patients' benefits," said Prof Derek Hausenloy, Director of NHRIS, "We envision a future where every heartbeat matters, where cardiovascular diseases are better understood and effectively treated or prevented."

Research Efforts in the Next Ten Years

NHCS has been actively involved in leading and contributing in several ground-breaking clinical trials, evaluating new treatments and interventions for various cardiovascular conditions. Over the next five to ten years, the research efforts for improved health outcomes in patients with heart disease will focus on three main areas: (1) Discovery of new treatments for heart disease to improve patients' outcomes; (2) Harnessing cutting-edge technologies such as artificial intelligence, heart imaging and digital technology to better diagnose and manage heart diseases; (3) Clinical trials and population health studies to prevent the onset of heart disease.

With the advent of new technologies, new frontiers of research are being increasingly explored at NHRIS, including:

▸ Visualising energy pathways inside the heart in patients with heart disease

Disturbances in energy producing pathways in heart muscle contribute to many heart conditions such as heart attacks, heart failure and diabetic heart disease. Understanding the metabolic pathways underlying these disturbances may provide new treatments to improve health outcomes in patient with heart disease. In this regard, there is currently a new novel imaging technology being investigated at NHRIS, called hyperpolarised magnetic resonance spectroscopy which allows the measurement of these metabolic pathways in the heart muscle of patients with heart disease. This technology is the only one available in Asia for studying heart disease, with only five other centres worldwide with this capability.

▸ Application of artificial intelligence to predict, diagnose and monitor heart disease

The advent of artificial intelligence (AI) has gained a strong foothold in healthcare, with various AI initiatives to augment clinical services and automate work processes for improved patient care at NHCS. NHCS researchers have demonstrated the potential of AI to enhance detect, predict and diagnose heart disease, by capturing and making sense of complex imaging information and data with greater precision and efficiency.

The use of AI provides clinicians with unprecedented insights into patients’ conditions, to allow for personalised care and early medical intervention, thus this could delay onset of illnesses and prevent adverse health outcomes.

APOLLO, which stands for AI-driven national Platform for CT cOronary angiography for clinicaL and industriaL applicatiOns, is an ongoing study since 2021 to build a national system comprising several modules that will perform different AI analyses on computed tomography coronary angiography images, and provide detailed AI-generated reports on patients’ conditions and their risk of developing cardiovascular disease in the future.

 

Improving Heart Research Efforts

NHRIS’ ground-breaking research initiatives have led to significant advancements in AI, discovery of new treatments, heart imaging and more. The notable achievements of NHCS in AI applications, clinical trials and collaborative research efforts highlight its dedication to improving patient care and shaping the future of cardiovascular medicine.

The research efforts at NHRIS will synergise nationwide with other heart research institutes and hospitals through CADENCE (Cardiovascular Disease National Collaborative Enterprise), a new national platform for bringing together heart research capabilities across Singapore in 3 major areas: data science, clinical trials, and AI or digital heart.

As NHCS continues its pursuit of research excellence, it is poised to make progress in preventing, diagnosing, and managing cardiovascular diseases, ultimately benefiting patients beyond Singapore, impacting individuals around the region and world.

This article is from Murmurs Issue 45. Click here to read other articles or issues.

References

1. Ramachandra CJA, Kp MMJ, Hausenloy DJ, et al. Inhibiting cardiac myeloperoxidase alleviates the relaxation defect in hypertrophic cardiomyocytes. Cardiovasc Res. 2022 Jan 29;118(2):517-530. doi: 10.1093/cvr/cvab077. Erratum in: Cardiovasc Res. 2022 Mar 25;118(5):1375. PMID: 33705529; PMCID: PMC8803077.
2. Schafer S, Cook SA, et al. IL-11 is a crucial determinant of cardiovascular fibrosis. Nature. 2017 Dec 7;552(7683):110-115. doi: 10.1038/nature24676. Epub 2017 Nov 13. PMID: 29160304; PMCID: PMC5807082.