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Research

Q&A with Amer Johri

Straight from the Heart

[Amer Johri]
Photo: Kingston General Hospital

As the field of cardiovascular science rapidly develops, novel technologies are emerging as attractive options not only for treating patients, but also for earlier identification and diagnosis of vulnerable patients. Dr. Amer Johri, an associate professor in the Queen’s Department of Medicine, founder and director of the Cardiovascular Imaging Network at Queen’s (CINQ), and a practicing cardiologist, is attracting national and international attention for his research into ultrasound techniques. He also actively advocates the concept of investigating fat and cholesterol build up located in the carotid artery as a “barometer” of identifying coronary atherosclerosis. Recently, Olivia Yau, an MSc candidate in the Department of Biomedical and Molecular Sciences, sat down with Dr. Johri to discuss his research and the work of CINQ.

Q: You began your career as a physician and now you are part of a unique group of clinician scientists here at Queen’s University. What role, if any, do your clinical duties play in your research?

A: Patients are the reason why we, the Cardiovascular Imaging Network at Queen’s University (CINQ), do research. Heart disease is the second leading cause of death for Canadians, and coronary artery disease risk factors like high blood pressure, increased blood cholesterol levels and increased blood sugar levels are skyrocketing. There is an urgent need to study methods for earlier, more accurate detection of these risks to deal with this “tsunami” that threatens to overwhelm our health care system. Our research is completely patient-focused and is enhanced by clinical work. We address questions like: How can we detect heart disease and stroke risks earlier? How can we increase the efficiency of current approaches to cardiovascular care?

The focus of our network is imaging technology, specifically ultrasound – a non-invasive, radiation-free, portable and inexpensive tool.

Q: You were recently elected as the Chair of the American Society of Echocardiography (ASE) Council on Vascular Ultrasound. What caused you to shift the focus of your research from cardiac to vascular ultrasound?

A: Cardiac ultrasound and vascular ultrasound are interconnected. I don’t really see this as a shift, but rather an extension of CINQ’s mission to better understand and treat atherosclerosis – a silent, yet deadly disease that involves hardening and narrowing of the arteries, eventually blocking blood flow and resulting in various cardiovascular events like heart attacks and strokes. My leadership role at ASE allows me to promote the importance of identifying and detecting atherosclerosis from less traditional angles like vascular ultrasound in a global manner, allowing collaboration in this field, and ultimately pursuing changes in clinical practice for patient benefit. Vascular ultrasound is a rapidly evolving technology. We are very excited to explore its development through 3D imaging, contrast imaging, radiofrequency analysis, gray scale median analysis and plaque texture analysis.

Q: You published a paper on 3D ultrasound showing it may be more accurate than 2D ultrasound. Can you explain how this understanding is being applied to research today?

A: We were one of the first groups to show that 3D ultrasound produced better images than 2D methods for visualizing plaque – the cholesterol build-up responsible for heart attack and stroke. 3D ultrasound is therefore the main method we use to assess the effects of novel therapies on heart disease. This work has attracted attention from industry, and subsequently a 3D ultrasound probe specific for plaque assessment was developed. I believe 3D ultrasound is the first step towards the future of cardiovascular risk stratification.

Q: As the founder of the Journal of Point of Care Ultrasound, can you elaborate on what point of care ultrasound is? What inspired you to start a journal dedicated to this technology?

A: Point of care ultrasound (POCUS) is an immediate, convenient form of examination that can be provided by the primary care physician with more portable tools like hand-held ultrasound devices. POCUS can be invaluable to patients in acute care settings, and is often used as an adjunct to physical exams. While it is changing the landscape of bedside physical assessment of patients, there are very few peer-reviewed resources available. We created an iBook to demonstrate the use of cardiovascular POCUS, but there was an acute need for an ongoing vehicle to provide education on general POCUS use. This is why we created the Journal of POCUS – a highly interdisciplinary and collaborative endeavour. Expert users from Kingston General Hospital’s Anesthesiology, Emergency, and Internal Medicine departments, as well as the Intensive Care Unit, are serving on our editorial board.

Q: You are a recent recipient of the Faculty of Health Sciences’ Mihran and Mary Basmajian Award for Excellence in Health Research, awarded to younger faculty members with meritorious contributions to health research. With this recent recognition of your success and momentum, where do you see yourself and your research in 10 years?

A: My plan is to have a sustainable research program in 10 years’ time. I envision that CINQ will have a life of its own and will be recognized worldwide for high-quality, translatable cardiovascular research leading to patient care solutions. This is why we are investing heavily in training the next generation of clinician scientists, and building important partnerships with the Queen’s School of Computing, the Clinical Evaluation Research Unit, researchers from Sun Yat-Sen University in China, and numerous other academic and industrial collaborators worldwide. I can share this vision of CINQ with you now, but the daring part of research is that you really don’t know where it will take you!

Keep up with Dr. Johri and his research by following him at @amerjohri on Twitter. Learn more about the CINQ lab at CINQlab.com, and please take a look at our latest issue and contribute at POCUSJournal.com.

(e)AFFECT Issue 11 Spring/Summer 2017