Dr Avedis Ekmejian – How best to determine if an artery blockage is dangerously impacting the flow of blood to the heart and when to intervene with invasive medical treatment.

When a patient presents to hospital or their cardiologist with a suspected blockage or lesion in their coronary artery, which is causing, or which could lead to chest pain or a heart attack, they will usually undergo a coronary angiogram. This determines whether they need a stent implanted to keep the artery open and maintain blood flow to the heart.

While implant surgery such as stenting is a common procedure – like all invasive procedures it can have side effects and dangers, including damaging the artery wall. Therefore, the clinical cardiologist needs to evaluate whether the narrowing is limiting blood flow to the heart before a stent is inserted. Sometimes the narrowing is so bad it is obvious, but at other times, further assessments are required.

Two common methods to evaluate whether the narrowing is limiting blood flow are, instantaneous wave-free ratio (iFR) and fractional flow reserve FFR. However, there can been differences between the iFR and FFR results, which may lead to uncertainty.

Dr Avedis Ekmejian’s research is looking at the mechanisms which could cause varying results between FFR and iFR, and how these differences can be interpreted. He will also look at the makeup and geometry of the plaque itself using intra-vascular imaging (OCT). He will look at whether increased irregularity and surface roughness within the lesion accounts for these differences. He will further undertake specialised coronary flow studies to determine whether impaired flow through the artery causes varying results between FFR and iFR.

The findings from this research should allow clinical cardiologists to more easily interpret FFR and iFR findings in their patients and guide their treatment more accurately, further refining the accuracy and safety of these tests and procedures.


To read more about the research Heart Research Australia is funding click here.



Latest Research

Impact of Epicardial plaque composition and geometry on coronary hemodynamics and flow (iEquate)

Dr Ekmejian has been investigating the relationship between plaque morphology, plaque geometry, and invasive coronary hemodynamics. The study includes patients being investigated for coronary disease, who were identified to have moderate (50-75%) narrowing of the arteries. By assessing their hemodynamics using a coronary pressure wire and an OCT (imaging technique) assessment of the plaque, it

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