Interview with A/Prof Kavitha Muthiah
Improving Lives for Patients with End-Stage Heart Disease
27 May 2021
It is seeing patients who are at death’s door that drives Associate Professor Kavitha Muthiah’s research into heart failure. The St Vincent’s Hospital cardiologist is determined to improve the lives of people who are being kept alive through artificial heart pumps.
Being appointed a new Clinical Faculty member at Victor Chang Cardiac Research Institute will allow A/Prof Muthiah to drive new research into the devastating side-effects that can plague patients who are supported with mechanical heart pumps, waiting for a heart transplant.
We are delighted to have you on board at the Institute. Can you tell us more about your research and what you plan to undertake here in our laboratories?
My research has focused on patients with end-stage heart failure who have reached a level where medications alone are not enough to help them and are implanted with a mechanical heart pump, which is known as the left ventricular assist device.
This device can generate up to 10 litres of blood flow and is capable of supporting the human heart and essentially taking over what the heart does in terms of cardiac function and support - until the patient receives a heart transplant.
What I have been trying to understand is how the body changes when this life-saving pump is implanted. One of the things I am studying is how the pump affects angiogenesis, (or blood vessel formation) that impacts on some of the adverse events that occur when patients are supported with the heart pump. My research will focus on how we can mitigate these adverse events.
What drove you into heart research?
In 2010, as part of my training to be a cardiologist, I did a whole year of advanced heart failure and transplant, and I fell in love with the sub-specialty. Not only the science, but I love looking after these patients. They are often knocking on death's door before they get the pump implanted, and it is such a rewarding experience to see them on the other side. I am passionate about advanced heart failure and transplant, because you can make a huge difference, saving lives with this technology, and with transplant.
Whilst you are a new clinical faculty member, it seems you have a long history with the Institute.
I've been involved ever since I did my PhD in 2011 at the Institute. Part of my thesis focused on microRNA regulation. I compared human heart tissue samples before and after they had been implanted with a left ventricular assist device.
I later undertook my postdoctoral research work at the Institute as well, in collaboration with some of the departments there.
I was fortunate to work closely with Dr David Humphreys who guided me through the basics of benchwork, even how to use a pipette. I'm from a clinical background, so going into a lab setting and trying to do RNA extraction was a big learning curve. David was incredibly helpful as I got my research career started.
My clinical and research mentors Professor Christopher Hayward, Professor Peter Macdonald and Professor Anne Keogh of course have been my inspirational guides; through thick and thin. Recently, Professor Jamie Vandenberg has been exceptionally helpful in drafting grant applications.
All of my work involves patients, so I will recruit patients from the hospital and some of the studies will be performed at the Institute in collaboration – others involved include Dr Renjing Liu and Professor Jason Kovacic. I’m excited and feel privileged to be able to continue to work in this world-class centre of excellence.
After your PhD you travelled the world, gaining experience at many prestigious hospitals and institutions by securing a number of fellowships. What was that like?
I became a qualified cardiologist in 2012 during my PhD. Then I went to the UK and I undertook several fellowships; King's College Hospital, London in Advanced Echocardiography and St. Bartholomew's Hospital in Adult Congenital Heart Disease, London - the biggest cardiothoracic centre in Europe now.
Additionally, I spent some time at Papworth in Cambridge in Advanced Heart Failure and Transplant and four weeks in Chicago at the Advocate Christ Medical Center before returning to Australia. I undertook my final fellowship as an Advanced Heart Failure and Transplant Fellow at the Alfred Hospital in Melbourne in 2016. It was a great experience to work in different centres of excellence abroad. and locally. It broadens your horizons and importantly, you build your research and clinical network.
Medicine has many unique scenarios, where the best path isn’t always immediately clear – having connected colleagues all over the world mean you can reach out and make decisions based on many years of combined experience that would never be possible alone.
You’ve mentioned that many of your patients experience very complex and tricky side-effects. What side-effect in particular are you going to focus on?
In the past, we've profiled the blood system and found there are certain blood components that change with the pump being in, and the change may contribute to increased bleeding.
I want to understand how the pump affects larger blood vessels, such as the aorta, with its continuous flow. Does it make the aorta stiffer, or does it cause reverse remodelling within the aorta and other blood vessels, like blood vessels in the eyes? Do these changes affect stroke risk?
I hope that the answer to these questions will lead to a precision medicine approach in these patients to avoid bleeding problems. For example, if you have a scenario where you have a high risk of bleeding, you may say, "Look, we don't need as much blood thinning medication in this particular patient," or “We should adjust the blood pressure tablets to aim for a lower blood pressure in this other patient.”
Acknowledgement of Country
The Victor Chang Cardiac Research Institute acknowledges Traditional Owners of Country throughout Australia and recognises the continuing connection to lands, waters and communities. We pay our respect to Aboriginal and Torres Strait Islander cultures; and to Elders past and present.
