Professor Julian Gunn https://www.sheffield.ac.uk/iicd/profiles/gunn
Dr Paul Morris https://www.sheffield.ac.uk/iicd/profiles/morris
Patients with coronary artery disease develop restricted blood flow, causing chest pain and limited lifestyle. Doctors reply upon angiogram images of the artery to estimate deficient flow, but this is unreliable. We can directly measure pressure gradients across narrowed arteries with a pressure-sensitive wire (the fractional flow reserve, FFR). This system is of clinical benefit to guide treatment with percutaneous coronary intervention (PCI; stenting); but it is cumbersome and invasive, and is done for few patients. There is a single threshold value (<0.80) for treatment, which may not be relevant to less active subjects. Also there are three major coronary arteries, with many branches, and it is rare to have FFRs measured in all vessels, so we lack information on cumulative flow limitation or ‘total ischemic burden’ of the myocardium.
Computational modelling of total cardiac ischemic burden can predict the impact of PCI in patients’ everyday lives.
1. Construct vFFRs in major vessels and calculate ischemic burden before and after PCI.
2. Assess patients’ symptom burden before and after PCI.
3. Measure activity and energy usage before and after PCI.
4. Relate change in ischemic burden at PCI to change in functional performance.
Patients requiring PCI will be identified and recruited in the primary supervisor’s clinical practice. They will be undergo questionnaire evaluation of quality of life and symptom burden before and 6 weeks after PCI. They will have activity monitoring before and 6 weeks after PCI. The baseline coronary angiogram will be processed to calculate vFFRs and measures of total ischemic burden. After PCI, the final angiogram will be similarly processed. The difference in total ischemic burden produced by PCI will be calculated and correlated with measures of quality of life and activity.
Coronary physiology is barely used in clinical practice. Computational modelling, combined with real measures of everyday activity, will usher in a new era in personalised treatment planning for patients with heart disease.
Benefits of being in the DiMeN DTP:
This project is part of the Discovery Medicine North Doctoral Training Partnership (DiMeN DTP), a diverse community of PhD students across the North of England researching the major health problems facing the world today. Our partner institutions (Universities of Leeds, Liverpool, Newcastle and Sheffield) are internationally recognised as centres of research excellence and can offer you access to state-of the-art facilities to deliver high impact research.
We are very proud of our student-centred ethos and committed to supporting you throughout your PhD. As part of the DTP, we offer bespoke training in key skills sought after in early career researchers, as well as opportunities to broaden your career horizons in a range of non-academic sectors.
Being funded by the MRC means you can access additional funding for research placements, international training opportunities or internships in science policy, science communication and beyond. See how our current DiMeN students have benefited from this funding here: http://www.dimen.org.uk/overview/student-profiles/flexible-supplement-awards
Further information on the programme can be found on our website: http://www.dimen.org.uk/
‘Virtual’ (computed) fractional flow reserve: current challenges and limitations.
Morris PD, van de Vosse FN, Lawford PV, Hose DR, Gunn JP. JACC Cardiovasc Interv 2015 8:1009-17. doi: 10.1016/j.jcin.2015.04.006
Virtual coronary intervention (VCI): a treatment planning tool based upon the angiogram. Morris P, Gosling R, Silva D, Lawford P, Hose R, Gunn J. JACC Cardiovasc Imaging 2018 https://doi.org/10.1016/j.jcmg.2018.01.019
Personalised fractional flow reserve: novel concept to optimise myocardial revascularization. Gosling R, Morris P, Lawford P, Hose D, Gunn J. EuroIntervention 2018 (in press)