Jan. 3, 2020

Cardiology trainee takes top spot in national research competition

Research project looks at ways to predict which heart failure patients are at risk of kidney problems

Dr. Cvetan Trpkov, MD, a sixth-year cardiology resident at the Cumming School of Medicine, is passionate about finding practical solutions to improve outcomes for patients. That hard work and dedication is paying off.

Trpkov recently placed first in the CCTN/CHFS Research Competition at the 2019 Canadian Cardiovascular Congress, held in Montreal in October. He was one of four finalists who presented their research projects — all related to heart failure — at the conference, the biggest cardiovascular meeting in Canada.

Trpkov’s research focuses on using ultrasound technology to identify heart failure patients at risk of developing kidney failure. Congestive heart failure patients often develop cardiorenal syndrome, a condition with symptoms like extreme fatigue and difficulty breathing that is a challenge to diagnose and treat.

The hallmark of heart failure is fluid retention, or congestion, caused by the heart’s inability to pump blood around the body efficiently. The congestion puts pressure on other organs in the body and is treated with diuretics, which force the kidneys to work harder to flush the excess fluid from the body in the form of urine.

The increased demand on the kidneys, which receive 20 per cent of the total volume of blood output from the heart, may cause the organs to fail — causing even more complications for the already ill patients.

For his study, Trpkov performed an ultrasound looking at the kidneys of patients already in the hospital with heart failure or heart attacks. He then looked at how blood flow in these patients differed from normal outflow patterns and discovered definitive patterns.

“All of the heart failure patients had abnormal blood flow in their kidneys,” says Trpkov, explaining conversely, the heart attack patients exhibited normal blood flow.

Eighty per cent of the heart failure patients developed acute kidney injury.

Although the test group size was limited, Trpkov says the study shows promise for using ultrasound to predict patients at risk of developing acute cardiorenal syndrome. It may also be a useful tool for treating and diagnosing patients.

Heart failure is an important topic, as it costs about $2.8 billion per year to care for the approximately 600,000 Canadians living with the condition. Trpkov is hopeful his research will help doctors make more informed decisions when treating patients with heart failure.

He explains advances in ultrasound have made the technology far cheaper and accessible. He predicts all physicians — not just radiologists and technicians — will use the technology in the clinic on a regular basis in the future. He intends to make ultrasound a big part of his practice. In fact, Trpkov is starting specialized training in echocardiography (ultrasound imaging) in 2020.

For now, he is grateful for his mentors, Drs. Nowell Fine, MD, Andrew Grant, MD, and Sandeep Aggarwal, MD.

“If you have an idea they will support it and let you run with it,” he says.

His supervisors are proud of Trpkov’s accomplishments.

“Trpkov has shown outstanding initiative and drive working on this research project,” says Fine, his research mentor. "He conceptualized, designed and implemented this study from the beginning and has required minimal if any supervision from his mentors, demonstrating clinical research skills well beyond his experience. We are very proud of him for winning this award and his work on this excellent project.”

The Libin Cardiovascular Institute is dedicated to improving patient care and outcomes through a patient-centred model. It supports innovative research that seeks to solve the real problems patients face.