Cardiovascular

CVD causes a quarter of all deaths in the UK, equating to one death every three minutes. Over 7.5 million people in the UK live with CVD. In our local community of 2.3 million in north west London, around 170,000 people have CVD and 280 die every month. Our research is driven by the high burden of CVD in our community and seeks to identify new treatments and technologies that will improve our patients’ quality of life and longevity.

Our theme focuses on three strategic aims that will ultimately transform the outlook for our local patients, as well as inform global practice:

• Use novel hospital and laboratory tools to enhance cardiovascular risk stratification
• Employ innovative point-of-care and remote monitoring tools to identify patients at risk and facilitate early medical intervention
• Identify and test new treatments.

Detailed Theme objectives can be found here.

To deliver our aims, we will use sophisticated artificial intelligence-based computational methods to integrate genetic and genomic analysis of DNA, blood and tissue biopsies with clinical diagnostic measurements collected from our patients. Our involvement in strategic NIHR partnerships including the NIHR-British Heart Foundation Cardiovascular Partnership and the NIHR-Health Informatics Collaborative will facilitate access to a wider range of clinical data to define and validate signatures of specific disease states. We will also leverage data from large Imperial-managed studies and clinical trials such as TRICODER, a cluster-randomised-controlled trial in 300 GP practices evaluating a point-of-care diagnostic for heart failure; LOLIPOP, which collects health records from 30,000 people living in west London since 2002;  AIRWAVE, an epidemiological study of British police officers and staff with more than 50,000 participants; and our ORBITA series of clinical trials that assess how interventional procedures and smart devices may benefit cardiovascular outcomes.

Below are some of the conditions we study:

• Atherosclerosis and coronary artery disease: Atherosclerosis is the buildup of fat in the arteries that supply blood to the heart. Over time, these fatty deposits (known as plaque) result in narrowed or blocked arteries and may cause serious complications, such as coronary artery disease and heart attacks.
• Heart attack and heart failure: Our team’s expertise spans both acute conditions such as heart attacks, as well as chronic conditions that affect the blood vessels of the heart and the heart’s tissue such as coronary artery disease, pulmonary hypertension and cardiomyopathies, a general term for diseases of the heart muscle.
• Haematological and immune-mediated disorders: Haematological diseases such as von Willebrand disease and immune-mediated disorders including autoimmune disease and long–COVID, are associated with vascular complications. Our team seeks to better characterise the biological processes that cause these complications in our patients to provide better healthcare for complex multiple long-term conditions (multi-morbidity).

Fellowships

• Beyond Scar: targeting of heterogeneous ion channel and gap-junction abnormalities as an ablation strategy Rasheda Chowdhury

Co-funded with the Imperial BHF CRE

• The All of Us dataset at the Broad Institute of MIT and Harvard: The rate of positive reports in carrier screening and rare variants of takotsubo cardiomyopathy Kathryn McGurk
• Investigating the use of personal remote monitoring data to monitor risk of clinical worsening and clinical course of patients with pulmonary hypertension Niamh Errington
• Linking molecular changes to whole organ function in diabetes mellitus patients Marina Strocchi
• Genomics of Cardiomyopathy Sean Zheng
• The role of IL-6 family cytokines in the pathophysiology of hypertrophic cardiomyopathy Mark Sweeney
• TRICORDER-PLUS Mihir Kelshiker
• Advancing the definition, diagnosis, and treatment of angina Michael Foley

Co-funded with the MLTC Theme

• The gut-kidney-heart axis as a driver of cardiovascular disease progression Petros Andrikopoulos
• Microbial catecholamine metabolism in human metabolic and cardiovascular health Kanta Chechi

A Smarter Way to Diagnose Obstructive Sleep Apnoea: A Wearable Sensor Replacing a Two-Year Wait

What is this project about?

Obstructive sleep apnoea (OSA) is a common condition where breathing repeatedly stops during sleep, significantly increasing the risk of heart failure, stroke, and lung disease. In the NHS, patients currently wait up to two years for a diagnostic test that costs £450, takes over an hour to interpret, involves uncomfortable cables and wires, and requires multiple hospital visits. This project tested a completely new approach — using the AcuPebble, a small wearable sensor developed at Imperial College, which patients apply themselves at home and which automatically analyses results — creating a faster, cheaper, and more comfortable “straight-to-test” diagnostic pathway.

Why does it matter?

Current OSA testing is not only slow and expensive but also inequitable — uptake is lowest among socio-demographically disadvantaged groups, and existing technology has known racial biases. By making testing self-administered, remote, and automated, this new pathway has the potential to reach patients who are currently being left behind. The study has now enrolled nearly 300 patients and demonstrated compelling results across five key areas: clinical outcomes, health economics, health equity, workforce efficiency, and environmental sustainability — strong enough to be shortlisted for the prestigious HSJ Awards “Modernising Diagnostics” category.

What are the outputs of the project?

The BRC pilot funding directly unlocked a further £73,329 from Imperial Health Charity to expand the implementation study, and the evidence generated has since been signed off as a ~£120,000 NHS business case to roll out the new pathway across North West London NHS Trusts from 2025 — a rare and direct example of pilot research translating into NHS standard-of-care. The project has been presented to the North-West London Integrated Care System’s clinical executive, with collaboration on health economic analysis to support sector-wide scale-up. Industry collaboration with Acurable Ltd. — an Imperial College spin-out — provides the AcuPebble technology underpinning the pathway. The project has also converged with Imperial BRC colleagues in Metabolic & Endocrine and Surgery & Cancer themes, led by Dr Boon-Lim, Dr Saira Hameed, and Mr Ahmed Ahmed, forming a multi-intervention programme for patients awaiting AF ablation.

How were patients and the public involved?

Patient involvement has been central and ongoing throughout the project. The Sleep Apnoea Trust Association (SATA) — the UK’s largest OSA patient charity — has provided independent patient representation, and a patient with lived experience of cardiorespiratory conditions, contributed directly to the study’s design and patient experience measures. Clinical interviews with patients on the AF ablation waiting list informed practical design decisions, such as removing the need to travel to hospital, to maximise equitable participation. Every patient participant provides qualitative feedback to inform ongoing improvements to the pathway, and as part of the HSJ Awards judging process, telephone interviews were conducted with over 100 patient participants to capture their experiences and suggestions.

Evaluating the Role of Sex Hormones in Hypertrophic Cardiomyopathy

What is this project about?

Hypertrophic cardiomyopathy (HCM) is a genetic heart condition where the heart muscle becomes abnormally thick, making it harder to pump blood effectively and increasing the risk of serious complications including heart failure and sudden cardiac death. Men and women experience HCM differently, with women tending to have more severe symptoms at the time of diagnosis, and hormonal differences between the sexes may help explain this. This project investigated how sex hormones — particularly oestrogen and testosterone — influence heart function and scarring in patients with HCM, using a combination of hormone measurements and advanced cardiac imaging.

Why does it matter?

Understanding why HCM affects men and women differently could open the door to more personalised treatments that take hormonal factors into account. The finding that lower oestrogen levels are associated with more severe disease — particularly in male patients — suggests that hormones may play a meaningful role in how HCM progresses. If confirmed in larger studies, this could lead to new treatment strategies that target hormonal pathways to reduce heart scarring and improve outcomes for patients.

What are the outputs of the project?

Key findings showed that lower oestrogen levels were associated with more severe ventricular hypertrophy and myocardial fibrosis (scarring), while testosterone levels were not associated with the extent of scarring — effects that were most pronounced in male patients. These findings provide the evidence base for larger external validation studies and have underpinned an ongoing academic collaboration between Dr Tayal and Prof Tricia Tan, theme lead for Metabolic & Endocrine, on sex hormone analysis. The project has contributed to a British Cardiovascular Society Consensus document on cardiovascular diagnosis and treatment among women.

How were patients and the public involved?

The team engaged directly with the BRC Community Partners group, presenting the project and seeking feedback on patient engagement strategy, dissemination approaches, and recruitment to the patient advisory group. Community Partners provided valuable input on questions including how to share study results accessibly, how frequently to hold engagement meetings, and how to connect with relevant patient networks. PERC was directly involved in supporting patient engagement activities throughout the project. This feedback shaped the team’s approach to involving patients in the next phase of the research.

Deep Molecular Phenotyping of New Onset Dilated Cardiomyopathy

What is this project about?

Dilated cardiomyopathy (DCM) is a serious heart condition where the heart becomes enlarged and struggles to pump blood effectively and is a leading cause of heart failure and the need for heart transplantation. While the genetic causes of DCM are increasingly understood, very little is known about what happens at the cellular level in the early stages of the disease — when new treatments are most likely to make a difference. This project applied cutting-edge molecular techniques, more commonly used in cancer research, to study the heart cells of patients with newly diagnosed DCM in unprecedented detail, with the aim of identifying which patients are most at risk and what treatments might work best for them.

Why does it matter?

Currently, doctors have limited tools to predict which DCM patients will recover with standard treatment and which will deteriorate and need more invasive interventions such as a defibrillator, mechanical heart support, or transplantation. By identifying molecular markers in heart tissue that predict recovery or resistance to treatment, this research could help doctors make earlier, better-informed decisions — potentially saving lives and avoiding unnecessary procedures. Studying the disease at its earliest stage, before irreversible damage occurs, is a critical and largely unexplored opportunity in heart disease research.

What are the outputs of the project?

Nineteen patients with newly diagnosed DCM were successfully recruited at the National Institute for Cardiovascular Disease in Bratislava, Slovakia, led by Dr Eva Goncalvesova, with comprehensive heart scans, blood tests, and heart tissue biopsies completed and six-month follow-up assessments carried out for nearly all patients. A formal Material Transfer Agreement was established between Imperial College London and the institute in Slovakia, enabling rare early-stage heart tissue samples — not available in the UK — to be shipped to the National Heart and Lung Institute for analysis. Whole genome sequencing has been completed for 15 patients, with the remainder underway, and single nuclei RNA sequencing libraries have been prepared and dispatched, with computational analysis imminent. A £15,000 British Heart Foundation ECR Pump Priming Award has been secured to extend the work into spatial transcriptomics for predicting treatment response in DCM. Two publications have been produced, including a paper in Nature Medicine and in The American Journal of Human Genetics.

How were patients and the public involved?

The research proposal was presented to and endorsed by a Patient Advisory Group at Royal Brompton Hospital, whose input helped refine the key clinical questions and study design. Patients with newly diagnosed DCM recruited through the REMIT-DCM study were consulted about the research, with 90% expressing enthusiasm to participate — many motivated by the fact that DCM is inherited and that improved treatments could benefit their children. Ongoing feedback from participating patients and their families continues to shape the study.

How Overactive White Blood Cells May Be Making Pulmonary Arterial Hypertension Worse

What is this project about?

Pulmonary arterial hypertension (PAH) is a rare, life-threatening condition where the blood vessels in the lungs narrow and are progressively destroyed, leading to right heart failure. If untreated, it is often fatal within three to five years. This project investigated the role of neutrophils — a type of white blood cell — in driving this damage. Using a specialised machine that measures how stiff or “squishy” cells are, the team discovered that neutrophils from PAH patients are significantly stiffer and more activated than those from healthy people, and that they become even stiffer as they travel through the diseased lung blood vessels. Stiffer neutrophils are more likely to get stuck in the narrow lung vessels, causing further damage and accelerating disease progression.

Why does it matter?

Current treatments for PAH manage symptoms but do not address the underlying disease process, and outcomes remain poor. The finding that neutrophils in PAH patients are abnormally stiff and overactive — and that this correlates with disease severity — points to a completely new mechanism that could be targeted therapeutically. If the team can identify ways to return PAH neutrophils to a healthy, less activated state, this could open the door to an entirely new class of disease-modifying treatments for a condition where options are desperately limited.

What are the outputs of the project?

The project identified a distinct biomechanical phenotype of neutrophil activation in PAH patients that correlates with clinical measures of disease severity — a novel and significant finding in the field. This pilot data has directly supported three further funding awards: a Rosetrees Trust Seedcorn Grant (£15,000) to study the impact of the local environment on neutrophil properties in PAH, an Association of Physicians of GB and Ireland Young Investigator Award (£19,960) to study neutrophil biomechanics in COPD, and a Wellcome Early-Career Award (£1,159,242) to investigate the impact of oxygen on neutrophil biomechanics in acute lung injury. Collaborative work with Prof Jochen Guck at the Max Planck Institute in Germany has optimised protocols for studying neutrophil trafficking in microfluidic chips mimicking blood vessels, leading to a joint MRC application for a new Real-Time Deformability Cytometer at Imperial. Prof Amer Rana is collaborating on real-time 4D modelling of vascular remodelling, and Prof Robert Stockley at the University of Birmingham is providing access to a novel elastase activity assay to measure neutrophil-secreted vessel-damaging proteins in PAH patient blood.

How were patients and the public involved?

Results were presented to Imperial Community Partners at the BRC Cardiovascular Community Meeting in March 2024, with discussion and feedback gathered following the talk. In October 2024, the team presented their work at the Imperial Pulmonary Hypertension Research Update for Patients event, organised and hosted by the research team and supported by Wendy Gin-Sing, Pulmonary Hypertension Nurse Consultant. The event attracted over 100 attendees via Zoom, with 75 participants completing a feedback survey — all agreeing the meeting was relevant and that they would attend again. Patient suggestions for improvements to the format were taken on board for future events.

Advancing Technology for Improved Atrial Fibrillation Treatment with the Tau20 System

What is this project about?

Atrial fibrillation (AF) is a common heart condition where the heart beats irregularly, increasing the risk of stroke and other serious complications. One of the main treatments is a procedure called ablation, where doctors use specialised equipment to target and treat the areas of the heart causing the irregular rhythm. However, current ablation procedures are not always successful, particularly in complex cases. This project developed and tested the Tau20 system — a new technology combining advanced hardware and software, including a novel tool called RETRO-Mapping — designed to help doctors more precisely identify the specific areas of the heart responsible for causing AF, making ablation safer and more effective.

Why does it matter?

AF affects millions of people worldwide and is a leading cause of stroke, heart failure, and hospitalisation. Improving the precision of ablation procedures could significantly increase their success rates, reduce the need for repeat procedures, and improve quality of life for patients — particularly those with persistent AF who are hardest to treat. By combining real-time electrical signal analysis with machine learning, the Tau20 system has the potential to transform how AF ablation is planned and delivered.

What are the outputs of the project?

The Tau20 system was successfully integrated into the Cardiac Catheter Laboratory at Imperial College Healthcare NHS Trust, with data collected from 15 AF patients currently being analysed to further refine the system. A user-friendly graphical interface for the RETRO-Mapping software was developed, and a new machine learning-enhanced version of the algorithm was created that significantly reduced the time needed to process heart electrical signals. Collaborations with Maddison Design and Donawa Life Science have been established to align the system with regulatory standards and support its transition from research to clinical use.

How were patients and the public involved?

Patients with AF who had undergone or were waiting for ablation were interviewed early in the project, with discussions focusing on their experiences, challenges, and perceptions of the technology. Their input directly shaped the design of patient-facing consent forms and information sheets, improving clarity and transparency around the experimental nature of the system. Throughout the project, patients reviewed the RETRO-Mapping software in patient involvement sessions, providing feedback that was incorporated into updates to the user interface to make it more intuitive for both patients and clinicians. Community Partner feedback was also incorporated into the study design, leading to greater attention to patient safety, comfort, and communication about the benefits of the system.

Editing Human Cells to Investigate the Genetic Causes of Lymphoedema

What is this project about?

Lymphoedema is a debilitating condition where excess fluid builds up in the body’s tissues, causing persistent swelling — most commonly in the arms and legs. Around 28,000 people in the UK are affected by primary lymphoedema, an inherited form of the condition, yet three quarters of cases currently lack a genetic diagnosis. This project investigated the role of a protein called ERG — which controls the activity of genes in the cells lining blood and lymphatic vessels — as a potential new genetic cause of primary lymphoedema. Using advanced gene editing techniques, the team created laboratory versions of the faulty ERG protein found in lymphoedema patients to study how it disrupts normal lymphatic vessel function.

Why does it matter?

Without a genetic diagnosis, patients with primary lymphoedema cannot access genetic counselling, targeted support, or emerging precision treatments. Identifying ERG as a causative gene would allow it to be added to the diagnostic screening panels used by clinicians, giving thousands of patients and families a diagnosis they currently cannot obtain. Beyond lymphoedema, a better understanding of how ERG controls lymphatic vessel function could also have broader relevance for managing fluid accumulation in other conditions such as heart failure.

What are the outputs of the project?

Initial experiments using gene-edited lymphatic endothelial cells provided functional evidence that the ERG variant p.Y388C causes cells to become dysfunctional what is consistent with loss of normal ERG function and directly supporting its role in lymphoedema pathogenesis. A key technical milestone was the successful generation of an immortalised lymphatic endothelial cell line, which overcomes the limited lifespan of primary cells and will enable more extensive and reproducible gene editing experiments going forward. The project supported successful grant application to the Medical Research Council. Collaborations with researchers at St George’s University of London and bioinformaticians at Mount Sinai Medical School have supported the identification of ERG coding variants in patients through analysis of whole genome sequencing data from the 100,000 Genomes Project.

How were patients and the public involved?

The team engaged with Imperial BRC Community Partners throughout the project, presenting the background and aims of the research prior to commencing the work and gathering feedback on research priorities and communication strategies. Community Partners provided valuable input on how to communicate the research accessibly across diverse patient groups, and their feedback helped shape the team’s approach to public engagement. Working with PERC, a lab tour was arranged for Community Partners, giving them a first-hand view of the research environment and the opportunity to ask questions about how the work was carried out. The team noted that this engagement was an extremely valuable experience that has deepened their appreciation of the importance of embedding patient and public involvement throughout future research projects.

Using Remote Monitoring and Digital Twins to Improve Treatment for Pulmonary Arterial Hypertension

What is this project about?

Pulmonary arterial hypertension (PAH) is a serious condition where the blood pressure in the lungs becomes dangerously high, placing enormous strain on the heart. This project investigated whether lower doses of an existing cancer drug — imatinib — could be a safer and more tolerable treatment option for PAH patients. A small group of patients who had sensors implanted in their pulmonary arteries, providing continuous daily blood pressure readings, were enrolled to track how their lungs responded to different doses of the drug over time. This continuous, real-world data also provided a unique opportunity to begin building a digital twin — a computer model of how the heart and blood vessels in the lung respond to treatment — which could in future help doctors personalise therapy for individual patients.

Why does it matter?

Imatinib has shown promise in reducing lung blood pressure in PAH, but at the standard dose of 400mg daily, many patients experience significant side effects. This study showed that lower doses are better tolerated while still reducing lung blood pressure in a dose-dependent way — an important finding that could make this treatment accessible to more patients. The use of implanted sensors to capture continuous, real-time pressure data is a major advance over traditional clinic-based measurements, providing a far richer picture of how patients respond to treatment over time.

What are the outputs of the project?

The pilot data generated by this project directly underpinned a major £8.8 million EPSRC award for a “Networks of Cardiovascular Digital Twins (CVD-Net)” project demonstrating the exceptional leverage generated by this BRC investment. The project has attracted wide media coverage, including features in The Times, Digital Health, and Pharmatimes, as well as an Imperial College news release. A collaboration with Prof Alexander Rothman’s group has supported the recruitment of a cohort of patients with implanted devices to expand the dataset for digital twin development.

How were patients and the public involved?

Patient involvement was informed by a prior survey of 119 PAH patients conducted in collaboration with the UK Pulmonary Hypertension Association and University of Sheffield, in which 79% of respondents felt that remote monitoring was very important and a further 19% felt it was important — providing strong patient-driven justification for the project’s approach. Patients with implanted pulmonary artery sensors contributed continuous real-world data throughout the study, making them active participants in generating the evidence base rather than passive research subjects. The full survey results have been made publicly available through the UK Pulmonary Hypertension Association website, ensuring transparency and accessibility for the wider patient community.

Our patients and their carers are at the heart of our vision. Our Community Partners focus group, made up of six members of our local west London community, will help guide our theme’s strategy and shape the next steps of our research. We also work with established patient and public panels within the Imperial NIHR-BRC and the BRC Patient Experience Research Centre to encourage engagement and participation to optimise personalised healthcare.

The Imperial Communications Department helps disseminate our research outputs and policy influencing practices to the public. For example, our team members recently co-produced a report highlighting challenges and ways to future-proof health research in the UK. We also support cardiovascular-focused educational activities for the public – this year, we are involved in the third Annual Imperial Science in Medicine School Teams Prize (2023) for sixth form students in the UK.

Equality, diversity and inclusion principles are embedded in our research strategy. We focus on providing personalised cardiovascular healthcare to our local ethnic and socio-economically diverse west London community, but anticipate our findings to impact patient care nationally and internationally. Our patients are involved in both shaping and delivering our research through participation in focus groups, consenting to health records access and donating biological samples for our studies, as well as recruitment in our clinical trials. Crucially, we also engage with local GP surgeries to reach our entire west London community. Our research is directly linked with the Imperial Health Knowledge Bank and the Imperial NIHR-BRC digital health theme that monitors research participation by age, ethnicity, gender, deprivation and disability.

In accordance with the Imperial BRC’s PPIEP Strategy , our theme has recruited a group of Community Partners to act as critical friends to our theme and share their valuable lived experience with our researchers and health professionals to help improve the relevance and quality of our research for the benefit of our North West London population.