60-SECOND INTERVIEW with Dr Justin Davies

Q. What is the concept behind the ‘Live from the Hammersmith’ initiative?

Live from the Hammersmith aims to provide an objective and independent snapshot of many of the worlds latests technologies being used in real world clinical environment by the worlds leading physicians.

Q. What are the advantages of live broadcasting of clinical procedures?

Live broadcasts give the opportunity for direct interaction between physicians from all parts of the world with the operators via a live question feed. This allows the operators to best feel the pulse of the community.

Q. How has the implementation of fractional flow reserve advanced clinical outcomes in cardiology?

FFR has become mainstream, and is now an important part of our assessment of coronary artery stenoses and the appropriateness of coronary revascularisation. Simplifying PCI wherever possible, especially in multi-vessel disease, has the potential to decrease procedural complexities and reduce medium and long term complications.

Q. What do you see as being the next major breakthrough in diagnostic coronary assessment?

Without a doubt multi-modality co-registration holds the potential to change our field. I am particularly excited about the fusion of physiology with anatomy and the possibilities for virtual PCI planning. This is where we can model the improvement in physiology, prior to deploying a stent. I believe that this has the potential to be a step change in the way we perform PCI.

Q. If you could offer one piece of advice to fellow cardiologists what would it be?

In the words of Dr Morton Kern, “retool or retire”. Continued revalidation and learning is essential for all of us to continue to offer the best in care for our patients.

Q. What has been the most memorable moment in your career as a cardiologist to date?

Having the opportunities to work with physicians from all around the world whom share a passion for improving the care of patients by continued research and refinement of the techniques we use in the catheter laboratory.

Performed by
Dr. Justin E Davies
Consultant Cardiologist
Imperial College NHS Trust

Justin Davies is a Senior Reserch Fellow and Hononary Consultant Cardiologist at the National Heart and Lung Institute, Imperial College London. His main research interests include the development and application of pioneering technologies in engineering to aid understanding of disease mechanisms, and in the diagnosis of pathological disease states.

After completing his undergraduate training at Imperial College, he was awarded a prestigious British Heart Foundation research fellowship to undertake his PhD at Imperial College. Since then, he has trained in interventional cardiology with a specialist interest in physiological and structural assessment of coronary disease states. In 2008, he was appointed as a Walport Clinical Lecturer to support his research activities alongside his ongoing clinical commitments. Through collaboration with Kim Parker and colleagues at institutions throughout the world, he has used mathematical modelling to aid understand of the mechanisms which lead to increased blood pressure which accompany ageing and pathological disease states. More recently Justin has developed coronary wave intensity as a tool to to assess the interaction between the coronary microcirculation and the aorta in the supply of blood to the heart.

In 2011 iFR (instantaneous wave-free ratio) was first described as a new technique for assessing the severity of a coronary stenosis using a pressure wire - without the need for administration of potent vasodilators. The results of the first-in-man study of the ADVISE (ADenosine Vasodilator Independent Stenosis Evaluation) were reported at TCT 2011, and subsequently ADVISE publication in Journal of American College of Cardiology (Sen S et al.). The original TCT slideset can be obtained here. Since then iFR has been evaluated in over 3000 patients, and multiple publications have categorised its classification match with other measures of ischaemia.

Using gold standard invasive independent measures of ischaemia iFR has been found to have an identical diagnostic accuracy to FFR.