Pathogenesis and Prognostic Significance of Cardiac Hypertrophy.
Key Faculty: Richard B. Devereux, MD (Professor), Peter Okin, MD (Professor), Craig Basson, MD (Professor)

In this area of research, we relate potential pathogenetic stimuli to echocardiographic and electrocardiographic measures of left ventricular (LV) hypertrophy and examine the relation of indices of LVH and of the regression of LVH to fatal and non-fatal outcomes using a variety of analytical strategies. This line of investigation utilizes data from nearly 24,000 adults in a variety of population-based and clinical samples.

Selected References

Devereux RB, Bella JN, Palmieri V, Oberman A, Kitzman DW, Hopkins PN, Rao DC, Morgan D, Paranicas M, Fishman D, Arnett DK: Left ventricular systolic dysfunction in a bi-racial sample of hypertensive adults: The HyperGEN Study. Hypertension. 2001;38:417-423.

Devereux RB, Wachtell K, Gerdts E, Boman K, Nieminen MS, Papademetriou V, Rokkedal J, Snapinn SM, Aurup P, Dahl–f B: Prognostic significance of left ventricular mass change during treatment of hypertension: The LIFE study JAMA. 2004;292:2350-2356.

Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS, Snapinn S, Harris KE, Aurup P, Edelman JM, Wedel H, Lindholm LH, Dahlof B, for the LIFE Study Investigators: Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events: The LIFE Study. JAMA. 2004;292:2343-2349.

Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS, Snapinn S, Harris KE, Aurup P, Edelman JM, Dahl–f B: Regression of electrocardiographic left ventricular hypertrophy by losartan versus atenolol: The LIFE Study. Circulation. 2003;108:684-690.

Okin PM, Devereux RB, Nieminen MS, Jern S, Oikarinen L, Viitasalo M, Toivonen L, Kjeldsen SE, Julius S, Snapinn S, Dahl–f B: Electrocardiographic strain pattern and prediction of cardiovascular morbidity and mortality in hypertensive patients. Hypertension. 2004;44:48-54.

Bella J, Devereux RB, Basson CT. Epidemiology of Cardiac Hypertrophy and Failure. In: Molecular Mechanisms for Cardiac Hypertrophy and Failure (ed. R. Walsh), 2005, in press.

Cardiovascular Effects of Obesity, Diabetes and Metabolic Abnormalities.
Key Faculty: Richard B. Devereux, MD (Professor)

In this area of research, we examine the effects of obesity, diabetes and a spectrum of metabolic abnormalities to echocardiographic and carotid ultrasonic indices of abnormal cardiac and arterial structure and function using a variety of analytical strategies. This line of investigation utilizes data from nearly 24,000 adults in a variety of population-based and clinical samples.

Selected References

Devereux RB, Roman MJ, Paranicas M, O'Grady MJ, Lee ET, Welty TK, Fabsitz RR, Robbins D, Rhoades ER, Howard BV: Impact of diabetes on cardiac structure and function: The Strong Heart Study. Circulation. 2000;101:2271-2276.

Liu JE, Palmieri V, Roman MJ, Bella JN, Fabsitz R, Howard BV, Welty TK, Lee ET, Devereux RB: The impact of diabetes mellitus on left ventricular filling pattern in normotensive and hypertensive adults: The Strong Heart Study. J Am Coll Cardiol. 2001;1943-1949.

de Simone G, Wachtell K, Palmieri V, Hille DA, Beevers G, Dahlof B, de Faire U, Fyhrquist F, Ibsen H, Julius S, Kjeldsen SE, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Devereux RB: Body build and risk of cardiovascular events in hypertension: The LIFE study. Circulation 2005;111:1924-1931

Psychosocial Aspects of Ischemic Heart Disease.
Key Faculty: Stephen Scheidt, MD (Professor)

Determinants of MI Onset Study is now finished. Some analogous work in case-control studies of depression, anxiety, other potential triggers of ventricular arrhythmias and ICD discharges. Role of psychosocial factors, particularly depression, has become well accepted in clinical cardiology over the past few years, although clinical trials, whether psychosocial interventions or with pharmacotherapy, have been disappointing to date.

Selected References

Allan R, Scheidt S. Cardiac psychology: psychosocial factors. In: Clinical Trials in Heart Disease: A Companion to Braunwald's Heart Disease, second edition. Manson JE, Buring JE, Ridker PM, Gaziano JM, Eds. Elsevier Saunders, Philadelphia PA, 2004: pp 386-398.

Allan R, Scheidt S. Cardiac psychology/behavioral cardiology: Psychosocial factors and heart disease. In: Atlas of Cardiovascular Risk Factors: A Companion to Braunwald's Heart Disease. Manson JE, Buring JE, Ridker PM, Gaziano JM, Eds. 2005. In press.

Progress in Cardiac Rehabilitation.
Key Faculty: Paul Kligfield, MD (Professor)

The Cardiac Health Center offers comprehensive cardiac rehabilitation for patients with a variety of heart disorders. Trainees and medical students make use of the physiologic data recorded during these sessions to investigate correlates of functional improvement in men and women of all ages.

Selected References

Hao SC, Chai A, Kligfield P. Heart rate recovery response to symptom-limited exercise after cardiac rehabilitation in patients with coronary disease with and without recent events. American Journal of Cardiology. 2002;90:763-765

Kligfield P, McCormick A, Chai A, Jacobson A, Feuerstadt P, Hao SC. Effect of age and sex on heart tate recovery after submaximal exercise during cardiac rehabilitation in patients with angina pectoris, after acute myocardial infarction, or after coronary bypass surgery. American Journal of Cardiology 2003;92:601-603

Chai A, Feuerstadt P, Kligfield P. Incremental improvement in submaximal effort capacity during the third month of cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation. in press (July 2005).

Cardiac Stem Cell Biology.
Key Faculty: Jay M. Edelberg, MD, PhD (Associate Professor), Craig Basson, MD, PhD (Professor)

Our present research program aims to develop the potential adult stem cells for cardiovascular regeneration as a means of improving endogenous cardiac repair mechanisms.

Selected References

Edelberg JM, Tang L, Hattori K, Lyden D, Rafii S. Young adult bone marrow-derived endothelial precursor cells restore aging-impaired cardiac angiogenic function. Circulation Research. 2002; 90:e89-93.

Xaymardan M, Tang L, Zagreda,L Pallante B, Zheng J, Chazen JL, Chin A, Duignan I, Nahirney P, Rafii S, Mikawa T, Edelberg JM. Platelet-derived growth factor-AB promotes the generation of adult bone marrow-derived cardiac myocytes. Circulation Research. 2004; 94:e39-e45.

Shmelkov SV, Meeus S, Moussazadeh N, Kermani P, Rashbaum WK, Hanson MA, Lane WJ, St. Clair R, Walsh KA, Dias S, Jacobson JT, Hempstead BL, Edelberg JM, Rafii S. Cytokine preconditioning promotes co-differentiation of human fetal liver CD133+ stem cells into angiomyogenic tissue. Circulation. 2005;111: 1175-1183

Fraidenraich D, Stillwell E, Wilkes D, Manova K, Basson CT, Benezra R. Rescue of congenital cardiac malformations in Id knockout embryos by early injection of small numbers of embryonic stem cells. Science. 2004;306:1-6.

Optimal Treatment Strategy of Acute Myocardial Infarction.
Key Faculty: Mun K. Hong, MD (Associate Professor), Manish Parikh, MD (Associate Professor)

I have been trying to address the topic both in the animal lab and in clinical practice. Both areas involve research fellows and clinical fellows in the cath lab. The first reference included one of our former clinical fellows, Dr. Eric Chou. The latter two references involved research fellows in the animal lab. In addition, I am collaborating with other faculty members, including Dr. Hazel Szeto from pharmacology and Dr. Aaron Marcus from hematology for ongoing projects in the animal lab. I have plans to collaborate with Dr. Mushlin and his group for a clinical project in the cath lab.

Selected References

Chou ET, Minutello RM, Parikh M, Bergman G, Wong SC, Hong MK. Can we identify vulnerable patients at risk for ST-segment elevation myocardial infarction based on their clinical characteristics? Coron Artery Dis. 2004;15:467-469.

Song WH, Shin JH, Lee JU, Kim HJ, Oh DJ, Edelberg JM, Wong SC, Szeto H, Hong MK. A potent opiate agonist protects against myocardial stunning during myocardial ischemia and reperfusion in rats. Coron Artery Dis (in press).

Kim HJ, Lee JU, Song WH, Shin JH, Oh DJ, Harrison K, Jakkula M, Wong SC, Hong MK. Feasibility and safety of regional myocardial hypothermia during myocardial ischemia and infarction in pigs. Coron Artery Dis. 2005;16:125-129.

Quantifying Exercise Tolerance Using Cardiopulmonary Exercise Testing.
Key Faculty: Maryjane Farr, MD (Assistant Professor)

We are involved in a protocol evaluating the differential exercise tolerance in patients who are chronically paced from the right ventricle, and how their exercise tolerance might be improved with biventricular pacing. We will also be looking at ventilatory parameters during exercise to identify sub-optimal chronotropic responses in either pacing modality.

Selected References

Farr M, Haythe J, LaManca J, Kubo S, Oh, JK and Mancini D. Severity of mitral regurgitation in CHF predicts decreased peak VO2 and increased ventilatory response to exercise. Abstract. JACC 2005.

Farr M, LaManca J, St John Sutton M, Zile MR, Gaasch WH, Itoh H, Mancini DM. Cardiopulmonary exercise testing cannot distinguish between patients with diastolic and systolic heart failure. Abstract AHA 2004.