Translational Vascular Function Research Collaborative 

• Molecular Mechanisms of Coronary Artery Spasm: Coronary artery spasm is a well-recognised clinical entity although its molecular mechanisms remain unclear. This project will utilise physiologic and molecular techniques to identify mechanistic differences amongst patients with a propensity to coronary artery spasm.
• Mechanisms underlying Coronary Microvascular Dysfunction: The coronary slow flow phenomenon is a coronary microvascular disorder that was first clinically characterised by this research team. This project will further advance our understanding of the pathophysiologic mechanisms responsible for this disabling condition.
• Vasomotor dysfunction in Peripheral Artery Disease: Peripheral arterial disease typically involves obstructive atherosclerotic lesions of the large leg arteries although the role of the microcirculation is less clear. In this project the functional properties and molecular characteristics of the microcirculation in patients with peripheral artery disease will be investigated.

• Vasomotor Studies of Patients with Myocardial Infarction and Non-Obstructive Coronary Arteries: Approximately 5-10% of patients who experience a myocardial infarct do not have significant coronary artery disease, prompting the clinical question of what is the underlying mechanism? This study will utilise invasive and non-invasive clinical techniques to elucidate potential mechanisms that may be responsible for the myocardial infarct.
• Vasomotor Properties of the Popliteal Artery: The popliteal artery is a peripheral limb vessel that is readily imaged thereby allowing dynamic assessment of its function. This project will assess the presence of vasomotor dysfunction in this vessel amongst patients with peripheral artery disease, thereby providing insights into the underlying pathophysiological processes and potentially identifying novel therapeutic targets.
• Exercise Therapy for the Management of Non-Obstructive Coronary Artery Disease: Patients with non-obstructive coronary artery disease (NoCAD) suffer from frequent episodes of angina but show patent epicardial coronary arteries angiographically. These patients are unresponsive to conventional anti-anginal therapies so currently there are no effective clinically available treatments for symptoms of NoCAD. It is well documented that exercise therapy is effective in the prevention and management of many cardiovascular disease but has not yet been evaluated as an effective therapy for the management of NoCAD. This study aims to identify the clinical and pathophysiological impact of a supervised exercise program vs usual care in symptomatic patient with NoCAD.

Consistent with the changing environment in medical research, this group adopts a ‘patient- orientated’ approach to the delivery of medical care in patients with vascular disorders by:

1. evaluating patient health status in population studies and
2. assessing the quality of care delivered

The group have developed large databases in patients with acute myocardial infarction, coronary artery and microvascular disease, coronary spasm, and peripheral artery disease. Most of these databases have international links thereby providing collaborative opportunities.

• Improving Health Outcomes in Patients undergoing Coronary Angiography: Coronary angiography is the clinical benchmark technique in the assessment of coronary artery disease with more than 8,000 performed in South Australia each year. Despite its diagnostic benefits in identifying the presence of coronary disease, its benefit to the patient has been less rigorously studied and will be the focus of this project. Optimising the Quality of Care in Patients with ST Elevation Myocardial Infarction: ST Elevation Myocardial Infarction (STEMI) is a medical emergency for which effective therapies have been developed, although their implementation may need to be optimised. This project will identify treatment gaps in the management of STEMI and investigate potential system improvements.
• Coronary Angiogram Database of South Australia (CADOSA): The Coronary Angiogram Database of South Australia (CADOSA) Registry was established to provide a comprehensive data infrastructure of invasive coronary procedures in order to evaluate the delivery of quality health care thereby facilitating clinical improvement and supporting clinical coronary research. The Registry now contains over 18,000 records, representative of public hospital clinical practice in the management of coronary artery disease. This unique Registry is attracting both national and international acclaim and continues to pioneer new innovations in clinical registry structure and function.
• Assessment of Coronary artery disease using Computed tomography Effectively for Stable Symptoms (ACCESS): The ACCESS Project is a research study that endeavours to detect patients that are likely to have a normal coronary angiogram before they have the procedure and refer them for a new, less expensive and safer procedure called coronary CT angiography. This innovative study is an initiative of CALHN staff and has recently been awarded a prestigious NHMRC Partnership Project grant valued at $1.5 million, including contributions from CALHN and the Heart Foundation (SA Division). Utilising the innovative clinical and research resources within South Australia, we anticipate a major impact on cardiology practice with this project.
• Health Outcomes in Patients with Intermittent Claudication: Intermittent claudication is the primary symptom of peripheral artery disease. It is the painful cramping in your leg muscles triggered by physical activity such as walking or climbing stairs. The pain usually goes away 5-10 minutes when you rest your legs. [Claudication is a latin term that loosely translates to 'limping'; source: HealthDirect Australia]. This project will examine the disability associated with this symptom and its impact on quality of life.
• Myocardial infarction with non-obstructive coronary arteries (MINOCA): Myocardial infarction with non-obstructive coronary arteries (MINOCA) describes a heterogeneous subset of myocardial infarction (MI) or heart attack. In contrast to most of MI presentations where occluded coronary arteries observed, MINOCA patients are presented with symptoms suggestive of MI without occluded coronary arteries. MINOCA is associated to significant morbidity/mortality and conventional MI guideline therapy may not be appropriate for these patients since the underlying mechanism responsible for their apparent MI is unclear.  This project will prospectively evaluate patients with MINOCA in relation to their clinical characteristics, potential pathophysiological mechanisms, contemporary discharge therapies, 12-month ischemic outcomes and health status. Importantly, we aim to provide direction for future interventional studies that will optimise the management of these patients.
• The TIC (Ticagrelor In Coronary microvascular dysfunction) Program: Ticagrelor is one of several anti-platelet agents utilised in the management of acute coronary syndromes. Preliminary studies have also demonstrated that it can augment coronary blood flow by increasing adenosine levels, providing evidence for it pleiotropic effects beyond inhibition of platelet aggregation. The TIC (Ticagrelor In Coronary microvascular dysfunction) Program is a multi-centre 4-year research program that focuses on ticagrelor’s effect on the coronary microvasculature, particularly focussing on its potential clinical benefits in coronary microvascular dysfunction.