Research and clinical trials

Current clinical trials

I recruit patients into clinical studies at Royal Papworth Hospital, one of the UK's leading centres for cardiovascular research. Current studies focus on how coronary artery disease is diagnosed and treated.

INCHARGE

Invasive or Non-Invasive Coronary Angiography in Stable Patients with High Clinical Likelihood of Coronary Artery Disease

When someone has chest pain that is very likely to be caused by narrowed heart arteries, doctors usually go straight to an invasive coronary angiogram. INCHARGE is an international randomised trial testing whether starting with a CT coronary angiogram instead is just as effective for these patients, while sparing many of them an invasive procedure.

The trial is led by Professor Marc Dewey at the University of Cambridge and Royal Papworth Hospital, and is funded by the British Heart Foundation, the German Research Foundation (DFG) and the German Heart Foundation. It builds on the DISCHARGE trial, which showed that CT was a safe first test for patients with an intermediate likelihood of coronary disease.

I am the site principal investigator for INCHARGE at Royal Papworth Hospital.

BIOPATTERN

Standard blood tests are taken from a vein in the arm, far from the heart. BIOPATTERN tests a new device, the Liquid Biopsy System, which takes tiny blood samples from inside the coronary artery, right next to a fatty plaque. The aim is to measure biological markers released by the plaque itself, which may help to tell apart different types of coronary disease and, in future, tailor treatment to the individual.

Patients who are already having a planned coronary procedure may be invited to take part. The sampling, together with imaging from inside the artery, adds around 30 minutes to the procedure, followed by a phone call after 30 days. The study is sponsored by PlaqueTec, a Cambridge company, and coordinated by the Papworth Trials Unit Collaboration, and aims to recruit 300 patients at specialist NHS heart centres in England.

British Orbital Atherectomy Registry (BOAR)

Orbital atherectomy is one of the specialist techniques used to treat heavily calcified heart arteries before a stent is placed. BOAR collects information on how patients treated with orbital atherectomy and optical coherence tomography (OCT) imaging do in everyday NHS practice across the UK.

Taking part involves no extra procedures: information is collected from your medical records and procedure images, with a follow-up phone call about a year later. The registry is sponsored by University Hospitals Dorset NHS Foundation Trust.

Cardiac biomarker research

Biomarkers are substances in the blood that reveal what is happening in the body. In heart disease, the most important is cardiac troponin, a protein released when heart muscle is damaged. Troponin blood tests are the cornerstone of diagnosing heart attacks in emergency departments.

Cardiac myosin-binding protein C

With a British Heart Foundation Research Fellowship, my PhD at King's College London investigated a new heart-specific protein, cardiac myosin-binding protein C (cMyC). It is more abundant in heart muscle than troponin and is released into the blood more quickly after injury, which suggested it could help diagnose heart attacks sooner.

In a study of 1,954 patients attending emergency departments with suspected heart attack, published in Circulation in 2017, cMyC diagnosed heart attacks as accurately as the best available high-sensitivity troponin tests. It was also better at sorting patients into "rule-out" and "rule-in" groups from a single blood sample, especially those who arrived soon after their symptoms began.

Troponin and natriuretic peptides

As an NIHR Academic Clinical Lecturer at King's College London, I continued to study how troponin and natriuretic peptides (BNP and NT-proBNP), markers of strain on the heart, are best used in practice.

This background shapes how I use blood tests in clinic today, for example in interpreting a slightly raised troponin or BNP result and deciding whether further tests are needed.

Publications and awards

My work has been published in leading peer-reviewed journals and presented at national and international meetings. It has been recognised with:

• the HyTest Cardiac Marker Award
• the Royal Society of Medicine Research & Innovation Prize
• Young Investigator Award finalist places at the British Cardiovascular Society and the American College of Cardiology
• finalist, BSCR Bernard & Joan Marshall Early Career Investigator Prize

Taking part in research

Clinical trials are how medicine improves. Patients who take part are closely monitored, and many value contributing to better care for others.

• Taking part is always voluntary, and you can withdraw at any time without giving a reason.
• Your care is not affected if you decide not to take part.
• Every study is reviewed and approved by an independent NHS research ethics committee.