Establishing Physiological Thresholds for Ischaemia in LMCA Disease
Research type
Research Study
Full title
Establishing invasive physiological thresholds for ischaemia in left main coronary artery disease
IRAS ID
265515
Contact name
Ozan Demir
Contact email
Sponsor organisation
King’s College London
Duration of Study in the UK
2 years, 1 months, 6 days
Research summary
The heart receives its own blood supply via a branching network of coronary arteries, which can become gradually narrowed by deposition of fat. Coronary artery disease occurs due to this narrowing. When this occurs in the main blood vessel that supplies the heart, the left main coronary artery (LMCA), it is associated with high rates of death.
At present it is not possible to objectively assess LMCA disease. Narrowing of the LMCA is usually graded by an eyeball estimate on an x-ray-based test called an angiogram but this can lead to serious errors, such that patients with important narrowings may be falsely reassured or those with only minor narowings may be treated with unnecessary heart surgery. A promising new technique called Fractional Flow Reserve (FFR) can be done during angiography, which allows accurate prediction of the effect of a narrowing on blood flow. Treatment based on FFR has been shown to improve symptom free survival, compared to angiography alone, but all studies to date have excluded LMCA patients.
We will assess the significance of narrowing in the left main stem in isolation and with concomitant downstream coronary artery narrowing. The study will assess whether FFR can be reliably used in patients with LMCA disease and establish the FFR cut-off value that could be used to guide how these high-risk patients should be treated. We will use cardiac magnetic resonance imaging, non-invasive test, to assist establishing the ischamic threshold.
The findings of this study will establish whether FFR can be reliably used in patients with LMCA disease and establish the FFR cut-off value that could be used to guide how these high-risk patients should be treated. This should lead to objective assessment of these narrowing’s and enable doctors to offer patient specific and tailored treatment options, which may result in avoiding unnecessary surgery.
REC name
London - Riverside Research Ethics Committee
REC reference
20/LO/0245
Date of REC Opinion
14 Apr 2020
REC opinion
Further Information Favourable Opinion