Educators of the Year

Each spring, the Cardiology and Interventional Cardiology fellows of VCU Pauley Heart Center select outstanding faculty members to honor as Educators of the Year. The 2013-2014 honorees were:

Richard Cooke, M.D., 
Evelyne Goudreau, M.D., 
Gautham Kalahasty, M.D., 
Anthony Minisi, M.D., 
Walter H.J. Paulsen, M.D., 
Andreas Prinz, M.D., 
and 
George Vetrovec, M.D.

Congratulations to these physicians, who are educating and inspiring a new generation of cardiologists!


Letter From the Chairman

I hope you enjoy this issue, which highlights some of the exciting research and clinical trials that are ongoing at VCU Pauley Heart Center. I am grateful to be surrounded by colleagues who believe, as esteemed physician Sir William Osler did, that medicine is always about learning new things.

One of these colleagues is cardiothoracic surgeon Dr. Vigneshwar Kasirajan, who has helped to transform VCU into one of the most preeminent total artificial heart centers on the East Coast. I am pleased that he has been selected as the new chair of the Department of Surgery for VCU Medical Center, and look forward to more of his transformations in the years ahead.

In this issue, you will learn about some of our junior faculty members, who are already making their mark in the world of medicine through their research. Our cover story profiles Dr. Antonio Abbate and Dr. Fadi Salloum, two young doctors who are truly devoted to scholarship and improving the conditions of patients with cardiovascular disease.

As you’ll also read in this issue, 35 years ago this July, two very young faculty members Dr. Michael Cowley and Dr. George Vetrovec—undertook the first coronary balloon angioplasty in our area. Dr. Cowley had only been here two years; Dr. Vetrovec, just three years. But, fascinated by the procedure, they had flown to Geneva to learn how to do it from the man who was its pioneer, Dr. Andreas Gruentzig.

Encouraging seekers has long been a part of our history. In this way, we vary from some other centers, where young curiosity is often stifled and told to wait its turn. At VCU, we can’t wait to begin.
Thank you for making all of these discoveries possible.

SINCERELY,
Kenneth A. Ellenbogen, M.D.
Chairman, Division of Cardiology


Researchers Target Heart Failure

Researchers Target Heart Failure

The odds are daunting. According to the Centers for Disease Control and Prevention, about 5.1 million people in the U.S. suffer from heart failure, a condition in which the heart loses its ability to pump effectively. Sadly, about half of those diagnosed with the condition will lose their battle within five years.

In this issue, meet two rising stars of research who are striking back at th is deadly disease with innovative therapies.

Hardworking, intelligent, creative—these are words that colleagues use to describe Antonio Abbate, M.D., Ph.D., and Fadi Salloum, Ph.D. Both are devoted to translational research, conducting basic science experiments with the goal of developing clinical therapies to improve the odds for patients with cardiovascular disease. The two doctors are friends—both have young families and grew up in Mediterranean countries (Abbate in Italy, Salloum in Lebanon). They collaborate on numerous research projects. Both have received American Heart Association (AHA) Young Investigator awards and other national recognitions and are principal investigators for several important research projects funded by entities including the National Institutes of Health (NIH) and the AHA.

Salloum-colleagueIt is a Thursday morning in August and Dr. Abbate, the James C. Roberts, Esquire, Professor of Cardiology, is making his rounds on VCU Medical Center’s 10th floor Coronary Intensive Care Unit (ICU). Most of the patients in this ICU have experienced an acute cardiac incident or are in the later stages of heart failure. One patient who suffered cardiac arrest breathes with the support of a ventilator’s pale blue tubing. At the nurses’ station in the center of it all, monitors continuously beep.

Abbate stops by the room of a longtime patient, who he notices has missed several appointments over the past few months. “I should be upset with you,” he says, teasing. The 53-year-old man has a critical blockage that will require a bypass and a pacemaker. Standing at the man’s bedside, Abbate says gently, “Well, it seems like it’s time for that surgery.”

“Dr. Abbate is like a spoonful of sugar. He can take care of the sickest of patients in the intensive care unit that you can imagine,” said Alpha “Berry” Fowler III, M.D., chair of VCU’s Department of Internal Medicine. “He is an amazing clinician.”

In addition to his work with patients, Abbate conducts research with Fowler and others as part of a multidisciplinary team focused on pulmonary and critical care at the Victoria Johnson Research Laboratories. He is the lead investigator in several preclinical (“basic science”) studies and the principal investigator or co-investigator in numerous clinical studies, in which he is examining the role of inflammation in heart disease. He has also published over 200 articles in scientific journals.

“He does everything. He’s the paradigm of a clinical researcher—from bench to bedside. His research takes him from the lab bench and molecules all the way to patient care and making it better,” said Kenneth Ellenbogen, M.D., chair of the Division of Cardiology.

Abbate grew up in the small town of Fondi, Italy (where his wife, Vera, is also from). As a young child, he lost his mother to cancer, which he believes drew him to medicine. “I realized how many people were ill and sick and required care. I thought [medicine] was something important to do. … I thought it would be a way to have my passion for science and doing something useful merge,” he said.

He received his medical degree from the University Campus Bio-Medico in Rome, graduating magna cum laude in 2000, and later obtained his Ph.D. in cellular and molecular cardiology from Catholic University, also in Rome. He completed his specialty training at Catholic University and VCU. He joined the VCU faculty in 2007, after one of his mentors, George Vetrovec, M.D., director of the Adult Cardiac Catheterization Lab, helped recruit him.

“I first met Dr. Abbate [in the summer of 1998] when he was a medical student in Italy, and he was just one of the most enthusiastic, intelligent folks that I’ve had the opportunity to be around. He just had huge energy and enthusiasm, and I thought, `This is the sort of person that we really want to have as a part of our faculty,’” said Vetrovec. “He’s been remarkable.”

“Dr. Vetrovec has given me so much guidance, opportunities, support and encouragement,” said Abbate. Once, after his grants were initially declined a few years ago, “Dr. Vetrovec told me, `Don’t worry—keep trying. You will succeed. They will come.’”

They did. Over the past six years, Abbate has collaborated with Benjamin Van Tassell, Pharm.D., an assistant and research professor with the VCU School of Pharmacy. Together, they have received over $3 million in NIH and other funding to develop a successful therapy using the drug anakinra to prevent or improve heart failure in patients who either have heart failure or have suffered a heart attack.

Their research involves Interleukin-1 (IL-1), a harmful pro-inflammatory agent that kicks into action following a heart attack. “Inflammation is a complex response to injury or infection,” explained Abbate. While initially IL-1 may contribute to healing, it also causes molecular and cellular changes to the myocardium “that may be compensatory at first but ultimately lead to heart failure,” he said. Anakinra is an IL-1 blocker that can prevent this further damage.

Following their initial animal model and early clinical trials, which received early support from VCU Pauley Heart Center and other sources, the pair is currently engaged in three larger NIH-funded trials in which they are providing anakinra therapy to three distinct groups of patients: 1) heart failure, 2) large heart attacks (STEMI) and 3) diastolic heart failure. These are Phase II clinical trials, which will hopefully guide the final Phase III studies for FDA approval.

His patients inspire his research. “They make it valuable. Knowing the patients, knowing the unmet needs in clinical practice, makes me approach research in a way to address those needs,” he said. “I realize how little we understand of disease and how much better we could be doing if we had more tools to treat patients.”

Hydrogen sulfide (H2S) is often associated with the rotten egg smell of swamps. Surprisingly, the noxious gas has healing properties too—and may prove a critical link to preventing heart failure, says Salloum, VCU assistant professor of medicine and physiology and biophysics.

“Hydrogen sulfide is toxic in certain concentrations—one whiff of it, and you’re dead. But it’s also something that enzymes naturally produce in our bodies,” Salloum says. After a person experiences a heart attack, his or her level of H2S drops. Of his research, Salloum says “I started looking at the physiological levels of hydrogen sulfide. … If the levels are too high, that will be bad. However, there’s a certain level we need to maintain, and if we go below that, it’s also bad.”

Salloum, a dedicated researcher who regularly puts in 10- to 12-hour days, stands in the bright, open lab room in the newly renovated Pauley Heart Center research laboratories in Sanger Hall. A long, white lab bench divides the room. Set on it are bottles of chemicals, test tubes and other tools that he uses to prepare doses of hydrogen sulfide for his preclinical studies.

Abbate-patientFor the past four years, he’s studied—with the support of a prestigious AHA National Scientist Development Grant—what happens to the body when hydrogen sulfide is given on a daily basis to animal subjects following a heart attack. He specifically traces inflammation and programmed cell death, two conditions that occur following a heart attack and can contribute to heart failure. “Both are significantly attenuated with hydrogen sulfide therapy,” he says.

Ranking his research proposal in the top 1%, the AHA recently provided Salloum with additional funding to further his work. He currently has two active grants as principal investigator to study heart failure prevention from the AHA and Novartis Pharmaceuticals and is co-investigator on three NIH grants. In addition to his AHA Young Investigator Award, he’s also received the American Association for the Advancement of Science’s Excellence in Science Award.

“His work is high impact. He’s looking at critical cellular and molecular mechanisms that address the transition from cardiac stress into heart failure, which really is still a challenging and difficult area,” said Edward Lesnefsky Jr., M.D., VCU professor of and chief of cardiology at McGuire V.A. Medical Center.

A native of Beirut, Salloum says his interest comes naturally. Growing up in a Mediterranean country, he has long heard about the sulfur-based hot springs in Europe and North Africa known for their healing properties. Interestingly, recent studies have shown the springs can alleviate edema and other symptoms of heart failure, he says. Additionally, garlic, a heart-healthy staple of the Mediterranean diet, also releases H2S.

He earned his B.S. in biology from the American University of Beirut in 1996. After graduation, he served in the Lebanese Army Medical Brigade and then emigrated to the U.S. in 1998 and moved to Richmond (where his wife, Lusene, is from) to pursue his doctorate in physiology from VCU School of Medicine. He completed his postdoctoral training in 2008 under the mentorship of Rakesh Kukreja, Ph.D., director of the VCU Molecular Cardiology Research Laboratories, and then joined the VCU staff in 2009.

As a young scientist, he has appreciated the creative and encouraging environment fostered by Kukreja. “There’s so much room to explore and advance the field in the vibrant research setting that we have here at Pauley Heart Center,” says Salloum.

Together, the two have been co-investigators on multiple NIH grants over the past 10 years and have jointly authored over 50 research papers. “Dr. Salloum’s extraordinary research productivity and work ethic impressed me the most when I recruited him as a faculty member. In fact, he is one of the most talented colleagues I have worked with during my 30 years at VCU,” Kukreja said. “He is very passionate about science and is very pleasant to work with. He thinks beyond his own work to support others.”

Another colleague, Fowler shares this perception. “Fadi Salloum, is first of all, a very good human being. He’s very polite. And most of all, he is a very intense scientist. When he goes into a research topic, he dives deep into the problem,” he said.

About 10 years ago, Fowler and Salloum joined efforts to create the very first mouse cardiac ischemia model at VCU—a blueprint on how to induce and treat the condition in mice, as a precursor to human studies. Salloum has taught the surgical skill to various research groups, including one in Rome.

Basic research is at the front end of a long process. After the animal studies come many years of clinical trials before FDA approval is possible. For instance, Salloum says it may be at least 10 years before his H2S therapy is available by prescription to humans.

“Dr. Salloum’s strength has been real dedication. He’s going to keep after it until he’s successful. … He’s also a very creative individual. And I think he’s just really getting started and that there’s much more that he will achieve,” said Vetrovec.

Kukreja added, “His research is going to have huge impact on the treatment of patients with myocardial infarction and heart failure in the future.”


Research Showcased at Pauley’s Heart Consortium

“We have had a tremendous year at the Pauley Heart Center,” said Kenneth Ellenbogen, M.D., chair of the VCU Medical Center’s Division of Cardiology, in his opening remarks to attendees of the 2014 Heart Consortium, held on April 29 at the Jefferson Hotel.

HeartConsort-1Ellenbogen brought the audience up to date on the latest initiatives at the center, including the search for a new director, the continuing rollout of the seven new GE labs (scheduled for completion in 2015) and the newly renovated Sanger Pauley Heart Center research labs.

Of the clinical setting, “We continue to be one of the most active TAVR [transcatheter aortic valve replacement]centers in our region. This procedure has helped us to serve many patients by replacing the aortic valve in a minimally invasive manner, which is safer for a subset of our patients who may not be open-heart surgery candidates,” he said. Innovations abound in the catheterization labs, where physicians are conducting ablation procedures to control blood pressure and implanting LARIAT devices to minimize stroke risk. And of the electrophysiology division, Ellenbogen said, “We are one of only less than 10 centers in the country using advanced computerized mapping to ablate atrial fibrillation.”

Vigneshwar Kasirajan, M.D., VCU chair of Surgery and of Cardiothoracic Surgery, shared the news that, in 2013, the Pauley Heart Center completed nearly 20 heart transplants, including two heart/liver transplants and a mother and son who received heart transplants two years apart. Each were bridged to those transplants by mechanical assist devices implanted by VCU’s surgical teams. “This is unprecedented,” Kasirajan said. “Our bridge-to-heart transplantation is arguably the best on the East Coast and one of the best in the country.”

2014-HeartConsort-3picsThis year, instead of a single keynote speaker, three young VCU cardiologists who are also scientists presented some of their leading-edge studies: Antonio Abbate, M.D., Ph.D. (whose work is highlighted in this issue), shared his research on the role of inflammation in heart disease. Electrophysiologist and Assistant Professor Jordana Kron, M.D., spoke about her interests, including cardiac sarcoidosis, a multisystem disease that can cause heart failure or sudden death, as well as about VCU’s leadership in mentoring, supporting and encouraging women in the field of cardiology. And finally, Keyur Shah, M.D., medical director of the Mechanical Circulatory Support Program, shared some of his clinical research in advanced heart failure.

“As an academic medical center, we are able to tightly weave science and clinical care. This means that the work that cardiologists like Jordana Kron, Keyur Shah and Antonio Abbate do is aimed directly at improving patient outcomes,” said Jerome F. Strauss III, M.D., Ph.D., dean, VCU School of Medicine.

Sheldon M. Retchin, M.D., M.S.P.H., senior vice president for Health Sciences, and CEO, VCU Health System, agrees. “Each year at the Pauley Heart Center Consortium event, we have an opportunity to showcase some of our faculty and their accomplishments. I am constantly inspired by the outstanding work of our physician-scientists at the Pauley Heart Center. The scope of their research is truly amazing,” he said. “All of us on the MCV Campus are truly grateful to the Pauley family and the hundreds of other donors who help to ensure the continued success of our efforts.”

 


Patient Recalls Amazing Recovery: “I was gone. I shouldn’t be here.”

Bryan-Kowalczyk-1Bryan Kowalczyk was not feeling well one morning last October, so he cut short a walk with his wife, Joanne. “My heart was racing. It just didn’t feel right,” he recalled.

He had experienced atrial fibrillation on and off since 2008, but something felt different this time. He sat to rest in the screened-in porch of their Williamsburg home. Shortly after, Mrs. Kowalczyk found him gasping for breath and called 911.

Her husband, she later learned, had gone into cardiac arrest. After rescuers arrived, it took them six minutes to restore his heartbeat. He arrived by ambulance at Sentara Williamsburg Regional Medical Center, where doctors discovered multiple blockages in his arteries. A helicopter arrived to transport him to VCU, the region’s only Trauma 1 hospital, and he went into cardiac arrest again. During this time, a priest administered his last rites.

“I was gone. I shouldn’t be here,” said Kowalczyk.

Doctors were able to revive him, and he was loaded onto the helicopter, where rescuers cooled his body using ARCTIC therapy. He arrived in Richmond and was taken to the Coronary Intensive Care Unit. There, amazingly, he recovered in the days that followed, under the care of a multidisciplinary team led by cardiothoracic surgeon Vigneshwar Kasirajan, M.D.; ARCTIC Director Mary Ann Peberdy, M.D.; and CICU Director Michael Kontos, M.D. A planned ICD (implantable cardioverter defibrillator) surgery was put on hold, however, when he contracted pneumonia and an infection. Once Kowalczyk was stabilized, doctors let him go home to recover.

He returned to the ICU twice over the next month—the first time for an allergic reaction to penicillin and the second time for continued cardiac problems. During the latter visit in November, his kidneys began to fail. He remained in the hospital for the next six weeks, under the care of the nurses that he calls “my angels” and his loving family.

Mrs. Kowalczyk stayed with him almost every day, and his other family members visited often. They even celebrated the holidays with him, including a memorable Christmas morning, when the Kowalczyks’ five-year-old grandson Nolan opened his presents under a decorated tree in a Richmond hotel lobby.

“The security guard let us do it. There wasn’t anyone at the hotel because it was Christmas,” Mrs. Kowalczyk said. After opening his presents—with Kowalczyk watching on his iPad—Nolan went with his family to visit “Pop-Pop” in his hospital room.

As Kowalczyk grew stronger, and his kidneys returned to normal functioning, his multidisciplinary team decided upon a new course. On January 7, he underwent a MAZE procedure and a coronary artery bypass graft surgery, led by Kasirajan. The surgery went well for Kowalczyk, as did the 12 weeks of rehabilitative care that followed. Since that time, he has not experienced any side effects or Afib. He enjoys walking and riding his bike again, and spending time with his family.

“He went through, unfortunately, the whole gamut at Pauley—but with a very good outcome at the end of it,” said Kasirajan. “It was a long, complex path.”

Kowalczyk has nothing but good things to say about his extended stay in the hospital. “Dr. Kasirajan and his whole crew—they were awesome.”


Kasirajan to Head Dept. of Surgery

Vig_Kasirajan

Congratulations to cardiothoracic surgeon Vigneshwar Kasirajan, M.D., who has been named as chair of the Department of Surgery of the VCU Medical Center. He began his new position August 1.

Kasirajan had served as interim chair of the Department of Surgery as well as chair of Cardiothoracic Surgery and director of Heart Transplantation. He received his medical degree from Madras Medical College in India and completed his specialty training at the Cleveland Clinic.

“Dr. Kasirajan has helped to create a vibrant environment at VCU, where he has been since 2000. In addition to his work with transplant patients, he is at the forefront of a new frontier in cardiac surgery that includes artificial hearts and mechanical assist devices,” said Jerome Strauss III, M.D., Ph.D., dean, VCU School of Medicine.

In 2006, Kasirajan led the first surgical team on the East Coast to implant the SynCardia Total Artificial Heart, the only device of its kind approved by the FDA. “His work in this field has helped establish VCU as one of the leaders in the realm of artificial hearts,” said Strauss.


Peberdy Selected as First Wright Professor

Peberdy

Mary Ann Peberdy, M.D., has been named the inaugural C. Kenneth Wright Professor in Cardiology. She serves as director of VCU’s Advanced Resuscitation, Cooling Therapeutics and Intensive Care (ARCTIC) program and medical director of the hospital’s code and rapid response teams.

“Dr. Peberdy has made important contributions to the field of cardiovascular resuscitation and has helped to transform the field,” said Kenneth Ellenbogen, M.D., chair of the Division of Cardiology of VCU Pauley Heart Center.

Peberdy has authored over 140 research papers while also maintaining an active cardiology practice, focusing on patients with advanced heart failure or recovering from cardiac arrest. She is a founding physician of the American Heart Association’s National Registry of CPR, which houses the world’s largest database for in-hospital cardiac arrest, and currently serves as co-chair of the AHA’s Research Task Force. She joined the VCU faculty in 1993 following her residency and cardiology training at the Medical College of Pennsylvania.

Last year, longtime contributor Ken Wright and his wife Dianne (who, sadly, passed away in October), established the professorship to recognize outstanding scholars on the Pauley Heart Center faculty. The award includes a stipend to support research.

The honorarium is named after Mr. Wright, who, according to Ellenbogen, “has been a huge benefactor to the university. He’s a big believer in education as the way to success.” Through the award, the Wrights “wanted to honor excellence, and they wanted to honor all of the contributions that Dr. Peberdy has made in cardiology as a mentor, researcher and doctor.”


Pauley Heart Center Welcomes New Faculty!

Bagameri_Gabor

Cardiothoracic surgeon Gabor Bagameri, M.D., joined the VCU faculty in June. He arrives from Mid-Atlantic Cardiothoracic Surgeons in Norfolk. He received his M.D. from Semmelweis University in Budapest, Hungary. He completed his surgical residency at Graduate Hospital, University of Missouri, and Thomas Jefferson Hospital, where he also undertook a vascular surgery fellowship. He completed his cardiothoracic fellowship at University of Pennsylvania.

“He’s going to bring new skills in endovascular and complex aortic reconstructions. He also has tremendous experience in transcatheter valve technology. He’s obviously a skilled surgeon, but also brings strong skills in teamwork. He is going to be a great match for the program, and we are delighted to have him join us,” said Vigneshwar Kasirajan, M.D., VCU chair of Surgery and of Cardiothoracic Surgery.

Having spent the last couple of years in private practice, Bagameri said, “I really missed working in an academic institution. VCU has an excellent reputation and the environment here is one of growth. It is an exciting time.”

Alex-Tan-218x300Electrophysiologist Alex Tan, M.D., joined the faculty as assistant professor of medicine in October 2013. He is from Beth Israel Medical Center in Boston, which is part of Harvard Medical School. He will be primarily at the McGuire Veterans Administration Medical Center. His clinical interests include implanting defibrillators and pacemakers, performing ablation procedures for atrial and ventricular arrhythmias, and device and lead extractions.

“I felt that VCU and the VA provided a good fit in terms of offering an environment that was supportive of translational research as well as being on the cutting edge of clinical electrophysiology,” said Tan.

According to Kenneth Ellenbogen, M.D., chair, Division of Cardiology, “Dr. Tan is the consummate cardiac surgeon; technically skilled, thoughtful and decisive.”


The American College of Cardiology Honors Vetrovec

Vetrovec_award_005

George Vetrovec, M.D., was named a Master of Cardiology by the American College of Cardiology (ACC). He is the director of the Adult Cardiac Catheterization Lab at VCU Pauley Heart Center, and he received the award at the organization’s 2014 Annual Convocation in Washington, D.C., on March 31.

The award recognizes distinguished practitioners in the field of cardiology who have consistently shown excellence in education, clinical practice, scholarship and support to the ACC, which has over 43,000 members worldwide.
“This award is given to no more than four people each year, and it’s the American College of Cardiology’s highest honor,” said Kenneth Ellenbogen, M.D., chair of Pauley’s Division of Cardiology. “It recognizes Dr. Vetrovec as someone who has made huge contributions to the field of cardiovascular medicine.”


Celebrating 35 Years of Balloon Angioplasty

hesssamp-gs_crop

This year marks the 35th anniversary of the first coronary balloon angioplasty at VCU, conducted in July 1979 by Michael Cowley, M.D., and George Vetrovec, M.D.

Early in their careers at VCU, the two physicians traveled to Switzerland to study the technique with Andreas Gruentzig, M.D., who conducted the world’s first successful coronary balloon angioplasty in 1977. Cowley went to Zurich in December 1978, later returning with Vetrovec.

VCU was an early adopter of the procedure. According to Cowley, VCU was among the first 10 centers in the U.S. to perform it. When the pair went abroad to study with Gruentzig, the number of balloon angioplasties performed worldwide hadn’t yet reached 100. Today, VCU Pauley Heart Center physicians undertake the lifesaving procedure on about 1,000 patients each year.

“Both Dr. Cowley and Dr. Vetrovec have made very important contributions to interventional cardiology that have led to great advances in the field. Their work has benefited millions of patients all over the world,” said Kenneth Ellenbogen, M.D., chair of Pauley’s Division of Cardiology.

The two physicians were recently recognized as Master Interventionalists by their peers at the Society for Cardiovascular Angiography and Interventions (SCAI). Both former presidents of the SCAI, the two cardiologists received the award at the organization’s annual meeting in Las Vegas in July. They were among 18 physicians selected by their peers for the inaugural MSCAI class.

“We’re the only two from the same center,” said Cowley. “It’s a major honor.”