They've seen it so many times, it's predictable. A patient is transported to the MUSC Chest Pain Center with a heart attack. He's caught in time. He's treated and released feeling fine only to be back in about six months with heart failure.

George Cooper IV, M.D., chief of cardiology at the Ralph H. Johnson VA Medical Center, and Michael Assey, M.D., director of the MUSC Cardiology Division, were discussing a recent case. The two embody a concept repeated time and again at MUSC: a close collaboration between researchers and clinicians with a single focus to their work—their patient.

Cooper explained that a heart attack usually leaves behind dead heart tissue. A portion of the heart just isn't working any more. To compensate, the healthy remaining heart cells enlarge and begin working harder to take up the slack, and the heart attack survivor feels fine.

But then, for some reason—and that's what Cooper has spent the past 15 years investigating -- this marvelous capacity of the heart to enlarge and compensate breaks down and begins to fail, the heart cells hypertrophy.

“We don't operate separate activities here,” Cooper said. “We don't separate our research from patient care and we don't separate MUSC from the VA. There is no artificial distinction here, and that creates a powerful synergism.”

It's that powerful synergism that has Cooper and his team on the threshold of understanding how a cell that valiantly enlarges to compensate the loss of another can ultimately become flaccid and fail. He wants to separate a healthy heart cell into an environment that will sustain it and then alter it with a gene thought to cause heart cells to hypertrophy. This would allow the mechanisms involved to be modeled and studied.

Assey notes that collaboration among clinicians and research scientists is part of a somewhat symbiotic relationship among doctors and scientists at MUSC.

“Over the years, income from clinical activities within the Division of Cardiology has been used to support the basic research efforts by clinicians and scientists, contributing significantly to these recent awards.” Two recently awarded cardiology research grants total more than $9 million.

Assey noted that proposed reductions in reimbursement for clinical activity threatens the mortar holding together clinical and research programs at U.S. academic medical centers. Without such support emanating from clinical activity of the Cardiology Division Faculty, equipment not funded by a restrictive grant from the NIH could never be purchased, or that young, promising investigator would not get a start as a biomedical research scientist.

“Dollars generated by clinical activity will no longer be able to make up the loss being felt by academic medical center research programs," Assey said. Those restrictive federal grants can cover only so much, he explained. The rest must depend on philanthropy.

The very structure of the Gazes Cardiac Research Institute underscores the collaboration between clinicians and basic researchers within the cardiology division. The basic research on the simplest unit of the heart (the cell) is going on on the second floor, and patients with congestive heart failure are seen on the first floor as they participate in clinical trials on congestive heart failure.

Principal investigators for these trials include clinician scientists within the Cardiology Division, under the general direction of Grady Hendrix, M.D., director of MUSC Cardiology Clinical Trials.

In addition, MUSC operates a multi-disciplinary congestive heart failure clinic, made up of physicians, nurse practitioners, nurses, pharmacists, and social workers. The program, directed by Adrian Van Bakel, M.D., provides optimal, cost-effective care for patients with advanced heart failure, which reduces the need for recurrent hospitalizations.

Patients in MUSC's Heart Center and at the VA Medical Center Cardiology Unit know that heart specialists treating them are never more than a few floors to a few city blocks away from world class biomedical investigators focusing on their specific problem.

“That's true throughout the university,” Assey said. “It is an integration of physicians and scientists that is rarely seen in other academic medical centers.”

Physician scientists working in the Cardiology Division collaborate with other scientists throughout the campus working in the area of congestive heart failure and other areas of basic cardiovascular research. This collaboration strengthens the total research efforts of the university, making all of the investigators more competitive for federal research grants.

Patient-focused research lands 2 big cardiology grants

Researchers in the MUSC Cardiology Division have received two large grants to continue their long-standing research into the causes of congestive heart failure.

George Cooper, IV, M.D., principal investigator for the grants and chief of cardiology at the Ralph H. Johnson VA Medical Center, emphasized that "this research is about our patients" underscoring the close cooperation between MUSC clinical cardiologists and basic researchers in the success of the Heart Failure Research Program.

The first of these awards is a five-year renewal of an National Institutes of Health (NIH) Program Project Grant, supporting a major portion of the Gazes Cardiac Research Institute's basic research on the molecular changes which precipitate heart failure. Co-investigators include Blase Carabello, M.D., Michael Zile, M.D., Donald Menick, Ph.D., Paul McDermott, Ph.D., Dan Kuppuswamy, Ph.D., and Terry O'Brien, M.D.

The second award is a five-year award from the Department of Veterans Affairs, which supports the training of basic clinical scientists who work in the area of heart failure. This VA grant is the only such award made to a Cardiology Division in nationwide competition.