What causes severe aortic stenosis and how to detect it early

Investigating the haemodynamic and physiological principles underlying paradoxical low flow-low gradient aortic stenosis versus normal flow-high gradient aortic stenosis (Dr Hannah McConkey)

Supervised by Dr Bernard Prendergast, this Clinical Research Training Fellow is looking for new ways to detect people who need treatment for severe aortic stenosis. A heart valve is like a one-way door that allows blood to flow from one chamber to the next in the correct direction. But the aortic valve can become narrowed as people get older – called aortic stenosis - and this can cause breathlessness, chest pain and blackouts. Patients are treated with aortic valve replacement. In around a third of patients with aortic stenosis, their injured heart is unable to push adequate amounts of blood through the diseased valve (called low flow, low gradient aortic stenosis), and although this group can have valve replacement surgery, they often present late to doctors and their prognosis is not as good as other patients. We currently know little about this severe disease, which is marked out by a narrowed aortic valve and also a thickened, stiffer heart and possibly disrupted flow in the coronary circulation supplying the heart. As so little is known about low flow, low gradient aortic stenosis, it is hard to detect patients at an earlier stage. In this project, the fellow will perform detailed blood tests, heart scans and measurements of pressure and flow in the heart’s pumping chamber and arteries to find out what causes this severe disease. They want to understand the disease process and identify markers of early disease to improve timing of valve replacement. By identifying when the heart becomes injured in aortic stenosis, this research will help doctors decide the best time to give people valve surgery, giving them the best chance of survival.