Calendar of Events

Join Pauley this fall and winter for some fun and informative community events.

September 14, 2019: American Heart Association Heart Walk at VCU Health Community Memorial Hospital in South Hill

Complete a one-mile route around the hospital, then enjoy food and games, music, blood pressure checks and health information, and an appearance by VCU mascot Rodney the Ram.

October 4, 2019: 5th Annual Pauley Heart Center Internal Heart Walk

For the fifth year, heart and stroke patients and their supporters will take part in this special walk around the VCU Medical Center’s hallways to raise funds for the AHA.

October 5, 2019: American Heart Association Annual Richmond Heart Walk

Lace up your tennis shoes for the 2019 Richmond Heart Walk. This year’s walk includes a 5K at Monroe Park. VCU Health is one of the sponsors of this fundraising event, which is co-chaired by Dr. Peter Buckley, dean of the VCU School of Medicine.

November 16-18, 2019: American Heart Association Scientific Sessions 2019

The AHA’s annual meeting devoted to the future of cardiovascular medicine and science will take place in Philadelphia. The prominent speakers will include Pauley researcher Dr. Fadi Salloum.

November 2, 2019: American Heart Association Innovation of the Heart

The AHA and VCU Health will co-host this kickoff for the Richmond Heart Ball, held at the McGlothlin Medical Education Center. The event will highlight AHA-funded research in the Richmond community.

December 14, 2019: High School to Health Care

Dr. Greg Hundley will lead this daylong program, now in its second year, which introduces students in grades 9-12 and their parents to a variety of health care occupations in cardiology.

February 8, 2020: 5th Annual Heart Health in Women Symposium

Led by Drs. Phoebe Ashley and Jordana Kron, this Continuing Medical Education (CME) event brings together prominent heart doctors from Pauley and across the U.S. to speak on the latest developments in women’s cardiac health.

 


Meet Dr. Amy Ladd, Clinical Studies

From her office in the West Hospital, Dr. Amy Ladd views the results of a database query on her computer screen, regarding the number of active human research studies at Pauley.

“It’s up to 72,” she said.

Scrolling down through the listings, she stops to pull up an individual trial. The record shows everything from the investigators, protocols and informed consent forms to funding sources and important watch dates. Ladd prepared most of the records for submission to the VCU Institution Review Board [IRB].

“This is the system we use for keeping track of our IRB submissions. It’s the regulatory side,” she said. “The VCU IRB oversees all human subjects research at the University. They want to make sure that we are doing the best we can to protect the participant’s health, privacy and confidentiality.”

When she prepares the records, she tries to anticipate the questions that the IRB may have. She works to ensure that the studies are compliant with hospital, state and federal regulations.

As one example, some patients may consent to the study team saving their blood samples for future studies. “Having those blood samples for a particular patient population can be really valuable for a researcher who is looking for biomarkers to develop new drugs, for instance. But the IRB wants to make sure that we are very transparent about that when we consent the patients,” she said.

She also works with VCU School of Medicine’s Clinical Trials Office, which among other things, negotiates study budgets on behalf of the research teams and the Office of Sponsored Programs, which ensures contract language is acceptable to the University. Some studies may require an additional level of approval from other departments. For instance, cardio-oncology studies require the o.k. of the VCU Protocol Review Medical Committee, which is affiliated with Massey Cancer Center. Additionally, about half the studies are funded by industry, which receives approval by an outside IRB—though the documents are also still reviewed by the VCU IRB.

While she tends to work early in the approval process, she remains in close contact with the clinical research coordinators throughout the trial. Sometimes a PI will want to amend the trial, which requires additional IRB approval.

Ladd said she shares the same focus as other members of the team: “The number one concern is patient safety. We’re doing these trials to benefit science and keep VCU as a top research institution, but none of that matters if we’re not helping patients and keeping them safe.”

Ladd, who holds a Ph.D. in Pathology from University of Maryland, has worked at VCU Health for 15 years. Previously, she held translational research-based positions in the Department of Pathology and the Parkinson’s and Movement Disorders Center.

She has worked for Cardiology since 2015 and has enjoyed the transition to human clinical trials. “It’s a huge need. Cardiac disease is the top medical issue with people in the country,” she said.

When asked if she enjoyed reading about the trials, she smiled. “I love it. I enjoy being in the know on all the cutting-edge research that’s going on here.”

To learn more about specific trials, please visit ClinicalTrials.gov.


VCU’s Jordana Kron is Searching for Answers

Dr. Jordana KronSarcoidosis is an inflammatory condition that can lead to cardiac failure when it affects the heart. Kron is investigating a new method to treat it.

A disease that has no cause or cure, sarcoidosis affects people of all ages throughout the world. Once considered a rare disease, the inflammatory condition now affects about 40 in every 100,000 African Americans in the U.S. and about five in every 100,000 white people. It occurs in all races and in men and women, but is most common among African American females ages 20 to 40.

The disease most commonly affects the lungs, but can involve almost any organ system including the skin, eyes, joints and heart. Cardiac involvement, which occurs in up to 25% of patients with sarcoidosis in other organs, can lead to life-threatening heart rhythm problems and heart failure.

“The field of cardiac sarcoidosis, and sarcoidosis in general, really needs new mechanistically driven therapies,” said Dr. Jordana Kron, an associate professor in the Virginia Commonwealth University School of Medicine and a cardiologist at the VCU Health Pauley Heart Center.

Cardiac involvement, which occurs in up to 25% of patients with sarcoidosis in other organs, can lead to life-threatening heart rhythm problems and heart failure.

In April, which is National Sarcoidosis Awareness Month, Kron was awarded a $50,000 Pauley Pilot Research Grant to investigate a new treatment protocol for cardiac sarcoidosis. The 15-month grant will be used to evaluate the efficacy and safety of using an interleukin-1 blockade to treat patients who present with cardiac sarcoidosis. The study is the first of its kind to explore the new treatment paradigm.

“A new, safe and effective treatment could be life-altering for patients with cardiac sarcoidosis. It may also open the door for new therapies for cardiac sarcoidosis and other inflammatory heart diseases in the future,” said Kron, a translational science scholar at the VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research.

Interleukin-1 is a protein whose presence indicates inflammation in the body. Kron’s research aims to evaluate if using medication to block the protein will help treat cardiac sarcoidosis.

“Corticosteroids are the most commonly used treatment for sarcoidosis, but there is little data showing their efficacy and they have significant side effects,” Kron said. “Interleukin-1 is the prototypical cytokine that plays a role in most inflammatory processes. Blockade of the protein has been shown to be effective in many types of heart disease.”

While cardiac sarcoidosis is the focus of Kron’s research, she is optimistic that — if shown to be effective — the blockade could be used to treat other forms of heart disease.

Tackling cardiac sarcoidosis

VCU has led clinical and translational research of cardiac sarcoidosis for nearly a decade and VCU Health is home to the Multidisciplinary Sarcoidosis Clinic, the only center of its kind in Virginia. At the clinic, located at the VCU Health Stony Point Campus, patients are able to meet with specialists in pulmonology, cardiology, electrophysiology and rheumatology during a single appointment.

In 2011, VCU researchers teamed with researchers at the University of Michigan and the University of Colorado to start the international Cardiac Sarcoidosis Consortium. Kron is a founding member. The consortium is a prospective, multicenter registry that tracks cardiac sarcoidosis patients worldwide. It includes demographic, clinical, medication and imaging data from more than 25 contributing centers in the U.S., Europe and Asia.

Kron attributes much of the headway she has made in researching sarcoidosis to support from the Wright Center, Virginia’s first institution to receive a Clinical and Translational Science Award from the National Institutes of Health. Dr. Antonio Abbate, associate director of the Wright Center, has served as a mentor and co-investigator on Kron’s research. Abbate, a cardiology professor at the VCU School of Medicine and a cardiologist at the Pauley Heart Center, also will share his expertise on cardiac inflammation and interleukin-1 blockers throughout the study. Dr. F. Gerard Moeller, director of the Wright Center, and Dr. Patrick Nana-Sinkam, the center’s KL2 program co-director, provided mentorship, support and feedback on grant writing for the project as well.

“Support from the Wright Center has enabled me to build on existing relationships and create new collaborations to help advance our understanding and treatment of this complex disease,” Kron said.

Dr. Kenneth Ellenbogen, chair of the Pauley Heart Center’s Division of Cardiology, also provided significant support for Kron’s research.

“I would not be where I am today without Dr. Ellenbogen’s mentorship,” she said. “He has played an invaluable role in my research career.”

Gathering critical data

Kron, who last October was awarded an endowment fund through the Wright Center to further support her research, is joined in the study by Co-PI Dr. Jennifer Jordan, an assistant professor in the VCU College of Engineering Department of Biomedical Engineering and director of the Cardiovascular MRI Core Lab at the Pauley Heart Center. Jordan’s research focuses on translational and clinical cardiovascular MRI techniques and cardiac magnetic resonance tissue characterization in patients who have received chemotherapy for breast cancer. For this study, she will be using her expertise in cardiac magnetic resonance to help assess inflammation in cardiac sarcoidosis and evaluate responses to treatment.

The Pauley Pilot Research Grant Program, which is made possible entirely by philanthropy, supports early stage research by physicians and scientists working to advance heart health. The program allows investigators to test novel ideas and gather enough data to apply for major research grants from institutions such as the NIH.

Kron plans to submit a proposal for external funding by February 2021.

“The results of this research will help me gather critical data to inform applications for larger grants later,” she said.

In addition to these grants, Kron has received two other internal grants this year related to cardiac sarcoidosis: A Johnson Center grant to participate in the first randomized controlled trial in cardiac sarcoidosis–an international trial looking at steroids vs. steroids plus methotrexate–and another Wright Center grant for her and Jordan to look at optimizing cardiac MRI in cardiac sarcoidosis patients with defibrillators.

 

Team researching puzzling cardiac disease receives American Heart Association funding

Friday, May 17, 2019

The American Heart Association has awarded a 2019 Collaborative Sciences Award to a team of Virginia Commonwealth University researchers investigating a new treatment for cardiac sarcoidosis, an inflammatory condition that can lead to heart failure.

Dr. Jordana Kron, an associate professor in the VCU School of Medicine and a cardiologist at the VCU Health Pauley Heart Center, is leading the study.

Sarcoidosis has no cause or cure and affects people of all ages throughout the world. Once considered a rare disease, the inflammatory condition now affects about 40 in every 100,000 African Americans in the U.S. It most commonly affects the lungs, but can involve almost any organ system including the skin, eyes, joints and heart. Cardiac involvement occurs in up to 25% of patients with sarcoidosis in other organs.

The $750,000 AHA award over three years is in addition to a $50,000 Pauley Pilot Research Grant that Kron received in April to investigate the new treatment protocol. The study evaluates the efficacy and safety of using an interleukin-1 blockade to treat patients who present with cardiac sarcoidosis. The study is the first of its kind to explore the new treatment.

Kron is joined in the study by Dr. Antonio Abbate, a cardiology professor at the VCU School of Medicine; Dr. William Gregory Hundley, director of the Pauley Heart Center; and Dr. Jennifer Jordan, an assistant professor in the VCU College of Engineering’s Department of Biomedical Engineering and director of the Cardiovascular MRI Core Lab at the Pauley Heart Center.

 


Dr. Antonio Abbate Honored

Dr. Antonio AbbateBy Anne Dreyfuss
C. Kenneth and Dianne Wright Center for Clinical and Translational Research

At a study abroad program in Fondi, a city halfway between Rome and Naples in central Italy, Henrico-native Krishna Ravindra discovered a passion for clinical and translational science. “Working with Dr. Abbate allowed me to see how a background in clinical medicine and translational research can allow one to not only help patients based on the current medicine available, but also have the opportunity to explore novel therapeutic strategies to improve patient care,” Ravindra said of Dr. Antonio Abbate, who leads the Virginia Commonwealth University study abroad trip hosted by the Instituto San Francesco and the University Campus Biomedico of Rome. During the three-week program, undergraduate VCU Honors College students study the signs and symptoms of disease and explore clinical and translational research.

When they returned to Richmond in the fall of 2017, Ravindra asked Abbate if he could shadow him during his clinical rotations at VCU Medical Center and volunteer on Abbate’s research team. Abbate, who is an associate director at the VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research, serves as the James C. Roberts, Esq. Professor of Cardiology at the VCU School of Medicine, as well as a practicing cardiologist at the VCU Health Pauley Heart Center and medical director at the VCU Medical Center Clinical Research Unit. “I am always happy to open my research team to undergraduate students,” Abbate said, adding that he became involved in research when he was 20 years old and benefitted from working with mentors who shared their enthusiasm for medical discovery and innovation early in his career. “It is important to offer students an opportunity to see what gets you up in the morning,” he said.

In the ensuing years Ravindra continued to volunteer on research projects under Abbate’s mentorship, including working with Abbate through the VCU Undergraduate Research Opportunities Program. On April 24 Abbate was recognized for his work through that program with the VCU Undergraduate Research Opportunities Program Faculty Mentor Award, an honor that recognizes faculty members who have demonstrated a commitment to regularly go above and beyond to engage undergraduate students in research opportunities.

“Dr. Abbate placed an enormous amount of faith in me as an undergraduate student to complete complex chart reviews, patient analyses, and retrospective data analyses,” Ravindra said.

Through UROP, Ravindra worked with Abbate on a retrospective analysis of patients who were treated at VCU Medical Center for Takotsubo cardiomyopathy, a complex clinical condition in which a person suddenly develops heart failure after emotional or physical stressors. Ravindra also worked on another research project aimed to predict the degree of cardiorespiratory fitness impairment in heart failure patients across a wide range of ejection fraction measurements, which indicate how much blood the left heart ventricle pumps with each contraction.

For four months Ravindra worked with Jessie van Wezenbeek, a graduate student from Amsterdam, on data collection and statistical analysis, which informed a manuscript detailing their findings. The manuscript published in the peer-reviewed journal Frontiers in Cardiovascular Medicine late last year and in November Ravindra presented the results of the pair’s research projects at the American Heart Association Scientific Sessions conference in Chicago.

“I would never have dreamed of getting to present at such a large conference as an undergraduate student before working with Dr. Abbate,” Ravindra said. “Working with Dr. Abbate opened that door for me, as he constantly pushed me out of my comfort zone and took time to teach me one-on-one.”

Ravindra said Abbate inspired him to pursue a career in clinical and translational science. In the fall he will start medical school at VCU. “Dr. Abbate has shaped my view of what it means to be a physician and has illuminated the benefits of being a physician-scientist,” he said. “He emphasized the bench-to-bedside process of clinical and translational research. Further, he showed me that the process of discovery is never-ending and that we can always strive to do more for our patients.”

Abbate has devoted a significant amount of effort toward training the next generation of clinical and translational scholars since joining VCU in 2007. In 2016, the School of Medicine awarded him with the Distinguished Mentor Award, an honor that recognizes significant contributions to the career development of others. In February, he was awarded the inaugural Thames-Kontos Mentoring Award from the VCU School of Medicine Department of Internal Medicine.

The Wright Center has funded two faculty-mentored undergraduate clinical and translational research projects through UROP every year since 2014. This summer, the Wright Center will fund biomedical engineering student Yasmina Zeineddine to research spinal cord injuries with mentor Dr. Carrie Peterson, who is an assistant professor in the Department of Biomedical Engineering at VCU College of Engineering. The Wright Center will also fund mechanical engineering student Sam Cole’s research on bioreactors for mechanical training of engineered tissues with mentor Dr. Joao Soares, who is an assistant professor at the VCU College of Engineering.

“The Wright Center is committed to fostering cross-campus collaborations with the VCU College of Engineering and other units on the VCU Monroe Park Campus with an aim of developing an interdisciplinary clinical and translational workforce that will be equipped to address emerging health care challenges,” said Wright Center Director Dr. F. Gerard Moeller. “We are happy to partner with the VCU Undergraduate Research Opportunities Program to help inspire an early interest in clinical and translational research among undergraduate researchers.”

 


Meet Dr. Jin Lee, of CHoR

Dr. Jin LeeFrom her fifth-floor office at the Children’s Pavilion, Dr. Jin Lee reflected on her first few months as chief of Pediatric Cardiology at Children’s Hospital of Richmond at VCU.

“It’s been really great. I feel like it’s exactly what I hoped it would be,” said Lee, an internationally admired interventional cardiologist.

Behind her, a large window revealed the busy streets of downtown Richmond. Things have gotten more hectic lately, with the construction of CHoR’s new $350+ million inpatient facility next door. Lee helped plan the hospital’s cardiovascular suite, which will include an operating room, a combined electrophysiology/catheterization lab and a hybrid catheterization/surgical lab. For now, she performs interventions at Pauley. “They have a reserved room for me,” she said.

Pauley Director, Dr. Greg Hundley is excited about her arrival. “She’s very compassionate and an excellent physician and has an enormous appreciation for research. She is going to be a phenomenal leader and researcher for the institution and a critical care provider for the children of Central Virginia,” he said.

Lee arrived to Richmond from the Hospital for Sick Children of Toronto, where she also served her residency and fellowship. The hospital has one of the highest volumes of pediatric cardiac catheterizations and surgeries in North America.

“She’s very compassionate and an excellent physician and has an enormous appreciation for research.

Some of her common cath lab procedures include diagnostics, correcting heart valves that are obstructed or impaired, enlarging blood vessels with stents, and closing holes or other defects. She treats patients who were born with structural heart problems as well as those who have acquired heart disease from infection, sickle cell disease, cancer treatment and even obesity–a growing problem in Richmond, she said.

Lee also has expertise in echocardiography, pulmonary hypertension, cardiac intensive care and transplantation.

“I was part of the team at Toronto that did the first ABO incompatible heart transplant on a newborn. It was a really exciting time because we were doing something that no one else had done in the world,” she said, with a smile.  Some babies are placed on the transplant list in utero. “They have a problem that’s identified that will cause them to have difficulty surviving.”

There are not many pediatric cardiologists in the world with Lee’s level of experience, said Dr. Thomas Yeh, Jr., CHoR’s chief of Pediatric Cardiothoracic Surgery. Yeh was a fellow at the Toronto hospital with Lee and helped recruit her to CHoR. “Jin is a fantastically skilled interventional cardiologist. She brings a new level of experience not only to Richmond but really to the East Coast,” he said. “She’s the consummate cardiologist wrapped up in an incredibly nice and caring person.”

Children's Hospital of Richmond renderingWhile receiving her medical degree at University of Toronto Medical School, Lee felt drawn to pediatrics. “Children are special because there’s a natural instinct for us to want to just take care of them, and I think everybody who does pediatrics always feels compelled to do that extra bit more when children are involved,” she said.

She brings a new level of experience not only to Richmond but really to the East Coast,” he said. “She’s the consummate cardiologist wrapped up in an incredibly nice and caring person.”

She also liked the challenge. “It is incredibly interesting in terms of the variety of heart disease that we encounter. A large portion of our patient population has congenital heart disease, meaning they are born with problems. There are really thousands of variations of what we can see, and every heart is actually quite unique.”

And now, after two decades in Toronto, she’s decided to take on the challenge of helping to build a cardiovascular program and a new hospital. The goal is for CHoR to be among the top 20 children’s hospitals in the U.S. by 2022.

“Probably the biggest draw for me was the scope and the ambition of the vision here, and the fact that it was really coming from all levels of the VCU Health enterprise, with tremendous support from the Children’s Hospital Foundation,” she said.

 


In Memoriam

The Pauley community mourns the sudden loss of Joshua Kochel, who passed away on June 20 at the age of 37. He was a radiology technician at the VCU Medical Center for 14 years, and a beloved member of the Cardiovascular Imaging team. Our hearts are with his family.


Letter from the Director

Dr. Greg Hundley, DirectorOver the past year, we’ve given great thought to where we are now and the challenges we will need to address in the future. Out of that process, we emerged with an updated mission for Pauley.

In this issue of The Beat, I hope you’ll enjoy reading about the new mission and some of the ways we are already carrying it out. Our cover story, for instance, focuses on the multidisciplinary teams that are helping us remain at the forefront of patient care and scientific discovery. You’ll also learn about innovative research taking place in our cardiac catheterization laboratories, now led by the outstanding clinician Dr. Zach Gertz, as well as through the work of our cardio-oncology and other teams. All these efforts are adding up: In 2018, we had a record-setting year for grants.

You’ll meet Dr. Beverly Spencer, who leads our Colonial Heights clinic. She’s one of the partners who help us better improve cardiovascular care for all by serving patients at our many locations throughout the Commonwealth.

Stories on excellence in training and education are featured throughout this issue—from the Jeopardy win by our fellows and the commitment of faculty like Dr. Antonio Abbate to the achievements of alumnus Dr. Thomas Porter. We also remember one of our great teachers, Dr. Michael Hess, who is sadly missed.

Finally, we celebrate the 40th anniversary of the first angioplasty in Virginia. Performed by Dr. Michael Cowley and Dr. George Vetrovec, the procedure was new and exciting. Though great skepticism surrounded it, it turned out to be an incredible, life-saving endeavor. The same spirit of innovation sparked by leaders like Drs. Cowley and Vetrovec continues today at the Pauley Heart Center—and is growing.

At Pauley, I’ve found a facility rooted in a restless, creative spirit that is continually renewed by the support of our visionary donors and reflected in our new mission. It’s a time of enormous optimism.

Sincerely yours,

Dr. Greg Hundley


Welcome, New Faculty!

Dr. Lucas, Dr. Trankle, and Angie CarnealDr. Alexander Lucas joined VCU as an instructor and was dually appointed in the Department of Health Behavior and Policy and the Pauley Heart Center. He has numerous peer-reviewed publications and has received grant support for his studies of exercise interventions on cancer patients.

“Alex Lucas is a young, dynamic behavioral scientist who is working to help us modify lifestyle behavior to help us improve cardiovascular health. We feel fortunate to have him here,” said Dr. Greg Hundley.

Lucas received his M.S. in Health and Exercise Science from Wake Forest University and his Ph.D. in Health and Exercise Behavior from the Ohio State University, where he also undertook postdoctoral research. His previous position was as a postdoctoral fellow at Wake Forest School of Medicine, Cancer Prevention and Control.

“I was drawn to VCU to work for Dr. Hundley, who I greatly admire. The opportunity to work with him here at VCU where he was building a new team was very attractive,” he said. “Also, upon meeting with the faculty in Health Behavior and Policy, I realized how much of an emphasis VCU places on working within the community and addressing health disparities, which is something I really want to be a part of.”

Fun Facts: “I love the outdoors and am also a runner, so I try and do as much of those two things as I can.” He is originally from Bulawayo, Zimbabwe. “In Zimbabwe, it’s quite a dry climate, and our main economy was based on tobacco, so there are some similarities to Virginia,” he said.

A familiar face, Dr. Cory Trankle, attended VCU Medical Center for his residency, postdoctoral clinical research fellowship and Cardiovascular Disease fellowship (serving as chief fellow his third year). He received his M.D. from the Medical College of Georgia. Trankle joined the faculty as an instructor in Non-Invasive Cardiology and will focus on cardiac magnetic resonance and echocardiography and conduct research exploring the use of these imaging modalities in new ways. He has published extensively, has led several Phase II clinical trials and is a reviewer for numerous publications, including Circulation and the Journal of the American College of Cardiology.

According to Dr. Antonio Abbate, who served as his research advisor, “Dr. Trankle is among the most talented trainees we have had at VCU, and we are very excited to have him join the faculty in the heart center. He is a dedicated, knowledgeable and compassionate physician with a clear passion for clinical research. He added, “I am certain that with his clinical and research acumen and his attention to details, Dr. Trankle will continue to promote groundbreaking research in the heart center.”

Trankle describes VCU as a “fantastic place to spend my postdoctoral training because of the wide range of patients that we care for, the connections we have with the basic science laboratories and other research organizations within the university, the wide range of subspecialist expertise within the medical center and the strong support from leadership in facilitating clinician-scientists as they pursue research investigations. I am tremendously thankful for the mentorship I have received, and I look forward to further developing as an academic cardiologist as I transition to faculty.”

Fun Facts: “In my spare time, I like to garden and homebrew beer. Some of the more exotic projects from this year have been pawpaw trees (native to Virginia), ghost chili peppers (one of the hottest peppers in the world), pineapple sage and three varieties of hops.”

Promotions spotlight: Angie Carneal, Nursing Director

Congratulations to Angie Carneal, who was named Nursing Director of the Pauley Heart Center. Her previous roles at Pauley include Interim Nursing Director and Nurse Manager of the Coronary ICU. She has over 10 years of nurse leadership and over 20 years of clinical experience. She received her RN from Richmond Memorial Hospital School of Nursing, her BSN from the University of Phoenix and her MSN from Western Governors University.

According to Carneal, “This role allows me to fulfill my passion for caring for others. I have simply transitioned over time from caring for few patients a day to impacting the care of all patients in the Pauley. In addition, I have the opportunity to shape an environment where nurses can deliver extraordinary care every day. As a nursing leader, nothing can be more rewarding than watching patients entrusted to your care heal and Pauley Heart nurses achieve their full potential.”

Administrator Clare Greene describes Carneal’s transition from interim to director as “seamless.”

“Angie is passionate about patient care and works diligently to streamline operations. She cares about her physicians and team members. She is a strong advocate for creating a work environment in which all can excel. I enjoy her candor and direct approach,” said Greene. “In addition to all this, she is an astute business leader and understands the finances. Angie is an experienced cardiovascular leader and brings to us a wealth of talent.”

FROM LEFT: DR. Alexander lucas, Dr. cory Trankle and Angie Carneal, nursing director


In Remembrance: Dr. Michael Hess

Dr. Michael HessWith great sadness, VCU Health announces the passing of Dr. Michael L. Hess in Richmond on April 13, at the age of 76, following a long illness. Although he is no longer with us, his love of patients and teaching, and his significant contributions to the fields of heart failure, heart transplantation and cardio-oncology will be remembered for many years.

Dr. Michael Hess was a small man, but he arrived in rooms with a booming voice and a large presence.

“He was a bit of a whirling dervish. A force of nature,” said Maureen Flattery, a nurse practitioner in cardiac transplantation who worked with Hess for more than 20 years. But, she added, his energy drove him to great accomplishments—from his innovative work with pioneering surgeon Dr. Richard Lower in the early days of cardiac transplantation and his creation of the International Society for Heart and Lung Transplantation (ISHLT) to his coming out of retirement in 2013 to start the cardio-oncology program at VCU Health.

Dr. Greg Hundley, director of VCU Health Pauley Heart Center, remembers Hess from his years as a student at VCU School of Medicine. “He was on the faculty then, and he was an internationally respected leader in cardiovascular physiology and also formative in many of the medical management issues related to cardiac transplantation,” he said. “He was a unique blend of friendliness and exceptional expertise in his craft.”

“He was a true giant in the field of medicine. Very few people accomplish in their career what he did in the first 20 years of his career,” said Dr. Kenneth Ellenbogen, chair of the Division of Cardiology in VCU’s School of Medicine. “He was a completely unselfish teacher, and an amazing physician and human being. So many people owe their lives to him. He was responsible for the field of heart transplantation getting off the ground. I don’t know how we could all ever thank him for everything he did for this field.”

Born in the small coal mining town of Philipsburg, Pa., on August 10, 1942, Hess attended St. Francis University, then the University of Pittsburgh Medical School, where he met and married his wife, Dr. Andrea Hastillo, who, like him, later became a VCU Health cardiologist. Hess was named a professor of both cardiology and physiology and published more than 200 research papers.

Hess received many honors over the years, including VCU’s University Award of Excellence as well as its Distinguished Clinician, Distinguished Scholarship and Distinguished Clinical Care awards. He was recognized seven times with the university’s Outstanding Teacher Award, an honor given annually by medical students, and was named the Outstanding Teacher for Advanced Cardiovascular Physiology four times.

“He was a true giant in the field of medicine. Very few people accomplish in their career what he did in the first 20 years of his career,” said Dr. Kenneth Ellenbogen.

Early in his career, Hess cared for the post-transplant patients of Lower.

In an interview, Hess recalled spending Tuesday nights on Lower’s porch with esteemed colleagues like Dr. H. M. Lee, “trying to pound out the problems that we were having at the time.” The problems in the 1970s and 1980s included high mortality rates for transplant patients and the fact that “the world of cardiac transplantation was so young that there were no rules, no guidelines,” he said.

At a 1981 meeting of the American Medical Association, Hess co-founded the ISHLT, a network for professionals in the fledgling transplant field, and served as the first president of the society.

Today, the organization is the world’s leading scientific society of transplantation physicians and surgeons and operates the International Registry for Heart and Lung Transplantation, the only database of its kind in the world.

In addition, “he was an excellent educator and clinician. His first concern was the patient and his second was to teach people how to take care of patients,” said Flattery. “His patients loved him.”

Hess was devoted to his wife and daughter, endocrinologist Dr. Samantha Hudson, and their extended family. In his spare time, he enjoyed reading, spending time with his loved ones and watching his beloved Pittsburgh Steelers play.

After one short-lived retirement, he returned to VCU Health to start Virginia’s first cardio-oncology program in 2013. He retired for good in 2017 but stayed engaged publishing and leading a grand rounds—to a standing ovation. On December 8, 2018—the date of his and Hastillo’s 50th wedding anniversary—he traveled to VCU Medical Center for the unveiling of the Dr. Michael Hess Library in the West Hospital.

Along with his family, “medicine, his patients, his students were his life. He was fully committed to the field. VCU Health and heart failure were his passion from beginning to end,” said Dr. Keyur Shah, section chief of heart failure. “He was very resilient.The fact that he came back and started a successful cardio-oncology program just speaks to not only his motivation but his passion to be involved in clinical medicine this late in his career.”

 


Early Pioneers Inspire Today’s Cath Lab

Dr. Michael Cowley and Dr. George Vetrovec

In its early years, the VCU cardiac catheterization lab was dedicated to diagnosis. That all changed when Dr. Michael Cowley and the lab’s new director, Dr. George Vetrovec, introduced balloon angioplasty to Virginia in 1979.

“It was the first time people with coronary disease could be treated without surgery. That’s obviously a huge thing to be able to offer to patients,” said Dr. Zachary Gertz, director of the Cardiac Catheterization Lab.

Over the years, as catheters, imaging and techniques have improved, cardiologists have been able to treat more patients, with increasingly complex interventions. In 2018, Pauley’s cardiologists performed 3,882 procedures in the hospital’s four cath labs, which operate around the clock.

Pauley draws many high-risk patients that other institutions turn away, such as frail patients that require temporary heart pumps during their interventions. “We still get the most challenging cases from all over the state,” said Gertz.

Gertz was recruited to the faculty in 2012 to develop the structural heart disease program, following his involvement in the first study for transcatheter aortic valve replacements [TAVRs]. In 2017, Dr. Barbara Lawson joined the team, and like Gertz, performs procedures such TAVRs and percutaneous closure of atrial septal defects and patent foramen ovale.

He has watched the evolution of TAVRs. At first, only patients at high risk of complications during surgery could undergo the procedure, then medium-risk patients were approved. Now, research indicates its suitability for low-risk patients.

He also took part in early studies for MitraClips, which are implanted in patients with leaky mitral valves, and sees mitral valve replacements and tricuspid valve repairs on the horizon.

Dr. Jose Exaire performs the lab’s most challenging interventions, on vessels with chronic total occlusion [CTO]—meaning they are completely blocked. He has an 85-90% success rate of successful PCIs for these patients. In only 10% of the attempts is he unable to penetrate the arterial wall, using a variety of approaches.

“There are always new developments to try to aid this complex procedure and thanks to that, we can attempt to tackle more complex patients,” said Exaire.

Not all the cases involve the heart; Exaire and Dr. Deepak Thomas also perform procedures on blockages in other parts of the body.

“These include, but are not limited to, interventions for lower extremity peripheral artery disease, upper extremity disease such as subclavian stenoses and renal artery interventions,” said Thomas. “Most cardiologists recognize that coronary disease rarely occurs in isolation and a full understanding of the `vascular’ part of cardiovascular can only help our patients in their overall wellbeing as we attack arterial injury from a medical, interventional and preventative standpoint.”

Research in the lab is ongoing, including one study in which stem cells are injected into heart tissue to regenerate areas that have experienced cell death after a heart attack.

Innovation has long been a part of the lab, said Gertz. “George [Vetrovec] started a cath lab that has the reputation of doing the best and most complicated things in Richmond and throughout the state,” he said, “and I just want to maintain that, along with our same high qualities and outcomes.”

Congratulations to Dr. Gertz on being named director of the Cardiac Catherization Laboratories this May! Stay tuned for more news about his appointment in our next issue.