NEWS R Cardiovascular Research Institute
IN THIS ISSUE 2 Message from the Director 3Discoveries 3 A Legacy of Leadership Science at the heart of medicine 4 Our Supporters The Wilf Family Heart attacks minus muscle damage, page 3 NEWS Cardiovascular Research Institute Stopping Heart Failure Before It Starts R ight now, about six million Americans are living with heart failure, in which the heart loses its ability to pump strongly enough to meet the body’s need for blood and oxygen. And about 450,000 die from it each year. Sometimes heart failure comes on for no reason—or so it seems. Mario J. Garcia, M.D., right, aims to convince these “normal” hearts to reveal their secrets. “Many patients have subtle abnormalities of heart function that until recently haven’t been detected,” says Dr. Garcia, the new chief of the Einstein/Montefiore division of cardiology and codirector, with Robert E. Michler, M.D., of the Montefiore-Einstein Center for Heart and Vascular Care. Dr. Garcia was recruited last year from Mount Sinai Medical Center, where he oversaw the cardiac imaging program. (continued on page 2) Newsletter for the Wilf Family Cardiovascular Research Institute ISSUE 2 • WINTER 2011 MESSAGE FROM THE DIRECTOR Stopping Heart Failure Before It Starts (continued from page 1) RICHARD N. KITSIS, M.D. Director, Wilf Family Cardiovascular Research Institute Dr. Gerald and Myra Dorros Professor of Cardiovascular Disease S ince the Wilf Family Cardiovascular Research Institute was established a year ago thanks to a remarkable gift from Einstein Overseer Zygmunt “Zygi” Wilf and his family, we’ve been busy searching the world for outstanding cardiovascular scientists who can enhance our existing strengths. We’ve already recruited three new faculty members; in this newsletter we introduce Drs. Mario Garcia and Nikolaos Frangogiannis. Discussions among new and existing faculty members almost always ignite fresh ideas, and that is already happening here. Plans are underway for a multi-investigator grant to study myocardial infarctions (heart attacks)— because heart attacks are both an important cause of mortality and the major cause of chronic heart failure. The goal: to increase our understanding of cardiovascular disease so we can devise more effective ways to diagnose and treat the number-one killer of people worldwide. If you or someone you know has been affected by cardiovascular disease, you may be interested to know that Einstein is forming a Visiting Committee on Cardiovascular Research. Committee members will be donors interested in our work at the Wilf Family Cardiovascular Research Institute. You’ll meet with leading Einstein faculty several times a year and learn about the latest cardiovascular research. Please see the last page of this newsletter for more information. He can now be found where the machines are: at Montefiore Medical Center, the University Hospital and Academic Medical Center for Einstein, or at the Gruss Magnetic Resonance Research Center (MRRC). Together, they offer a complete menu of imaging options, from stateof-the-art patient angiography, echocardiography (ultrasound) and MRI, CT and nuclear imaging to advanced systems for research studies. “There are very exciting developments in echocardiography, the area where I’ve worked the longest,” says Dr. Garcia, Einstein’s Pauline A. Levitt Chair in Medicine and professor of radiology. Working with computer specialists and biomedical engineers, Dr. Garcia measures the velocity of blood flow through the chambers of a patient’s heart. Then, using hemodynamic equations, he calculates the resulting pressures within the heart, all without invasive catheterization. With this information, he says, it’s possible to estimate how efficiently the heart beats. Or consider an older man complaining of fatigue and shortness of breath during physical activity—a sign of heart failure. According to Dr. Garcia’s recent research, cardiac fibrosis (scarring of the heart muscle) could be involved. Cardiac fibrosis is a well-known legacy of a past heart attack but may also develop for hidden reasons, in both men and women. “Using cardiac MRI, we’ve been able to identify and characterize how fibrosis develops,” says Dr. Garcia. Fibrosis is present in about 80 percent of all cases of hypertrophic cardiomyopathy, the heart enlargement that leads to heart failure and often sudden death—even without a heart attack. Using the new 3 Tesla Philips magnetic resonance system at the Gruss MRRC, “we can work faster and at higher resolution, identifying scars as small as 1 millimeter long,” he says. The next step: to understand how fibrosis and heart enlargement occur and develop therapies to treat these problems—and help that older man resume his workouts. CORONARY MAGNETIC RESONANCE IMAGING (MRI) How it works: Radio waves and the body’s magnetic field plus computers produce 3D action or still images. What it shows: Precise dimensions of the heart, scarring after heart attack, congenital heart defects, inflammation. Radiation? No. Invasive? Not usually. Contrast medium is sometimes used. ECHOCARDIOGRAPHY (ULTRASOUND) How it works: High-frequency sound waves create action or still images of heart chambers, heart valves and blood flow; can be 3D. What it shows: Blood-flow velocities, indirect measurements of pressures within the heart, congenital heart defects, blood clots, tumors. Radiation? No. Invasive? Not usually. Contrast medium is sometimes used. discoveries Gaining a better understanding of cardiovascular disease and stroke requires a team effort. Cardiologists, cell and molecular biologists, geneticists and other specialists are all needed. The three scientists profiled on this page exemplify the different approaches that Einstein researchers take as they seek better treatments for cardiovascular disease. Nikolaos G. Frangogiannis, M.D. V. S. Srinivas, M.B.B.S. Robert C. Kaplan, Ph.D. Professor of Medicine (Cardiology) The Edmond J. Safra/Republic National Bank of New York Chair in Cardiovascular Medicine Associate Professor of Clinical Medicine Department of Medicine (Cardiology) Professor Department of Epidemiology & Population Health A heart attack happens when a blocked artery starves the heart of oxygen. It often starts a downward spiral for heart health: The damaged heart becomes inflamed, which activates substances that break down collagen fibers needed for support. The heart then tries to replace the collagen—which can create scarring that stiffens the heart and leads to heart failure. By examining animal heart muscle tissue, Dr. Frangogiannis hopes to waylay the molecules that govern the process so hearts could heal without scarring, “the ultimate goal of cardiovascular research,” he says. In a 2010 American Journal of Pathology study, he and his colleagues found that stimulating a cell-surface receptor called CCR5 triggers recruitment of blood cells with potent antiinflammatory activity that protects the heart from collagen breakdown—the potential basis for an extremely useful therapy. The College of Medicine welcomes Dr. Frangogiannis, who came from Baylor College of Medicine in Houston to Einstein last fall. People with type 2 diabetes face an increased risk of heart disease. Using the population of a major clinical study—the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial—Einstein researchers looked at whether race influenced how people with type 2 diabetes and heart disease viewed their own health, on a scale from poor to excellent. The results, published earlier this year in the American Journal of Public Health, indicated that blacks were more likely than whites to rate their health as fair or poor. For whites but not blacks, a previous heart attack and use of insulin were associated with a fair or poor self-rating. “This is important, because we know that people’s self-ratings of their health both reflect and influence their actual health status,” says Dr. Srinivas, one of the authors of the study. “So teaching people to assess their health more realistically may actually lead to improvements in their health.” Dr. Kaplan is a cardiovascular disease (CVD) epidemiologist who studies HIV. The HIV-cardiology connection? “Antiretroviral therapies have transformed HIV infection into a chronic disease, and we need to understand what happens to HIV patients who live longer,” he says. Dr. Kaplan notes that HIV infection appears to accelerate atherosclerosis— the accumulation of fat-laden plaque deposits in arteries that is fueled by inflammation. “This is not surprising, since HIV patients have longstanding immune-system activity and inflammation,” he says. His studies—showing that antiretroviral therapy prevents standard HIV complications as well as cardiovascular disease—have encouraged physicians to be aware of CVD risk in their HIV patients. Dr. Kaplan is also an investigator for the ongoing Hispanic Community Health Study, a study of 16,000 Latinos, 4,000 of whom are in the Bronx. The investigators hope to learn why Hispanic people are particularly prone to obesity and type 2 diabetes, a disease that often accompanies obesity, and develop ways to combat them. CORONARY ANGIOGRAPHY How it works: Technician threads a thin tube (catheter) through the groin artery to the heart, then injects dye visible to X-rays, yielding action or still images of the insides of blood vessels. What it shows: Coronary artery blockage or narrowing. Radiation? Yes. Invasive? Yes. CORONARY CT ANGIOGRAPHY How it works: CT scan uses X-rays to produce 3D action or still images. Einstein has been the site of extraordinary progress in heart What it shows: Artery narrowing or blockage, heart-function probhealth. lems, aneurysms, blood clots, calcium buildup. Radiation? Yes. Invasive? No. Requires contrast medium. A legacy of leadership in molecular cardiology Dr. Frangogiannis’ arrival at Einstein continues the College of Medicine’s strong leadership in molecular cardiology research. The principal investigator of Einstein’s first NIH cardiovascular training grant, some 40 years ago, was James Scheuer, M.D., who is now professor emeritus in the department of medicine (cardiology) and chair emeritus of the department of medicine. His work on myosin, a protein-based component of heart muscle, signaled the birth of one of the first molecular cardiology programs in the country. The grant was passed on to Leslie Leinwand, M.D., Ph.D., to Peter Buttrick, M.D., and most recently to Dr. Richard Kitsis, laying the foundation for the Wilf Family Cardiovascular Research Institute. our supporters VISITING COMMITTEE TO CONVENE FOR MORE INFORMATION Einstein is forming a Visiting Committee on Cardiovascular Research. The committee will be composed of supporters who wish to be more deeply involved in cardiovascular research at Einstein. They will meet with leading Einstein faculty several times a year and learn about the latest research in cardiovascular medicine. Each meeting will feature a question-and-answer session during which members can talk to our researchers about issues, concerns and current cardiovascular topics in the news. If you or your family members have been affected by cardiovascular disease, this will be a wonderful way for you to learn about the newest research developments as they are taking shape. The first meeting will take place later this year. To learn more or to get involved, please call Christie Hubbard at 718.430.4171, or e-mail her at [email protected] For more information or to learn more about supporting the work of the Wilf Family Cardiovascular Research Institute at Albert Einstein College of Medicine, please contact Glenn Miller, associate dean for institutional advancement, at 718.430.2411 or [email protected] CONGRATULATIONS, DR. KITSIS! Dr. Richard Kitsis, the director of the Wilf Family Cardiovascular Research Institute, was among a select group of cardiology researchers in New York City honored as “Rock Stars of Research” by the American Heart Association. Rock of Ages Broadway star Constantine Maroulis bestowed the awards at the 2010 New York City Go Red for Women Luncheon. Dr. Kitsis also is the Dr. Gerald and Myra Dorros Chair in Cardiovascular Disease. THE WILF FAMILY CARDIOVASCULAR RESEARCH INSTITUTE OUR MISSION: •To better understand cardiovascular disease—the world’s number-one killer •To translate this knowledge into novel treatments to relieve suffering and improve human health ADMINISTRATION Director Richard N. Kitsis, M.D.