Her research interest focuses on integrated cardiac physiology in patients with ACHD/structural heart disease and pulmonary artery hypertension (PAH), studied using her echocardiographic/Doppler expertise.
Her research projects have not only helped produce publications in high impact factor journals but also contributed to significant improvement of patient care.
Physiological clinical studies
- Her study on right ventricular function in different loading conditions (congenitally corrected transposition of great arteries, transposition of great arteries after Mustard repair and primary pulmonary hypertension) has contributed to the understanding of adaptive mechanisms of the right ventricle.
- Findings in comparative multimodality imaging studies of transthoracic echocardiography and Cardiovascular Magnetic Resonance measures in ACHD improved the accuracy of echo assessment of right ventricular function in routine clinical practice.
- Doppler index for assessing the severity of the coarctation of aorta and validated the index with CMR; it is now routinely used in our clinical practice.
- Pulmonary regurgitation index, to quantify the degree of regurgitation, is widely accepted and used in everyday clinical practice, not only in the UK but internationally.
- She was the first to describe ischemic right ventricular behaviour at fast heart rate in the setting of systemic RV.
- Comparing right sided ventriculo-ventricular interaction and ventriculoarterial coupling in Eisenmenger syndrome with different aetiology assessing changes in these measures in response to medical therapy.
- The first to describe the disturbed atrio-ventricular function in ACHD patients who developed atrial arrhythmia, the deleterious effect of arrhythmia on clinical functional status and P wave morphology towards predicting the onset of arrhythmia.
- Her paper studying ventricular dyssynchrony (Circulation 2007) laid the foundation for the development of multi-site pacing for the treatment of heart failure in ACHD patients. This and similar research in assessing synchrony underpinned the clinical echo-guided optimisation service with frequent referrals from electrophysiologists for an authoritative opinion.
Clinical outcome studies
- She devised a composite score for prognostic value in Eisenmenger syndrome which is now routinely used for guiding their clinical management.
- She showed the value of the simple systolic and diastolic ratio as accurate measure for identifying patients at high risk of adverse event in patients with respiratory disease, primary pulmonary hypertension and in patients with univentricular heart.
- Lead echo investigator/core lab for national and international clinical studies
Major research contributions and their impact and influence
- She had 156 publications (126 original scientific research papers and 30 case reports or scientific letters).
- She has authored the only text book on Echocardiography in Adult Congenital Heart Disease (Springer 2007) and has written 20 chapters for books edited by others.
- She has authored by invitation the Consensus recommendations for echocardiography in adults with congenital heart defects from the International Society of Adult Congenital Heart Disease (ISACHD) (2018).
- She has contributed to EACVI position statement: Imaging the adults with congenital heart disease: a multimodality imaging approach (2018) and contributed to an already cited ACHD imaging review in European Heart Journal 2015
- She has participated in a studio interview on multimodality imaging tutorials for online training instigated by the EACVI (part of the European Society of Cardiology), (2018)