Institute of Cellular Medicine

Staff Profile

Dr Steve Parry

Clinical Senior Lecturer/Consultant


Research Interests

1: Falls and Syncope

Falls and syncope are closely inter-related topics with enormous scope for high quality clinical and basic science research.

Ongoing research
• Intravenous Adenosine Testing in the Diagnosis of Unexplained Syncope
This is an exciting new field with huge potential, both in academic and clinical terms. My study is the first to comprehensively examine the possible indications for adenosine testing in the context of unexplained syncope, with the results being used to inform a large scale clinical trial. Funding for the pilot study was via a Special Trustees grant, and I am currently working with collaborators to develop the definitive randomised study for submission to the MRC for Trial Grant funding, incorporating substantial quality of life and health economic components. This study has enormous potential in terms of both grant generation and high impact factor publication because of its novelty and the poor quality and paucity of previous research.

• Home Orthostatic Training in Vasovagal Syncope: The HOT-VVS study
Orthostatic training is a promising treatment for vasovagal syncope. This study is the first randomised placebo-controlled attempt to examine the role of such training, and the first to examine cardiovascular and baroreflex changes accounting for symptomatic improvement; again, this pilot study will inform a larger study, with further funding applied for from the British Heart Foundation with the pilot results.

• The Role of Home Activity Monitoring in Falls Prevention
This project is being developed with the Vivatech Company marketing the Wristcare wrist-watch-like home activity monitor. Observational pilot data have shown a 70% reduction in fall rates using the device; I am in negotiations with the company on funding for a randomised, controlled study of Wristcare versus usual care in fallers presenting to the Accident and Emergency service. Additional funding will being sought from Research into Ageing.

• The Pathophysiology of Carotid Sinus Syndrome (CSS)
Surprisingly little is known of the pathophysiology of this common cause of falls and syncope. I am lead investigator on a study building on pilot work I did on cerebral autoregulation in CSS and I hope to unravel some of the reasons why patients with carotid sinus hypersensitivity change from the asymptomatic state to suffering falls and syncope. The study is examining cerebral autoregulation via transcranial Doppler studies in response to graded hypotension induced by lower body negative pressure, with the wider autonomic abnormalities in the disorder studied using MIBG scanning. Substantial funding for a two year fellowship has been approved recently by the Royal College of Physicians/Dunhill Trust and the Special Trustees.

• Early Implantable Loop Recorder (ILR) Investigation in the Management of Syncope in the Older Patient
The diagnosis of syncope in the older patient can be challenging, with investigations stretching over one to two years. The ILR is recommended by the European Society for Cardiology as the final investigation in the diagnosis of syncope, but I believe that early implantation of the ILR will provide a higher diagnostic yield much earlier. I propose to test this with a randomised trial of ILR use versus usual care and am currently developing this study for submission via the HTA open call route. A sub-study is planned in older patients with cognitive impairment, and again quality of life and health economic data will form vital components of the study.

2: Cognitive Impairment and the Neurocardiovascular Disorders

Following some interesting initial results from a large MRC study on the development of dementia following stroke, the MRC have funded a further 5 year study on this project (Prof R Kalaria, lead applicant). I have replaced Prof Kenny as clinical lead for the study, and am now involved as day to day study co-ordinator.

Future Research

While continuing a strong interest in clinical research in falls and syncope (with a multicentre treatment study in vasovagal syncope in the early stages of planning, as well as a comparison of provocative tilt studies), I am developing a stronger research strand in the pathophysiology of vasovagal syncope.

I was recently lead collaborator for Newcastle in a multi-centre study examining the role of implantable loop recorders in the diagnosis of unexplained syncope (ISSUE 2), and am co-investigator (with Dr M Reuber, University of Sheffield) on a project studying psychogenic syncope.

I have recently been asked to be a steering group member developing a randomised study of a novel pacing algorithm in the management of vasovagal syncope (led by Prof Richard Sutton, Hon Prof Clinical Cardiology at Imperial College, London).