Q&A with Dr Hashrul Rashid

Finding ways to detect leaflet thrombosis (LT) earlier to improve health outcomes.

What are you currently researching?

Aortic stenosis is one of the most common valvular heart diseases and is characterised by abnormal narrowing of the aortic valve, which restricts the flow of blood from the left ventricle of the heart into the aorta. Severe aortic stenosis can be serious and potentially life-threatening. Treatment for severe aortic stenosis includes transcatheter aortic valve replacement (TAVR). TAVR is a procedure to replace the narrowed or diseased aortic valve with a new valve. TAVR has revolutionised the treatment of patients with symptomatic, severe aortic stenosis by halving mortality over medically treated patients.

The aortic valve has flaps called leaflets which open to let blood flow and then close to keep blood from flowing backward. Leaflet thrombosis (LT) is common in patients treated with TAVR. It is characterised by thickening and reduced motion of the leaflets. Some studies have shown an association between LT and stroke or valve degeneration, however the clinical significance of LT is not yet clear and requires further research. My research project examines the mechanism of LT, predictors and clinical impact of this condition.

What difference will your research make to people’s cardiovascular health in Australia? 

Prevention is always better than the cure. If we can prevent stroke or valve dysfunction, we may help many patients treated with transcatheter aortic valve replacement (TAVR) to lead independent lives and prevent unnecessary hospital admissions. Hopefully by detecting leaflet thrombosis (LT) earlier, we may be able to closely monitor patients earlier and in select patients, commence treatment to resolve the LT.

What motivated you to do your research? 

I was initially attracted to cardiovascular research due to the strong impact it has on improving clinical outcomes and saving lives, far more than other medical based research. Cardiovascular medicine is also a highly evolving field, with newer technologies being developed every year. In fact, it has been a decade since transcatheter aortic valve replacement (TAVR) has been widely performed and has recently been demonstrated to outperform surgical aortic valve replacement in certain clinical outcomes such as stroke and bleeding complications. I am truly excited to see what the next decade holds for cardiovascular medicine.

Are there any achievements or discoveries from your research you can share with us? 

In a chapter of my PhD, we have previously demonstrated a concerning association between leaflet thrombosis (LT) and cerebrovascular events (stroke), which was published in the Eurointervention Journal in 2018. It was recently awarded as one of the journal’s best research papers, which was highly cited and downloaded. I was also invited as a speaker at ESC to present a State-of-the-Art lecture on this topic and later was awarded the TCT Asia Pacific Best Abstract award.

We also demonstrated certain novel clinical predictors for LT and for the first time, demonstrating that patients with LT may develop earlier failure of the valves. This study was awarded the CSANZ Registrar Prize last year. 

More recently, I was fortunate to be selected for the Young Investigator Award at the Society of Cardiac Computed Tomography (SCCT), which I was awarded the first runner up. This research demonstrated the depth and expansion of the valve strongly correlates with LT. This may change the practice of deploying transcatheter valves, as it would guide the operators to play close attention on the depth and expansion of the valve during the procedure. It has also been selected as finalist for the ESC Best Moderated Abstract competition in August 2020. 

What difference does your Heart Foundation funding make to you, your research and your future in research?

I feel extremely grateful to be awarded grant support from the National Heart Foundation as it is a highly prestigious and sought-after award. It has given me the ability to have financial independence to cover research and conference travel costs. It also provides a platform for me to explore future collaboration through the Heart Foundation Alumni Community, which has many eminent cardiovascular researchers.