Q&A with Dr Prajith Jeyaprakash

Dr Prajith Jeyaprakash received a Heart Foundation 2021 Charles Coghlan PhD Scholarship. After graduating from his medical degree at the University of New South Wales in 2013, Prajith completed his internship, residency, and basic physician training at Westmead Hospital. In 2018, he moved to the Nepean Hospital to undertake advanced training in cardiology. During his three years of training, he also completed a Masters of Medicine (Clinical Epidemiology) with the University of Sydney. He became a fellow of the Royal Australian College of Physicians in January 2021, before commencing his PhD with Professor Kazuaki Negishi and Dr Faraz Pathan at the Nepean Campus of the University of Sydney. In his spare time, Prajith enjoys spending time with his wife and family, as well as playing club soccer.

What are you currently researching?

Current treatments for life-threatening heart attacks include the use of stents to open a blocked coronary artery. However, half of people who have had a successful stent procedure can still have tiny clots in the very small blood vessels of the heart (known as ‘microvascular obstruction’). People with these tiny clots tend to have worse outcomes than people who do not. To date, there is no way to successfully treat microvascular obstruction. One potential treatment may involve repurposing an existing tool – high-power ultrasound – to break up the tiny clots and save more heart muscle from being damaged. Early studies are showing promise, but we need much larger human trials to explore how effective and safe this treatment is. My research will involve a trial (called REDUCE) to assess ultrasound in treating heart attacks across three Australian hospitals. We anticipate this treatment will reduce heart muscle damage and improve outcomes. In the future, ultrasound could be used in ambulances to treat heart attack early, reduce heart muscle damage, and ultimately save more lives.

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

If our research is successful, our REDUCE trial will demonstrate the application of a new treatment option for heart attack. Combined with world first physiology data and a cost effectiveness analysis, our data will inform clinical guidelines. We will also have the capacity to generate a new model of care for people having a heart attack. The aim is to improve cardiovascular outcomes by reducing muscle damage. We hope to improve quality of life, reduce the need to go to hospital and improve mortality.

Our project will also build capacity for other cardiology trials in Australia to explore the use of ultrasound as a treatment for heart attack. The potential of ultrasound to treat heart attacks is enormous. A commercially available ultrasound is small enough to load into an ambulance. This would allow it to be used by paramedics to treat people having a heart attack before they even reach hospital. This could provide an innovative opportunity to start treatment from the time an ambulance arrives, reducing the time from onset of symptoms to the time blood flow through the artery is restored. We aim to use our current research as a platform to commence this ambulance trial in Australia in the future.

What motivated you to do your research?

Research to me represents the scientific community pushing boundaries in knowledge to improve people’s lives. Since my early years studying in medical school, I have held great admiration for those that have advanced the field of medicine throughout history. Reading about the history of medicine and the incredible advances inspired me to consider pursuing research with my clinical career. Since then, I have been fortunate to work with senior researchers who are hard-working, passionate, and driven to advance science. They have given me the motivation to find my own niche in the field of cardiology, and to hopefully contribute to our scientific community.

I was also motivated by the collaborative opportunities available in research. Going to conferences and speaking to senior researchers is always exciting, and I enjoy seeing how passionate everyone is about what they do. When done well, collaborative research is the coming together of the greatest minds for the common good of improving health.

Are there any achievement or discoveries from the past year from your research that you can share with us?

In 2021, I published six peer review articles, in collaboration with international experts in the fields of cardio-oncology (the management of heart disease as a side effect of cancer treatment) and left atrial mechanics (how the left upper chamber of the heart is working). I wrote a review highlighting how body size can impact on the size of the left atrium. This has significant implications in a society with an increasingly obese population. I believe my work may assist us to better understand the connection between body size and organ size. I have also worked to better understand the effects of breast cancer chemotherapy on the heart. My review published in 2021 quantified the average decline in heart function expected after chemotherapy. This work will hopefully lead to future clinical trials, to find new ways to prevent heart damage from chemotherapy.

What role has Heart Foundation funding had in your career journey?

My Heart Foundation PhD Scholarship has been incredibly humbling and has allowed me to focus my time on running this multicentre clinical trial to the best of my ability. This funding has allowed me to travel to the three hospitals involved in the trial more easily and provided a track record to help secure larger scale funding for trial running costs. It has also allowed me to dedicate more time to enrolling patients into our trial.

Beyond this trial, this scholarship provides a foundation for my future in research. It has provided me with an excellent platform to approach international centres to further my training. My career aspiration is to become a world-leading clinician scientist with expertise in heart imaging, treatments for heart attack and understanding how the tiny blood vessels in the heart work. I would like to lead multicentre clinical trials in interventional and translation research, to help bridge the gap between research and what the findings mean in ‘real world’ settings.

My PhD, as supported by this Heart Foundation scholarship, will hopefully establish a strong, competitive track record for me to achieve this dream.

Do you have a message for Heart Foundation supporters?

Thank you to the Charles Coghlan Family and Heart Foundation donors and supporters for their incredible support! I am so honoured and humbled to help the Heart Foundation in its efforts to improve cardiovascular outcomes for all Australians. I look forward to sharing my research outcomes over the next few years.