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Luck of the draw: Allen pulls out the win in Manhattan Beach

Local study may keep more hearts beating

Arnie and JoAnn Johnson, right, join Dr. Eric Fenstad and Kristine Fortman, CEO of the Minneapolis Heart Institute Foundation, left, at the Brainerd Dispatch offices to talk about a new study on pulmonary hypertension to be conducted locally. Steve Kohls/Brainerd Dispatch

A local medical research study may soon yield new knowledge about a relatively unknown form of heart disease.

The Minneapolis Heart Institute's Baxter location will be the nexus of a planned research project tracking pulmonary hypertension. The disease is localized—elevated blood pressure in the vessels coming from the right side of the heart, which connect the lungs to fuel the process of breathing and oxygenating blood. A shrinkage in blood flow from hypertension gradually renders the heart pointless, because fresh oxygenated blood can't get to organs.

However, the symptoms are vague: shortness of breath, lightheadedness, chest tightness, or passing out. Even if a doctor already suspects a patient has hypertension, measuring blood pressure in a specific area of the circulatory system requires way more technology than a simple blood pressure cuff. It requires an ultrasound of the blood vessels so doctors can see how the blood is pumping, and then calculate pressure based on Bernoulli's equation (a fancy physics way of saying fluid slows down when the pressure in a tube goes up). If the numbers don't check out, the third step is sticking a catheter in that person's veins to gauge blood flow directly.

As a result, pulmonary hypertension is notoriously difficult to diagnose, and people often go years without knowing they have it.

The planned Baxter study aims to help fix that by identifying phenotypic nuances, or genetic markers, within the blood. If doctors know which markers are linked to the disease, they can diagnose it with the help of a blood test, without having to rely on external symptoms that could mean anything. It also may help doctors identify which body chemicals can be switched off to minimize the risk of developing the disease

The institute's Dr. Eric Fenstad has dedicated his career so far to fighting the disease, having already authored the largest American study of patients with pulmonary hypertension.

Thanks to a donation from Brainerd area couple Arnie and JoAnn Johnson, in addition to a pledge from them to match more donations up to $25,000, Fenstad now is on the way to receiving the resources he needs to pull the trigger on the new study.

"This donation is going to jump-start a research idea I've had for some time," he said.

Private donations are especially important in today's expensive medical research environment, when traditional sources like the National Institutes of Health and other government funds are limited, Fenstad said. The study will cost over $300,000.

The Johnsons have a special motivation to contribute money to fight pulmonary hypertension: JoAnn is one of the 50 or so people with the disease who take part in a support group at the Baxter Minneapolis Heart Institute location.

Johnson first realized something was wrong in the wake of two open-heart surgeries when she had trouble breathing, she said. She couldn't say enough how important the study was to the community.

"We believe in it so strongly," she said.

If the study is approved by regulators, Fenstad will start enrolling 50-100 study subjects in October, he said. The study calls for little effort—just a blood draw—so the local residents who have pulmonary hypertension will be excited to participate, Fenstad said. Most big studies take place in urban centers rather than rural areas, so his study will offer a unique glimpse, he said.

"Is pulmonary hypertension more common in rural areas, or does it have the same commonality compared to urban areas?" Fenstad said. "What we find from looking at different large pulmonary hypertension registries is that there's black holes ... where patients live, but we don't see pulmonary hypertension being diagnosed. And northern or central Minnesota is one of those black holes."

Treatment of hypertension depends on cost and which of the five types of pulmonary hypertension a patient is dealing with. In some cases, blood thinner medication helps lower pressure and increase flow to the lungs.

But the medication route can be iffy, as patients can have blood pressure that is too low in areas other than the vessels that have the pulmonary hypertension. They can also hyper-react to the blood thinner medication. So it's up to researchers like Fenstad to find out new ways to diagnose and treat the disease.

"You don't find too many doctors who will designate so much time, and get involved in research," JoAnn Johnson said.

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