Monday, 14 August 2017

MonashHeart and Monash University research into coronary artery disease wins trifecta of prizes

Dr Ihdayhid and Associate Professor Ko
MonashHeart interventional cardiology fellow and Monash University PhD candidate Dr Abdul Ihdayhid was recognised for his ground-breaking research into coronary artery disease, receiving two highly prestigious awards in Perth last week, following on from winning the Young Investigator Award at the Society of Cardiovascular Computed Tomography last month in Washington D.C.  

Dr Ihdayhid was awarded the most highly regarded Ralph Reader Prize at the annual scientific meeting of the Cardiac Society of Australia & New Zealand (CSANZ) as well as the prestigious Geoff Mews Memorial Fellows’ Prize at the Australia & New Zealand Endovascular Therapies Meeting (ANZET) for his research into assessing the functional significance of coronary artery disease.

Patients with suspected angina (chest pain caused by reduced blood flow to the heart) usually need further tests to determine if they have coronary artery disease, as well as the functional significance of the narrowing of the arteries.  

“The functional significance represents the degree to which a narrowing affects blood flow to the heart muscle—and this is a strong predictor of long term outcomes and the benefit from potential treatments,” said Dr Ihdayhid. 

The current accepted gold standard for assessing the blood flow and functional significance of a coronary narrowing is using fractional flow reserve (FFR), only obtained during invasive coronary angiography using a specialised pressure wire inserted into the coronary artery.

Dr Ihdayhid said CT coronary angiography (CTCA) is rapidly becoming the first-line test for investigating coronary artery disease. 

“It is an excellent test for ruling out disease, however in the presence of a narrowing it has limited ability at determining the degree of blood flow limitation.”

“Patients often need undergo further tests to determine the functional significance, associated with potential side effects, inconvenience to the patient and overall cost to the health system,” Dr Ihdayhid said. 

In a world-first, Dr Ihdayhid’s research has shown an alternative technique, known as CT Derived Fractional Flow Reserve, is a novel and non-invasive method for determining FFR with superior diagnostic performance, and importantly, with no potential side effects and reduced cost to the health system.

“There are two emerging techniques that provide us with the ability to assess both anatomy and function using a CTCA: CT Stress Myocardial Perfusion (CTP) and CT Derived Fractional Flow Reserve (CT-FFR).”

“CTP requires two scans performed 20 minutes apart and a medication to maximise coronary blood flow.   This is associated with increased side-effects, contrast and radiation exposure to patients,” Dr Ihdayhid said. 

Dr Ihdayhid’s research investigated CT-FFR as a novel non-invasive method for determining FFR.

“Current CT-FFR techniques require the use of a supercomputer and external off-site processing with a turn-around time of around 24-48 hours, hence reducing its clinical utility.”

“MonashHeart has been collaborating with Toshiba Medical Japan in developing a world-first point of care CT-FFR technique that can be performed on-site and within 30 minutes of CTCA acquisition.”

“Our recently published work has demonstrated that it is highly accurate when compared to FFR determined invasively.”

Dr Ihdayhid said their results demonstrated that CT-FFR had superior diagnostic performance at detecting functionally significant disease when compared to CTP and they achieved these results in less time and with less contrast and radiation exposure.  

“These results take us one step closer to utilising a resting CTA in delivering both anatomical and functional information in a single, rapid, safe and accurate investigation,” Dr Ihdayhid said. 

The Monash research team has finished recruiting 500 prospective patients with suspected coronary artery disease in whom they will perform a CT-FFR analysis to assess the real-world feasibility and utility of this cutting-edge technique. 

Dr Ihdayhid said if the results are promising, their next step will be a multi-centre randomized control trial. 

Dr Ihdayhid acknowledges the tremendous and ongoing support of his PhD supervisor, Associate Professor Brian Ko, Consultant Interventional Cardiologist at MonashHeart.

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