Coronary heart disease
Learn about Coronary heart disease (CHD, also known as Ischaemic Heart Disease or IHD), including causes, symptoms, diagnosis, treatments and prevention.
Coronary heart disease is one of the UK’s leading causes of death and the most common cause of premature death. It is a condition where the blood vessels supplying the heart are narrowed or blocked. BHF researchers have helped to develop a new diagnostic tool to assess the severity of the disease, informing treatment decisions.
The primary cause of coronary heart disease is the build up of fatty material inside the coronary arteries. Over time, the build up causes the artery to narrow (stenosis), limiting blood flow to the heart muscle, which can lead to angina and increase your risk of having a heart attack or stroke. Patients with stenosis may require a procedure such as coronary angioplasty or bypass surgery to help improve blood flow to the heart.
Traditionally, doctors have used a diagnostic technique called fractional flow reserve (FFR) to help decide what treatment the patient needs. FFR checks the blood pressure and flow in the coronary arteries, investigating the severity of stenosis. The technique requires the patient to take a powerful drug called adenosine, which can have side effects such as chest pain, and cannot be given to everyone.
In 2014, a new alternative technique called instantaneous wave-free ratio (iFR) was developed at Imperial College London, thanks to research part-funded by BHF. Unlike FFR, iFR does not require patients to take adenosine, this saves time and eliminates the potential side effects experienced by patients. This new technology attracted funding from industry to test its efficiency in a large multicentre international clinical trial which found that a 96% reduction in patient discomfort could be achieved using this new technique, with patient outcomes similar to those previously shown with FFR.
Another benefit is that iFR is more cost-effective compared to FFR with a 10% cost reduction and 25% reduction in hospital readmissions. iFR is now widely used across the world with cardiologists often stating that the use of this technique saves both time and money.
The iFR technology, created thanks in part to work by BHF-funded researchers Professor Darrel Francis and Dr Justin Davies and colleagues at Imperial College London, was patented in 2010 and licensed to a well-known heart imaging company. It is now being used in over 5000 clinics worldwide, and is used in more than 30 hospitals in the UK.
The use of iFR has really increased the adoption of the use of pressure wires to evaluate the significance of coronary stenoses. I see this tool as being very important for assessing patients with coronary heart disease and ensuring that we deliver treatment with the best possible outcome for patients.
First published 24th April 2023
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