Use of minimally invasive techniques to improve heart function.
Our group is lead by Prof Adrian Banning (www.thecardiologist.co.uk) and it aims to understand how to optimise heart function in patients presenting with atherosclerosis.
Atherosclerosis is a condition affecting the coronary vascular system and is responsible for a progressive restriction of blood supply to the heart, with clinical presentation varying from stable angina (when such blood restriction occurs slowly and progressively over time) to acute myocardial infarction (when such blood restriction is sudden and quick). Restoration of patency of the coronary artery affected by atherosclerosis can be achieved today with percutaneous coronary intervention with stenting of the “culprit” vessel in the catheterization laboratory.
Our research is ”based” in the catheterization laboratory, when coronary revascularization is performed. Initially using a combination of intravascular imaging techniques and pressure-wire based techniques, we aim to understand when results of coronary stenting are suboptimal and how and when it can be improved in patients with stable non-emergent coronary artery disease. In this specific clinical context, our research group has been long involved in key large randomised clinical trials (eg Taxus , Syntax and Excel), aiming to establish the best treatment options for patients presenting with specific conditions of ischemic heart disease such as left main stem disease or multivessel coronary artery disease.
A second and larger line of research is specifically focused on patients admitted for emergent presentation with acute myocardial infarction. We are using a combination of novel intravascular imaging and pressure-wire based techniques to identify during the revascularisation procedure those patients at higher risk and with a higher chance of experiencing a suboptimal/incomplete or even detrimental response to the conventional treatment with stenting.
This research has led us to derive and to validate an easy algorithm and risk scoring system for the early identification of poor responders to conventional treatment. This scoring system, called ATI score, combines three simple and easily available parameters, namely patient’s age, thrombotic burden in the coronary artery and function of the coronary capillary bed at the time of presentation. We have showed that patients with high ATI score have a higher risk of developing a larger infarct size with subsequent higher risk of poor recovery.
We are currently applying this scoring system to investigate the safety and the efficacy of novel therapies for the treatment of those high risk patients with acute myocardial infarction, likely to be poor responders to the conventional therapeutic strategies. In this context we are enrolling patients in the OxAMI PICSO study, which is investigating the efficacy of the Pressure-controlled Intermittent Coronary Sinus Occlusion (PICSO) device specifically in high risk patients with acute myocardial infarction.
Clinical studies and trials
Ox – OPT
De Maria GL et al “The influence of coronary plaque morphology assessed by optical coherence tomography on final microvascular function after stenting in patients with ST elevation infarction “
Top Ranked Oral Presentation Italian Society of Interventional Cardiology (GISE) Meeting, Genova, Italy October 2016
De Maria GL et al “The ATI score (Age-Thrombus Burden- Index of Microcirculatory Resistance) in STEMI: A cardiac magnetic resonance study”
ACI Young Investigator Award, London, UK January 2017