Coronary artery disease occurs when fatty deposits (plaques) build up inside the arteries that supply blood to the heart. Some plaques remain stable, while others continue to grow or become more likely to rupture, which can lead to a heart attack. Identifying plaques that are at higher risk of progression could help doctors provide earlier and more personalized treatment.
The purpose of this study is to determine whether combining information about blood flow within the coronary arteries with information about a person's biological response to blood flow can improve prediction of plaque growth. Participants undergoing treatment for coronary artery disease will have a specialized heart scan to assess blood flow patterns around plaques in their coronary arteries. Researchers will also collect blood samples to study cells that line blood vessels and investigate how these cells respond to blood flow forces.
The study will follow participants over time to determine whether plaques are more likely to progress in individuals who show a stronger biological response to abnormal blood flow. The findings may help researchers develop new ways to identify patients at higher risk of future heart problems and support the development of more personalized approaches to prevention and treatment of coronary artery disease.
Age ≥40
Stable angina, defined as typical symptoms with evidence of reversible ischemia in non-invasive test and/or documented obstructive coronary artery disease on coronary angiography (>70% stenosis of at least one major epicardial coronary artery or positive fractional flow reserve study)
Patient that is willing and can provide written informed consent.
Acute coronary syndrome within <3 months
Estimated glomerular filtration rate (eGFR) <60ml/min/1.73m²
Previous coronary artery bypass surgery
Decompensated heart failure, or left ventricular ejection fraction ≤30%
Single group
PCCTA scan
Procedure/SurgeryDuring the scans, the patient will be cardiac monitored using ECG synchronisation. PCCTA scan acquisition and parameters will follow Barts Health's standard operating procedures and institutional protocols.
Endothelial cell isolation from peripheral blood sample
Other interventionA 50mL blood sample will be collected from consenting patients. The blood will be processed to isolate peripheral mononuclear cells. These cells will be cultured to support the growth of endothelial colony forming cells (ECFCs).
Percentage change in plaque burden over 12 months
Percentage change in plaque burden over 12 months, analysed using linear regression with response to WSS as a continuous predictor
ECFC isolation from peripheral blood sample
Peripheral blood will be drawn at the point of recruitment. Blood will be processed to culture endothelial colony forming cells (ECFCs).
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Queen Mary University of London
Lead sponsor
Barts & The London NHS Trust
Collaborator
