Future-proofing the human heart

A HUNDRED years ago, if one were to bet between Man landing on the moon or being able to successfully treat heart disease in the coming era, most would have backed our ability to treat the heart: Jules Verne's 1865 fantasy of "sending man to the moon in a projectile" would have remained just that.

Things turned out somewhat differently. When Neil Armstrong took his "one small step for man" in 1969, the discipline of coronary angioplasty was almost a decade away, implantable cardiac defibrillators would take about 15 more years to be approved, the first permanent artificial heart would be used only in 1982 and mechanical heart valves for babies wouldn't be available for almost 50 years. We walked on the moon but were many miles away from effectively tackling heart disease.

While dealing with an ever-pulsating four-chambered pump isn't the same as flying through (roughly) 375,000 kilometres of cold, unforgiving space, finding ways to treat complications of the human heart is perhaps the medical equivalent of the moon landing - complex, highly technical and fraught with the risk of failure.

It's complicated

A human heart beats about 3 billion times over an average lifetime, and every heartbeat generates enough force to pump blood through thousands of metres of blood vessels. A tiny flutter in the beat pattern, a small clot in the heart's blood vessels, a little hole in the heart's chambers or a leaky valve could prove disastrous. Heart disease remains the No 1 killer worldwide: every year, 17.9 million deaths - roughly three times the population of Singapore - are due to heart disease.

Surgical repair of the heart is like tinkering with the engine of a plane at 30,000 feet. Decades of research led to the development of the heart-lung machine in the 1950s. This device takes over the function of the heart, giving surgeons a window to operate successfully. Arguably, it was the heart-lung machine that had a significant part to play in expansion of the cardiac medical devices industry: some estimates suggest that the heart devices market is expected to almost touch US$70 billion, by 2026.

Through the 1970s and onwards, modern technology has made heart treatment safer, more predictable and with better outcomes. Like the Apollo missions, technology from many different areas has come to the rescue. The human heart is perhaps the only organ where diverse technology - used in bullet trains, Bluetooth and Artificial Intelligence - is playing a huge role in improving our odds of survival.

Bullet train tech keeps hearts pumping

The global burden of heart failure is heavy - a 2018 study estimates it at US$108 billion, in direct and indirect costs. Heart transplants offer a choice when conventional therapies no longer work. Unfortunately, waiting lists for human hearts are long - for instance, public records show that Singapore has performed over 60 heart transplants since 1990.

In some cases where a heart is available, a transplant may not be a suitable option. Left Ventricular Assist Devices (LVADs) have become a viable option for mana ging heart failure, taking over the function of pumping blood out from a weakened heart. However, in early pumps, friction between moving parts could cause damage to blood cells or lead to blood-clotting.

Looking to overcome these challenges with early heart pumps, researchers drove innovation into the heart pump. Today, magnetic levitation technology, once associated with bullet trains, solves the problem by reducing pump friction. It reduces trauma to blood cells by reimagining blood flow through the pump.

Long-term clinical trial data with Abbott's HeartMate 3 LVAD, with Fully Maglev TM Flow technology, highlights an unprecedented survival rate, low rates of suspected pump thrombosis (rupture of cells) and the lowest-ever published stroke rate for the category of LVADs. A technology popularly associated with trains is giving hope to those that cannot access a new heart.

Heart monitors that talk to smartphones

Bluetooth is a technology synonymous with the "hands-free" headsets; in recent years, it has made inroads into healthcare. About two years ago, researchers leveraged Bluetooth technology to reimagine heart monitoring and created Confirm Rx, the world's first smartphone-enabled insertable cardiac monitor.

Implanted just under the skin in a minimally invasive outpatient procedure, this Bluetooth-powered device helps physicians remotely identify abnormal heart rhythms, which develop when disease or injury disrupts the heart's electrical signals, causing the heart to beat erratically.

The smartphone's interface enables physicians to better monitor their patients' heart rhythms from afar. Through a smartphone app, patients can even annotate their symptoms for the physician's review.

Artificial Intelligence helps determine heart attacks

AI is the newest tool lending itself to the cause of the human heart. A recent study in the journal Circulation showcases an algorithm, called the MI3 (Myocardial Infarction Ischemic Index) created by AI technology, that can help Emergency Department doctors better determine which patients are having a heart attack.

Trained and evaluated across 11,000 patients globally, statisticians used AI technology to develop an algorithm that looks at the personal factors most predictive to someone having a heart attack, so patients can receive treatment faster or be safely discharged earlier.

This is among the first effective demonstrations of how machine learning could be used to help doctors make clinical decisions on whether their patients are having a heart attack or not.

A hundred years ago, doctors were reluctant to touch the heart as it was considered risky. We've come a long way since - research is breaking new ground across genetics, robotics and predictive diagnostics. In this age of convergence of the physical, biological and digital worlds, the heart may well be the catalyst of the Fifth Industrial Revolution - where humans and devices combine in concert, creating a sum much greater than its parts.

As explorers of the human heart, there's much to discover. And lots more to do.