​Cardiac Function (Noninvasive Assessment)


About the group

The idea for this development came from Dr. Vellani’s observation of changes in the QRS waveform with ST depression occurred together during exercise tolerance test in patients with single vessel stenosis. Measurements of the voltages and directions of averaged 30-80 QRS waveforms at each stage of exercise formed the basis of the analysis of electrical vectors for detection of ischemia. 

Software was developed at AKU to analyse orthogonal ECG signals with minimal noise, to provide an averaged lead signal representative of each stage of exercise.  Orthogonal planar vectors derived from these signals enabled measurement of changes in magnitude and direction of the resultant vectors. The method of data acquisition during exercise and analysis of electrical vectors has been patented in the USA and Pakistan. 

Reduction in progression of the voltages of depolarization vectors indicated the region of ischemia and its spatial orientation. Compared with myocardial perfusion scan the sensitivity and specificity of detection of ischemia by changes in vectors in 114 patients were 88% and 71%, respectively. 

Correlation with coronary angiography will establish the accuracy and limitations of the method. Trial of the exercise test for ischemia in service will be done with high resolution data acquisition equipment currently under construction. ​​

Aims and Objectives

  • To develop a system for recording high-resolution ECG signals during exercise that contain minimal artefact without the use of filters, in order to identify changes in electrical vectors that indicate myocardial ischaemia, for use in a health service.
  • To determine the accuracy of electrical vectors for detection, location and severity of stenosis of coronary arteries shown by coronary angiography.
  • To determine the relation of physical work units with the detection of ischaemia and the extent of coronary stenosis.
  • To determine whether the absence of ischaemia indicated by electrical vectors during stress is associated with less than 50% stenosis of a coronary artery. 
  • To assess the value and feasibility of using the system for analysis of electrical vectors during exercise for clinical decisions. 

Research Themes

Reliable cost-effective, widely accessible exercise test for detection and location of inducible myocardial ischaemia.​​


Membership

​Cameruddin W. Vellani
Distinguished University Professor's Office, Department of Medicine, Medical College, AKU
The lead scientist; responsible for the original idea, conception and design of the study. He is the overall in charge and will oversee all aspects of the project
​
​Mohammad Yusuf
Department of Radiology, Medical College, AKU
Created the software for analyzing cardiac vectors and is responsible for technical developments
​
​Satwat Hashmi
Department of Biological and Biomedical Sciences, Medical College, AKU
Responsible for the investigation of the pathways that determine the sequence of ventricular depolarization, analysis of data and the physiological correlation with the conduction pathway leading to ventricular depolarization
​
​Zainab Samad
Professor & Chair
Department of Medicine, Medical College, AKU
​
​H.R. Ahmed
Department of Biological and Biomedical Sciences, Medical College, AKU
Responsible for investigation of the localization and patho-physiological mechanisms of the production of atheroma		​
​Mehwish Shehzad
Research Coordinator
Department of Medicine, Medical College, AKU
Responsible for coordination and management of data acquisition, validity of data and correlation of results with other tests for detection of myocardial ischaemia, and utilization of the exercise test in a health service.​

​
​Hira Mehtab
Research Associate, Biomedical engineer
Department of Medicine, Medical College, AKU
Responsible for operation and maintenance of newly constructed, custom-build high resolution bio-amplifiers and orthogonal bipolar lead system for recording electrocardiographic signals (ECG)
​
​Safia Awan
Department of Medicine, Medical College, AKU
Responsible for the statistical analysis of data		​
​Rafeh Ahmed
Manager 
HR Change and Transformation, AKUH
​
​Yawer Saeed
Assistant Professor, Clinical Cardiac Electrical Physiologist
Department of Medicine, Medical College, AKU
​
​Nasir Rehman
Assistant Professor, Interventional Cardiologist
Department of Medicine, Medical College, AKU
​
​Shagufta Nadeem
Manager
Department of Cardiopulmonary Diagnostics, AKUH
​
​Nasiruddin Ahmed 
Senior Medical Officer
Department of Cardiopulmonary Diagnostics, AKUH
​
​Saleem P​irani and Moeenuddin
Bio-medical Specialists
Department of Biomedical Engineering, AKUH
Responsible for providing biomedical expertise for the project
​
​Acknowledgement, with profound gratitude, of support and continued interest:

Saleem Sayani, Abdul Muqeet, H. Imtiaz Ahmed, Ahsan Nawaz and Bio-Medical engineers
Aga Khan Development Network Digital Health Resources Centre (AKDN dHRC)
Provision of finance, equipment, bio-medical engineering expertise and services for the project from 2018-2021.

​

Publications

  1. Vellani C, Yusuf M, Mahmud S, inventors; AGA KHAN UNIVERSITY, assignee. Vectorcardiographic Signal Analyzer. USA 9,226,674 B22016 
  2. Vellani C, Yusuf M, Mahmud S, inventors; AGA KHAN UNIVERSITY, assignee. Vectorcardiographic Signal Analyzer USA 9,560,981 B2 2017.
  3. Vellani C, Yusuf M, Mahmud S, inventors; Vectorcardiographic Signal Analyzer Pakistan Patent No.142638  November 2017.
  4. Vellani CW, Yusuf M, Mahmud S, Hashmi S. Ventricular depolarisation vectors in exercise induced myocardial ischaemia. Sci Rep. 2017;7(1):14649. Epub 2017/11/09.
  5. Vellani CW, Hashmi S, Mahmud S, Yusuf M, Awan S, Kazmi K. Changes in ventricular depolarisation vectors during exercise caused by regional myocardial ischaemia. Sci Rep. 2019;9(1):16365. Epub 2019/11/11.

Grants

  • Two grants awarded by University Research Council of AKU were approved, the first in 2004, the second in 2014
  • The work done after 2004 led to two patents (USA). Patent No: US 9, 226, 674 B2: January 5, 2016; US 9,560,981 B2: February 7, 2017 and subsequently registered in Pakistan
  • AKU has funded continuation of the project through Aga Khan Development Network Digital Health Resources Center (AKDN dHRC)
  • Department of Medicine
  • University Reserach Council (URC)

Projects / Studies

  • Trial of data acquisition equipment that is under construction locally, to be followed by trial of exercise test of the newly develop exercise test for inducible myocardial ischaemia, using a bicycle ergometer in clinical service at AKUH.
  • Exploration of producing low-cost ECG recorder locally.
  • Proposed, with equipment to be planned: non-invasive identification of slow conduction pathways causing tachyarrhythmias.
  • Investigation of the origin of atheroma due to inhaled chemical toxins, in collaboration with Department of Biological and Biomedical Sciences (BBS) led by Dr Satwat Hashmi

Engagement and Involvement: Public and private

AKUH and AKDN-dHRC for trial of the newly developed exercise test for assessment of its value and limitations for use in distributed health services.

Contact

​Professor Cameruddin W. Vellani
Group Lead
camer.vellani@aku.edu