Haemodynamics and physiology underlying low flow aortic stenosis
Research type
Research Study
Full title
Investigating the haemodynamic and physiological principles underlying paradoxical low flow-low gradient aortic stenosis.
IRAS ID
198673
Contact name
Bernard Prendergast
Contact email
Sponsor organisation
Nottingham University Hospitals NHS Trust
Duration of Study in the UK
2 years, 3 months, 20 days
Research summary
The aortic valve, which allows blood to travel from the left ventricle to the aorta, can become narrowed as people age, known as aortic stenosis. This can lead to breathlessness, chest pain and blackouts, and once symptomatic, the prognosis is bleak without valve intervention. A variant of this disease, called low flow aortic stenosis can occur but it is not understood why patients with normal left ventricular function do not generate enough force across the narrowed valve to demonstrate severity. These patients have diminished survival with and without valve surgery when compared to patients with high pressure gradients, yet their outcomes are improved with valve intervention rather than conservative management. We aim to characterize this disease process and understand why the heart responds differently to stress, and valve intervention both immediately, and after several months. By understanding this condition, it is hoped we can identify key components causing heart injury and therefore targets for improved survival.
We plan to carry out a cardiac MRI scan before percutaneous valve implantation, and after 6 months. At the time of valve implantation, we will also take a number of measurements from the heart artery, left ventricle and blood steam markers of heart strain from the cardiac vein. 4 rice grain-sized biopsies from the left ventricle will allow us to identify features of scar and regeneration. By understanding the disease process, we can develop ways of detecting a failing heart early, and ensure appropriateness of treatment and optimal timing of treatment. At present, only observational, non-invasive parameters have been used to characterise this disease progress so this project will provide significant information into how these patients respond to treatment and what makes them “high-risk”.REC name
London - Westminster Research Ethics Committee
REC reference
16/LO/1619
Date of REC Opinion
18 Oct 2016
REC opinion
Further Information Favourable Opinion