2003 Annual Report - Research Division

In 2003, the research division of the Minneapolis Heart Institute Foundation (MHIF) coordinated more than 100 studies in various areas of cardiovascular medicine. Highlights include:

Level One Heart Attack Program

The Level One Heart Attack program is a treatment protocol developed for Minnesota community hospitals that are transferring heart attack patients to Abbott Northwestern Hospital. Timothy Henry, MD, interventional cardiologist and director of research at MHIF, and David Larson, MD, of the Ridgeview Medical Center’s Emergency Department in Waconia, Minn., conceived the concept, which was organized and implemented by cardiac nurse Barbara Unger, RN. Because time is of the essence when treating heart attacks, the goal of the Level One protocol is to safely transfer patients requiring angioplasty in 90 minutes or less from the first medical contact at their local community hospital to the time the first balloon is inflated or stent placed in the patient at Abbott Northwestern Hospital. The protocol, the first of its kind in the United States, has had a major impact on the care of Minnesota patients and has attracted regional, national and international interest in replicating the program. This is an example of the innovative approach, backed by research, that cardiologists at Abbott Northwestern Hospital and MHIF practice.

Teamwork: starts with local EMS "911" and continues to Abbott Northwestern Hospital.

Peripheral Arterial Disease (PAD) Program

In 2003, the Foundation welcomed Alan Hirsch, MD as director of the Minneapolis Heart Institute’s Vascular Medicine Program and medical director of Abbott Northwestern’s newly created Vascular Center. Dr. Hirsch is also an associate professor of Epidemiology for the University of Minnesota’s Department of Public Health. His current research focuses on innovative treatments for peripheral arterial disease (such as poor leg circulation) and venous diseases (such as blockages in leg veins). PAD is a common condition associated with high risk of heart attack, stroke, death, and amputation. However, both health professionals and the public remain largely unaware of these risks. To help address this issue, Dr. Hirsch plans to establish a community-based PAD awareness, screening and treatment program.

Dr. Hirsch is the author of a position paper entitled “Mandate for Creation of a National Peripheral Arterial Disease Awareness Program” that was co-published in seven national and international vascular specialty journals. In the coming year, he will lead the effort to create such a program. He is also chair of the American Heart Association committee that is creating new national PAD care guidelines.

Hypertrophic Cardiomyopathy (HCM)

HCM is a genetic cardiac disease characterized by the thickening of the wall of the heart. It is responsible for the majority of deaths on the athletic field. In the January 23, 2003 issue of the New England Journal of Medicine, the Foundation’s Hypertrophic Cardiomyopathy Center published a landmark study documenting the significance of the left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. The effort was led by HCM Center director Barry Maron, MD, along with John Lesser, MD, and Sue Casey, RN. This is a particularly important observation because it shows for the first time that a well-known component of HCM, obstruction to blood flow from the left ventricle, has a profound adverse affect on the outcome of patients with this disease, often leading to progressive heart failure and cardiovascular death. The implication of the data is that strategies to reverse obstruction, such as surgery, have the potential to not only improve symptoms but to enhance long-term survival and quality of life.

The Sudden Death in Athletes Web site was also developed by the Hypertrophic Cardiomyopathy Center. This Internet-based system to gather information about sudden death in athletes gives the U.S. National Sudden Death in Athletes Registry a high-tech approach to research. In addition, the Web site is a resource on various topics related to sudden death in athletes. To learn more, please go to www.suddendeathathletes.org.

Interventional Cardiology

In 2003, the Foundation played a major role in landmark studies that documented the benefit of drug eluting stents for the treatment of coronary artery disease. MHIF continues to be involved in a number of important trials to further define the uses and benefits of these stents, which are designed to block excessive cell growth that can cause restenosis (renarrowing of the artery) after stent implantation.

Cardiologists Wesley Pedersen, MD and Robert Schwartz, MD also spearheaded a trial to investigate a new treatment option for elderly patients who have severe aortic stenosis (a hardening of the aortic valve that makes it difficult for blood to be pumped out of the heart), but who cannot or do not want to have open-heart aortic valve surgery. This less invasive approach uses radiation and balloon valvuloplasty to keep the aortic valve open and functioning.

OPTIMIST Program

The Foundation’s OPTIMIST (OPTions In Myocardial Ischemic Syndrome Therapies) program continued to grow. This program focuses on patients with chronic angina (chest pain) and complex coronary artery blockages that cannot be successfully treated with angioplasty or bypass surgery. The program tracks the natural history of these patients, as well as offers them treatment options such as angiogenesis (growing new blood vessels), and a spinal cord stimulator to decrease the angina pain. Timothy Henry, MD was the lead author of the VIVA trial published in Circulation that studied a growth factor in angiogenesis. Currently, there are three ongoing gene therapy trials. Trials using adult stem cells will take place in 2004.

Other Research

In addition to the research featured above, the Foundation has been active in the study of cardiovascular surgery devices and techniques, the treatment of congestive heart failure, pacemakers and defibrillators, imaging techniques in cardiovascular medicine and their place in clinical medicine and preventive cardiology. Cardiac surgeons at MHIF have played a major role in a key trial investigating gene therapy to prolong the life of bypass grafts. The Foundation also continues its support of important databases that track the natural history and treatments of various cardiovascular diseases.

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