Cognitive Outcome And Therapeutic Interventions For Coronary Artery Disease.
Funder
National Health and Medical Research Council
Funding Amount
$392,104.00
Summary
Dementia is recognized as an increasingly important factor affecting quality of life as people age. Deaths from heart disease are declining, in part due to improved surgical techniques and to the use of less invasive methods to keep arteries open such as coronary stenting. It is now well known that 20 to 60% of patients experience some degree of impairment in thinking ability (cognitive impairment) after cardiac surgery, that this will persist in some of these individuals for years and may incre ....Dementia is recognized as an increasingly important factor affecting quality of life as people age. Deaths from heart disease are declining, in part due to improved surgical techniques and to the use of less invasive methods to keep arteries open such as coronary stenting. It is now well known that 20 to 60% of patients experience some degree of impairment in thinking ability (cognitive impairment) after cardiac surgery, that this will persist in some of these individuals for years and may increase the risk of long-term problems. Cognitive impairment affects people in many ways. While it is not yet known whether the occurrence of cognitive impairment predisposes to dementia, it is thought that Mild Cognitive Impairment (MCI) may do so. We propose to explore the link between MCI and Post Procedural Cognitive Deficit (PPCD) in patients with coronary disease from before the first point of objective diagnosis, i.e. prior to the coronary angiogram, and over a 12-month period, through and subsequent to further treatment interventions such as stenting or cardiac surgery. Our Pilot data suggest that PPCD does indeed occur after angiography, and we propose to identify how long this lasts, whether MCI predisposes to it and whether it is better to wait until it resolves before further interventions are undertaken. In this way we hope to identify the safest treatment strategy for patients with coronary disease that will minimize the occurrence of Cognitive Deficit and possibly longer-term cognitive changes after investigation and treatment for their symptoms.Read moreRead less
Evaluation And Planning Of Coronary Revascularization Services.
Funder
National Health and Medical Research Council
Funding Amount
$591,527.00
Summary
This project concerns operations to unblock or bypass the coronary arteries that supply the muscle of the heart. The project has two parts. One is concerned with checking that changes in medical and surgical treatment of coronary artery disease have been followed by improvements in survival of affected patients. The second will use data on changes in the Australian population, changes in the frequency of heart disease and changes in treatments for heart disease to predict how many coronary opera ....This project concerns operations to unblock or bypass the coronary arteries that supply the muscle of the heart. The project has two parts. One is concerned with checking that changes in medical and surgical treatment of coronary artery disease have been followed by improvements in survival of affected patients. The second will use data on changes in the Australian population, changes in the frequency of heart disease and changes in treatments for heart disease to predict how many coronary operations will be needed in Australia over the next decade. This is a vital step in planning hospital services for patients with coronary disease.Read moreRead less
Microvascular Function And Outcome In Patients With Acute Coronary Syndromes
Funder
National Health and Medical Research Council
Funding Amount
$79,514.00
Summary
Damage to the small vessels of the heart is a hallmark of heart attacks. Furthermore, small vessel dysfunction (MVD) is associated with a worse prognosis even in the presence of an unblocked major coronary artery following a heart attack. Using novel invasive assessments, we aim to analyse the prevalence and clinical predictors of MVD, assess the impact of MVD on short and long-term outcome after heart attack and address the impact of new treatments on MVD and heart muscle recovery.
The Access Project - Assessment Of Coronary Artery Disease Using CT Effectively For Stable Symptoms
Funder
National Health and Medical Research Council
Funding Amount
$754,369.00
Summary
Invasive Coronary Angiography (ICA) provides x-ray visualisation of coronary disease (CAD) that is essential for coronary surgery/balloon angioplasty. However many patients undergo this procedure without requiring these therapies despite the associated severe complications. The ACCESS Project screens patients scheduled for ICA, identifying those unlikely to have CAD and referring them for non-invasive CT angiography. This strategy reduces procedure complications and result in major cost savings.
Studying Coronary Physiology Within Human Coronary Arteries Using Computational Fluid Dynamics
Funder
National Health and Medical Research Council
Funding Amount
$383,834.00
Summary
The aim of this project is to combine the recent technological advances within the individual fields of coronary physiology, three-dimensional coronary angiography, and computational fluid dynamics to develop a novel method to calculate realistic coronary blood flow. This technique will provide a simple and clinically applicable method to measure physiological parameters such as microcirculatory resistance and shear stress within _live� human coronary arteries.
In Vivo Evaluation Of Coronary Atheroma Burden And Its Association With Focal Coronary Endothelial Function
Funder
National Health and Medical Research Council
Funding Amount
$123,736.00
Summary
Heart attacks remain the leading cause of death in the western world. It has been recently identified that the burden of plaque buildup in the coronary arteries is a major predictor of future heart attacks. Furthermore, it also known that impaired relaxation within the coronary arteries also increases the future risk of heart attacks. The dynamic relationship between these two critical factors remains unknown and an understanding of this is important for predicting future heart attacks.
Effects Of Risk Factor Control On Atherosclerosis, Vasoreactivity And Cardiac Ischemia In Patients On Dialysis
Funder
National Health and Medical Research Council
Funding Amount
$212,126.00
Summary
End-stage renal failure is one of the commonest serious chronic diseases; in Australia, over 10,000 patients are in dialysis programs or have functioning transplants. The commonest cause of death in this patient group is coronary artery disease, and attempts are routinely made to identify patients with this problem, with the intent of controlling this risk by angioplasty or bypass surgery. Unfortunately, these procedures may be less effective than usual, because the process of artery narrowing i ....End-stage renal failure is one of the commonest serious chronic diseases; in Australia, over 10,000 patients are in dialysis programs or have functioning transplants. The commonest cause of death in this patient group is coronary artery disease, and attempts are routinely made to identify patients with this problem, with the intent of controlling this risk by angioplasty or bypass surgery. Unfortunately, these procedures may be less effective than usual, because the process of artery narrowing is more aggressive in patients with renal disease. Moreover, this process may cause patients with negative testing for coronary disease at one point in time to develop coronary problems over follow-up. In this study, we propose to use a standard stress testing protocol to stratify the risk of coronary events in a group of at risk patients on dialysis. Those at highest risk will undergo bypass surgery, while those at intermediate and low risk will be randomized to usual care, or an aggressive treatment of atheroma with cholesterol reduction, folic acid supplementation (aiming to normalize homocysteine), blood pressure and blood sugar control. The effects of this approach will be followed by examination of biochemical markers of atherosclerosis, and imaging of arterial thickness and reactivity (reflecting tests of structure and function of the vasculature). We will also assess of the progression or reduction of abnormal cardiac stress responses, and the occurence of events at follow-up. Finally, follow-up data will be used to compare the predictive value of the 2 stress testing protocols. The results of this study will enhance our understanding of the importance of the atherosclerotic process in renal patients, and move the management approach for coronary disease in renal failure toward active risk factor control and away from revascularization.Read moreRead less
Advancing The Epidemiology Of Coronary Heart Disease: Reliable Monitoring, Secondary Prevention And Future Projections
Funder
National Health and Medical Research Council
Funding Amount
$314,644.00
Summary
Coronary heart disease imposes a significant health care burden in Australia, and there have been major changes to the way in which this disease is diagnosed and treated. This project will develop a new method for accurate monitoring of the burden of coronary heart disease nationally, will assess the effectiveness of current drug treatments for people with coronary heart disease and estimate future rates of coronary heart disease in the whole population.