NEWS R Cardiovascular Research Institute

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NEWS R Cardiovascular Research Institute
2 Message from the Director
3 A Legacy of Leadership
Science at the heart of medicine
4 Our Supporters
The Wilf Family
Heart attacks minus
muscle damage, page 3
Cardiovascular Research Institute
Heart Failure
Before It Starts
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
Stopping Heart Failure
Before It Starts
(continued from page 1)
Director, Wilf Family
Cardiovascular Research
Dr. Gerald and Myra Dorros
Professor of Cardiovascular
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
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.
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.
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.
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)
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
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
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
“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
disease (CVD)
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.
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.
How it works: CT scan uses X-rays to produce 3D action or still
Einstein has been the site of extraordinary progress in
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
our supporters
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]
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.
•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
Richard N. Kitsis, M.D.
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