Testing a new diagnosis tool to prevent fatal heart attacks

Establishing invasive physiological thresholds for ischaemia in left main coronary artery disease

Any of the arteries in the heart can become narrowed and prone to blockages, which can lead to a heart attack. However, when the left main coronary artery (LMCA) becomes blocked, this is more likely to cause a heart attack that is fatal. Narrowing of the LMCA is usually judged by a doctor looking at an angiogram, a way of visualising blood vessels, but this is not as accurate as it could be. This means that some patients who have narrowed LCMA that is cause for concern may be falsely reassured, or those with only minor narrowing of the LCMA may be treated unnecessarily with heart surgery. In this project, Professor Divaka Perera plans to test whether a technique called Fractional Flow Reserve (FFR) can be done during an angiogram. FFR compares the actual pressure required to pump blood through a diseased artery compared with what would be expected of the normal artery. Previous studies have shown that FFR is better than angiograms alone for predicting the impact of blood vessel narrowing in some patients, but these studies have not included people with narrowing of the LMCA. Professor Perera will assess whether FFR can be reliably used in patients with LMCA disease and establish an appropriate cut-off value that would determine which patients are at high risk and should therefore be treated.