Research 3 A Life-Threatening Gender Gap
Technology 4 Joining Forces to Treat PAH
A Safer Route to the Heart Seeing Hearts More Clearly
Harvey Continues To Change Caring For The Heart ®
C ardiac C rusaders
Since 2007, Samuel Dudley, MD, PhD has parlayed his knowledge into the most ambitious and comprehensive cardiac translational research program in the city. by Susan Reich When you’re battling the number one killer of men and women in the United States—lost time can mean lost lives. This sobering truth is never far from the mind of Samuel Dudley, MD, PhD, professor and chief of UI Cardiology. Dudley and his researchers are waging a war against heart disease—a war that begins at the molecular level and culminates in cutting-edge clinical care. They are racing against the clock as they collaborate on the development of advanced treatments for cardiovascular disease—a killer that claims the lives of nearly 40,000 Illinois residents each year. Dudley and his team are at the forefront of a new paradigm in medical science known as “translational research.” By breaking down the barriers that have traditionally existed
between basic and clinical research and fostering collaboration between the two disciplines, translational research has the potential to accelerate the development of lifesaving treatments for patients in need. Dudley is uniquely equipped to bridge the divide between laboratory bench and patient’s bedside. A pioneering proponent and practitioner of translational research— and the only chief of cardiology in the city of Chicago who continues to conduct investigations at the laboratory level—he knows exactly what it takes to shepherd a scientific breakthrough from single molecule physics through human clinical trials. “What distinguishes us from other centers for cardiac medicine in Chicago is our ability to go from single molecule drug design to human clinical trials all in one place,” he notes. “That’s true translational research. We are the only section of cardiology in the academic medical centers in Chicago that
The Cath Lab at the University of Illinois Hospital & Health Sciences System Cardiology
can do this. That’s the whole idea behind our Center for Cardiovascular Research, which brings together basic and clinical science. Currently, we have seven basic scientists and 14 clinical scientists engaged in intensive translational research projects that combine molecular science, basic population epidemiology, cardiac imaging and advanced therapeutics to generate new discoveries that will benefit patients. This collaboration between our basic and clinical scientists is what sets us apart and makes our program truly unique.” Dozens of potentially lifesaving cardiac therapies are currently in the translational pipeline—including the development of new continued on page 6
Our motto is superior science for paramount patient care. UI Cardiologists help shape the future of excellence in cardiovascular medicine, spearheading innovative research and advancing new and less invasive medical techniques.
Cardiology Faculty Section Chief and Professor Samuel C. Dudley, MD, PhD
CHIEF, CLINICAL CARDIOLOGY AND PROFESSOR George T. Kondos, MD
Boaz Avitall, MD, PhD Leon Frazin, MD
UI Cardiology has played a central role in the history of the University of Illinois Hospital & Health Sciences System. In the late 1970s, the section came to national prominence for its contributions to the emerging area of clinical electrophysiology. The section subsequently established its coronary calcium-screening program, one of the oldest and best-regarded programs of its kind in the country. Since the late 1990s, the section again has gained nationwide recognition, this time for its research efforts in mechanisms and treatment of heart failure. Currently, we are developing new blood tests for diastolic (relaxation) heart failure, sudden cardiac death, and atrial fibrillation. We have developed and will be testing new treatments for diastolic heart failure and to prevent sudden cardiac death. UI Cardiology's commitment to shaping the future of cardiac patient care is reflected in our intensive research environment, which includes more than 15 laboratories focused on defining cures for cardiovascular diseases. Major research funding for the UI Cardiology and the Center for Cardiovascular Research includes more than $10 million in annual National Institutes of Health support, including a collaborative program project and training grants in conjunction with the UIC Department of Physiology. The UI Cardiology Program has ranked in the Chicago area in NIH funding and either first or second for American Heart Association funding each of the past ten years. We take great pride in our training programs, which attract the worldâ€™s finest applicants and have established the careers of many past and present leaders in cardiac medicine. We provide unique educational, research, career development, and research experiences for our students, faculty, and patients within Chicago and the country. We have an NIH sponsored clinician scientist tract that allows trainees to spend at least two years dedicated to their research. We are committed to offering the safest, most compassionate and most effective clinical care to optimize patient outcomes. Our physicians are trained to treat a wide range of cardiac conditions, and many have focused their training and expertise in a particular cardiac specialty. Treating a high volume of patients has given them extensive medical experience to complement their thoughtful and technically outstanding services. Our catheterization group has pioneered access using a blood vessel in the wrist, making catheterization safer and recovery quicker. It is an honor and pleasure to lead UI Cardiology. Please enjoy our inaugural edition of Heart Beats.
Joan Briller, MD, FACC Robert Danziger, MD Tohru Fukai, MD, PhD Jalees Rehman, MD Adhir Shroff, MD, MPH, FACC, FSCAI Thomas Stamos, MD Beata Wolska, PhD
Kathrin Banach, PhD Nitin Barman, MD Marcelo Bonini, PhD Ankit Desai, MD Afshin Farzaneh-Far, MD, PhD David Geenen, PhD Mayank Kansal, MD Melissa Robinson, MD Mladen Vidovich, MD, FACC, FSCAI Chief of Cardiology, Jesse Brown VA Hospital
Cardiovascular Program for Women Joan Briller, MD, FACC, FASE Cardiac Catheterization Laboratory Adhir Shroff, MD, MPH, FACC, FSCAI Cardiac Magnetic Resonance Imaging Afshin Farzaneh-Far, MD, PhD Cardiovascular Disease Fellowship Program Thomas Stamos, MD Clinical Trials Program Mladen Vidovich, MD, FACC, FSCAI Heart Center George T. Kondos, MD Interventional Cardiology Fellowship Program Adhir Shroff, MD, MPH, FACC, FSCAI
Samuel C. Dudley, MD, PhD
Professor and Chief of UI Cardiology
UI Center for Outcomes Research and Education Mladen Vidovich, MD, FACC, FSCAI
A L ife -T hreatening G ender G ap
Heart disease is the leading killer of women in the U.S., yet research shows that women often receive inferior cardiovascular care. by Susan Reich Women hospitalized for heart attacks are less likely to receive recommended treatments than men—and women suffering from the most serious form of heart attacks, known as STEMIs, are more likely to die while hospitalized than men. Joan Briller, MD, associate professor of medicine and director of the Heart Disease in Women Program at the University of Illinois Hospital & Health Sciences System is working to close this life-threatening gender gap. “When I was training in cardiology, physicians didn’t recognize that women got heart disease,” Briller explains. “We now know that almost one in two women will develop heart disease in their lifetime—and more women will die from some form of cardiovascular disease each year than men.”
disease in women may be preventable. “If we can identify early predictors of heart disease in women and intervene earlier,” she adds, “we will have a much better chance of preventing heart disease from developing in these patients down the road.” Briller’s program, established in 2001, is the most comprehensive of its kind in the city. It provides state-of-the-art cardiac screening, prevention and therapy services, as well as specialized care for pregnant women with heart disease. The program has a research component as well. A number of studies are underway, including a ground breaking initiative on pregnancy and heart disease—a research focus of Briller’s.
“For reasons we don’t completely understand,” says Briller, “some women develop peripartum cardiomyopathy, or heart failure, during or soon after pregnancy. The University of Illinois Hospital & Health Sciences System has joined forces with 30 research institutions across the country to study the connection between pregnancy and heart disease. The data that we gather will hopefully help us find a way to treat this form of heart disease, which is the only cause of maternal mortality that is increasing.”
To compound the problem, says Briller, “the way that plaque forms in the arteries is different in women and the risk factors behave a little bit differently. Multiple studies have given us a much better idea of how to treat heart disease in women and what puts women at risk. We now believe that up to 80 percent of heart
UI Cardiology Contribution
Your gift to UI Cardiology provides education, research and patient care services that would otherwise be unavailable. Your generosity allows us to fund chair and professorship endowments that are used to recruit and retain high quality faculty; fellowship endowments used to benefit residents; research funds to augment faculty research activities; program support to supplement student educational activities; funding for laboratories and facilities; and unrestricted funding to support the highest financial priorities identified by the section chief. To make a contribution to UI Cardiology, please contact David Eaton in our Office of Medical Advancement at 312.335.0475 or visit: email@example.com.
Heart Beats 3
J oining F orces to T reat P ulmonary A rterial H ypertension
UI Cardiology and UI Pulmonary have established a comprehensive care program for patients with Pulmonary Arterial Hypertension (PAH). The Pulmonary Hypertension Clinic at the University of Illinois Hospital & Health Sciences System is a multidisciplinary program caring for patients with pulmonary arterial hypertension (PAH), an abnormally high blood pressure in the arteries of the lungs. As PAH is characterized by both lung disease and right heart failure, a partnership between UI Cardiology and UI Pulmonary, Critical Care, Sleep an Allergy has been established to foster a comprehensive care program for patients with PAH. Ankit A. Desai, MD, instructor of medicine in UI Cardiology, and Roberto F. Machado, MD, associate professor in UI Pulmonary, actively participate in the PAH clinic and in the inpatient setting. Desai is an expert in PAH who was trained at the University of Chicago under international PH leaders such as Stuart Rich, MD. Machado, formerly at the University of Chicago, is a recognized leader in PAH. He was trained at the Cleveland Clinic as well as the NIH and has over ten years of experience caring for patients with PAH.
The team approach of care is comprised of dedicated PAH doctors (both in the clinic and catheterization lab), specially trained PAH pharmacists and nurses, leaders in PAH research and additional support staff. “This multidisciplinary team provides education and continuous support for patients and families,” says Desai. “We are able to provide state-of-the-art and advanced PAH therapies for these patients.” UI Hospital also offers the latest in diagnostic testing available for patients with PAH including high resolution cardiac CT, an advanced 3 Tesla cardiac MRI, and 3D echocardiography. Unique to the UI Hospital program is the fact that the majority of right heart catheterizations that are used to define PAH are performed using a brachial (arm) approach during the initial diagnostic and follow-up testing. “This allows us to provide the greatest comfort possible to patients,” says Desai.
Ankit A. Desai, MD, Instructor of Medicine in UI Cardiology
Additionally, the Pulmonary Hypertension Clinic is dedicated to the concept of personalized care; all patients will have the opportunity to undergo the latest in genetic and genomic testing. Desai notes that “it is important to define their individual disease to receive the optimal response to therapy.”
All patients will have the opportunity to participate in clinical research trials, which tests the most promising therapies.
UI Cardiology Referral
If you are a physician and would like to refer a patient, please contact the UI Cardiology office at 312-996-6730.
If you are patient and would like to make an appointment with any of our physicians, please contact our Referral Center during regular business hours at 866-600-CARE.
For more information visit http://hospital.uillinois.edu.
A S afer R oute
The standard treatment for diagnosing arterial blockages and clearing blocked arteries involves threading a catheter through the femoral artery in the groin. But the procedure can cause complications such as bleeding in two to nine percent of patients. Patients must lie still for up to six hours after the procedure—a hardship for elderly patients with back problems—and walking can be uncomfortable for days. The University of Illinois Hospital & Health Sciences System cardiologists are among the first in Chicago to offer a safer, more patient-friendly alternative. The new technique, called transradial angiography, involves threading a catheter through the small radial artery in the wrist rather than the larger femoral artery in the groin. “It’s a simple change that has a dramatic impact on the experience and recovery of the patient,” say Adhir Shroff, MD, MPH, FACC, FSCAI, associate professor in UI Cardiology. “Patients who have the procedure done via the wrist can immediately sit up, eat and walk without pain. The transradial approach can also reduce bleeding, the most common complication, particularly among women and the elderly, to less than one percent.”
S eeing H earts M ore C learly Cardiac magnetic resonance (CMR) imaging is a new diagnostic procedure that uses a large magnet to produce extraordinarily detailed moving images of the heart and blood vessels. It is a safe, non-invasive procedure that does not use radiation or iodine based contrast agents, which are typically required in other imaging tests. Use of magnetic resonance imaging in the field of cardiology is evolving at a rapid pace. However, most hospitals in the United States are currently unable to offer this unique technology due to a very limited number of experts in this new field. Fortunately for the patients at University of Illinois Hospital & Health Sciences System, this is not the case. The CMR program was established in 2010 under the direction of Afshin Farzaneh-Far MD, PhD, assistant professor of medicine. Farzaneh-Far was recruited to UI Cardiology from the Duke Cardiovascular Magnetic Resonance Center, which is the largest and preeminent CMR program in the world. Having been involved in imaging thousands of patients over a four year period at both UI Hospital and Duke, Farzaneh-Far brings extensive experience and expertise in CMR.
cardiovascular scanners and is situated immediately adjacent to the hospital and its outpatient clinics. The Advanced Imaging Center houses a 3T Philips cardiovascular MRI scanner and is situated across the University of Illinois campus, approximately 10 minutes walking distance from the main hospital. Two further state-of-the-art GE 3T scanners will be available for use later in the year. Within a year of its inception, the CMR program at UI Hospital has undergone tremendous growth and is already one of the highest volume centers in the entire region. Based on experiences at other leading centers in the U.S. and Europe, Farzaneh-Far envisions that the CMR stress testing program in particular will undergo exponential growth over the next few years. “The accuracy paired with the ability to provide a vast array of information about the structure and condition of the heart, all in just 45 minutes, makes CMR imaging an excellent testing procedure to offer our patients.” Afshin Farzaneh-Far MD, PhD, Assistant Professor of Medicine
To date, CMR is the most sophisticated and accurate form of cardiac imaging developed to identify and characterize abnormalities of heart muscle and blood flow. “CMR allows safe, non-invasive diagnosis of many heart conditions which were previously impossible to identify during life or required very invasive procedures to do so,” says Farzaneh-Far. “Moreover, one of the most exciting applications of CMR is ‘stress testing’ which has now evolved to be probably the most accurate form of stress testing yet developed.” The CMR program at UI Hospital encompasses two cardiovascular scanning facilities. The Outpatient Care Center houses two 1.5T GE
Cardiac Crusaders continued from page 1
therapies to prevent diastolic heart failure, which affects half of all people with heart disease in the U.S.
UI Cardiology Participates in AHA Heart Walk
“Although there are many therapies for systolic heart failure, there are currently no FDA-approved therapies for diastolic heart failure,” Dudley points out. “Our team has developed four potential therapies for diastolic heart failure that will be going to human trials in the near future.”
On September 23rd members of the University of Illinois Health & Sciences System participated in the AHA Heart Walk to show concern and commitment for cardiac disease awareness. Together, 15 teams raised over $40,000 and UI Hospital placed 9th out of 132 competing companies.
The impact of these new therapies could be profound. “Approximately 2.5 million Americans suffer from diastolic heart failure,” Dudley notes. “If these drugs fulfill their potential, we may, for the first time, be able to control and in some cases even reverse or prevent—diastolic heart failure, rather than just masking the symptoms.”
Combined, UI Cardiology receives more than $1 million in research dollars each year from the American Heart Association. These awards have helped many of our physicians start and grow in our careers. Moreover, the AHA helps UI Cardiology with quality guidelines and organizing things like Mission Lifeline, a program to identify cardiac centers of excellence.
Clinical trials are also underway on a blood test to predict sudden death risk in patients with heart failure. “Heart failure affects more than five million Americans and increases the risk of sudden death,” says Dudley. “The gold standard to prevent this sudden death risk is the use of an implanted cardiac defibrillator (ICD), a device that involves a costly surgery that puts the patient at risk for multiple complications such as major bleeding, pneumothorax, perforation of the heart, arrhythmia induction, stroke, heart attack and death. ICDs are highly effective, yet 70 percent of the patients who receive these defibrillators never need them. Meanwhile, there are about 200,000 people who die suddenly each year whose lives could have been saved by an ICD. “Right now, there is no blood test to assess sudden death risk in patients,” he continues, “and the current predictive technology is expensive, time-consuming, difficult, invasive and not particularly effective. We are in the process of developing a proprietary blood test to predict arrhythmic risk in heart failure patients. This test—if successful—will enable us to determine which of the more than 550,00 patients who are diagnosed with heart failure each year could benefit from an ICD. This blood test would prevent unnecessary ICD implants, a measure that would save approximately $150 million in healthcare costs annually, and help us determine when an ICD could potentially save lives.” The test, which measures sodium current levels, may do more than predict sudden death risk: it may also enable physicians to prevent sudden death in patients with structural heart disease by regulating sodium channel levels with channel-blocking antiarrhythmic drugs. Dudley has established a medical diagnostics company to confirm the blood test’s efficacy in Phase II multi-site trials and, if the test fulfills its promise, develop a product prototype for commercial distribution. Preliminary data from the clinical trials suggests that the blood test is performing well. If all goes according to plan, this lifesaving cardiac intervention could get green-lighted by the FDA within the next two years.
H arvey ® C ontinues F or T he H eart Recently Michael S. Gordon ’59, MD ’61, director of the Gordon Center for Research in Medical Education at the University of Miami, donated $20,000 in support of Dr. George Kondos at the Cardiovascular Teaching Center (CTC) in UI Cardiology. The CTC is a state-of-the-art teaching, simulation and learning center that has provided hands on experience for over 2,000 medical students, residents and cardiology fellows since it was established in 1991. The CTC ensures that our trainees are well versed with respect to the cardiovascular physical exam.
The focal point of the CTC is a Cardiopulmonary Patient Simulator (CPS) named Harvey®. Harvey® was developed by Dr. Gordon and is the namesake of his mentor W. Proctor Harvey, from George Washington University, who was a world recognized master clinician. Harvey® is able to simulate 30 different cardiovascular diseases, including variations in blood pressure, jugular venous pulses, carotid pulses, peripheral arterial pulses, and precordial impulses. In addition, cardiac and pulmonary auscultation in all of
Intermediate Lesion Assessment Workshop
6th Transradial Angiography and Intervention Workshop February 2012
Dr. Adhir Shroff and Dr. Mladen Vidovich hosted their first Intermediate Lesion Assessment Workshop on November 2nd, 2011. This one-day course was attended by interventional cardiologists, nurses and cath lab personnel. The primary focus of this course is instruction in the use of FFR (Fraction Flow Reserve) and OCT (Optical Coherence Tomography). OCT and FFR are cutting-edge technologies both available at UI Hospital and Jesse Brown VA and routinely used in daily clinical practice to improve patient outcomes and deliver state-of-the-art care. Attendees of the course earned 7.0 AMA PRA Category 1 Credit(s)TM.
Percutaneous Cardiac Assist Device Workshops On December 7, 2011, Drs. Adhir Shroff and Mladen Vidovich will hold their 4th Percutaneous Cardiac Assist Device Workshop. This one-day workshop was designed to educate interventional cardiologists regarding the use of a Percutaneous Cardiac Assist Device (PCAD) during high-risk coronary interventions and for patients in cardiogenic shock. The PCAD is a relatively new heart pump which aids interventional cardiologists in successfully treating high risk patients who need coronary revascularization but who are not candidates for bypass surgery. The physicians who successfully completed this course received 7.0 AMA PRA Category 1 Credit(s) TM. Nurses will receive 3.5 CNE credits and technicians will receive 3.0 ASRT CE credits.
Drs. Adhir Shroff and Mladen Vidovich will hold their 6th Transradial Angiography and Intervention Workshop. This oneday workshop is designed to educate interventional cardiologists, nurses, cath lab personnel and hospital administrators about the use of the transradial approach for cardiac catheterization. The approach involves much less risk and offers a more comfortable method to perform heart catheterization. It is widely practiced in other parts of the world. The physicians who successfully completed this course received 7.0 AMA PRA Category 1 Credit(s)™ Nurses will receive 3.5 CNE credits and technicians will receive 3.0 ASRT CE credits.
Dr. Adhir Shroff
Dr. Mladen Vidovich
Percutaneous Cardiac Assist Device Workshop March 14th, 2012 For more information about any of our courses, please contact Lisa Stigger at firstname.lastname@example.org or 312.996.9086.
T o C hange C aring the auscultatory areas of the chest may be heard. Various normal and abnormal cardiovascular and pulmonary findings, which vary with respiration, may also be simulated. The CTC moreover houses numerous cardiovascular simulation and training DVDs as well as three new EKG training programs and also serves seasoned clinicians to review their physical exam skills. Dr. Gordon’s generous contribution has allowed for several renovations and the purchase of updated and new cardiovascular teaching programs. An additional offering to all the trainees is the direct access to one of the program creators, George T. Kondos, MD, professor of medicine, chief, UI Clinical Cardiology, and acting chairman of medicine. Dr. Kondos is part of the University of Miami Cardiology Consortium and has worked alongside Dr. Gordon to help develop various educational programs. The CTC was one of first cardiology simulation centers in the Midwest, and without the generous support of Dr. Gordon the CTC would not have been possible. One of Kondos’ favorite quotes from Frances W. Peabody,
Dr. George T. Kondos and his students in the Cardiovascular Teaching Center at the University of Illinois Hospital & Health Sciences Systems
MD is, “...for the secret in the care of the patient is in caring for the patient.” Thanks to Dr. Gordon the Cardiovascular Teaching Center will continue to train countless numbers of medical students, residents, cardiology fellows and other health care providers.
Heart Beats 7
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Our motto in UI Cardiology at the University of Illinois Hospital & Health Sciences System is superior science for paramount patient care. Our cardiologists help shape the future of excellence in cardiovascular medicine, spearheading innovative research and advancing new and less invasive medical techniques. Questions or Comments?
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If you are a physician and would like to refer a patient, contact 312-996-6730. If you are patient and would like to make an appointment with any of our physicians, please contact 866-600-CARE.