UNC Cardiology News

Health benefits of exercise

WRAL discusses the health benefits of exercise; Dr. Rick Stouffer is one of the experts quoted: "An individual who walks 5 or 10 minutes a day is going to live longer than an individual who's totally sedentary... And people who work out more intensely tend to live longer than less active individuals." Read the story and see video here.

McAllister Heart Inst. presents: Jeff Holmes, MD, PhD, Prof. of Biomedical Engineering & Medicine at the University of Virginia

Seminar Title: “Scar Formation After Myocardial Infarction: What Happens, Why does it Matter, and What Can We Do about It?
When Nov 14, 2017
from 02:00 PM to 03:00 PM
Where 1131 Bioinformatics
Contact Name
Contact Phone 919-962-7110
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Presentation Preview: Myocardial infarct expansion has been associated with an increased risk of infarct rupture and progression to heart failure, motivating therapies such as infarct restraint and polymer injection that aim to limit infarct expansion. However, an exhaustive review of quantitative studies of infarct remodeling reveals that only half found chronic in-plane expansion, and many reported in-plane compaction. Using a finite element model, we demonstrate that the balance between scar stiffening due to collagen accumulation and increased wall stresses due to infarct thinning can produce either expansion or compaction in the pressurized heart potentially explaining variability in the literature and that loaded dimensions are much more sensitive to changes in thickness than in stiffness. Our analysis challenges the concept that in-plane expansion is a central feature of post-infarction remodeling; rather, available data suggest that radial thinning is the dominant process during infarct healing and may be an attractive therapeutic target.

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Same Day Deep Vein Thrombosis Clinic Opens in Meadowmont

UNC Heart and Vascular at Meadowmont has opened a same day Deep Vein Thrombosis (DVT) Clinic. Patients with suspected DVT are able to bypass the emergency department for same day evaluation and outpatient treatment. For patients, this means efficient work-up and initiation of necessary therapy without the cost and inconvenience of a trip to the ER.

UNC Heart and Vascular at Meadowmont has opened a same day Deep Vein Thrombosis (DVT) Clinic. Patients with suspected DVT are able to bypass the emergency department for same day evaluation and outpatient treatment. For patients, this means efficient work-up and initiation of necessary therapy without the cost and inconvenience of a trip to the ER.

The clinic houses a clinical laboratory equipped to measure relevant biochemical and coagulation parameters, a state of the art peripheral vascular laboratory, and providers with expertise in the management of venous thromboembolic disease. All of this makes it possible to diagnose DVT, counsel patients, and initiate therapy from the Meadowmont Clinic.

Alan Hinderliter, MD, of the Division of Cardiology, says physicians from across UNC can refer patients to the clinic with a simple phone call. From there, providers in the clinic will evaluate the patient, acquire the necessary diagnostic studies, start treatment if a DVT is diagnosed, and refer the patient for prompt follow-up with UNC’s internationally recognized team of thrombosis experts, while always keeping the referring physician and other member of the care team updated.

Details:

UNC Heart and Vascular at Meadowmont

300 Meadowmont Village Circle

Suite 301

Chapel Hill, NC

Clinic Hours:

Monday – Friday: 8:30 a.m. – 3:30 p.m.

Contact:

Referring physicians should call 984-974-2900 and press “Option 2” for Vascular

Simple Genetic Test Promises Better Outcomes in Heart Stent Patients

A study co-authored by Rick Stouffer, III, MD, the Henry A. Foscue Distinguished Professor of Medicine, chief of cardiology at UNC, highlights potential of personalized medicine in patients with cardiovascular disease.
Simple Genetic Test Promises Better Outcomes in Heart Stent Patients click to enlarge George "Rick" Stouffer III, MD
Simple Genetic Test Promises Better Outcomes in Heart Stent Patients click to enlarge Craig Lee, PharmD, PhD

November 2, 2017

Researchers in the Division of Cardiology, School of Pharmacy and UNC McAllister Heart Institute at the University of North Carolina at Chapel Hill are part of a national study which found that a quick, precise genetic test, when used to guide medication selection, can significantly reduce the risk of cardiovascular events in patients who receive a coronary stent. The study was conducted by the National Institutes of Health's Implementing Genomics in Practice (IGNITE) network, and published online November 1. 

The test identifies a genetic deficiency that affects the body’s ability to activate clopidogrel, a common anti-clotting drug given after a coronary artery stent is inserted. Researchers at UNC and six other sites throughout the country analyzed medical outcomes in 1,815 patients who had genetic testing at the time of their cardiac procedure. They found that 572 patients (approximately 30 percent) had a gene which predicted that clopidogrel would not be metabolized normally (a loss-of-function allele). The risk for major adverse cardiovascular outcomes was twice as great in these patients if they were treated with clopidogrel compared to alternative therapy.

The study examined the effect of genotype-guided treatment on cardiovascular outcomes after a percutaneous coronary intervention, or PCI, in which a metallic stent is inserted into a heart artery to treat a blockage. The findings are the first from a large group of U.S. patients to show that the risk of cardiovascular problems is reduced when PCI patients with a genetic deficiency get an alternative medication.

“Patients with the genetic deficiency saw significantly better outcomes when treated with an alternative drug,” said Craig Lee, PharmD, PhD, associate professor at the UNC Eshelman School of Pharmacy and a co-author of the study.

The genetic test that identifies a patient’s response to clopidogrel is performed by the UNC Health Care Molecular Pathology and Genetics Lab.

“We are using this test on a daily basis to help decide in a timely manner which drug to prescribe, said George “Rick” Stouffer, III, MD, the Henry A. Foscue Distinguished Professor of Medicine, chief of cardiology at UNC, and a coauthor of the current study.

The results of this trial show the power and the promise of personalized medicine, which tailors medical decisions based on a patient’s genetic information and other unique characteristics.  

“This is an important breakthrough in personalized medicine because it shows how a genetic marker can be used to modify treatments and improve patient outcomes,” said Tim Wiltshire, PhD, director of the UNC Center for Pharmacogenomics and Individualized Therapy.

The present research was organized through a collaborative genomic medicine network funded by the National Institutes of Health and known as Implementing Genomics in Practice. The UNC Center for Pharmacogenomics and Individualized Therapy is an affiliate member of this network. Other institutions that participated in the clopidogrel research were the University of Florida, the University of Maryland-Baltimore, the University of Pittsburgh, the University of Alabama-Birmingham, Vanderbilt University Medical Center, the University of Illinois-Chicago, Indiana University-Indianapolis, Sanford Health, Duke University and the University of Pennsylvania. The lead author of the study was Larisa Cavallari, Pharm. D., director of the Center for Pharmacogenomics at the University of Florida College of Pharmacy. These findings were presented Nov. 15 at the American Heart Association’s Scientific Sessions in New Orleans and will soon be published by the Journal of the American College of Cardiology-Cardiovascular Interventions.

 

When Time is Muscle: UNC Cardiologists Beat the Clock

Two UNC interventional cardiologists, George "Rick" Stouffer, MD, and Michael Yeung, MD, led a study that showed a simple hemodynamic ratio determined at the time of angioplasty provides a rapid prediction for in-hospital mortality in STEMI patients.
When Time is Muscle: UNC Cardiologists Beat the Clock click to enlarge George "Rick" Stouffer, MD, and Michael Yeung, MD

By Kim Morris, UNC Department of Medicine

For the interventional cardiologist treating a patient with a heart attack, nothing is more important than being able to make the best decision when the clock starts ticking. A heart attack that completely blocks a major artery puts a patient at the highest risk for death. When a major artery is blocked, heart tissue is starved for oxygen and begins to die very quickly.

This type of heart attack, known as a STEMI (ST-segment elevation myocardial infarction), leads to significant changes on an electrocardiogram. The cardiologist treats the heart attack by opening the blocked artery to perform an angioplasty (angioplasty performed for STEMI is known as emergency primary percutaneous coronary intervention or PPCI). This procedure involves threading a catheter to the heart, putting a wire in the artery and then tracking a balloon over the wire. The balloon is inflated and deflated at the site of the blockage to restore blood flow, and in most cases, a stent is implanted. Then, the cardiologist must determine if the patient needs mechanical support for a failing heart. Calculating the risk of heart failure, cardiogenic shock, and death at the time of the procedure can be critically important because early initiation of blood pressure support can improve survival.

Two interventional cardiologists at UNC, George "Rick" Stouffer, MD, and Michael Yeung, MD, led a study that showed a simple hemodynamic ratio determined at the time of angioplasty provides a rapid prediction for in-hospital mortality in STEMI patients.

“Our results show that a simple index predicted mortality at a level consistent with the more commonly used and more cumbersome prognostic indices,” said Dr. Stouffer, chief of cardiology, co-director of UNC’s McAllister Heart Institute and the Henry A. Foscue Distinguished Professor of Medicine. “Knowing which patients will likely survive this type of heart attack enables us to treat them much more aggressively.”

The researchers conducted a retrospective single-center study examining simple hemodynamic parameters obtained at the time of cardiac catheterizations. Current 30-day mortality rates for patients with STEMI range from 2.5% to 10%, and 10.5%--24% of those patients require mechanical support, such as a balloon pump or impella.

“Our question was, when people come in with a heart attack, how do we identify those--while on the table in the cardiac catheterization lab--who are at high risk of dying versus the people who will make it,” said Dr. Yeung, an assistant professor of medicine affiliated with UNC Cardiology at Nash in Rocky Mount, who also leads UNC’s cardiology mission trips to Nicaragua twice annually.  “We’re looking at how much they’re congested and how well the heart is pumping, to determine whether they will do well or not.”

The project examined the utility of an index based on systolic blood pressure (SBP) and left-ventricular end-diastolic blood pressure (LVEDP) ratio measured at the time of PPCI. Researchers examined adult patients age 18 and older treated at UNC between 2007 and 2011. They found the SBP/LVEDP ratio was an effective, rapid way to calculate risk.

“When we have a patient on the table, in the middle of the heart attack, we don’t have a lot of time,” said Dr. Yeung. “But what we’ve found is that LVEDP, a measurement of filling pressures and systolic blood pressure, a measure of how well the heart is pumping, is all that's necessary to make a rapid assessment of the size of the heart attack and risk of death. It’s a simple way to calculate in our head how sick the patient is.”

This first phase of the study was recognized as the editor’s choice for Catheterization and Cardiovascular Interventions, published by the Society for Cardiovascular Angiography and Interventions Foundation in September, 2017.

The second phase of the study, soon to be published, looks at hemodynamic parameters and how they correlate to the size of the heart attack.

Since 2008, UNC Medical Center has been a leader in STEMI treatment and has been recognized annually by the American Heart Association for excellence in STEMI care.

Other participants in this study include Mike Sola, MD; Kiran Venkatesh, MD; Melissa Caughey, PhD; Rob Rayson, MD; and Xuming Dai, MD.

 

UNC Medical Center Offers Innovative Non-surgical Treatment for Enlarged Prostate

Prostatic Artery Embolization (PAE) is a catheter-based procedure to help improve symptoms caused by an enlarged prostate.
UNC Medical Center Offers Innovative Non-surgical Treatment for Enlarged Prostate click to enlarge Ari Isaacson, MD

CHAPEL HILL, N.C. – October 25, 2017 – For the last four years, doctors at the UNC Medical Center in Chapel Hill have been using an innovative, catheter-based procedure called Prostatic Artery Embolization (PAE) for the treatment of an enlarged prostate, also called benign prostatic hyperplasia, or BPH.

UNC Medical Center now performs more PAE procedures per year than all but a few hospitals in the U.S. It is also one of just a few hospitals that offers PAE to patients who are not enrolled in a clinical trial.

“The PAE procedure can take anywhere from one to three hours, depending on the location and size of the prostatic arteries,” said Dr. Ari Isaacson, a vascular interventional radiologist at UNC. “Then, most patients go home the same day.”

About half of men age 50 and older have problems with urination because of BPH. That percentage increases to 80 or 90 percent in men older than 70.

In men with BPH, the prostate becomes enlarged, resulting in urinary problems such as difficulty in starting, weak flow or the need to frequently go.

Until recently, treatments for BPH were limited to medications such as alpha blockers (Flomax or Hytrin), 5-Alpha reductase inhibitors (Avodart or Proscar), or surgical procedures such as transurethral resection of the prostate (TURP). In TURP, a surgical instrument is inserted into the penis and then used to trim and remove excess prostate tissue.

There are pros and cons to both medical and surgical approaches. Medications can help relieve symptoms and reduce the size of the prostate. But they often have side-effects that affect quality of life and the benefits of the medications only last if the patient takes them continuously.

In comparison, TURP surgery improves symptoms more quickly and the improvements are longer lasting. However, in some cases, a man’s prostate is too large to be removed through a TURP procedure. TURP also carries a risk of sexual side effects such as erectile dysfunction or retrograde ejaculation (the ejaculation of semen into the bladder instead of out through the penis).

PAE’s Non-Surgical Approach
PAE is performed through a small puncture in the groin or the arm. A catheter is inserted through the artery and directed toward the prostate. Once the catheter is positioned in the artery supplying blood to the prostate, tiny particles called microspheres are injected that plug up the artery, blocking blood flow in a procedure called embolization.

“This process is then repeated on the other side, usually through the same original puncture,” Dr. Isaacson says.

The PAE procedure blocks the blood flow to the areas of the prostate that are most affected by BPH, causing these areas to become dead tissue. These areas of dead tissue then cause the prostate to soften, alleviating some of the pressure that is causing blockage of the urine.

Over several months, the body’s immune system reabsorbs the dead prostate tissue and replaces it with scar tissue. The scar tissue slowly contracts, resulting in shrinkage of the prostate. Over a six-month period, the prostate will shrink by 20 to 40 percent, resulting in improved and less frequent urination.

“About 75 to 80 percent of men treated with PAE experience a significant and lasting improvement,” Dr. Isaacson says.

Appointments for PAE evaluation are available in Chapel Hill, Raleigh, Hillsborough and Siler City. For more information about PAE at UNC, click here. 
 

UNC Cardiology at the American Heart Association

The Scientific Sessions of the American Heart Association are coming up soon (November 11-15, 2017, Anaheim, CA). As always, UNC faculty, fellows, and other researchers are making a strong presence. Download a listing of UNC Cardiology action at AHA this year here.

MHI Seminar Series Presents: Ming Cui Gong, Ph.D., M.D., Prof of Physiology and Cardiovascular Research Center at the University of Kentucky College of Medicine

“Disrupted Circadian Rhythms of Blood Pressure and Vascular Function in Diabetes”
When Oct 24, 2017
from 02:00 PM to 03:00 PM
Where 1131 Bioinformatics Bldg.
Contact Name
Contact Phone 919-843-5512
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Presentation Preview: The normal blood pressure circadian rhythm is essential to human health, as morning BP surge is associated with increased incidence of life-threatening cardiovascular events. Moreover, disruption of blood pressure circadian rhythm, which occurs in up to 75% of diabetic patients, is emerging as an index for future target organ injury and poor cardiovascular outcomes. However, the mechanisms underlying the disruption of blood pressure circadian rhythm in diabetes remain largely unknown. Using diabetic and various genetic modified mouse models, our studies demonstrated that the vascular smooth muscle clock gene Bmal1 plays an essential role in regulating the time-of-day variations in vascular contractility and blood pressure circadian rhythms under physiological and diabetic conditions.

Faculty Host: Christopher Mack, cmack@med.unc.edu

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Skills of a Tar Heel, Luck of the Irish

In May, a faulty heart valve nearly put an end to Jim Weber. But after receiving a transcatheter aortic valve replacement at UNC Medical Center, Weber says he feels like he’s been gifted with years he didn’t have before. A lifelong Notre Dame fan, Weber joined Matt Cavender, the doctor who performed the valve replacement, as the Fighting Irish faced the Tar Heels at Kenan Stadium.
Skills of a Tar Heel, Luck of the Irish click to enlarge Dr. Cavender with Jim Weber at Kenan Stadium (photo by Jon Gardiner, UNC-Chapel Hill)

Jim Weber had an aortic valve replaced in 2009. This past spring Weber’s doctors discovered that the valve was leaking and needed to be replaced again.

His doctors had hoped to wait until he was somewhat healthy before replacing the valve, but Weber’s health had been on the decline for months. “I had no appetite. I couldn’t sleep. In the period between Thanksgiving and April of this year, I lost 50 pounds,” Weber recalls.

One night in May, Weber, who lives in Lexington, North Carolina, had to be rushed to High Point Regional Hospital in an ambulance because his condition had deteriorated to the point that his organs had begun to shut down. It wasn’t long before doctors at the High Point Hospital transferred him to UNC Medical Center.

By the time he arrived in Chapel Hill, Weber had lost consciousness. Matt Cavender, MD, MPH, one of the doctors on the team who performed Weber’s valve replacement, described Weber’s condition on arrival. “He was in shock, could not respond to us, and had kidney failure. Once he arrived at UNC, I worked with my colleagues, John Vavalle and Tommy Caranasos, to come up with a plan to replace his valve. We felt that it was the only way he would be able to survive. The doctors and nurses in our cardiac intensive care unit and our cath lab staff were able to help us implement and execute that plan and we are thrilled to see how well Mr. Weber has done.”

Transcatheter aortic valve replacement (TAVR) is a minimally invasive valve replacement procedure that is often ideal for patients who may be too ill for open heart surgery.

After his TAVR, Weber spent a week in recovery at the Medical Center.

“I could not have asked for better care,” he says. “It wasn’t just that everyone was positive and helpful, it felt like how I was doing was important to them.”

Weber’s recovery has been remarkable. He spends his free time these days outside as much as he can. He walks for an hour a day and works in his yard often.

Weber has had to make a few changes, including a low-salt diet – something, he joked, that he “wouldn’t wish on an enemy” – but otherwise he says he is feeling better than he has in years.

“Dr. Cavender and his crew gave me time that I didn’t have before,” says Weber. “I feel like I was gifted with years to live and they’ve added quality to my life also. A year ago I couldn’t have done the things that I do now.”

That includes cheering on Notre Dame’s football team. Weber grew up in Indiana and has been a lifelong fan.

“When I was a kid I used to believe that if you were good, when you died you got to go to Notre Dame.”

Dr. Cavender knew that Weber was a fan, so when the Fighting Irish were scheduled to face the Tar Heels in Chapel Hill, he invited Weber and his family to Kenan Stadium to have lunch at the Carolina Club and watch the game. In his pocket, Mr. Weber carried the ticket from the last time he watched UNC play Notre Dame, in 1971 at Notre Dame Stadium.

Weber says that he could not be happier with the care he received at the Medical Center and that he felt blessed to have them so close, but that as far as the action on the gridiron, he was sticking with his team.

 “If Dr. Cavender were a quarterback at UNC I would definitely root for him. But since he’s not, I had to root for my Irish.”

Learn more about the TAVR program at http://www.med.unc.edu/medicine/cardiology/uncheartvalve.

Record attendence for 2017 NC Cardiovascular Update

 Record attendence for 2017 NC Cardiovascular Update click to enlarge Dr. Smith and Dr. Fuster
 Record attendence for 2017 NC Cardiovascular Update click to enlarge Dr. Cavender presenting

Over 200 primary care providers, internists, cardiologists, ER physicians, RNs, NPs, pharmacists and other providers attended this year's NC Cardiovascular Update. This annual continuing education event is jointly organized by the UNC Center for Heart and Vascular Care and the Mountain Area Health Education Center.

Eighteen UNC providers gave presentations and participated in panel discussions. The keynote speaker was Dr. Valentin Fuster, Physician-in-Chief, Mount Sinai Hospital; Richard Gorlin, MD/Heart Research Foundation Professor, Icahn School of Medicine; and Director of Mount Sinai Heart, the Zena and Michael A. Wiener Cardiovascular Institute, and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health.

Dr. Fuster opened the conference with the 16th Annual Ernest Craige lecture, speaking on early detection of subclinical atherosclerosis. His scope of discussion was broad, covering cardiovascular health and disease throughout the human lifecycle, emphasizing the distinct approaches needed for different age groups. With the overall aging of the population, we can expect an increasing rate of heart failure and coronary artery disease; given this, he argued, in the 50+ population, we need efficient, early screening, such as by biomarker testing, and effective, real-world solutions, such as the polypill, which both increases medication adherence and is cost-effective. In the younger population, modifying exercise and nutrition habits, along with other lifestyle behaviors, should be a primary concern, going all the way to teaching children to make health a priority.

Other talks ranged from surveys of recent advances in cardiac procedures, imaging technologies, and pharmaceutical treatments to overviews of current clinical best practices for frequently seen conditions and concerns. Dr. Sidney Smith discussed the impact on clinical practice of the large, Nation-wide SPRINT trial investigating the effect of lowering blood pressure on a range of common diseases. Dr. Jack Kuritzky discussed the latest in lipid treatments— PCSK9 inhibitors— and how to use them effectively clinically in light of the latest guidelines. Dr. John Vavalle spoke in sequence with surgeon Dr. John Ikonomidis on percutaneous and surgical treatment of mitral valve disease. Other lectures covered coronary artery disease in women, heart failure evaluation and treatment, the state of the art in nutrition, and the latest in invasive and non-invasive management of atrial fibrillation, among other topics.

Session breaks were an opportunity for participants to talk more informally, grab some catered snacks, and peruse the exhibition booths lining the lobby from leading pharmaceutical and medical device companies.

UNC Cardiology is already hard at work planning next year's NC Cardiovascular Update, which will take place October 19 and 20, 2018 at the William and Ida Friday Center.

Bristol-Myers Squibb Foundation Provides $1.7 million grant to UNC School of Medicine to fund program streamlining Afib care & education for underserved populations

Atrial fibrillation hospitalizations reduced by 30 percentage points in first year of program.
Bristol-Myers Squibb Foundation Provides $1.7 million grant to UNC School of Medicine to fund program streamlining Afib care & education for underserved populations click to enlarge Anil Gehi, MD

CHAPEL HILL, N.C. – September 29, 2017 – UNC School of Medicine cardiologist Anil Gehi, MD, will use a $1.7 million grant from the Bristol-Myers Squibb Foundation to further innovate a care model, launched in 2015, that reduced hospitalizations for patients with atrial fibrillation (Afib) presenting in the emergency room by more than 30 percentage points in its first year.

Atrial fibrillation, which affects more than 2.7 million Americans, is characterized by an irregular heartbeat and is associated with an increased risk for blood clots, stroke, heart failure and multiple other heart complications according to Dr. Gehi who serves as associate professor of medicine at the UNC School of Medicine, program director of UNC’s Clinical Cardiac Electrophysiology Fellowship.

The three-year grant from the Bristol-Myers Squibb Foundation will enable Dr. Gehi  to continue development of a new protocol he established at UNC Medical Center through a pilot grant from the UNC Center for Health Innovation and adapt and evaluate its application primary care and urgent care settings as well.

UNC President Margaret Spellings applauded Dr. Gehi’s work and the Bristol-Myers Squibb Foundation team.  "We’re committed to increasing the amount of world-class research at our universities because these efforts spur economic growth and improve the quality of life of our citizens,” said President Spellings.  “We are extremely proud of Dr. Gehi’s work and thankful that it is being sustained through the generosity of the BMS Foundation.” 

“Supporting significant innovations in access to cardiovascular care that are homegrown by those caring for patients in safety net settings is a top priority for the Bristol-Myers Squibb Foundation,” said John Damonti, president, Bristol-Myers Squibb Foundation. “This partnership with UNC Health Care will help patients access the right care, in the right setting, in a timely manner and receive the education and support they need to manage their Afib.” 

Avoiding Unnecessary Hospitalization

“When we launched the pilot in 2015, we realized that many Afib patients were hospitalized unnecessarily, which certainly drives up the cost of healthcare for patients, and these hospitalizations didn’t necessarily improve quality of care,” Gehi said. “We felt that one of the major problems with Afib care was that it is very disorganized. Patients bounce around between many different providers – primary care providers, cardiologists, electrophysiologists, emergency medicine physicians. There’s just not very good coordination of care for these patients.”

As a result, there’s very little emphasis on education and prevention, which is critical in managing a chronic condition like Afib, Gehi explained.

“I always tell my patients: I may never be able to cure you of your atrial fibrillation, but I can work with you to manage it so that it doesn’t affect your life,” Gehi said. “We teach patients the importance of stroke prevention. We teach them how to tell when they’re in atrial fibrillation, and we teach them what they can do themselves – when they need to seek medical attention and when they can manage it on their own. It’s about getting patients more engaged in their own health.”

For many Afib patients – particularly those in vulnerable populations – access to specialty care can be extremely limited. Gehi hopes this grant can improve and perhaps remedy the lack of access in areas in and around the Triangle, Rocky Mount and High Point through partnerships with UNC Hospitals Hillsborough campus, UNC Rex Healthcare, Nash Health Care and High Point Regional Hospital.

Afib Transition Clinics vs Hospitalization

“We’re trying to address the problem of poor access by setting up a new pathway for care for patients who have the most challenging and urgent medical needs, primarily those who are coming into the emergency room,” Gehi said. “We have set up a new pathway here at UNC Medical Center by developing a new protocol for the emergency room so that ER physicians can triage Afib patients. Those patients who aren’t particularly high risk for poor outcomes might be discharged from the ER and sent to an Afib transition clinic.”

The Afib clinic at UNC is located at UNC Cardiology’s Meadowmont clinic in Chapel Hill. It is staffed by clinical pharmacists, though the protocol provides for any advanced practice provider to be able to staff the clinic.

“One of the things that’s so novel about our protocol is that our clinic is staffed with clinical pharmacists trained in the management of chronic illnesses, like diabetes or Afib,” Gehi said. “They are able to see these patients on a next-day basis and are able to do a lot of the patient education, which has been missing from traditional care models. They can also coordinate Afib care across all the patient’s providers.”

The 30 percentage-point reduction in hospitalizations in 2015 demonstrated that Afib can be treated in an outpatient setting for most patients, despite the statistic that upwards of 80 percent of Afib patients who go to the ER throughout the country are hospitalized, Gehi said.

“We were able to get that number down in the 50 percent range, and with further education we should be able to reduce it even further,” Gehi said. “We are quiet certain we have improved the quality of care for these patients, as well.”

The Bristol Myers Squibb Foundation grant will allow Gehi to expand this program throughout the UNC Health Care system, and potentially into other clinics and hospitals in North Carolina and across the country.

“The grant proposal was to establish other Afib clinics like the one we did here, targeting areas with a high proportion of vulnerable patients and to train local providers how to triage the patients and which ones would be appropriate to send to our clinics,” Gehi said.  “Our hope is that with this type of expansion, we can show that this model is scalable, and we’ll have a larger number of patients to demonstrate outcomes in better patient care, reduced emergency room visits, and reduced hospitalizations.

“We want this to be something that can be integrated into what is already present at other hospitals and primary care and specialty care clinics. It’s beneficial to patients, beneficial to the ER, and it’s beneficial to the providers.”

For more information on Afib, visit the UNC Health Care website at: https://www.unchealthcare.org/a-fib-transitions-of-care-network/.

Click here to watch Gehi discuss the work with WRAL.

About UNC School of Medicine

The UNC School of Medicine (SOM) is the state’s largest medical school graduating approximately 180 new physicians each year. It is consistently ranked among the top medical schools in the US and is among the most well funded for its research efforts.  More than half of the school’s 1,700 faculty members served as principal investigators on active research awards in 2016. Two UNC SOM faculty members have earned Nobel Prize awards.

About Bristol-Myers Squibb Foundation

The Bristol-Myers Squibb Foundation is committed to improving the health outcomes of populations disproportionately affected by serious diseases by strengthening healthcare worker capacity, integrating medical care and community-based supportive services, and addressing unmet medical need. The Foundation engages partners to develop, execute, evaluate and promote innovative programs to help patients with lung cancer and removing barriers to accessing care in the United States, HIV and comorbid diseases such as cervical and breast cancers and tuberculosis in sub-Saharan Africa, hepatitis B and C in China and India and veterans’ mental health and well-being in the U.S.

For more information about the Bristol-Myers Squibb Foundation, please visit www.bms.com/foundation or follow us on LinkedIn, Twitter, YouTube and Facebook.

 

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Qian Lab awards and publications

Dr. Li Qian of the McAllister Heart Institute is in the news twice this month:

Editor's Choice: Journal highlights new research that can identify high-risk patients

Editor's Choice: Journal highlights new research that can identify high-risk patients click to enlarge Dr. Michel Yeung
Editor's Choice: Journal highlights new research that can identify high-risk patients click to enlarge Dr. Rick Stouffer

Researchers conducted a retrospective single-center study examining simple hemodynamic parameters obtained at the time of cardiac catheterization to predict in-hospital mortality following ST-elevation myocardial infarction (STEMI). Current 30-day mortality rates for patients with STEMI range from 2.5% to 10%, and 10.5%–24% of those patients require mechanical hemodynamic support. The project examines the prognostic utility of an index based on systolic blood pressure (SBP) and left-ventricular end-diastolic blood pressure (LVEDP) ratio measured at the time of emergency primary percutaneous coronary intervention (PPCI). The entire study is outlined in the Editor’s Choice article of the September 2017 issue of Catheterization and Cardiovascular Interventions

The single-center study evaluated adult patients (≥ 18 years) with STEMI undergoing PPCI from April 11, 2007, to December 12, 2011. The final study included 219 patients with a mean age of 60 ±14 years. Patients’ LVEDP, SBP, and aortic diastolic blood pressure were obtained after successful revascularization and compared to major mortality risk scores.

“Our results are the first to demonstrate that the ratio of SBP/LVEDP when measured at the time of PPCI is a useful predictor of in-hospital mortality and 30-day mortality for patients experiencing STEMI,” said George Stouffer, MD, Division Chief of Cardiology at the University of North Carolina Chapel Hill Hospitals. “Invasive hemodynamic measurements at the time of PPCI have the theoretical advantage of better reflecting both left ventricular loading conditions and afterload than do non-invasive assessments. Our results show that this simple index predicted mortality at a level consistent with more commonly used, and more cumbersome prognostic indices, such as the Thrombolysis in Myocardial Infarction (TIMI) score, the Global Registry of Acute Coronary Events (GRACE) score and Killip Class.”

The SBP/LVEDP ratio ≤ 4 was associated with a likelihood ratio of 4.7 for in-hospital death, 5.8 for intra-aortic balloon pump (IABP) usage and 5.9 for the combined IABP usage or in-hospital death. “The performance characteristics of this ratio at high levels provide rapid and accurate identification of patients at the time of PPCI for STEMI who are low risk for death or need for IABP,” Stouffer added. A total of 20 (9.1%) patients died in-hospital and 34 (15.5%) required an IABP. The area under curve (AUC) for SBP/LVEDP ratio for in-hospital mortality (0.69) was more predictive than LVEDP (0.61, P = 0.04) or pulse pressure (0.55, P = 0.02) but similar to Shock Index and Modified Shock Index.

“SBP/LVEDP is a rapidly determined ratio that can provide important prognostic information at the time of PPCI,” said Michael Yeung, MD, Assistant Professor of Medicine, Division of Cardiology at the University of North Carolina Chapel Hill Hospitals. “The pressure values are readily obtained during PPCI and identify a population at high risk for mortality. This presents an opportunity to identify patients who might benefit from more aggressive hemodynamic support while in the Cardiac Catheterization Laboratory.” 

The authors of “Ratio of systolic blood pressure to left ventricular end-diastolic pressure at the time of primary percutaneous coronary intervention predicts in-hospital mortality in patients with ST-elevation myocardial infarction” include Michael Sola, MD; Kiran Venkatesh, MD; Melissa Caughey, PhD; Robert Rayson, MD; Xuming Dai, MD; George A. Stouffer, MD; and Michael Yeung, MD.

The McAllister Heart Institute presents Dr. Nikolaos Frangogiannis

Dr. Nikolaos Frangogiannis, MD - The Edmond J Safra/Republic National Bank of New York, Professor of Cardiovascular Medicine and Professor, Department of Medicine at the Albert Einstein College of Medicine will present a talk entitled " The functional pluralism of fibroblasts in the remodeling myocardium".
When Sep 12, 2017
from 02:00 PM to 03:00 PM
Where 1133 Bioinformatics
Contact Name
Contact Phone 919-843-2293
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Presentation Preview:  Cardiac fibroblast populations expand following injury and mediate repair, while contributing to adverse remodeling and ventricular dysfunction. A growing body of evidence suggests that in addition to their matrix-secreting properties, cardiac fibroblasts have a wide range of functions in cardioprotection, regulation of inflammation and tissue repair. This presentation will discuss emerging concepts on the role of fibroblasts in cardiac repair, remodeling and fibrosis

More information about this event…

Staring down the widowmaker

Roger Darr’s heart attack was caused ventricular fibrillation, or “sudden cardiac death”. Most patients who experience ventricular fibrillation at home do not survive. But thanks to high quality CPR provided by his quick-thinking wife, first responders, the Emergency Room staff at Central Carolina Hospital, and the providers at the UNC Medical Center, Roger is around to tell his story.
Staring down the widowmaker click to enlarge Roger Darr and his wife Diana
Staring down the widowmaker click to enlarge Joe Rossi, MD

Roger Darr’s heart stopped just after his lunch break. If his wife hadn’t been with him, it likely wouldn’t have started again.

After spending his morning at the top of a 10-foot ladder, preparing to run wire at a building in Sanford, his wife Diana showed up with lunch. Roger works in IT and was installing hardware in a building still under construction. He took a break to sit with her and eat the salad she brought. After they finished, she offered to help him carry a few spools of wire to the second floor.

He had nearly carried all the boxes up when Diana saw him sit down on the steps leading to the roofline. For a moment it appeared as though he had just taken a moment to rest. Then he slumped and she knew something was wrong. 

He was unresponsive. He wasn’t breathing. He didn’t have a pulse. Diana pounded on a nearby window to get the attention of a group of construction workers outside. They called 911 while she began CPR.

She had taken a CPR class a few years before, something her employer requires everyone on staff to do. She admits that her certification was a little out-of-date.

“It’s been a little while since I’d been through the program,” she said. “I think they were still teaching rescue breaths the last time I got certified.”

Diana performed CPR on Roger for more than 10 minutes before the EMTs arrived and relieved her. When they did, she collapsed. She was exhausted.

Joe Rossi, MD, director of Cardiac Catheterization Lab at UNC Hospitals, who placed Roger’s stent after he arrived to UNC, said that her quick response is part of the reason Roger was able to come through his experience so quickly and so well.

 “During a cardiac arrest, consistent, high-quality CPR can dramatically reduce the more catastrophic outcomes such as brain damage,” said Rossi, who is also a Clinical Associate Professor in the School of Medicine and Program Director of Interventional Cardiology Fellowship.

The EMTs managed to revive Roger with a combination of CPR and defibrillation, loaded him into the ambulance, and took him to the emergency department at Central Carolina Hospital.

“Roger’s mother met us at the ED,” recalls Diana, “so did our preacher, and we all prayed together right there in his room. Right after that I looked at his monitors and I knew something was not right.”

Roger coded again shortly afterward.

The doctors at Central Carolina stabilized him quickly but recognized that the care Roger needed would require emergency transfer. The ED doctors at the Sanford hospital contacted the UNC Medical Center Catheterization Lab and the Carolina Air Care Helicopter to pick Roger up.

He was still unconscious when he arrived at the cath lab, but he had an occlusion in his left main coronary artery, a blockage commonly described as “the widowmaker.”

“That’s the artery that supplies most of the blood to the heart, and when that artery occludes most people don’t make it, most people die suddenly. And that’s what happened to Mr. Darr.  His heart stopped twice before he arrived at UNC and then for a third time when he laid down on our procedure table.”

When Roger coded for a third time it was while he was on the table in the cath lab. To take some of the pressure off of his heart, Dr. Rossi inserted a device called an Impella through an artery in Roger’s groin.

“The Impella is a minimally invasive left ventricular assist device.  It has a little motor that sucks the blood out of the heart (the left ventricle) and keeps it circulating in the body. It’s doesn’t pump as efficiently as a heart, but it does enough that if your heart is just very weak, or stops,  it can make up the difference and provide time for us to place a stent.”

As the Impella was placed, CPR continued, which is not standard protocol but was necessary given the severity of Roger’s condition.

“It’s very unusual to place an Impella while someone is receiving CPR but it can be done. And that’s what we were forced to do for Mr. Darr. We did the whole procedure while we continued CPR to keep him alive. The truth is that most patients don’t make it through something like that.”

These interventions were necessary to keep Roger’s blood circulating to his organs and give Dr. Rossi and his team time to place the stent and open the blockage. Rossi said that the CPR Roger received throughout his experience was crucial to his survival and quick recovery.

“Not only did he receive really good CPR from our cath lab staff while we were placing the stent, he also received high-quality resuscitation in the Central Carolina- Sanford ER, and from his wife and from EMS before he arrived at the hospital,” Rossi said. “He’s been able to recover so well and so quickly because he received such effective CPR through the whole experience.”

Even after his stent was placed – and though he had come through a procedure that most people don’t survive – his condition was still precarious.

“They tell me I kept two nurses running for 48 hours straight,” Roger said.

For those two days Roger’s body temperature was kept low to prevent organ damage. This is also known as “targeted temperature management”, which minimized organ injury after cardiac arrest.

Roger was particularly susceptible to such an injury, since he had lost one of his kidneys years earlier to cancer. If the remaining one was damaged, it meant a lifetime of dialysis.  

Roger spent a week in a medically induced coma, with a respirator to help him breath. When his doctors thought his body could handle it, he was taken off the respirator and brought back to consciousness.

When he woke up, Diana remembers, he was still very weak.

“Those first few days he couldn’t even hold a glass of water to drink it.”

But he bounced back quickly and after a short period of rehabilitation, he was becoming his old self.  

“His last week in rehab, it was almost like he was back at work, giving people advice about their computers,” said Diana.

Now back at home in Sanford, Roger has to take it a little easier than he used to – for now he’s not climbing up ladders to run wire, but he’s helping customers set up their computers. He was sent home from the hospital with a walker and wheelchair to help him get around. According to Diana, he never once used the wheelchair and only needed the walker for a couple of weeks.

Dr. Rossi said that the quality and speed of Roger’s recovery has everything to do with the quality of care he received throughout the experience – from his wife giving him CPR, through the excellent care he received in Sanford, to the work of his cardiac care team at UNC Medical Center.

“He was lucky,” said Rossi. “His wife was trained in CPR, the EMTs were contacted quickly, he got great care in Sanford and he was transferred here efficiently. If we can get patients to UNC quickly from other hospitals, more of them are able to survive major events like this. The fact that Roger was able to bounce back so quickly is a testament to the quality of care he received at every step in the process.”

Since going back to work, Roger has made sure his customers know how important it is they are prepared for someone having a heart attack, because he knows firsthand that the key to survival is a quick response.

“It’s imperative,” he said. “If you can help keep someone alive in those first few minutes, it can make a huge difference for them and their family.”

UNC Hospitals Cardiac Rehabilitation Program Certified by Industry Leader

UNC Hospitals Cardiac Rehabilitation program was recognized for its commitment to improving the quality of life by enhancing standards of care.

August 31, 2017

Chapel Hill, NC – The UNC Hospitals Cardiac Rehabilitation Program is proud to announce the certification of its cardiac rehabilitation program by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). UNC Hospitals Cardiac Rehabilitation program was recognized for its commitment to improving the quality of life by enhancing standards of care.

“We are very pleased that our application was approved and that our program is certified by AACVPR.  We will continue to provide our patients with the highest quality program and care every day,” said Mary Ann Compton, MA, ACSM-CEP, CCRP, Program Director of the UNC Hospitals Cardiac Rehab Program.

Cardiovascular and pulmonary rehabilitation programs are designed to help people with cardiovascular problems (e.g., heart attacks, coronary artery bypass graft surgery) and pulmonary problems (e.g., chronic obstructive pulmonary disease [COPD], respiratory symptoms,) recover faster and improve their quality of life. Both programs include exercise, education, counseling, and support for patients and their families.

The UNC Hospitals Cardiac Rehabilitation program participated in an application process that requires extensive documentation of the program’s practices. AACVPR Program Certification is the only peer-review accreditation process designed to review individual programs for adherence to standards and guidelines developed and published by AACVPR and other professional societies. Each program is reviewed by the AACVPR Program Certification Committee and Certification is awarded by the AACVPR Board of Directors.

AACVPR-certified programs are recognized as leaders in the field of cardiovascular and pulmonary rehabilitation because they offer the most advanced practices available. AACVPR Program Certification is valid for three years.

About AACVPR
Founded in 1985, the American Association of Cardiovascular and Pulmonary Rehabilitation is a multidisciplinary organization dedicated to the mission of reducing morbidity, mortality and disability from cardiovascular and pulmonary disease through education, prevention, rehabilitation, research and disease management. Central to the core mission is improvement in quality of life for patients and their families.

 

 

Dr. Brian Jensen delivers Whitehead lecture

Dr. Brian Jensen delivers Whitehead lecture click to enlarge MacNider Hall, UNC School of Medicine

Dr. Brian Jensen delivered this year's Whitehead Lecture. Each year's Whitehead lecturer is selected by the Whitehead Medical Society on the basis of leadership, dedication, and devotion to medicine and teaching. Dr. Jensen's concluding remarks encouraged the medical students in the audience to keep the big picture and the important things in mind through the challenges of medical school:
There will be many moments that would get zero Likes on Instagram. But, be patient with yourselves—don't allow the struggles to feel like failures. Work hard and take satisfaction in daily and weekly accomplishments, however modest and incremental they may seem. And never forget that the role towards which you are working—the privilege of helping patients cope with their own suffering—offers deep and durable, albeit delayed, gratification.

The Whitehead lecture serves as the unofficial convocation for the School of Medicine. At the same event, Dr. Jensen also received the Hyman Battle Distinguished Excellence in Teaching Award in the Foundation Phase. At a subsequent gathering, Dr. Jensen joined six generations of past Whitehead Lecturers at UNC's Ackland Art Museum for art viewing and conversation.

McAllister update

Recent news from our McAllister Heart Institute colleagues:

New research by Bautch lab

Dr. Vicki Bautch has a new publication in Nature Cell Biology, “Endoglin moves and shapes endothelial cells.”  Dr. Bautch is Beverly Long Chapin Distinguished Professor and Chair of Biology and Co-Director of the McAllister Heart Institute. 

Carrie Neal honored for nursing excellence

Carrie Neal, RN, BSN, CCRN-CMC Carrie Neal, RN, BSN, CCRN-CMC is one of this year's Great 100 Nurses in North Carolina. Ms. Neal is the clinical coordinator for UNC's heart failure program. This award recognizes outstanding registered nurses Statewide and has been given out annually since 1989.

Learn more about heart failure care at UNC.

First leadless transcatheter pacing device at UNC

First leadless transcatheter pacing device at UNC click to enlarge The Micra transcatheter pacing device

On July 5, 2017, the UNC electrophysiology team led by Dr. Anil Gehi implanted the first leadless transcatheter pacing device at UNC Medical Center. The Micra transcatheter pacing device, made by Medtronic, is a new type of cardiac device that provides for traditional pacemaker functionality without the need for a traditional pacemaker system of wires (leads) with a device in a chest surgical "pocket." Pacemakers are often required to treat bradycardia, or slowing of the heart rhythm, to prevent symptoms including fatigue, shortness of breath, or fainting spells. The Micra device, about the size of a large vitamin and cosmetically invisible, is a self-contained device implanted directly into the heart. Less than one-tenth the size of a traditional pacemaker (and weighing about the same as a penny), the Micra is delivered through a catheter inserted in the femoral vein and has an average longevity of more than 12 years.

The Micra represents an important advance in treatment options. "Leadless pacing is a game-changer technology. Although currently only capable of single-chamber ventricular pacing, future developments will likely open up leadless pacing options to more and more patients," Dr. Gehi comments.

Learn more about patient care options at UNC for heart rhythm disorders.

AHA Mission: Lifeline Award for UNC Hospitals

For the fourth year in a row, UNC Hospitals received the Mission: Lifeline®  STEMI Receiving Center Gold Achievement Award. Learn more here.

Dr. Matt Cavender at 2017 ADA Presidents' Session

Dr. Matt Cavender at 2017 ADA Presidents' Session click to enlarge Dr. Cavender with 2017 ADA Presidents

Dr. Matt Cavender was chosen to give a talk at the Presidents' Session of the 2017 American Diabetes Association Scientific Sessions. His talk, entitled Hospitalization for Heart Failure and Death in New Users of SGLT-2 Inhibitors in Patients With and Without Cardiovascular Disease, presented findings from the CVD-REAL study, a large, multinational study examining the effectiveness of sodium glucose cotransporter-2 (SGLT-2) inhibitor treatment in reducing cardiovascular events in patients with type 2 diabetes. SGLT-2 inhibitors are a newer generation of glucose lowering drugs that may provide a useful alternative option for diabetic patients; Dr. Cavender has previously published research as part of the CVD-REAL study indicating that use of SGLT-2 inhibitors was associated with lower mortality and with lower risk of hospitalization for heart failure.

Dr. Jason Katz is Physician of the Year for Anesthesiology Residents

The graduating class of anesthesiology residents elected Dr. Jason Katz Physician of the Year; the award was conferred at Anesthesiology Grand Rounds on June 21, 2017.  In addition to being an inspiring educator, Dr. Katz is Director of Cardiovascular Clinical Trials and Medical Director of UNC's Mechanical Heart Program, Cardiac Intensive Care Unit, and Cardiothoracic Intensive Care Unit and Critical Care Service.

Multiple awards for Nash Heart Center

The Nash Heart Center team received three awards for quality and performance:

  • The 2017 Action Registry Silver Performance Achievement award from the National Cardiovascular Data Registry for demonstrating sustained achievement of performance measures in the treatment of acute myocardial infarction patients through the implementation of American College of Cardiology/American Heart Association Clinical Guideline Recommendations.
  • The Mission: Lifeline® NSTEMI Silver Achievement Award from the American Heart Association for its continued success in using the Mission: Lifeline® NSTEMI program.
  • The Mission: Lifeline® STEMI Receiving Center Silver Achievement Award from the American Heart Association for its continued success in using the Mission: Lifeline® STEMI program.

Dr. Michael Yeung and Dr. Xuming Dai are the physician leaders on the Nash team. The other Nash Heart Center providers are Drs. Zehra Husain, Ruihai Zhou, Roy Flood MD, and Stephanie Martin. The Heart Center Service Team consists of representatives from Nash EMS, ED, Cath Lab, Critical Care, Cardiopulmonary Support Unit, Cardiac Observation Unit, Pharmacy, Lab, & Cardiac Rehab. The team is led by Tera Joyner, AMI/Chest Pain Program Coordinator. Sarah Heenan, Executive Director of the Nash Heart Center is the management facilitator and Michelle Cosimeno, Associate CNO is the senior leadership sponsor. Meredith Hayes is Cardiovascular Services Quality Coordinator.

Statement from the Nash Heart Center team:
Our hospital receives patients from five different county EMS agencies and the Primary PCI program here definitely serves a need in Nash county and the surrounding area. Our EMS agencies, ED physicians and staff, cardiologists, & cath lab staff work efficiently to provide the highest level of timely expert care for our cardiac patients. We work to ensure that every patient is followed through the continuum of care after discharge into follow-up with cardiac rehab and cardiology clinic follow-up. It is a great honor for our team to receive this recognition in the first year of our program.

AHA research funding for Dr. Brian Jensen

AHA research funding for Dr. Brian Jensen click to enlarge Dr. Brian Jensen

Dr. Brian Jensen has been awarded a Grant-in-Aid from the American Heart Association for his proposal “Metabolic mechanisms of cardioprotection through alpha-1A adrenergic receptor activation.”  This grant will fund an expansion of previously published work indicating that the oral alpha-1A agonist dabuzalgron could be repurposed as a novel heart failure therapy. Preliminary data for this project were generated with the support of an NC TraCS $50K award.

McAllister news

News about our colleagues at McAllister Heart Institute:

Renal Denervation Clinical Trial at UNC

A new video features interviews with Dr. Rick Stouffer and Dr. Alan Hinderliter and provides an overview of the RADIANCE-HTN clinical trial, which is investigating renal denervation for treatment of hypertension.  Learn more about clinical trials at UNC Cardiology. 

New Leadership for McAllister Heart Institute Announced

Ronald Falk, MD, Chair of the Department of Medicine, has announced new leadership that will build on the successes of the UNC McAllister Heart Institute.
New Leadership for McAllister Heart Institute Announced click to enlarge Dr. Vicki Bautch and Dr. Rick Stouffer

By Kim Morris, Department of Medicine

Dr. Rick Stouffer and Dr. Victoria Bautch have been appointed Co-directors of the UNC McAllister Heart Institute and will guide the future of UNC’s cardiovascular research. Dr. Bautch is Beverly Long Chapin Distinguished Professor and Chair of the Department of Biology. Dr. Rick Stouffer is Henry A. Foscue Distinguished Professor of Medicine and Chief of the Division of Cardiology.

“The team reflects Dr. Chip McAllister’s mission for cardiovascular research, linking basic science with translational science to allow us to more effectively advance biological discoveries into clinical care, to help patients now and in the future,” said Dr. Falk.

“We are fortunate to have Vicki and Rick assume these roles,” said Dr. McAllister. “They’re the perfect combination to carry out the vision and mission of the Institute, from bench to bedside. The clinician has the bedside view, the researcher has the tools to understand the mechanisms of molecular cardiology.”

Established in 2009 through a generous endowment from Hugh A. “Chip” McAllister, Jr., MD, (’66), MHI is already home to many talented investigators who study cardiovascular disease. Under the inspiring leadership of Nigel Mackman PhD, MHI has become a center of excellence in cardiovascular biology and thrombosis.

Dr. McAllister founded the Institute following a career dedicated to cardiovascular disease research and treatment. He is one of the world’s leading cardiovascular pathologists and has studied more diseased aortic valves than anyone in the world. He emphasized that treating advanced life-threatening heart disease was not enough.

“We treat patients with intracoronary stents and artificial hearts, but we must better understand cardiovascular disease in order to prevent it. We have to look at the causes and collaborate with other specialties.”

The new team aims to strengthen the existing continuum of cardiovascular research by building bridges that invite subspecialty communities to work together to better understand cardiovascular disease. Dr. Bautch describes the MHI as the catalyst for understanding the mysteries of cardiovascular health and disease. Both she and Dr. Stouffer recognize opportunities to expand MHI to include new areas such as biomedical engineering, clinical research and public health. “Research advancements at MHI will improve clinical care through the development of new diagnostic tools and cardiovascular therapies,” said Dr. Stouffer.

FIRE funding for oral history collaboration

Dr. Ross Simpson, along with his collaborator in UNC's Department of History, Dr. Malinda Maynor Lowery, was awarded a Fostering Interdisciplinary Research Explorations (FIRE) grant by UNC's Office of the Vice Chancellor for Research and the Institute for the Arts and Humanities. FIRE grants are intended to foster innovative new interdisciplinary research collaborations. Only three projects were funded out of a strongly competitive field. The funded project is entitled Stories to Save Lives: Using Oral History to Understand the Social Context for Sudden Death and will combine the expertise of UNC's Southern Oral History Program, of which Dr. Lowery is Director; the SUDDEN project, of which Dr. Simpson is a leading investigator; and UNC's Odum Institute. This project will investigate oral history as a method to better understand the habits and beliefs of persons at risk for sudden unexpected death. 

UNC’s valve program at Grand Rounds

Drs. John Vavalle (Cardiology) and Thomas Caranasos (Surgery), leaders of UNC's Valve Clinic, presented at UNC Department of Medicine Grand Rounds. The presentation, "Leading the Charge: A New Era in the Treatment of Valvular Heart Disease," goes over new options for both aortic and mitral valve disease and provides an update on UNC's valve program.  Watch the video from the Department of Medicine. 

“Do it right, do it quickly, and do it with a good attitude"

Dr. Matt Cavender is a UNC Department of Medicine featured physician. Read the Q&A about the fast-paced field of Cardiology, patient-centered care at UNC, and baseball. 

Global Partnership Award for Dr. Ross Simpson

Dr. Ross Simpson is a winner of a 2016-7 UNC Global Partnership Award. He received this travel funding award for a trip to New Zealand to discuss and further ongoing collaborative research into sudden unexpected death with researchers at the National Institute for Health Innovation and the Department of Medicine at the University of Auckland. In addition, he conducted several seminars at the University Of Auckland School Of Population Health and the Department of Medicine.

Dr. Simpson also received a Distinguished Visitor Award from the University of Auckland for this trip.

UNC Structural Heart Program holds patient reunion

In March, the UNC Structural Heart Program hosted a group of grateful patients and their families for its first ever patient reunion.

Patients and families gathered with program physicians and staff at the Friday Center for a festive day of celebration. There was food, fun, and even dancing.

Many of the family members gave testimonials on their positive experiences, sharing stories of all they have been able to experience following their procedures. There were tales of vacations, time with family, and resuming those activities that the patients had gotten too weak to do before their surgery.

"Today I'm in good health. I'm working, I'm living my life like nothing ever happened," said former patient Sue Long.

Proudly wearing a UNC t-shirt, Dennis Elks said he came to Chapel Hill requiring the use of an oxygen tank, after a valve replacement, he no longer needs the oxygen tank and is again able to be active.

"I'm out in my yard, I'm able to walk my dog, mow the grass, do the things that I want to do," Elks said.

Victor Lucas of Chapel Hill said before his TAVR procedure he thought his days of playing music and attending festivals were over. He could no longer manage the walking and stamina required.

"Now, I know I will have several more years being out, joining my friends across the country playing music," Lucas said.

"Treat your patients as you would want your family or yourself to be treated"

"Treat your patients as you would want your family or yourself to be treated" click to enlarge Dr. Paula Miller

Dr. Paula Miller is a UNC Department of Medicine featured physician this month. Read the Q&A about Dr. Miller's career and care philosophy, among other topics. 

Mending Hearts in Nicaragua

In February, three UNC interventional cardiologists and a team of dedicated health care professionals travelled to Nicaragua to perform a life-saving, minimally invasive procedure on as many patients as they could, and to bring the best in cardiac care to a country without heart surgeons.
Mending Hearts in Nicaragua click to enlarge John Vavalle, MD, MPH (left), and Michael Yeung, MD (center), watch Lucius Howell, MD, perform a procedure on a patient.
Mending Hearts in Nicaragua click to enlarge Transporting all the equipment they would need was one of the challenges faced by the team.

For many Nicaraguans, a diagnosis of a heart condition such as mitral valve stenosis – a debilitating complication that can be the end result of untreated strep throat – is grim news that offers little in the way of hope.

 “If patients have the money, they can travel to another country to receive care, said Michael Yeung, MD, a UNC interventional cardiologist and assistant professor of medicine at the UNC School of Medicine. “If they don’t have the money, they die.”

To help bridge this enormous gap, Yeung, along with a group of UNC experts including John Vavalle, MD, MPH, Alan Hinderliter, MD, Lucius Howell, MD, Joshua Vega, MD, Roman Baczara, RN, and Charlene Marie Whayne, RN, travelled to Leon, Nicaragua, as part of medical mission called Project Health Leon, aimed at bringing life-saving, high-level medical expertise to a country with no heart surgeons and not enough cardiologists to meet the developing nation’s medical needs.

“Medicine is a calling and a passion for us,” said Vavalle, associate professor of medicine in the division of cardiology and medical director of the UNC Structural Heart Disease Program. “It’s very gratifying to be able to use our knowledge and skills to help those who are suffering and who would not otherwise have access to the kind of care we provide.”

Project Health for Leon was originally started by physicians from the Brody School of Medicine at East Carolina University. In recent years, their medical missions have grown to include cardiologists and heart surgeons from across the state. In 2015, Yeung and Howell joined the mission, offering minimally invasive structural interventions for problems such as damaged heart valves, which can’t be treated with medication.

A Vital Procedure

For their trip this year, Yeung, Howell and Vavalle’s goal was to perform percutaneous mitral valvuloplasties on as many patients as they could in two weeks. This is a minimally invasive procedure in which a balloon is inserted into a mitral valve damaged by disease to improve the flow of oxygen-rich blood to the heart.

In Nicaragua, this technique is uncommonly valuable to patients suffering from mitral valve stenosis.

In the US, strep throat is a common, if unpleasant, ailment that normally clears up after a course of antibiotics. But if left untreated, strep throat can lead to a much more serious infection called rheumatic fever, an inflammatory disease that attacks the joints, skin and heart, and can cause permanent damage to these tissues.

In some cases, the damage caused by rheumatic fever is so severe that it leads to mitral valve stenosis, a devastating heart condition in which a narrowing of the mitral valve restricts blood flow to the left side of the heart. This narrowing reduces the volume of oxygen-rich blood from the lungs, leading to fatigue and shortness of breath.

 “There are antibiotics to treat strep throat available in the country but there isn’t a network of care that’s able to deliver medication and other care when and where it’s needed,” said Howell, a cardiology fellow at the School of Medicine. “Part of Project Health for Leon is devoted to preventing these gaps in care by using every approach we have available in this country, from prophylaxis to surgery. The end goal is to eradicate rheumatic heart disease and the complications that come from it.”

The symptoms of mitral valve stenosis can be devastating, and they are all more tragic because it is a condition that is, by the standards of medicine in the developed world, preventable. This is why, Yeung said, the skills that he and his colleagues are able to bring to Nicaragua are so valuable.

“Only a few people are able to perform mitral valvuloplasties in North Carolina,” said Yeung. “The patients are happy because this minimally invasive procedure solves their problem, and they can go home the same day. “

An OR in a Hockey Bag

Planning the trip took Howell and his colleagues more than a year. They needed to get permissions from the School of Medicine here in Chapel Hill, the University in Leon, the airline and the Nicaraguan government.

“We had to create a manifest of everything we were planning on taking,” recalled Howell, “right down to the pens and the hairnets.”

They also had to plan for every contingency that they might encounter.

“We had to prepare for the fact that we wouldn’t have any surgical back up for this,” said Howell. “Something that might not be life-threatening in an American operating room could be incredibly dangerous in Leon, so we had to be sure there was a way to fix it if something went wrong, like an accumulation of fluid around the heart or someone needing a pacemaker.”

Past surgical groups that have travelled to Nicaragua as part of the medical mission have shipped containers of equipment by boat but that can take weeks or sometimes months. The other option was for the trio to carry what they needed with them on their backs.

“We packed our equipment into hockey-sized duffel bags and checked them with the airline,” said Howell.  “This is a global health issue, but we were working to improve medical conditions in this country that is, in fact, very close. We had breakfast in Miami and by lunchtime we were in Leon.”

Once they were in country, it was time to get down to work. Howell said that as a fellow, the experience was incredibly enriching.

“Not only was I able to see patients with a disease that, in this country, you rarely see in such an advanced state, but because of the limitations of bringing such a small group, it gave me a chance to really step into a lot of different roles. One minute you’re a surgeon, the next you’re a medical Spanish liaison, and the next you’re a diplomat. It was a very invigorating experience.”

 Leap of Faith

More than just an educational opportunity, this procedure is able to transform the lives of people suffering from mitral valve stenosis.

Vavalle recalls one patient in particular who years earlier was forced to quit nursing school because of debilitating symptoms. She was the first Nicaraguan patient the group performed the procedure on.

“The moment we had completed her procedure and wheeled her back into the recovery room, everyone was in tears – the patient, her husband, us,” Vavalle said. “Because we had just accomplished something that we weren’t certain we could do.

“There were a lot of unknowns when we went wheels up at RDU – customs, the state of the operating room, the availability of imaging equipment. And many of these patients had to travel a long way to get to the clinic, so we weren’t sure they’d be able to get there on time. We went to great lengths to ensure success but it was a leap of faith.”

After her procedure, the patient asked Dr. Yeung how she could thank them. He told her that the best way was for her to return to nursing school so she can help others in her country.

“It was an amazing moment,” recalls Vavalle. “And it was exactly the kind of moment  we went to Leon for.”

by , UNC Health Care

Cavender part of new diabetes drug study to combat cardiovascular disease

Diabetes is known as the strongest risk factor for cardiovascular disease. The connection is one that Matthew Cavender, MD, MPH, has closely considered, especially when it comes to a relatively new drug class for diabetes.
Cavender part of new diabetes drug study to combat cardiovascular disease click to enlarge Dr. Matthew Cavender at UNC Medical Center's Catheterization Lab

By Kim Morris, Department of Medicine

Diabetes is known as the strongest risk factor for cardiovascular disease. The connection is one that Department of Medicine Cardiologist Matthew Cavender, MD, MPH has closely considered, especially when it comes to a relatively new drug class for diabetes.

“My research is focused on the interaction between coronary artery disease and diabetes,” said Cavender. “Diabetes has long been a risk factor for cardiovascular disease, with conditions that contribute to a 50% higher risk. We’ve known this for a long time but until recently we haven’t had medications designed for diabetes that appeared to reduce cardiovascular events.”

Cavender, who joined Medicine less than one year ago, has been recognized by Cardiology Today as one of Cardiology’s next generation of innovators in part for his contributions to a worldwide study that investigated SGLT2-inhibitors. The study, known as CVD-REAL, was presented at the recent American College of Cardiology meeting in Washington DC. In the CVD-REAL study, outcomes from 300,000 patients across the US, UK, Sweden, Norway, Denmark and Germany were examined.

“We have known that cardiovascular specific therapies can improve outcomes in patients with diabetes. In this study, we considered drugs primarily geared toward treating diabetes that could be effective in reducing cardiovascular events in patients with diabetes.”

Cavender was one of two cardiologists in the investigation sponsored by AstraZeneca that looked at three SGLT2-inhibitors: empagliflozin, canagliflozin and dapagliflozin. The study considered the association between these medications and hospitalization for heart failure and mortality, compared to medicines such as DPP-4 inhibitors, metformin and insulin, commonly used to treat type 2 diabetes.

“We found that the results in each country, regardless of which compound predominates, had lower rates of hospitalization for heart failure and had lower rates of cardiovascular death when treated with a SGLT2-inhibitor. In fact, SGLT2-inhibitors reduced the rate of hospital admission for heart failure or death from heart failure by almost 50%.

Identifying a class of medications that show reductions in cardiovascular events is a significant finding for patients with diabetes. That’s because heart disease is the primary cause of death in people with diabetes, not necessarily complications with their diabetes. Although more trials are underway, Cavender believes SGLT2-inhibitors will become one of the preferred treatment for patients with diabetes, especially those who are at high risk for cardiovascular events. The results also demonstrate the strength of intra professional medicine teams.

Dr. Matt Cavender is a Next Gen Innovator

Cardiology Today has selected Dr. Matt Cavender as one of its Next Gen Innovators, "a bright group of early career cardiologists identified as innovators in the field."  Dr. Cavender joined UNC's inverventional cardiology team in 2016,  and since then has been a valued faculty member, performing procedures, seeing patients in clinic, and pursuing an active research program. 

UNC Division of Cardiology Shines at ACC.17

More than 18,000 people, mostly cardiovascular health professionals, converged on Washington, D.C. for the American College of Cardiology’s 66th Annual Scientific Showcase – ACC.17 – during which UNC researchers gave 36 presentations.

More than 18,000 people, mostly cardiovascular health professionals, converged on Washington, D.C. for the American College of Cardiology’s 66th Annual Scientific Showcase – ACC.17 – during which UNC researchers gave 36 presentations.

“UNC had an impressive and palpable presence at this conference, which is the most important annual cardiology meeting in the world,” said John Vavalle, MD, assistant professor of medicine in the division of cardiology, who was involved in several presentations, including one on transcatheter aortic valve replacement, or TAVR. Read more about UNC’s TAVR program here.

Also at ACC.17, Sidney Smith, MD, was honored with the Master of ACC Award.

For more information on ACC.17, check their website.

UNC heart transplant faculty at ISHLT 2017

UNC heart transplant faculty at ISHLT 2017 click to enlarge Dr. Jason Katz presenting at ISHLT 2017

UNC faculty with research featured at this year's International Society for Heart and Lung Transplantation Scientific Sessions included Drs. Patricia Chang, Brian Jensen, Jason Katz, and Lisa Rose-Jones from Cardiology and Drs. Thomas Egan and Jennifer Nelson in Surgery.

Dr. Jason Katz presented research from PREVENT (PREVENtion of HeartMate II Pump Thrombosis), a multicenter study evaluating clinical management standards aimed at reducing clotting risk in patients receiving a HeartMate II Left Ventricular Assist Device. His presentation, Impact of Adherence to Standard Practice Guidelines for Patients Receiving a Left Ventricular Assist Device - Insights from the PREVENT Study, examined the relationship of care practices throughout the multicenter study with clinical outcomes. Patients whose care most closely matched current best practice guidelines were found to have improved survival and reduced risk of complications such as bleeding and thrombotic events. Dr. Katz is the Medical Director of UNC's Mechanical Heart Program, Cardiac Intensive Care Unit, and Cardiothoracic intensive Care Unit and Critical Care Service, and Director of Cardiovascular Clinical Trials.

Also at ISHLT 2017, Internal Medicine resident Amanda Clark presented research she worked on with Dr. Patricia Chang and other Cardiology faculty and providers evaluating the impact of socioeconomic factors on heart transplant outcomes.

Learn more about heart transplant and LVAD options at UNC Health Care.

UNC Cardiology providers honored for exceptional patient satisfaction

UNC Heath Care honored five UNC Cardiology faculty with the 2017 UNC Health Care and UNC Faculty Physicians Award for Carolina Care Excellence:
Dr. Charles H. Hicks
Dr. Paula F. Miller
Dr. Paul Mounsey
Dr. Ross J. Simpson, Jr.
Dr. Rick Stouffer

This award recognizes providers with the highest patient satisfaction: UNC Health Care surveyed patients, asking if they would recommend their provider's office to friends and family. Award recipients had 95% or more of the patients answer this question "yes, definitely."

Also receiving this award were two providers who work closely with our Cardiology faculty: Julie Lewis, ANPMegan Andrews, NP  Zack Deyo, PharmD, Adjunct Assistant Professor, UNC Eshelman School of Pharmacy.

Innovation Pilot Award for Dr. Larry Klein

UNC Cardiology faculty member Dr. Larry Klein is one of the lead investigators on a project awarded an Innovation Pilot Award by the Center for Health Innovation at UNC's School of Medicine.

This award is intended to fund innovative research and is highly competitive, with four winners out of 30 applications in this year's round.

The award winning project is a collaboration with Dr. Spencer Dorn in UNC's Division of Gastroenterology. Drs. Dorn and Klein will be developing a predictive model and a web application that will aim to optimize how patients are scheduled and prepared for gastrointestinal procedures.

Learn more about this project and the award.

UNC introduces bioresorbable stent technology

UNC introduces bioresorbable stent technology click to enlarge Image of the Absorb GT1 bioresorbable vascular scaffold (BVS) in an artery.

UNC's C.V. Richardson Cardiac Catheterization Lab placed its first two bioresorbable stents on March 14, 2017, introducing a new treatment option for patients in addition to traditional metal stents.  Dr. Joseph Rossi and Dr. Xuming Dai were the performing physicians.

Metal stent placement has been widely used to treat obstructive coronary heart disease; however, metal stenting can lead to potential complications that continue to challenge the medical field, such as in-stent restenosis (a re-narrowing of the artery). Bioresorbable stent technology may provide a promising path forward. According to Dr. Dai, "It would be perfect if a stent could be easily put in, keep the newly opened artery expanded until healed, and disappear without leaving any residual materials."

The stents used were Abbot Vascular's Absorb GT1, which represents the first generation of bioresorbable stent technology. It was approved by the FDA in July 2016. This stent features a matrix of poly-L-lactide, the same polymer used in dissolving sutures. Once placed, the stent over time releases everolimus, a drug that helps prevent surrounding arterial tissue from over-growing and subsequently obstructing the stent. Over a period of one to three years after implantation, the stent dissolves into water and carbon dioxide, leaving behind a restored artery without any further traces of the stent. UNC Medical Center's interventional team continues to gain experience and achieve excellence in new technologies to provide our patients with the best care available.

First UNC TAVR under conscious sedation

UNC's heart valve team performed UNC's first transcatheter aortic valve replacement (TAVR) under conscious sedation on March 14, 2017. This UNC first was the result of a multidisciplinary collaboration between cardiology, cardiothoracic surgery, anesthesiology, nursing, and the TAVR coordinators.

Dr. Emily Teeter was the anesthesiologist, Dr. Thomas Caranasos was the cardiothoracic surgeon, and Dr. John Vavalle and Dr. Matt Cavender were the structural heart interventional cardiologists on the team. Dr. Doug Shook, the chief cardiac anesthesiologist at Brigham and Women's Hospital, visited UNC to mentor the team during the first procedure.

Using conscious sedation instead of general anesthesia can be an excellent option for appropriate patients, often leading to a quicker recovery and high patient satisfaction.

Learn more about TAVR at UNC, along with other treatment options for valvular heart disease.

Smith Recognized With American College of Cardiology Top Honor

Sidney C. Smith, Jr, MD, will be presented with the Master of the ACC Award at ACC’s 66th Annual Scientific Session.
Smith Recognized With American College of Cardiology Top Honor click to enlarge Dr. Sidney Smith

March 14, 2017

Sidney C. Smith, Jr., MD, FACC, has been awarded the 2017 Master of the ACC Award by the American College of Cardiology in honor of contributions to the cardiovascular profession. Smith, Jr. will be recognized for these achievements along with all 2017 Distinguished Award winners at the Convocation Ceremony on March 19 during the ACC’s 66th Annual Scientific Session in Washington.

Dr. Smith is a professor in the University of North Carolina School of Medicine and a clinician in the UNC Center for Heart and Vascular Care.

“Dr. Smith, Jr.’s invaluable contributions to the field of cardiovascular medicine show unparalleled dedication to excellence and boundless commitment to improving patient care,” said ACC President Richard Chazal, MD, FACC. “It is a privilege to be able to honor Dr. Smith, Jr. with the Master of the ACC Award and celebrate his contributions to and achievements in cardiology.”

The Master of the ACC Award recognizes and honors Fellows of the American College of Cardiology who have consistently contributed to the goals and programs of the College and who have provided leadership in important College activities. MACCs have been members of the College for at least 15 years and have served with distinction and provided leadership on various College programs and committees.

Dr. Smith received his medical degree from Yale Medical School and completed his medical internship, residency, and cardiology fellowship at the Peter Bent Brigham (now Brigham and Women’s) Hospital/Harvard Medical School in Boston, MA. Dr. Smith is a past president of the American Heart Association (AHA) and the World Heart Federation (WHF).  Among his many honors include the AHA Physician of the Year Award, AHA Distinguished National Leadership Award, AHA Gold Heart Award, AHA Eugene Drake Award and the NHLBI/NIH Award of Special Recognition. Dr. Smith has authored or co-authored more than 350 published papers and chapters and has served on the editorial boards for the Journal of Cardiovascular Medicine, Journal of Clinical and Experimental Cardiology, Journal of the American College of Cardiology and Circulation. Each year since 1998, he has been elected to Best Doctors in America.

Eighteen Distinguished Awards will be presented at the Annual Scientific Session this year, each recognizing an individual who has made outstanding contributions to the field of cardiovascular medicine. Recipients are nominated by their peers and then selected by the American College of Cardiology Awards Committee.

The American College of Cardiology is a 52,000-member medical society that is the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, offers cardiovascular accreditation to hospitals and institutions, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more, visit acc.org.
                   

New research from Jensen lab points to promising new drug treatments for heart failure

A new paper published in the Journal of the American College of Cardiology: Basic to Translational Science shows that the oral selective, alpha-1A adrenergic receptor agonist, dabuzalgron,  prevents doxorubicin-induced heart injury in mice. Dabuzalgron was well-tolerated in multiple Phase 2 trials for treatment of urinary incontinence, but development was halted due to lack of clinical efficacy.  These new findings suggest that repurposing dabuzalgron may hold promise as a novel treatment for heart failure.

Dr. Brian Jensen led the multi-disciplinary, multi-institutional project, which received initial funding from NC TraCS.

Read the paper, "An Oral Selective Alpha-1A Adrenergic Receptor Agonist Prevents Doxorubicin Cardiotoxicity," here.

New plant-based hemophilia treatment from Dr. Timothy Nichols

Dr. Timothy Nichols on research team developing new approaches to hemophilia treatment. Read an overview of the research or access the full article "Oral Tolerance Induction in Hemophilia B Dogs Fed with Transplastomic Lettuce."

"UNC Hospitals among first to offer cardiac mapping"

UNC is one of the first medical centers nationally to offer EnSite Precision™ cardiac mapping to patients undergoing treatment for cardiac arrhythmias. WRAL features Dr. Anil Gehi, a UNC faculty member who is leading the way with this technology.

Read the story and watch the video here to learn more and hear from a patient who was treated at UNC with this innovative cardiac mapping system.

"For 100th time, UNC uses less invasive procedure to replace aortic valve"

UNC Cardiology's transcatheter aortic valve replacement (TAVR) program is featured is featured by WRAL.  Please read the story and watch the video here.

Dr. John Vavalle is interviewed and explains the procedure.

Dr. John Vavalle selected as a 2017 Health Care Hero

Triangle Business Journal selected Dr. John Vavalle one of this year's Health Care Heroes, together with Dr. Thomas Caranasos, for their successful development of UNC's Valve Clinic. They were honored for their surgical skill, caring concern for patients, and the drive and energy the demonstrated in building the the Valve Clinic from 2014 to today. Read more about the honor and other UNC winners

38th Annual North Carolina Cardiopulmonary Rehabilitation Association Symposium

The UNC School of Medicine has provided continuing education support for this symposium.
When Mar 09, 2017 06:00 PM to
Mar 10, 2017 04:35 PM
Where UNC Friday Center for Continuing Education
Contact Name
Contact Phone 984-974-2569
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The 38th Annual North Carolina Cardiopulmonary Rehabillitation Association Symposium, "Embracing a New Culture in Contemporary Rehabilitation," will be held March 9-10 at the William & Ida Friday Center for Continuing Education in Chapel Hill.

The UNC School of Medicine has provided continuing education support for this symposium. The opening talk, "When Can We Stop Holding Our Breath?" will be given by Grace Ann Dorney Koppel, president of the COPD Foundation, and is open to the public.

The North Carolina Cardiopulmonary Rehabilitation Association is a state affiliate of the American Association of Cardiovascular and Pulmonary Rehabilitation Association (AACVPR).  The NCCRA was founded in 1984 as a nonprofit organization dedicated to the mission of reducing disability from cardiovascular and pulmonary disease through education, prevention, rehabilitation, research and disease management.  The multidisciplinary organization includes physicians, exercise physiologists, registered nurses, dietitians, respiratory therapists, physical therapists, mental health professionals, and vocational rehabilitation counselors.  The NCCRA is committed to improving the quality of life for our patients and their families.

More information about this event…

UNC Medical Center is First in the Mid Atlantic to Treat Patients with Next Generation Cardiac Mapping System

New technology enables tailored treatment for patients with cardiac arrhythmias.
UNC Medical Center is First in the Mid Atlantic to Treat Patients with Next Generation Cardiac Mapping System click to enlarge The new cardiac mapping system facilitates complex arrhythmia diagnoses through easy visualization of voltage pathways on a single "SparkleMap." This gives cardiac electrophysiologists a way to visualize the spread of electrical activity in the heart.

January 30, 2017


Contact:
Tom Hughes
(984) 974-1151


CHAPEL HILL, N.C. – UNC Medical Center is the first in the Mid Atlantic U.S. to treat patients with the EnSite Precision™ cardiac mapping system, a next-generation platform designed to provide automation, flexibility and accuracy for diagnostic mapping used in ablation procedures to treat patients with abnormal heart rhythms (cardiac arrhythmias). UNC Medical Center was among the first sites in the United States to utilize this technology, which recently received FDA clearance.

When physicians use catheter ablation to treat cardiac arrhythmias, several long, flexible tubes with wires - called catheters - are inserted into the heart. Diagnostic catheters record and “map” electrical information from the heart. The Abbott EnSite Precision cardiac mapping system provides highly detailed anatomical models and maps to enable diagnosis of a wide range of arrhythmias, guide therapy and expand procedural options. Ablation catheters deliver radiofrequency energy. The heat from the catheter creates a lesion or scar on the tissue where the abnormal heartbeats originate. As a result, this tissue is no longer capable of conducting or sustaining the arrhythmia.

 “We have been using an earlier cardiac mapping system here at UNC for several years. The new mapping system is much faster – what used to take us hours now can be done in minutes – and it enables us to treat more complex cases than we could before,” said Paul Mounsey, MD, PhD, the Sewell Family/McAllister Distinguished Professor in the UNC School of Medicine and director of heart rhythm services for the UNC Center for Heart & Vascular Care.

“The technology in mapping systems is rapidly advancing. These new tools allow us to more rapidly understand complex arrhythmia circuits and have improved the efficacy of our procedures,” said Anil Gehi, MD, associate professor in the UNC School of Medicine and an electrophysiologist in the UNC Center for Heart & Vascular Care.

One of the distinctive features of the EnSite Precision cardiac mapping system is that it uses intelligent automation tools, which are designed to enable faster and more accurate high density maps allowing tailored treatment for a variety of cardiac arrhythmias, including complex cases. The ability to create rapid high-resolution models speeds up mapping time and minimizes fluoroscopic radiation exposure for both the patient and the clinicians.

The most common arrhythmia is atrial fibrillation, affecting more than 3 million Americans and millions more worldwide. Atrial fibrillation, also called AF or Afib, is a very fast, irregular heartbeat that occurs when the upper chambers of the heart beat so fast that they only can quiver. Atrial fibrillation can be dangerous, as over time it can cause more serious conditions such as stroke.

Marcia Van Riper is one of the first patients to be treated with the EnSite Precision system at UNC Medical Center. A professor and chair of the Family Health Division in the UNC School of Nursing, Van Riper has suffered from atrial fibrillation on and off for the last 10 years. Dr. Gehi performed her ablation procedure in early January.  Nine days later she was back on the job.

“Last week I lectured on family-centered genomic healthcare to my class of 164 nursing students, and it went great!” Van Riper said. “I was very impressed with the care I received at UNC Medical Center. Dr Gehi and his team provided excellent care, as did the nurses and nursing assistants.”

Below is a "SparkleMap" video captured during a cardiac ablation procedure performed at UNC Medical Center. The "SparkleMap" gives cardiac electrophysiologists a way to visualize the spread of electrical activity in the heart during an abnormal rhythm, and allows them to find the proper location for ablation.



About UNC Health Care
With more than 30,000 employees statewide, UNC Health Care has provided high-quality, patient-centered care for more than 60 years. UNC Health Care is a not-for-profit health care system owned by the state of North Carolina and based in Chapel Hill. The system includes UNC Hospitals in Chapel Hill, the UNC School of Medicine and nine affiliate hospitals across the state. To learn more, click here.


UNC's Dr. Sidney Smith receives two major AHA awards

This is the first time that the American Heart Association (AHA) has presented two major awards to one recipient.
UNC's Dr. Sidney Smith receives two major AHA awards click to enlarge Dr. Smith accepts the Chairman's Award and the James B. Herrick Award at the American Heart Association's Scientific Sessions in New Orleans on Nov. 13. copyright American Heart Association/Phil McCarten 2016, Opening Session, Sunday

Below is a press release issued by American Heart Association:

NEW ORLEANS, Nov. 14, 2016 — For the first time, the American Heart Association (AHA) has presented two major awards to one recipient: long-time volunteer leader and former AHA President Sidney C. Smith Jr., M.D., of the University of North Carolina at Chapel Hill.

First, Smith received the James B. Herrick Award of the AHA Council on Clinical Cardiology, an annual honor saluting excellence in the advancement of cardiology practice. Ileana Pena, M.D., council chair, presented the award, a citation and medallion, at a Saturday, Nov. 12, council dinner meeting in New Orleans.

Then, on Sunday, Nov. 13, Smith received the Chairman’s Award, a tribute to outstanding volunteer service on behalf of the AHA. The award was presented during the opening of the American Heart Association Scientific Sessions 2016 at the New Orleans Ernest N. Morial Convention Center. Association Board Chairman Alvin L. Royse of Hillsborough, Calif., presented the award, a citation and $1,000 honorarium.

To read the full release, click here.

Following the ‘Tinman’

Inspired by a genetic discovery by her PhD mentor, UNC heart researcher Li Qian followed the ‘Tinman’ down the yellow brick road to an award-winning career in science, including the Jefferson-Pilot Fellowship in Academic Medicine.
Following the ‘Tinman’ click to enlarge Li Qian, PhD. Photo by Caroline Curran, UNC Health Care / UNC School of Medicine.

Scientist Li Qian, PhD, has forged an award-winning career at the UNC School of Medicine. In just a few short years since joining the faculty, she’s been recognized for her cardiac research by The American Heart Association. She was the first-ever recipient of the Boyalife, Science and Science Translational Medicine Award in Stem Cell and Regenerative Medicine. And now she has earned a UNC School of Medicine Jefferson-Pilot Fellowship in Academic Medicine, which includes $20,000 to be used toward scholarly endeavors.

We caught up with Qian, assistant professor of pathology and laboratory medicine at the UNC School of Medicine and member of the McAllister Heart Institute, to discuss her research in cardiac reprogramming, her goal to inspire young women to pursue careers in science, and how and why she chose the UNC School of Medicine.   

By Caroline Curran, caroline.curran@unchealth.unc.edu

As a young girl growing up in China, did you ever imagine you’d spend your career in science, studying the heart, at a university in the United States? What were some of the obstacles you’ve had to overcome to follow your dreams?

When I was little, I was always encouraged to do what I wanted and follow my dreams, especially pursuing my interest in science. My parents both work for a university. My dad is a professor of engineering and my mom is an accountant. I was quite fortunate that we lived in a positive and open environment – one that fostered the growth that’s critical for one’s future success.

I was drawn to science by curiosity as a kid. I clearly remember the first time I ever saw a cell under a microscope. It was the onion cell experiment. Ever since then, I have always been fascinated by the question of how a single cell becomes an organ and, ultimately, becomes a whole life form.

At the time I graduated from college in China, one of the best places to do basic research was the States because of its reputation in basic science, the opportunity to work with world-renowned scientists and the strong infrastructure and cutting-edge technology.

I also like the diversity, openness and welcoming atmosphere to people from different backgrounds. However, as an incoming international student, getting started in a completely different environment was extremely challenging. Imagine the language barriers I had when I first came to this country. I could barely understand a sentence if the conversation was not face-to-face. My PhD mentor, Rolf Bodmer, witnessed and complimented me when he realized that I followed the American dream by growing from a shy international student into a dynamic young leader in science.

You always knew that you wanted to pursue some field of science. How did you become interested in the heart?

It was the story of the “Tinman.” In the 1980s, I read in the news that a neurobiologist at the University of Michigan used fruit flies to identify master genes that regulate neuronal cell fate. He was screening for important transcription factors critical in the development of the peripheral nervous system, but serendipitously identified a homeobox gene that, when mutated, resulted in the absence of heart formation in the fruit fly. He was fascinated by this discovery and named the gene the Tinman, which is a reference to “The Wizard of Oz.” This work was published in 1989, and after that follow-up studies identified the vertebrate counterpart of the Tinman gene, NKX2.5. By studying a family in Pennsylvania with a high incidence of congenital heart disease, scientists from Harvard University found that the disease was caused by a mutation in NKX2.5. The scientist who identified Tinman was Dr. Bodmer, my PhD mentor. His work opened up the field and I was lucky to have a chance to work with him in his lab.

Your research is now focused on cardiac reprograming – converting cardiac scar tissue cells into functional cardiomyocytes. What are your immediate and long-term goals for this research?

Basic research is so important. We never know how basic research will be used in identifying factors that cause diseases. When Rolf discovered the Tinman gene, he did not know that there would be a family whose cardiac disease could be traced back to that gene.

For me, I want to see my research and my approach used on a patient. That’s the immediate goal, within five to 10 years. I know there’s so much research that needs to be done to really help a patient one day.

It will take some time, but we are collaborating with many labs in the field and we share with them our unpublished data to accelerate the field. And it’s only if we all work together to accelerate our research that we can realize our goal of helping patients with our approach as soon as possible.

But, in terms of career goals, it never ends. In terms of heart disease, there are always new diseases that are being discovered. One therapy might be a good treatment, but then a better treatment might come along. We always try to address the most urgent, most challenging question in the field. But it’s always changing. I think my lab will continue to take on the major challenges in the field.

Even with reprogramming, our lab will work to develop therapies and targeted medicine beyond the type of cardiac disease we are working on now. Research-wise, there’s just no end. There are so many things I can do.

You’ve mentioned that mentorship – both as a mentor and a mentee – played a big part in your early career and why you made the decision to come to UNC. Why is that so important to you?

It’s incredibly important to me to help mold young scientists, especially young women scientists in this field. My lab has a lot of young women trainees. It’s very rewarding for me to mentor and promote the next generation of scientists. I am grateful that my former mentors trained me in a very positive, encouraging, and supportive manner. It helps to build a positive research environment that fosters the love of science and the spirit of teamwork.

UNC has a lot of brilliant women studying, doing research, and practicing medicine, and that really influenced my decision to join the faculty here. UNC has done such a wonderful job in promoting women scientists. That’s a very effective way to attract young female scientists to come here to start their careers. At multiple levels, they are viewed as role models for young scientists, especially young women scientists.

Your husband is also a basic scientist at UNC who studies the heart. What are your family dinner conversations like? Do you encourage your daughters to pursue careers in science or medicine?  

Although we are both scientists, we talk about a lot of different things at our dinner table, from things that happened in my daughters’ school, their love for ice skating, and, of course, science. Because of these conversations, my older daughter, who is now 10, has asked me about cell reprograming and how it works.

I fully respect their choices they make for their education and their careers when they grow up. I encourage them to find their passions and follow their dreams, but I will also certainly create an environment for them so that they will be exposed to science and technology.

I go to my daughters’ schools to give lectures a few times a year. Science and biology are a big part of it, but it’s not just to share the science. It’s to tell the students: anything is possible; be wild and be crazy with your goals; be brave, and go on to realize your goals and your dreams.

Dr. Sidney Smith to Receive 2 American Heart Association Awards

Dr. Sidney Smith will be the recipient of both the James B. Herrick Award for Outstanding Achievement in Clinical Cardiology and the Chairman's Award at the 2016 American Heart Association Scientific Sessions. The Herrick Award honors a physician whose scientific achievements have contributed profoundly to the advancement and practice of clinical cardiology. The Chairman's Award honors contributions to further the AHA's strategic goals.

Cardiology Research Highlights from the Department of Medicine

UNC Cardiology's research is featured by the Department of Medicine. In-progress research by faculty members Dr. Brian Jensen, Dr. Patricia Chang, Dr. Xuming Dai,  Dr. Jason Katz, and the cardiac electrophysiology group is highlighted.  Check out the the great review of Cardiology research highlights.

Heart Failure Feature: Podcast with Dr. Patty Chang

Heart Failure Feature: Podcast with Dr. Patty Chang click to enlarge Dr. Patty Chang, UNC Cardiology

Dr. Patty Chang, Associate Professor of Medicine in the Division of Cardiology and Director of the Heart Failure and Transplantation Program, is featured in a Chair's Corner podcast interview. She discusses the latest research and treatment options for heart failure with Dr. Ron Falk, Chairman of UNC's Department of Medicine.  Listen to the podcast and learn about UNC's Heart Failure Program.

Governors Club Provides a New Source of Support for Children’s Health

UNC Children’s First-Ever Endowed Chair from a Residential Community
Governors Club Provides a New Source of Support for Children’s Health click to enlarge Dr. Timothy Hoffman

For Immediate Release: November 1, 2016
For Information Contact: (919)491-5541

Chapel Hill, NC: This year’s Big Ten – ACC Charity Golf Challenge at Governors Club has special significance as the event celebrates the announcement of the Governors Club Distinguished Professorship in Pediatric Cardiology.

The announcement reflects ten years of effort and leadership from Dr. Fred Bowman, a member of Governors Club and a retired pediatric cardiac surgeon. While Dr. Bowman is an alumnus of the UNC School of Medicine, his UNC ties actually date back to his birth on Franklin Street in Chapel Hill. “What we do should have a purpose,” said Dr. Bowman. “This is just our way of giving back.”

Dr. Bowman enlisted the support of Lowell Hoffman, the organizer of the Governors Club Big Ten – ACC Charity Golf Challenge. Participants of the event include alumni from Big Ten and ACC schools, who have a friendly competition to raise money for local charities. Since 2009, the event’s ACC alumni participants have supported the Chair in Pediatric Cardiology. They have raised over half a million dollars.

“This Chair is both a ‘thank you’ and an emblem of recognition for the mission and leadership of the men and women at UNC Children’s,” Mr. Hoffman said.

Dr. Timothy Hoffman, the Chief of Pediatric Cardiology at UNC Children’s, will assume the title of Governors Club Distinguished Professor. “I’m so grateful for the support of everyone at Governors Club,” Dr. Hoffman said. “This support couldn’t come at a better time, and will mean a great deal to the children we care for and their families.”

Funds from the Governors Club will be flexible, allowing Dr. Hoffman to identify priority efforts in research, clinical care, and teaching that need support. UNC Children’s will also provide updates on how funds are being used.

About Governors Club: Governors Club is a community of caring people who have found their way to Chapel Hill from across the country and around the world. It is a balance of younger people with families and of retired men and women who find ways to “give back” of their life experience and resources.

The Governors Club community includes some 900 families as well as a separately chartered country club with membership across and beyond the Triangle region. The Club offers a multitude of social and educational programs, dining, fitness and sports activities including 27 holes of Championship Jack Nicklaus golf.

About UNC Children’s: UNC Children's clinical home, N.C. Children's Hospital, is a major referral center for children with complex conditions and consistently recognized by U.S. News & World Report as one of "America's Best Children's Hospitals" on its annual list.

N.C. Children’s Hospital has 150 inpatient beds and a comprehensive children's outpatient center located in the same building, enabling your child to see multiple specialists in a single visit.

Our physicians work hand-in-hand with community hospitals and pediatricians all across the state, providing specialty care to more than 70,000 children from all 100 counties in North Carolina each year.

UNC Hospitals’ quality improvement program leads to quicker treatment of STEMI heart attacks

To address full cardiac arrest of hospital patients, new measures reduced the average time between symptom onset and the start of treatment by 72 percent.
UNC Hospitals’ quality improvement program leads to quicker treatment of STEMI heart attacks click to enlarge George A. Stouffer, MD
UNC Hospitals’ quality improvement program leads to quicker treatment of STEMI heart attacks click to enlarge Xuming Dai, MD, PhD

Media contact: Tom Hughes, 984-974-1151,

September 21, 2016

CHAPEL HILL, NC – In 2012, UNC Hospitals launched an initiative aimed at reducing the time it takes hospital staff to recognize when a patient is having a STEMI (ST elevation myocardial infarction) heart attack – the sudden and complete blockage of a heart artery – and to begin appropriate treatment. Now, encouraging results from that effort have been published as a research letter in JAMA Cardiology.

“These results show that it is possible to expedite care of these patients,” said George A. Stouffer, MD, chief of cardiology at UNC Hospitals and senior author of the JAMA letter. “Our study was not large enough to determine whether these changes will result in improved survival across the country but the results are encouraging."

STEMI is considered to be more serious and life-threatening than a non-STEMI heart attack, in which a coronary artery is severely narrowed but not completely blocked.

Nationwide, there are approximately 11,000 cases of STEMI each year among hospital inpatients, and about 4,300 deaths in this group.

“When patients who are in the hospital for a non-cardiac condition have a STEMI, the onset is not usually heralded by chest pain and thus health care providers may not suspect that a coronary artery has occluded,” said Xuming Dai, MD, PhD, an interventional cardiologist at UNC Hospitals who was first author on the manuscript.. “As a result, the time it takes for restoration of coronary blood flow for inpatients may be much slower and more variable than it is for patients brought to a hospital emergency department because of a suspected heart attack.”

One key component of the STEMI quality improvement program was empowering nurses and other non-physician health care providers to activate the response team when they suspected a patient was having a STEMI. Once activated, the team rapidly identified and triaged inpatient STEMIs, following a protocol that closely resembles the model used by paramedics and other first responders in the outpatient setting. These combined measures reduced the average time between symptom onset and the start of treatment by 72 percent.

“This is one of the first studies to identify ways to improve care of patients who have a heart attack while in the hospital,” said Stouffer, who is also a member of the UNC McAllister Heart Institute. “Based on our encouraging results, Dr. Dai and Dr. Smith at UNC are coordinating a study of 17 leading hospitals around the United States that are implementing these changes. We anxiously await the results, as this would be the first study to show that the very high mortality associated with in-hospital STEMI could be reduced."

In addition to Stouffer, authors of the study are Xuming Dai, MD, PhD; Dane Meredith, MD, MPH; Edward Sawey, MD; Prashant Kaul, MD; and Sidney C. Smith Jr., MD. All are in the division of cardiology in the UNC School of Medicine.

 

Challenging the status quo: Katz examines training, staffing and research in cardiac intensive care

Jason Katz, MD, MHS, medical director of UNC’s cardiac intensive care unit, examines the challenges facing cardiac intensive care units and clinicians, and offers innovative recommendations for training, staffing and research for this emerging field.
Challenging the status quo: Katz examines training, staffing and research in cardiac intensive care click to enlarge Jason Katz, MD, MHS. Photo by Max Englund, UNC Health Care.

Media contact: Caroline Curran, caroline.curran@unchealth.unc.edu, (984) 974-1146

CHAPEL HILL, NC – Jason Katz, MD, MHS, associate professor of medicine at UNC School of Medicine and medical director of the cardiac intensive care unit, was the lead author of a recently published manuscript in the Journal of the American College of Cardiology that examined the early growth and maturation of critical care cardiology, and the challenges and uncertainties that threaten to stymie the growth of this fledgling discipline.

Katz’s recent piece followed a scientific statement he was previously tasked with crafting for the American Heart Association and the American College of Cardiology that outlined the evolution of care required to treat critically ill cardiovascular patients, and how those evolving requirements should shape training, staffing, and research.

On the training front, for example, dedicated fellowships for critical care cardiology do not currently exist at most medical schools. There are ways to receive training, Katz said, but not in a streamlined track similar to those seeking specialty certification in pulmonary and critical care medicine. Katz wants to help establish a more formal fellowship pathway at the UNC School of Medicine.

“We’re trying to create a critical care program at UNC that’s not specifically catered to the cardiovascular specialists, but that would lend itself to critical care training for our medicine subspecialist, in general, and then could be tailored to the specific interests and goals of the trainee,” Katz said. “For instance, someone can finish cardiology subspecialty training and then come to do our fellowship and be trained in critical care medicine with a focus on cardiovascular critical care.”

In his paper, Katz examines staffing challenges facing cardiac intensive care units and clinicians – one of which is determining whether an open or a closed model of care is more appropriate for the unit.

In an open ICU model, a physician can admit a patient to the ICU and will continue to provide care throughout the patient’s hospital stay, while in a closed ICU, the patient’s care is transferred to a dedicated critical care team, which can provide comprehensive, multidisciplinary care during their ICU course.

Katz recently shifted UNC’s cardiac intensive care unit from an open to a closed unit.

“As a result, we’ve improved care efficiency and outcomes in many areas, and – perhaps most importantly – we’ve improved nurse-physician relations and the educational experience for our trainees,” he said.

It is imperative to address training and staffing issues, Katz said, because the care patients require is becoming more complex. As modern medicine continues to advance, cardiac intensive care unit patients require a more specialized and disciplined level of care.

“In this paper we also highlight imperatives necessary to optimize care for the increasingly complex group of patients who now occupy our cardiac intensive care and the requisite skills our physicians must now possess to effectively and safely care for them,” Katz said. “In order to provide the highest quality of care, one must now not only understand a patient’s cardiovascular illness, but also must understand how multi-system organ injuries and critical illnesses play a role in their hospital course.”

Katz is hopeful that as more intensivists embrace the cardiac aspect of critical care in their training and staffing, patients will be the ultimate beneficiaries.

“We owe it to our patients. We owe it to our nurses. We owe it to our patients’ families to continue to innovate; to be willing to think outside the box, to better understand optimal care practices for these patients,” Katz said. “The status quo is not good enough anywhere in medicine, but particularly here in this rapidly evolving field.”

Katz is the medical director of the UNC Cardiac Intensive Care Unit and Critical Care Services, the medical director of the UNC Cardiothoracic Intensive Care Unit and Critical Care Service, the medical director of the UNC Mechanical Heart Program, and the director of cardiovascular clinical trials at UNC.

TAVR program continues growth, fosters integration

UNC Medical Center’s Structural Heart Team offers patients a chance at a more active life, promotes collaboration across the UNC Health Care system.
TAVR program continues growth, fosters integration click to enlarge Purcell Kimsey and Barry Cheek, MD
TAVR program continues growth, fosters integration click to enlarge UNC Medical Center's Structural Heart Team

By Jamie Williams, jamie.williams@unchealth.unc.edu

In May, World War II veteran Purcell Kimsey traveled to Chapel Hill for a transcatheter aortic valve replacement (TAVR) procedure. He brought his cardiologist with him.

Barry Cheek, MD, a cardiologist with High Point Regional Hospital has been treating Kimsey for three years. When he referred Kimsey to UNC Medical Center to undergo the TAVR procedure, he knew he and his practice partners Kurt Daniel, MD, and Joe Rossi, MD, would be able to coordinate closely with the TAVR team at UNC Medical Center to ensure Kimsey received the highest quality care. Daniel travelled from High Point Regional to Chapel Hill and assisted with the surgery, and the physicians’ constant communication ensured that Kimsey’s follow-up appointments could occur in High Point.

“The fact that we can have this collaboration and provide continuity of care to our patients is an incredible asset,” Cheek said.

In addition to treating Kimsey, Cheek said he has known the Kimsey family for several years through the High Point church they both attend.

John Vavalle, MD, assistant professor of cardiology, and Tommy Caranasos, MD, assistant professor of surgery, both co-directors of the UNC TAVR program, said the collaboration between physicians from UNC Medical Center and High Point Regional is representative of the integrated network that UNC Health Care has established across North Carolina to provide the highest level of care for patients.

“This patient’s family was comforted by the fact that someone who they know and trust was there to assist with the surgery,” Vavalle said. “That’s a level of service that I don’t think is available a lot of other places.”

“The collaborative relationship we’ve fostered  with High Point Regional and other practices across the state is really representative of the care that we aim to provide here at UNC for all patients in North Carolina,“ Caranasos said.

Kimsey’s granddaughter, Kimsey Parker, was reassured by the amount of care her grandfather received.

“The commitment was heartwarming, and honestly a surprise,” Parker said. “I knew that we had great people taking care of him.”

In addition to providing benefits to patients, the partnership is also beneficial for High Point Regional and its physicians.

“There are many procedures that are now being performed in academic medical centers that in the future may be more accessible in a larger community hospital like High Point Regional,” Daniel said. “So I want to be there to learn; I want to be able to collaborate and be involved. That’s a great advantage for us and it provides important continuity for our patients.”

The first TAVR procedure was performed at UNC Medical Center in late 2014. Now, Vavalle & Caranasos expect the number of cases in year two of the program to triple. Much of that increase can be attributed to great patient outcomes, coupled with the work done to establish relationships with cardiologists across North Carolina.

“In the first year, I think the natural instinct is for people to sit back, watch, and really make sure we know what we’re doing,” Vavalle said. “Now, we can get out, meet with cardiologists across the state, and show them our results.”

TAVR provides a treatment option for aortic valve replacement for many patients who previously had no other options or were considered too high-risk for conventional open heart surgery. With TAVR, physicians have the ability to provide aortic valve replacement via minimally invasive approaches, providing outcomes that are just as good as, and sometimes better than, surgical valve replacements.

The UNC program has pioneered a number of innovations aimed at expanding the availability of TAVR to more patients who may not have been eligible for the procedure before. The team has introduced the suprasternal TAVR approach, a point of differentiation from other TAVR programs. The team has also participated in the rollout of a next-generation valve that can be repositioned, helping to ensure proper placement.

The team is able to offer the procedure to patients like Kimsey, who at 95, is the oldest they have treated.

“This procedure is all about improving the quality of life for these patients,” said Cassie Ramm, AGNP-C, Structural Heart Disease Nurse Practitioner. “Our patients are at a point with their symptoms where they really aren’t able to get outside, aren’t able to visit their families. Many say they’ve lost their independence. We are able to give them that back.”

Even at 95, Kimsey shows no signs of slowing down. The lifelong High Point resident is a former Golden Gloves champion boxer and Navy veteran. He’s had many successful business ventures in High Point and even had a hand in founding Camp Cheerio, a summer camp in the North Carolina Mountains.

Following his procedure he was excited to pursue one of his principle hobbies, painting, while also spending the summer traveling to the beach with his children and grandchildren.

These stories are becoming familiar to the UNC Structural Heart Team.

“We’ve recently been seeing our first group of patients returning for their 12-month checkup, and these are people who have regained their ability to get out and live their lives,” Vavalle said. “I see a lot of vacation pictures.”

UNC Hospitals honored with Mission: Lifeline achievement award

UNC Hospitals earned the award by meeting specific criteria and standards of performance for the quick and appropriate treatment of STEMI patients by providing emergency procedures to re-establish blood flow to blocked arteries when needed.

June 14, 2016

UNC Hospitals has received the Mission: Lifeline® Gold Receiving Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer severe heart attacks. 

Every year, more than 250,000 people experience an ST elevation myocardial infarction (STEMI) the most deadly type of heart attack caused by a blockage of blood flow to the heart that requires timely treatment. To prevent death, it’s critical to restore blood flow as quickly as possible, either by mechanically opening the blocked vessel or by providing clot-busting medication.

The American Heart Association’s Mission: Lifeline program’s goal is to reduce system barriers to prompt treatment for heart attacks, beginning with the 9-1-1 call and continuing through hospital treatment. UNC Hospitals is recognized for having a 85% composite adherence and at least 24 consecutive months of 75% or higher compliance on all Mission: Lifeline STEMI Receiving Center quality measures to improve the quality of care for STEMI patients.

“UNC Hospitals is dedicated to improving the quality of care for our patients who suffer a heart attack, and the American Heart Association’s Mission: Lifeline program is helping us accomplish that goal through nationally respected clinical guidelines,” said George Stouffer, MD, chief of cardiology. “We are pleased to be recognized for our dedication and achievements in cardiac care, and I am very proud of our team.”

In addition to receiving the Mission: Lifeline Gold Receiving award, UNC Hospitals has also been recognized as a recipient of Mission: Lifeline’s Gold-Plus award, which recognizes the hospital has not only reached an achievement score of 75 percent or greater on all Mission: Lifeline Receiving Center Quality Measures, but also for achieving at least a 75 percent achievement on First Door to Device time under 120 minutes  for STEMI transfer patients from other facilities.

“The Mission: Lifeline Gold Receiving Award was earned through teamwork and a dedication to saving lives,” says Prashant Kaul, MD, medical director of the UNC Chest Pain Center. “The team of UNC cardiologists, emergency department physicians, cardiac catheterization lab staff, emergency department staff, coronary intensive care unit nurses, EKG staff, and performance improvement staff worked together and in partnership with Orange County Emergency Medical Services (EMS), First Health Carolinas EMS, Durham County EMS, and Alamance County EMS to achieve this recognition.”

“We commend UNC Hospitals for this achievement award, which reflects a significant institutional commitment to the highest quality of care for their heart attack patients,” said James G. Jollis, MD, Chair of the Mission: Lifeline Advisory Working Group. “Achieving this award means the hospital has met specific reporting and achievement measures for the treatment of their patients who suffer heart attacks and we applaud them for their commitment to quality and timely care.”

UNC Hospitals earned the award by meeting specific criteria and standards of performance for the quick and appropriate treatment of STEMI patients by providing emergency procedures to re-establish blood flow to blocked arteries when needed. Eligible hospitals must adhere to these measures at a set level for a designated period to receive the awards.

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About UNC Health Care
The UNC Health Care System is a not-for-profit integrated health care system owned by the state of North Carolina and based in Chapel Hill. It exists to further the teaching mission of the University of North Carolina and to provide state-of-the-art patient care.

UNC Health Care is comprised of UNC Hospitals, ranked consistently among the best medical centers in the country; the UNC School of Medicine, a nationally eminent research institution; community practices; home health and hospice services in seven central North Carolina counties; Caldwell Memorial Hospital in Lenoir, NC; Chatham Hospital in Siler City, NC; High Point Regional Health System in High Point, NC; Johnston Health in Clayton and Smithfield, NC; Lenoir Memorial in Kinston, NC;  Nash Health Care in Rocky Mount, NC; Pardee Hospital in Hendersonville, NC; UNC Physicians Network; UNC REX Healthcare and its provider network in Wake County; and Wayne Memorial Hospital in Goldsboro, NC.
 
Learn more about UNC Health Care at http://www.unchealthcare.org.


About Mission: Lifeline
The American Heart Association’s Mission: Lifeline program helps hospitals and emergency medical services develop systems of care that follow proven standards and procedures for STEMI patients. The program works by mobilizing teams across the continuum of care to implement American Heart Association/American College of Cardiology Foundation clinical treatment guidelines.  For more information, visit heart.org.

SUDDEN investigators sign collaboration agreement with Cuban research group

The agreement resulted from a two-day scientific meeting held in February at the University of Havana's Center for Demographic Studies.
SUDDEN investigators sign collaboration agreement with Cuban research group click to enlarge Ross J. Simpson, Jr. MD, PhD, is principal investigator for the SUDDEN Project at UNC.

April 7, 2016

CHAPEL HILL, N.C. — Researchers from the University of North Carolina School of Medicine have reached an agreement with researchers in Cuba to develop strategies to prevent sudden unexpected death (SUD).

“Researchers and preventive cardiologists at the University of North Carolina and the University of Havana will be working together to understand the causes of sudden death,” said Ross J. Simpson, MD, principal investigator for the SUDDEN Project at UNC. “A better understanding of these causes will help us prevent many of these premature deaths in the U.S. and in Cuba."

"We look forward to working with the SUDDEN team from UNC to prevent sudden unexpected death in both countries," said Luis A. Ochoa Montes, DSc, principal investigator of the Cuban Sudden Death Study.

SUD is a malfunction of the heart that results in a rapid loss of blood flow through the body leading to death. It is a very rapid process and may have few or no known warning signs. SUD is a common cause of death in the United States, killing approximately 1,000 people each day, or one every two minutes.

The agreement resulted from a two-day scientific meeting held in February at the University of Havana's Center for Demographic Studies. Ross J. Simpson, MD and Irion W. Pursell, RN, leaders of the SUDDEN Project at UNC, met with researchers  from GIMUS (Sudden Death Research Group of Cuba). Researchers from both groups presented data on the impact of sudden death in their respective communities and discussed prevention strategies.

"This historic collaboration between UNC and the University of Havana will help pave the way for new, effective strategies to prevent sudden unexpected death," Pursell said.

As a result of the agreement, the researchers will conduct a pilot project that will screen sudden death cases in Cuba using existing SUDDEN methodology. Research findings from the collaboration will be disseminated through international meetings, conferences, and manuscript publications.

Sudden death is a major public health problem in the United States and globally, accounting for an estimated 10 percent of deaths each year. There are many inconsistencies in the reporting and characterization of sudden death. The SUDDEN Project has taken an innovative approach to the problem, using new methods to capture every potential sudden death in the state of North Carolina. GIMUS' efforts have brought light to the critical need for a generally accepted clinical definition of sudden death and targeted heath policy for high-risk groups.

The SUDDEN Project at UNC is a retrospective epidemiologic study conducted in 18 counties throughout the United States. SUDDEN is designed to investigate the epidemiological, genetic, and pathophysiological causes of SUD.  The study aims clarify risk factors, estimate incidence and underlying pathophysiology of SUD by sampling broadly in a diverse, socioeconomically and ethnically representative populations. To date, the SUDDEN study has published several articles in peer-reviewed journals and presented findings in various meetings including the U.S. Centers for Disease Control and Prevention (CDC), the American Heart Association, EuroPrevent, and Patient-Centered Outcomes Research Institute (PCORI).
 

Adding stress management to cardiac rehab cuts new heart incidents in half

UNC’s Alan Hinderliter, MD, teamed up with Duke doctors to quantify the benefit of stress management to heart health.
Adding stress management to cardiac rehab cuts new heart incidents in half click to enlarge Alan Hinderliter, MD

Media contact: Mark Derewicz, 984-974-1915, mark.derewicz@unch.unc.edu

March 21, 2016

CHAPEL HILL, N.C. – Patients recovering from heart attacks or other heart trouble could cut their risk of another heart incident by half if they incorporate stress management into their treatment, according to research from Duke Health and UNC Health Care.

The findings, published March 21 in the American Heart Association journal Circulation, are the result of a randomized clinical trial of 151 outpatients with coronary heart disease who were enrolled in cardiac rehabilitation due to heart blockages, chest pain, heart attacks, or bypass surgery. They ranged in age from 36 to 84 years old.

About half of the patients participated in three months of traditional cardiac rehabilitation, which included exercise, a heart-healthy diet, and medications to manage cholesterol and high blood pressure.

The other half went to cardiac rehab and also attended weekly, 90-minute stress management group meetings that combined support, cognitive behavior therapy, muscle relaxation, and other techniques to reduce stress. Patients were followed for an average of three years after rehab.

Thirty-three percent of patients who received only cardiac rehabilitation had another cardiovascular event such as a heart attack, bypass surgery, stroke, hospitalization for chest pain or death from any cause. By comparison, 18 percent of the patients who participated in stress-management training during their cardiac rehabilitation had subsequent cardiovascular trouble – about half the rate of the other group.

Both sets of patients that went to rehab fared better still than recovering heart patients who elected not to attend rehab; 47 percent of the latter group later died or had another cardiovascular incident, according to the article. 

Reducing stress may seem like an obvious part of any plan for improving heart health, said lead author James Blumenthal, PhD, a clinical psychologist and professor in psychiatry and behavioral sciences at Duke.

“Over the past 20 to 30 years, there has been an accumulation of evidence that stress is associated with worse health outcomes,” Blumenthal said. “If you ask patients what was responsible for their heart attacks, most patients will indicate that stress was a contributing factor.” But stress management is typically not part of most cardiac rehabilitation programs, he said.

“I think part of the issue is that stress is hard to define, and there’s no universally accepted way of measuring it or treating it,” Blumenthal said. “The data we provide indicate that by reducing stress, patients can improve clinical outcomes, even beyond the benefits that we know exercise already has on reducing stress and improving cardiovascular health.”

For the trial, patients’ stress levels were measured using five standard instruments on which participants self-reported their levels of depression, anxiety, anger, and perceived stress. Overall, those who participated in stress management reported reductions in anxiety, distress, and their overall level of perceived stress.

Both groups that participated in cardiac rehabilitation saw similar and significant physical improvements in their cholesterol levels and proteins that indicate heart disease-related inflammation, as well as their exercise capacity.

“We have known for some time that participation in a supervised exercise program is beneficial in patients with coronary heart disease,” said Alan Hinderliter, MD, associate professor of medicine in the division of cardiology at the UNC School of Medicine and co-investigator on the trial. “The results of this study suggest that stress management is also a very important element of a comprehensive cardiac rehabilitation program. The intervention was clearly helpful in reducing stress levels, but we need additional research to confirm the benefits of stress management in improving cardiovascular outcomes.”

Although death rates from heart disease have improved, it remains the number one cause of death in the United States and is growing worldwide, according to the American Heart Association.

Dr. Hinderliter is a member of the McAllister Heart Institute and the UNC Center for Heart and Vascular Care. 

In addition to Blumenthal and Hinderliter, study authors included Andrew Sherwood, PhD; Patrick J. Smith PhD; Lana Watkins PhD; Stephanie Mabe; William E. Kraus, MD; Krista Ingle, PhD; and Paula Miller, MD.

The National Heart, Lung, and Blood Institute, a component of the National Institutes of Health, supported this study.

UNC Hospitals’ care earns Blue Distinction® Center+ Designation for Quality and Cost-Efficiency for Five Service Lines

Blue Cross and Blue Shield of North Carolina ranked UNC Hospitals’ bariatric surgery, cardiac care, knee & hip replacement, spine surgery, maternity and complex & rare cancer service lines highly as part of the Blue Distinction Specialty Care program

March 7, 2016

CHAPEL HILL, NC – Blue Cross and Blue Shield of North Carolina (BCBSNC) designated UNC Hospitals a Blue Distinction® Center+ in bariatric surgery, cardiac care, knee & hip replacement, spine surgery, and maternal health and a Blue Distinction Center® in complex & rare cancers. Blue Distinction Centers are nationally designated health care facilities shown to deliver improved patient safety and better health outcomes, based on objective measures that were developed with input from the medical community.
 
Research shows that facilities designated as Blue Distinction Centers demonstrate better quality and improved outcomes for patients compared with their peers. On average, facilities designated as a Blue Distinction Center+ are 20 percent more cost efficient in an episode of care compared to non-Blue Distinction Center+ designated health care facilities.
 
“This distinction demonstrates our commitment to provide exemplary care to our patients,” said UNC Hospitals President Gary Park.
 
Quality is key. Only those facilities that first meet nationally established quality measures were considered for designation as a Blue Distinction Center+. UNC Hospitals is proud to be recognized by BCBSNC for meeting the rigorous selection criteria for each of its specialties set by the Blue Distinction Specialty Care program.
 
“We’re doing the homework for our customers by putting a spotlight on hospitals and facilities that offer high quality services at a fair price.” said Dr. Brian Caveney, chief medical officer of BCBSNC. “With health care costs continuing to rise, patients want to know how much value they are getting for their health care dollar. Identifying which providers meet or exceed industry standards is an important part of that equation.”
 
Since 2006, the Blue Distinction Specialty Care program has helped patients find quality providers for their specialty care needs in the areas of bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacements, maternity care, spine surgery and transplants, while encouraging health care professionals to improve the care they deliver.
 
For more information about the program and for a complete listing of the designated facilities, please visit www.bcbs.com/bluedistinction.

About UNC Hospitals
UNC Hospitals is an 840-bed public, academic medical center operated by and for the people of North Carolina. The Hospitals' mission is to provide high quality patient care, to educate health care professionals, to advance research and to provide community service. UNC Hospitals includes North Carolina Cancer Hospital, North Carolina Children's Hospital, North Carolina Memorial Hospital, North Carolina Neurosciences Hospital, North Carolina Women's Hospital, and UNC Hospitals Hillsborough Campus. Each year UNC Hospitals cares for patients from all 100 counties in North Carolina and several surrounding states.
 
About BCBSNC
Blue Cross and Blue Shield of North Carolina improves the health and well-being of our customers and communities by providing innovative health care products, services and information to more than 3.91 million members, including approximately 1 million served on behalf of other Blue Plans. Since 1933, we have worked to make North Carolina a better place to live through our support of community organizations, programs and events that promote good health. We have been recognized as one of the World’s Most Ethical Companies by Ethisphere Institute every year since 2012. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Visit BCBSNC online at bcbsnc.com. All other marks are the property of their respective owners.

About Blue Cross Blue Shield Association
The Blue Cross Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for nearly 105 million members – one in three Americans. For more information on the Blue Cross Blue Shield Association and its member companies, please visit bcbs.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA.

About Blue Distinction Centers
Blue Distinction Centers (BDC) met overall quality measures for patient safety and outcomes, developed with input from the medical community. A Local Blue Plan may require additional criteria for facilities located in its own service area; for details, contact your Local Blue Plan. Blue Distinction Centers+ (BDC+) also met cost measures that address consumers’ need for affordable health care. Each facility’s cost of care is evaluated using data from its Local Blue Plan. Facilities in CA, ID, NY, PA and WA may lie in two Local Blue Plans’ areas, resulting in two evaluations for cost of care; and their own Local Blue Plans decide whether one or both cost of care evaluation(s) must meet BDC+ national criteria. National criteria for BDC and BDC+ are displayed on bcbs.com. Individual outcomes may vary. For details on a provider’s in-network status or your own policy’s coverage, contact your Local Blue Plan and ask your provider before making an appointment. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers.

‘I was in good hands’

Hillsborough hospital employee and Haw River resident Dennis Clayton has enjoyed working at the new medical facility since 2012 – and after suffering a recent heart attack while at home, he feels fortunate to live nearby.
Dennis Clayton (Photo by Max Englund/UNC Health Care)
Dennis Clayton (Photo by Max Englund/UNC Health Care)

One evening last fall, Dennis Clayton was with his wife, Sharon, at their home in Haw River when a feeling of indigestion set in. Dennis had experienced it before, so he took a couple tablets to relieve the discomfort. Time passed but the feeling only intensified. He decided to try baby aspirin but there was no change.

“I told Sharon, ‘We have to go to the hospital,’” says Dennis, who has worked in Plant Engineering at UNC Hospitals’ Hillsborough medical campus for nearly four years. “The pressure on my chest was so great it was like there was an elephant or something huge sitting on it. I was hoping it wasn’t a heart attack but in my mind I knew it was.”

Dennis and Sharon have lived in Haw River for more than twenty years, a few miles off Interstate 40, west of Mebane, in Alamance County. They got in the car, hopped on the highway, and drove to the Hillsborough hospital, where Dennis had been earlier that day as part of the three-man team that takes care of the HVAC units at the medical facilities.

In the past, if Dennis or Sharon needed to go to the hospital for any reason, they drove to Chapel Hill, taking Highway 54. That drive, familiar to Dennis because he spent five years working at UNC Hospitals before transitioning to the Hillsborough medical campus, took him close to 40 minutes.   

“Part of the reason I moved to the Hillsborough hospital for work was because of its proximity to our house – it’s only about 15 minutes away,” he says. “That night I knew that it would be quicker for us to get to Hillsborough and that the care would be just as good. It’s more convenient for me.”

Sharon pulled up to the front of the Hillsborough Emergency Department. Dennis got out of the car, entered the building, and told the guard and receptionist that his chest was hurting badly and that he thought he was having a heart attack. They immediately brought him a wheelchair and took him into the examining room. After an initial exam, he was moved to another room, where they ran an electrocardiogram of his heart.

“They confirmed that I was having a heart attack,” he says. “After awhile, the nitroglycerine they’d given me wasn’t helping, so they transferred me to Chapel Hill. I’m glad I went in, because they evaluated me quickly, took great care of me, and sent me on for more immediate care. I was in good hands.”

When he arrived in Chapel Hill, it was clear Dennis was going to require surgery on an artery that was 98 percent blocked. So, he went straight from the Chapel Hill Emergency Department to the cardiac catheterization lab for surgery.

“It all happened so quickly,” he says. “But they knew what they needed to do – they had to go in around my groin and blow up one of the veins around my heart and put a stent in.”

The surgery was a success, and two days later he returned home to Haw River. He has since been rehabilitating three times a week, for two hours per session, which has helped him regain his strength. He has also completely changed his diet. He confesses that Thanksgiving and Christmas, while great to be with family, were challenging from a food standpoint.

“No more salt – and I love salt,” he says. “I’m eating more fresh vegetables and staying away from steak and ham and bacon – I don’t eat anything like that anymore. When it comes to meat, it’s just chicken and fish.”

All told he’s lost 22 pounds in the last few months.

“I feel much better,” he confirms. “I’m just thankful to be alive.”

Dennis and Sharon have two children together, and since his heart attack, he's gained even greater appreciation of all that he has. His daughter and two granddaughters live next door to him and Sharon and his son, with whom he enjoys drag-racing, lives in Roxboro.

“We’re a close bunch,” he says. “I was just so happy to have been there with them over the holidays.”

Dennis has to go back for an appointment in a few months because of a leaky valve and three more arteries that are 40 percent blocked. He hopes that medication will help prevent another surgery. In the meantime, he’s glad to be working again at the Hillsborough hospital.

“Everyone in my department was supportive,” he says. “It’s a nice bunch of people working here and everything is state of the art – it’s fun to come to work.”

by Zach Read - zachary.read@unchealth.unc.edu

The heart of the matter

Alj and his mom, Tina, have but one wish this holiday season: a new heart for Alj. Mother and son currently occupy a room on 5 Children’s, a dedicated team of medical experts keeping him stable until a donor heart becomes available for transplant. This is their story.
The heart of the matter click to enlarge Then and now: Tina recreates an image captured by the Daily Tar Heel during Alj's initial PICU stay 13 years ago.

The young man in room 5C24 is sitting upright in his hospital bed playing a video game, the picture of health. Somewhat slight in stature for a 13-year-old, Alj (pronounced “Al Jay”) Jeffries has radiant cocoa skin and warm, dark chocolate brown eyes. When asked a question, he is quick to offer a polite, soft-spoken response in a voice that is perhaps deeper than you might have expected. And almost always, he’ll flash that shy smile. It’s a smile that will steal your heart. And therein lies the irony.

To look at him, you’d never guess Alj is losing his 13-year battle against heart disease. His only hope of long-term survival: a heart transplant.

“He’s kept me calm through this whole storm,” says his mother, Tina Turner, a constant presence by his side, steadfast in her faith that the life-saving miracle for which they’ve been waiting will come in time.

Tina has held on to that faith since the very beginning of their medical journey, when at a mere 4 months of age, her bubbly baby boy became lethargic, his usual coos and giggles replaced by odd grunting sounds.

Alj’s grandmother was the first to raise the alarm. Something is seriously wrong with the baby, she thought, and took him to UNC Hospitals’ emergency department. An X-ray revealed Alj’s enlarged heart, so constrained in his tiny chest cavity, it was barely squeezing.

The official diagnosis was dilated cardiomyopathy, a disease in which the heart muscle becomes weak and enlarged, making it difficult to pump blood through the body. Although the exact cause is unknown, Alj’s family suspects his condition was genetically inherited. His half-sister, Carissa, 15 years older than Alj, also had heart disease and would later succumb to it at age 19, years after a heart transplant of her own.

Four-month-old Alj was admitted to the pediatric intensive care unit (PICU), the family told he likely wouldn’t make it through the night.

“We cried and cried and just held each other,” remembers Tina of their first stay in the PICU; there would be more in the years to come. “But then, something deep in my heart, it told me, no, he’s here for a reason. I gotta stay strong for him. I gotta stay positive for him.”

Tina has stayed strong and positive ever since—through that first PICU stay that spanned four months, through other hospitalizations they’ve had at N.C. Children’s Hospital, through innumerable outpatient appointments with Alj’s cardiologists and other specialists. Talking to Alj, it’s clear a mother’s faith and strength is contagious.

“I’m here for a reason and trying my best to stay strong for my mom and my brother and my dad,” says Alj. “Even though my heart is sick on the inside, I’m so strong on the outside.”

Alj with Dr. Buck
Alj with this pediatric cardiologist, Dr. Scott Buck. (Click to enlarge.)
Through the expert care provided by his UNC Children’s cardiology team, Alj has stayed as strong as he could for as long as he could. He’s received regular care and followed his doctors’ advice to the letter. That means Alj avoids strenuous physical activity, which includes fun things that kids his age regularly enjoy and take for granted—playing sports, riding a bike, or running. Despite the precautions taken, cardiomyopathy is a progressive disease, often leading to life-threatening heart beat irregularities, heart valve problems, blood clots, and even heart failure. 
  

In Alj’s case, his heart has taken him about as far as it can. He needs a heart transplant, and he needs it soon.

According to his pediatric cardiologist, Scott Buck, MD, an associate professor of pediatrics in the UNC School of Medicine, there are currently about 300 children waiting for a heart nationwide.

“It is inherently unpredictable,” says Dr. Buck of finding a suitable heart for Alj. “The wait can be days but most often it is weeks and even months—and each year about 50 kids succumb to illness [before receiving a transplant] due to lack of donor availability.”

The United Network for Organ Sharing (UNOS) oversees organ transplantation in the United States and is in charge of fairly determining who receives donated organs. Organs are assigned based on how sick a person is and how quickly he or she needs a new organ. Alj is classified as status 1A, the level of most critical need, but organs assignments also are based on best match for the organ donated. The organ has to be the right size for the person's body, for example, and the donor must have same blood type as the recipient.

“Alj’s heart function is severely impaired, which puts him at the highest status on the transplant list,” explains Dr. Buck. “But the good news is that, although he’s very sick, longevity after transplant is extraordinarily high, so we expect a great outlook for Alj after transplant.”

Dr. Buck encourages families to discuss and make decisions about organ donation before an unexpected life event puts them in the position of having to decide. In North Carolina, registering as an organ donor can be done simply through the Department of Motor Vehicles or via organizations like Donate Life North Carolina.

Alj with Mom
Says mom, Tina: I wish I could take his old heart and preserve it, because that heart is so precious, beautiful, warm, loving, and kind. (Click to enlarge.)
Knowing another person must die for her son to live has been difficult for Tina.
  

“I personally don’t want another’s loved one to pass away—I absolutely hate that part of it—but if a family would somehow find it in their heart to give us that gift . . .” Tina’s eyes well with tears as her words trail off. She pauses a few seconds before she finishes her thought. “Word just can’t describe the gratitude I would feel.”

Until a donor heart is found, Alj will likely remain at the Children’s Hospital, a continuous infusion of medication to help maintain regular heart contraction, medical experts closely monitoring him. After a lifetime battling an ever-worsening heart condition, Alj feels comfortable and at ease in the hospital—but Tina prays for so much more for her son.

“I just want a life for him, for him to be renewed, for him to enjoy all of the things he’s had to miss out on,” she says. “After 13 years, it’s time for him to start living.”

Editor’s note: Tina is a nursing technician on 5 East at N.C. Memorial Hospital. UNC Health Care employees wishing to donate hours to her may do so through human resources. The family has also set up a “Team Alj” Facebook page for those interested in following their journey or offering words of encouragement.

This Story in the News

Meet Dr. Timothy Hoffman, chief of pediatric cardiology

For Dr. Timothy Hoffman, there is nothing more important than community and the teamwork needed to provide optimal patient- and family-centered care.
Meet Dr. Timothy Hoffman, chief of pediatric cardiology click to enlarge Dr. Timothy Hoffman joined UNC Children's as chief of pediatric cardiology in March 2015.

It’s obvious that community and collegiality is important to Timothy Hoffman, MD. In conversation, it’s a concept that comes up often when he talks about his work at UNC Children’s and elsewhere.

“What’s impressed me most about the Division of Pediatric Cardiology is that this group is a family, and they have welcomed me and my wife, Pam (Pamela Ro, MD), with open arms.”

Dr. Hoffman is a recent addition to the division—joining UNC as chief of pediatric cardiology this past March—but he is outspoken about the quality program he found upon his arrival.

“I have been impressed with the level of care and the commitment to family-centered care,” reflects Hoffman. “It’s always been important to me that the family of a patient be involved as an integral member of the care team.”

Hoffman’s devotion to family and community was cemented in his own early days in Pennsylvania.

“I grew up in Pittsburgh in a blue collar family. We’re the sort of folks who all live within five miles of each other, but I’m the one who has done a bit of traveling,” he says with a laugh. “In fact, I went to Allegheny College which is 90 miles north of Pittsburgh and then to West Virginia University, which is 90 miles south, so I stayed close to home and family.”

After completing medical school at WVU, Dr. Hoffman remained at WVU for his residency and became chief resident. Although he would go to Children’s Hospital of Philadelphia for his fellowship training and first faculty job—and then on to Nationwide Children’s Hospital, where he spent 13 years and helped establish a heart transplant program—his affinity for his WVU “family” is apparent in his words and reflections.

“I got interested in pediatric cardiology while at WVU, primarily through the mentors I had there,” says Dr. Hoffman. “I was fascinated by the great level of care that had to be taken for these patients and how complex their cases could be. I learned that cardiology also gave you the ability to practice general pediatrics and all aspects of patient care.”

Dr. Hoffman specifically mentions Larry Rhodes, MD, now chair of pediatrics at WVU, as a man “who loves the care of children, especially those with heart disease.” Rhodes was in his time mentored by William Neal, MD, who also helped Dr. Hoffman chose his specialty.

“We talk about the role of mentors quite a bit,” reflects Dr. Hoffman. “They created quite a legacy at WVU and helped do great things in pediatric cardiology. Their legacy of care influences me. I’d like to do the same thing and build on the great foundation already here.”

Now at UNC, Dr. Hoffman is particularly interested in multi-level care.

“Pediatric cardiology is a discipline that involves so many other areas—cardiothoracic surgery, anesthesia, critical care, neonatology, oncology, just to name a few,” he says. “Because the services are so interlinked in how they care for these patients, I’d like to work toward collaborative services across departments and divisions and keep raising the bar on how we care for patients in North Carolina.”

“My vision is that in five years we will have expanded our regional and national footprint and enhanced the delivery of subspecialty services for the region,” he continues. “We also have a goal to be collaborating nationally and have faculty participate in multi-center initiatives to advance the field of cardiology.”

Dr. Hoffman is optimistic about these goals.

“Absolutely, we have been supported by hospital leadership, and the members of the division are on board. We’re a family, and we have the support we need to grow. This is an established division with energetic individuals providing the best care. From this strong foundation we will grow. Our goal is to enhance the overall service line, not only for the hospital but for the region and state.”

But no matter how much the division may grow, it all comes back to patient- and family-centered care.

“In this field, there are tremendous successes and also tragic challenges,” says Dr. Hoffman. “Every patient I’ve come in contact with has some impact on me in some way. It’s always been the joy of my job to talk to the families, getting to know them.”

“It makes you feel that you are special in their lives,” he continues, “And vice-versa. That’s the most heart-warming part of this job.”

UNC enrolling patients in Momentum 3 Clinical Trial

UNC is one of 60 medical centers nationwide chosen to participate in the MOMENTUM 3 Clinical Trial to evaluate the effectiveness and safety of the Thoratec® HeartMate 3™ Left Ventricular Assist Device (LVAD). This multi-center study will compare the HeartMate 3 LVAD to the HeartMate II® LVAD in advanced stage heart failure patients.
UNC enrolling patients in Momentum 3 Clinical Trial click to enlarge Jason Katz, MD

Media Contact: Jamie Williams, jamie.williams@unchealth.unc.edu, 984-974-1149

The HeartMate 3 is an investigational implantable device that helps to circulate blood throughout the body. Occasionally referred to as a “heart pump”, it is designed to supplement the pumping function of the heart in patients whose hearts are too weak to adequately circulate blood on their own. The Thoratec HeartMate II is the most commonly implanted LVAD and has supported well over 20,000 patients with end-stage heart disease but, Jason Katz, MD, said that the HeartMate 3 investigational device has many added features that may help to reduce the risk of complications and improve patient outcomes.  The MOMENTUM 3 Clinical Trial is designed to evaluate the performance and safety of the HeartMate 3 at six months of LVAD support in subjects with advanced heart failure.*

Katz, director of Cardiovascular Clinical Trials and medical director, UNC Mechanical Heart Program, said that cardiologists across the UNC Health Care system should consider referring their patients with advanced, left ventricular heart failure for consideration of enrollment in this trial. Patients who would qualify are those who have had frequent hospitalizations and a declining quality of life.  

Katz, is one of two principle investigators conducting the trial – along with Brett Sheridan, MD, surgical director of Mechanical Circulatory Support and Transplantation. He added that the novel study design of this trial may allow for greater patient eligibility and enhanced device applicability.

“Historically, studies have separated patients into categories based on whether or not they are transplant eligible. This study includes patients in both categories and we are hopeful that broad eligibility will lead to robust enrollment,” Katz said.

At UNC Hospitals, six study participants have already enrolled in the trial, and enrollment will continue until the 60 participating sites enroll just over 1,000 patients. The device is being evaluated for long-term support for patients who are not candidates for cardiac transplant as well as for short-term support as a bridge to cardiac transplantation.

Katz said several technological advancements make the HeartMate 3 a potentially exciting development for both patients and physicians.

“There are several features of the investigational device researchers hope will work better with the body and the blood [during and after the surgical implantation].  These features may help to reduce risk factors like bleeding and stroke which have plagued the field of mechanical support,” Katz said.  The MOMENTUM 3 Clinical Trial will be evaluating the effectiveness and safety of the HeartMate 3 to determine whether these features will reduce the risk of complications and improve patient outcomes as compared to the currently approved model, the HeartMate II. 

The results of the first 50 patients participating in a trial in Europe, the HeartMate 3 CE Mark clinical trial, were recently presented at the Heart Failure Society of America National Conference, and, Katz said the results were positive.

 To be considered for the MOMENTUM 3 Clinical Trial, patients:

• will have heart failure symptoms that are difficult to manage, even with medical treatment

• are unable to perform physical activity without discomfort

• have noticed a decline in quality of life due to the disease

• have been hospitalized one or more times for heart failure in the past six months

All randomized subjects will be followed for 24 months or to outcome (transplant, explant, or death), whichever occurs first.

Physicians who would like to refer patients to the clinical trial team should utilize the UNC Center for Heart & Vascular Care’s Open Access Referral System. This one-call referral service can be reached at (866)862-4327. More information is also available here.

For more information regarding the MOMENTUM 3 Clinical Trial visit http://www.thoratec.com/vad-trials-outcomes/ongoing-clinical-trials/hmiii-usa.aspx.

* US: Caution: Investigational Device: Limited by Federal United States law to investigational use.

How HeartMate 3 Works:

The HeartMate 3 LVAS includes a Full MagLev™ centrifugal blood pump and is designed to supplement the pumping ability of the weakened heart’s left ventricle, which is responsible for pumping oxygen-rich blood from the lungs throughout the body. The device is implanted above the diaphragm, immediately next to the native heart, and is attached to the aorta (the main artery that feeds blood into the entire body), leaving natural circulation in place while providing all of the energy necessary to propel blood throughout the body. The patient wears an external, wearable controller and battery system that powers the pump. The HeartMate 3 LVAS can pump up to 10 liters of blood per minute.

New Device will make TAVR procedure available to more patients

UNC’s Center for Heart & Vascular Care has been offering Transcatheter Aortic Valve Replacement (TAVR) for less than a year. In that time, the team has built a national reputation for excellence, allowing UNC to be among the first phase of the rollout of a next generation TAVR device, Evolut-R, developed by Medtronic. This valve is the first repositionable transcatheter valve ever available.
New Device will make TAVR procedure available to more patients click to enlarge UNC's TAVR Team (L to R): John Vavalle, MD, Thomas Caranasos, MD, Michael Yeung, MD, Cassie Ramm, MSN, RN, AGPCNP-C
New Device will make TAVR procedure available to more patients click to enlarge Judith Merritt

By Jamie Williams, jamie.williams@unchealth.unc.edu

“When we learned that this device was nearing approval, we obviously wanted to bring it to UNC as soon as possible. To be included in the first phase of the rollout is a great testament to our team and the confidence Medtronic has in our new program,” said John Vavalle, MD, assistant professor of Medicine in the Division of Cardiology.

TAVR provides a treatment option for aortic valve replacement for many patients who previously had no other options or were at high risk for conventional open heart surgery. With TAVR, physicians have the ability to provide aortic valve replacement via minimally-invasive approaches, providing outcomes that are just as good as, and sometimes better than, surgical valve replacements.

Vavalle called the new device a “game changer” that will open the procedure up to more patients and add an additional level of patient safety.

“The least invasive way to do TAVR is through the femoral arteries in the groin, but the patient’s arteries have to be large enough to accommodate the delivery sheaths,” Vavalle said. “Since this new delivery system is much smaller, the femoral approach will be available to more patients.”

In fact, the first patient who received the TAVR procedure with this new device would not have qualified for TAVR if UNC was not able to offer this new technology, and was previously turned away from two other experienced TAVR centers in the area.

But, Judith Merritt of Evergreen, North Carolina, was able to receive TAVR at UNC. Only hours after her procedure, she was up and walking around her hospital room, and was home from the hospital after only a few days.

“I really couldn’t ask for anything better than the care I received here at UNC,” Merritt said. “Without this I don’t know what I would have done.”

Vavalle said without TAVR Merritt would have required an open heart procedure, which would have presented tremendous risk and prolonged recovery for the 71-year-old.

“For her, this was a tremendous advantage,” Vavalle said. “This new technology made her a TAVR candidate at UNC, whereas previously it may have been too risky. She has done remarkably well.”

Thomas Caranasos, MD, assistant professor of Cardiothoracic Surgery, another member of the TAVR team, added that this new device is also much safer due to the fact that the operators have the ability to recapture and reposition the valve once it has been deployed.

“Previously, you had one shot to get it right,” Caranasos said. “With this valve you have the ability to recapture and reposition it, which adds a new level of safety to the procedure.”

The UNC TAVR team looks forward to continued success and rapid growth of their program, and are appreciative that both patients and developers of TAVR technology have already recognized UNC as a leader in the field.

 

Healthy hearts reunite with caregivers

September’s Heart Reunion provided patients and their families an opportunity to reconnect with one another and members of their care team.
Healthy hearts reunite with caregivers click to enlarge The Williams family.

By: Morgan Noelle Smith, student of the UNC School of Media and Journalism

The UNC Children’s Heart Center hosted an event on Sept. 12 that tugged on the heartstrings of all those in attendance; literally. Almost 200 families of children receiving specialized heart surgery gathered at the Heart Reunion to reunite with other heart families and their caregivers.

One of those parents in attendance was Lauren Williams, the mother of 2-year-old Benji, who has already undergone two open heart surgeries and is on schedule to have his third open heart surgery next summer.

Williams’ son was born with multiple critical heart defects that prevented his right ventricle from developing due to his pulmonary valve never opening. The medical plan to address his defects and give him a chance at life will make him a single ventricle baby—basically he will have half a heart.

“Tomorrow is never guaranteed for anyone, but heart families are reminded of that every moment of every single day,” Williams says, reflecting on the past two years of her son's journey. "Benji reminds many that the next breath—or next beat—may not ever come, but he continues to march on, the only way heart warriors know how."

When Benji was born, there was little chance for his survival given one of the diagnosed heart defects. Williams says the care from UNC Children's has given her two years with a boy who never should have lived.

About 200 children receive surgery to correct congenital heart defects at N.C. Children’s Hospital each year. The Heart Reunion was created to enable patients and their families to interact and share stories with one another.

The event was filled with games, crafts, and an array of heart-themed treats. Parents of patients watched their children run, play, and be active, while patients were able to interact with other children facing similar health challenges. 

Benji's Heart Doctors
Benji with his favorite heart doctors, Drs. Michael Mill, Jennifer Nelson, and John Cotton. (Click to enlarge.)
“I know [the surgeons] carry such heavy burdens on their shoulders every day.  They do not always get to deliver good news,” says Williams. “It is so important and vital for their spirit and their mental health to see these kids running around, just being kids and seemingly so healthy.”
 

The UNC Children's Heart Center team has hosted the Heart Reunion annually for 17 years but took a hiatus last year due to a lack of funding. A generous donor—the father of a former patient, now a college sophomore—sponsored this year's event.

Williams says the reunion had a nice turnout but fewer attendees than she had anticipated. She states that more families should consider coming to events such as these, because they gives families hope, foster relationships between families who share similar stories, and can help develop friendships between peers who understand.

“Seeing older kids there with similar conditions as my son gives me hope that I will not outlive my child,” she says. “There were faces of health, strength, tenacity and fortitude—the same qualities I see in my son every day. It strengthened my resolve fight just as hard against congenital heart defects as these incredible heart warriors.”

UNC’s Wolfgang Bergmeier, PhD, earns Bridge Grant

The American Society of Hematology fills gap in decreased federal funding, supports 13 blood research projects.
UNC’s Wolfgang Bergmeier, PhD, earns Bridge Grant click to enlarge Wolfgang Bergmeier, PhD

Earlier this year, Wolfgang Bergmeier, PhD, professor of biochemistry and biophysics in the UNC School of Medicine, discovered that the protein Rasa3 is critical during the process by which the anti-clotting drug Plavix dissolves arterial clogs that trigger heart attacks. This week, Bergmeier received funding to continue researching the complex mechanisms involved in heart-related conditions. He was one of 13 recipients of an American Society of Hematology Bridge Grant, a one-year, $150,000 award designed to bridge the gap between an investigator’s National Institute of Health (NIH) grants.

The NIH is the world’s top provider of medical research grants, but a decade of flat funding followed by across-the-board spending cuts has drastically reduced the agency’s budget. As a result, the NIH is no longer able to fund as many high-scoring proposals as it did in the past. This has led to vigorous competition for NIH R01 awards and prevents otherwise worthy projects from receiving vital financial support. In some cases, this means that important veins of research must be halted.

In an effort to preserve hematology research projects amid this uncertain funding environment, in 2012 the American Society of Hematology (ASH) committed $9 million to create the ASH Bridge Grant program, which is designed to allow researchers to continue their critical work while obtaining additional data to strengthen their grant applications. Since the beginning of the program, ASH has funded 74 researchers.

“When NIH does not have the adequate funds to support medical research, science loses,” said ASH President David A. Williams, MD, of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Harvard Medical School. “When scientists aren’t funded, they spend more time applying for alternative grant funding than on scientific research and discovery, and some must reduce the size or close their laboratories completely. This environment endangers not only existing programs, but also the next generation of scientists who are growing disheartened with the field and abandoning research careers for other paths.”

Research projects supported by ASH’s latest bridge grants encompass a wide range of basic, clinical, and translational hematology research. Funded projects include exploring the role of a protein in malaria formation, the molecular genetics of a congenital bone marrow disease, and a treatment for infant leukemia.

Bergmeier said he will use the grant to investigate the mechanisms that control the adhesiveness of circulating blood platelets. A better understanding of these processes is relevant for our understanding of platelet activity associated with certain diseases and the antithrombotic activity of drugs that affect platelet signaling.

“This ASH Bridge Grant will help our lab tremendously, as it will bridge a gap in our NIH funding and allow us to continue this clinically very relevant line of research” Bergmeier said. “Our long-term goal is to improve the treatment for patients with cardiovascular disease. The development of improved therapies, however, depends on continuous support for basic science projects, mostly provided by the NIH. Unfortunately, these grants are harder and harder to obtain.”

Williams said, “The revolution we are experiencing in new treatments for many blood diseases and blood cancers has been made possible by the funding of research over the past several decades. While ASH is proud to help sustain important hematology research that ultimately benefits patients during this significant downturn in federal support, there is no substitute for an NIH grant.

“We urge lawmakers to work together and arrive at a bipartisan solution that replaces sequestration with a balanced approach to deficit reduction and allows necessary funding increases for NIH. Such funding is critical for continuing America’s pre-eminence in biomedical research, stimulating employment in high-tech jobs and – most importantly – improving and extending the lives of our patients.”

Read more about Bergmeier’s work.

Visit the ASA website to view the complete list of ASH Bridge Grant recipients.

To make a donation, or take action in support of federal funding for biomedical research, visit here.

The American Society of Hematology (www.hematology.org) is the world’s largest professional society concerned with the causes and treatment of blood disorders. Its mission is to further the understanding, diagnosis, treatment, and prevention of disorders affecting blood, bone marrow, and the immunologic, hemostatic, and vascular systems by promoting research, clinical care, education, training, and advocacy in hematology. The official journal of ASH is Blood, the most cited peer-reviewed publication in the field.

UNC researchers find two biomarkers linked to severe heart disease

The finding published in PLoS One suggests that elevated oxidized LDL cholesterol and fructosamine – a measure of glycated proteins in blood sugar – are signposts for the development of severe coronary disease, especially in females.
UNC researchers find two biomarkers linked to severe heart disease click to enlarge Left: moderate heart disease with limited arterial blockages in the heart of a pig. Right: severe disease with several near-total blockages. The two biomarkers were greatly elevated only in severe disease.

Media contact: Mark Derewicz, mark.derewicz@unchealth.unc.edu, 919-923-0959 

July 6, 2015

CHAPEL HILL, NC – Insulin resistance affects tens of millions of Americans and is a big risk factor for heart disease. Yet, some people with the condition never develop heart disease, while some experience moderate coronary blockages. Others, though, get severe atherosclerosis – multiple blockages and deterioration of coronary arteries characterized by thick, hard, plaque-ridden arterial walls. Researchers at the UNC School of Medicine created a first-of-its-kind animal model to pinpoint two biomarkers that are elevated in the most severe form of coronary disease.

The study, published today in the journal PLoS One, suggests two new targets – oxidized LDL cholesterol and glycated proteins (i.e., fructosamine or hemoglobin A1c) – that researchers can further investigate and perhaps target through medications to help people with insulin resistance avoid the worst kind of heart disease.

“If these correlations were also found in insulin resistant humans, then we would want to do everything we could to treat them because they would be at a very high risk of developing severe cardiovascular disease,” said Timothy Nichols, MD, professor of medicine and pathology and first author of the PLoS One paper.

Interestingly, Nichols and his colleagues did not set out to pinpoint the two key biomarkers. They wanted to create an insulin resistant animal model that mimicked human heart disease. They chose pigs, which are metabolically similar to humans and have hearts very much like human hearts. By feeding the animals a diet high in fat and salt over the course of a year, all the pigs became insulin resistant. That is, their bodies produced a lot of insulin but their cells did not respond to the hormone as well as normal. All the pigs also developed coronary and aortic atherosclerosis. But only about half of the pigs developed the most severe form of the disease.

When the researchers checked the pigs for high levels of insulin resistance, they found no correlation with the most severe atherosclerosis. This was a surprising and unexpected finding.

David Clemmons, MD, the Sarah Graham Kenan Professor of Medicine, professor of biochemistry and biophysics, and senior author of the PLoS One paper, knew that the scientific literature suggested a correlation between atherosclerosis and glycated proteins – proteins bonded with sugars in blood.

Clemmons and colleagues tested the pigs for high levels of fructosamine and oxidized LDL cholesterol, which are surrogates for high levels of glycated proteins. Sure enough, all the pigs with severe heart disease had elevated levels of fructosamine and oxidized LDL.

“Also, this correlation was more common in females,” Clemmons said. Fourteen of the 20 pigs that developed severe atherosclerosis were females. Fourteen of the 17 pigs that did not develop severe atherosclerosis were male. “This surprised me, so I looked in the literature for anything similar.”

Clemmons found a study from Finland published in 2005 showing that elevated glycated protein levels were strongly associated with advanced heart disease and increased mortality in women but not in men.

“The underlying causes of this correlation are unknown,” Clemmons said. “But now we have a unique animal model that very much mimics what we see in humans. Our model is a good predictor of diet-induced atherosclerosis in females.”

A next step could be to study the affected heart tissue to find abnormal biochemical reactions in the cellular pathways involved in glycated proteins and severe coronary disease.  This could lead to potential new treatment approaches or tailored dietary interventions.

Clemmons added, “We could also study what’s different about these female pigs that make them much more susceptible to severe heart disease, if they have higher levels of glycated proteins.”

The National Institutes of Health and the North Carolina Biotechnology Center funded this research.

Timothy Nichols, MD is a physician at the UNC Heart and Vascular Center and director of the Francis Owen Blood Research Laboratory. David Clemmons, MD, is a member of the UNC Diabetes Care Center.

UNC Receives $15M AHRQ Award to Advance Heart Health in NC Primary Care

UNC’s Heart Health Now! Advancing Heart Health in NC Primary Care project is one of seven grantees awarded as part of the AHRQ initiative, EvidenceNOW – Advancing Heart Health in Primary Care.
UNC Receives $15M AHRQ Award to Advance Heart Health in NC Primary Care click to enlarge Dr. Sam Cykert

Chapel Hill NC (May 26, 2015) – The University of North Carolina at Chapel Hill and a cooperative team of health care and quality improvement experts were recently awarded a $15M federal grant from the Agency for Healthcare Research and Quality (AHRQ) to help primary care practices use the latest evidence to improve the heart health of millions of Americans. UNC’s Heart Health Now! Advancing Heart Health in NC Primary Care project is one of seven grantees awarded as part of the AHRQ initiative, EvidenceNOW – Advancing Heart Health in Primary Care, which supports the broad U.S. Department of Health and Human Services (HHS) effort for Better Care, Smarter Spending, and Healthier People, and is aligned with the Departments’ Million Hearts® national initiative to prevent heart attacks and strokes.

“The goal of the EvidenceNOW initiative is to give primary care practices the support they need to help patients live healthier and longer,” said HHS Secretary Sylvia M. Burwell. “By targeting smaller practices, we have a unique opportunity to reduce cardiovascular risk factors for hundreds of thousands of patients, and learn what kind of support results in better patient outcomes.”

Heart disease is the leading cause of death for men and women in the United States. In North Carolina, the latest data show an annual cardiovascular death rate of 263 per 100,000, explaining almost one-third of deaths in the state, more than any other cause. To successfully prevent heart attacks it is critical that health care professionals work with patients to adopt the ABCS of cardiovascular prevention: Aspirin use by high risk individuals, Blood pressure control, Cholesterol management, and Smoking cessation. New evidence is continually evolving about how to best deliver the ABCS. The goal of this initiative is to ensure that primary care practices have the evidence they need and use it to help patients live healthier and longer.

As part of the EvidenceNOW- Advancing Heart Health in Primary Care, Heart Health Now! is composed of public and private partnerships and multidisciplinary teams of experts that will recruit and engage 250-300 small, independent primary care practices and provide quality improvement services typically not available to them because of their size. These services include onsite practice facilitation and coaching, expert consultation, shared learning collaboratives, and electronic health record support.

“I’ve cared for many people throughout my career who suffered the debilitating effects of a heart attack or stroke way too early,” said Sam Cykert, MD, professor of medicine, Division of General Internal Medicine and director of the Program on Health and Clinical Infomatics at UNC-Chapel Hill. “Because of the lack of sophisticated information systems and processes that could quickly identify risk and prioritize new evidence for care, many of these folks missed opportunities that could have prevented the paralysis, shortness of breath and death that often resulted from premature disease. By partnering with North Carolina practices to build in the needed supports, we have the potential to prevent thousands of heart attacks, strokes, and deaths within a few short years.”

Heart Health Now! is based at the Cecil B. Sheps Center for Health Services Research in partnership with the NC Area Health Education Center (AHEC) Program’s Practice Support Services, the UNC School of Medicine, Community Care of North Carolina (CCNC) and its family of Informatics Services . AHEC and CCNC have already built a standard of success in these areas. To learn more, visit

While Heart Health Now! will conduct an internal evaluation, AHRQ also awarded a grant to the Oregon Health and Science University (OHSU) to conduct an independent national evaluation of the overall EvidenceNOW initiative. The team will study the impact of the EvidenceNOW interventions on practice improvement and the delivery of cardiovascular care. In addition, the evaluation team will study which practice supports and quality improvement strategies are most effective in improving the implementation of new evidence.

UNC’s grant will run for three years and the evaluation grant for four years. Together, these grants represent one of the largest research investments to date by AHRQ. For more information about AHRQ’s EvidenceNOW initiative, including details on each of the grantees and cooperatives, visit: http://www.ahrq.gov/evidencenow.html. To read the full summary of UNC’s project, go to: http://www.shepscenter.unc.edu/project/heart-health-now-advancing-heart-health-in-nc-primary-care/

EvidenceNOW supports AHRQ’s overall mission to ensure that evidence is understood and used. Funding for this initiative comes from the Patient-Centered Outcomes Research Trust Fund created by the Affordable Care Act and supports AHRQ’s mandate to disseminate and implement patient-centered outcomes research findings so that new findings are integrated into the delivery of health care.

For more information about Million Hearts, visit http://millionhearts.hhs.gov/index.html.

 

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Media Contact: Sonya Sutton, Sheps Center Communications Specialist. 919-962-4714; ssutton@unc.edu 

With every beat of his heart

When 14-year-old Sam presented with a heart arrhythmia never before documented in the medical journals, pediatric electrophysiologist, Dr. Sunita Ferns, found herself facing the most challenging case of her career.

Fourteen-year-old, Sam, always knew he was a bit different from his peers.

"I always had shorter breath than the other kids; I always couldn't run as fast as the other kids," explains Sam. "I just couldn't keep up no matter what."

ferns650.jpg
Dr. Sunita Ferns

His mother, Susan, just chalked it up to Sam being a bigger kid, even in middle school when he started experiencing periodic episodes that included headaches and nausea accompanied by shakes and chills.

"In retrospect, with what we know now, it all makes sense," says Susan. "But at the time, I wondered if he wasn't just trying to get out of school."

Everything changed during a visit to Sam's pediatrician's office in the family's hometown of Wilmington, N.C. An astute nurse practitioner examining Sam for a suspected case of bronchitis noticed pulsing in his neck and discovered Sam's heart rate was nearly twice as fast as it should be. These turned out to be important clues to a set of problems Sam had endured for years.

Sam was referred to James Loehr, MD, at UNC Children's cardiology practice in Wilmington. Testing revealed that Sam had supraventricular tachycardia (SVT), a condition that arises from improper electrical activity in the heart which presents as a rapid heart beat. Dr. Loehr referred Sam to Sunita Ferns, MD, MRCPCH, assistant professor of pediatric cardiology, who directs invasive electrophysiology program at N.C. Children's Hospital.

sam04
Dr. Ferns hugs Sam's mother, Susan, while his grandmother looks on following surgery. Click to enlarge.
Dr. Ferns knows this to be a very serious condition.
 

"This is like running a marathon for your entire life through the day and night," Dr. Ferns explains, "and with time the heart function begins to take a toll, and you develop heart failure."

Dr. Ferns also realized Sam's was a very unusual case. The problem was occurring right on top of the tissue that normally controls the electrical impulses of the heart.

"It's in an extremely unusual location,"adds Dr. Ferns. "They are usually in a location that's far away from the normal conduction system, so they can be taken care of easily."

Resolving the arrhythmia without damaging Sam's normal conductive tissue would be tricky, if it was possible at all. With no effective pharmaceutical options, Dr. Ferns faced a dilemma: attempt to surgically address the arrhythmia by burning the wayward synapses, which could likely leave Sam in need of a pacemaker, or to leave the condition alone, which would ultimately be fatal.

Sam32.jpg
Sam goes for the basket following his surgery.
Complicating the decision was the fact that, despite an extensive search, the pediatric cardiology team couldn't find a single case like Sam's anywhere in the medical literature. Dr. Ferns and her team would be in completely uncharted territory with a surgical intervention, but complete heart failure some years from now was not an option.
 

Sam had his surgery at UNC Hospitals on Dec. 12, 2014. Using state-of-the-art equipment that measures heart tissue down to the tenth of a millimeter, Dr. Ferns and her team went to work on Sam's arrhythmia in a procedure that Dr. Ferns describes as "touch and go."

"I knew there was such a high risk of heart block, I was trying my best not to go off path," recalls Dr. Ferns.

She felt the case was a success, but only time would tell if the tissue was permanently destroyed or if it would regenerate and cause recurrent SVT. A post-operative visit with Dr. Loehr four weeks later confirmed what everyone hoped: Sam's surgery was a success.

Mom, Susan, beams when she talks of how much stamina Sam has now that his heart function is normal. For his 15th birthday in January, she got him a basketball hoop and enjoys watching Sam and his friends play pickup games out in the cul de sac in front of their house.

Sam, too, has noticed a big difference in how he feels. He is no longer missing school and is considering following in Dr. Ferns footsteps by one day pursuing a career in cardiology.

"Dr. Ferns is my hero," says Sam with a big smile. "She saved my life!"

The greatest gift

Born with a congenital heart defect, Samiya was diagnosed with congestive heart failure at just 4 months old. Her only hope of survival: a heart transplant. But would it come in time?

A weary LaCria Hicks stood on the sidewalk just beyond the entrance of N.C. Children’s Hospital that unforgettable September night. Her daughter, Samiya, just two days past her first birthday, occupied a room in the pediatric intensive care unit (PICU) just a couple of floors up. Troubled by the baby’s worsening condition, LaCria had been unable to tear herself away from her daughter's bedside and missed the final shuttle to the Ronald McDonald House.

As guest services personnel secured alternative transport for her, the beleaguered mother reflected on an earlier conversation with one of the critical care physicians amidst the evening’s chaos.

“Be straight with me,” she had implored him just past midnight. They had been waiting for more than six months. Was there hope they would find a heart in time?

In a moment she will never forget, the doctor had taken her hand in his and, eyes locked on hers, said, “She is going to be a stubborn teenager.” And with that, she found renewed faith.

“The doctors haven’t lost hope, so I haven’t lost hope,” she thought to herself as she waited for transport. And then her mobile phone rang.

A heart defect

LaCria’s pregnancy had been considered high risk from the start given a previous history of gestational diabetes. She and husband, Chris, felt reassured by the extra monitoring until LaCria’s four-month ultrasound revealed some anomalies.

Samiya spent her first birthday in the PICU.
The couple was referred to the UNC Children’s Heart Center, where Blair Robinson, MD, did a fetal echocardiogram. He confirmed a narrowing of the baby’s aortic arch along with a hole in her heart.
 

“Dr. Robinson was great,” says LaCria. “He explained Samiya’s heart defects and the course of treatment. He said she would need three surgeries, the first at 5 days old and the next would be around 6 months, and then another when she was like 5 or 6.”

LaCria’s pregnancy became difficult. She developed gestational diabetes again and then pre-eclampsia, a complication of pregnancy whose hallmarks are high blood pressure and protein in the urine. The dangerous condition can compromise organ function and threaten both the mother and unborn baby’s health, delivery of the baby being the only cure. As such, Samiya was born a couple weeks shy of full term.  

“She spent a day in the NICU and then was transferred to the PICU in anticipation of her heart surgery, which went as anticipated,” recounts LaCria. “We stayed about three weeks post-op. She went home with a feeding tube, so we had some complex care issues, but things were going about how we expected.”

But by the time Samiya was 4 months old, LaCria became concerned by some frightening symptoms. Samiya was vomiting frequently, and she had bouts when her face would turn blue. Dr. Robinson did an echocardiogram, which revealed a terrifying development. Samiya was suffering from congestive heart failure.

“It horrifying. I went into panic mode. I didn’t really understand what it all meant,” says LaCria.

Samiya was admitted to the PICU. When surgical interventions didn’t improve her condition, her care team presented another option: a heart transplant.

“That was very hard and painful decision for us,” recalls LaCria. “I am a Christian woman. How can you pray for a heart? How can you pray for another person’s child to die? I had a hard time reconciling that, but there were no other options. Even on the transplant list, there weren’t any guarantees. Would she be strong enough? I finally surrendered. God, if it is your will, your will done.”

The ensuing months were difficult on the family. The family, LaCria, Chris, and Samiya’s two older siblings, Briana and Brandon, spent the summer at the Ronald McDonald House. When school started back up again, Chris spent his days in Chapel Hill at the hospital with Samiya, while LaCria went to work and ran back and forth with the older kids. She visited Samiya every day.

“It’s a complete waiting game,” LaCria remembers of those months waiting for a heart transplant. “We didn’t know when it was going to come, if it was going to come. At the beginning, it didn’t occur to me that she wasn’t going to make it that far. But then her condition began to deteriorate. Her oxygen levels were dropping for no reason. She had been through so much, so much suffering.”

The phone call

“The doctors haven’t lost hope, so I haven’t lost hope,” was the last thought to cross LaCria’s mind before her mobile phone rang that September night, just two days past Samiya’s first birthday.

Radiothon
A year after her transplant, Samiya returned to participate in the Radiothon.
“Mrs. Hicks?” said the man who identified himself as a member of the transplant team. “I just want you to know, we found a heart for Samiya.”
 

“I just busted out screaming,” recalls LaCria. “Tears and yelling and jumping around. He’s still talking, telling more, and I’m not hearing him.”

The transplant surgery took 10 hours. Michael Mill, MD, was Samiya’s transplant surgeon.

“Dr. Mill, I swear that man is heaven sent,” says LaCria. “I never felt so confident. He just told me this is the perfect time, this is meant to me—lots of positive affirmation that everything was going to be okay.”

“When we saw him again after the operation, you could tell everyone was tired, that they had given it their all,” remembers LaCria. “And Dr. Mill, he stayed afterwards and prayed with my mom.”

Samiya spent three months in the hospital following the transplant surgery and was discharged week before Christmas.

“It was beautiful, our own Christmas miracle,” says LaCria.

Now 4 years old, Samiya is a happy child, a natural comedienne who loves to play and dance, says her mom.

“She goes to playground and comes back with five friends,” beams LaCria. “She never met a stranger.”

“Maybe it has to do with all the time she spent in the hospital,” continues LaCria, “all the people who became part of our extended family. They mean the world to us—Dr. Robinson, Dr. Mill, Dr. [Cheri] Hanson and Dr. [Benny] Joyner in the PICU. And the nurses, I call them the ‘unspoken champions.’ Too many to count, they are our heroes. They’ve given us the greatest gift.”

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High mortality associated with STEMI heart attacks that occur in hospitalized patients

A new study by UNC researchers confirms their surprising earlier finding: Patients who suffer a STEMI heart attack while while in the hospital for something else are more likely to die than patients who have the same type of heart attack outside the hospital.
Dr. George A. “Rick” Stouffer

Media contact:  Tom Hughes, 984-974-1151,

Sunday, November 16, 2014

In 2013, University of North Carolina School of Medicine researchers published a study with a surprising finding:  Patients who suffered an ST elevation myocardial infarction (STEMI) heart attack while in the hospital for something else are more likely to die than patients who had the same type of heart attack outside the hospital.

Today the UNC researchers published a new study, based on data from more than 62,000 patients treated at hundreds of hospitals in California, which confirms their earlier finding.

“This study is the largest ever performed on patients who have a heart attack while they are in the hospital for a non-heart related condition,” said George A. “Rick” Stouffer, MD, chief of cardiology at UNC and senior author of the study, published today (November 16, 2014) by the Journal of the American Medical Association.

In the new study, Stouffer and his co-authors analyzed data from the California State Inpatient Database, which included 62,021 STEMI patients treated in 303 California hospitals from 2008 to 2011. Of these patients, 3,068 (4.9 percent) suffered a STEMI while hospitalized for conditions that were not heart-related. A STEMI occurs when an artery in the heart is suddenly and completely blocked. This type of heart attack is considered to be more serious and life-threatening than a non-STEMI heart attack, in which a coronary artery is severely narrowed but is not completely blocked.

The new study found that patients who developed STEMI while hospitalized were more likely to be older and female, and less likely to be treated with measures that are routinely used for patients who suffer a STEMI outside the hospital, such as cardiac catheterization or angioplasty. In addition, the hospitalized patients were three times more likely to die than those who were not in the hospital when their STEMI started.

“There are several reasons why the mortality rate is so high in patients who have a STEMI while in the hospital," Stouffer said. "The patients are older and have more co-morbidities such as lung or kidney disease than do patients who have a STEMI outside of the hospital. But our study shows that the use of percutaneous coronary intervention was associated with a lower mortality rate, even in the highest risk patients. This finding, along with our earlier observation that recognition of STEMI in hospitalized patients is often delayed, suggests two areas in which the care of these patients can be improved."

First author of the study is Prashant Kaul, MD, assistant professor of cardiology in the UNC School of Medicine. Co-authors are Jerome J. Federspiel, PhD; Xuming Dai, MD; Sally C. Stearns, PhD; Sidney C. Smith Jr., MD; Michael Yeung, MD; Hadi Beyhagi, MD; and Lei Zhou, MD.

All of the authors are UNC faculty with appointments in the School of Medicine, the McAllister Heart Institute, the UNC Gillings School of Global Public Health and the Sheps Center for Health Services.

Popular cancer drug target implicated in cardiovascular defects

Research led by UNC’s Kathleen Caron, PhD, shows that halting the protein CXCR7 leads to over activation of adrenomedullin, a hormone needed at proper levels for normal cardiovascular development

Media Contact: Mark Derewicz, 919-923-0959, mark.derewicz@unchealth.unc.edu

September 8, 2014

Kathleen Caron
Kathleen M. Caron, PhD, Department of Cell Physiology and Physiology
CHAPEL HILL – UNC School of Medicine researchers have discovered an unlikely relationship between CXCR7 – a protein implicated in tumor growth and metastasis – and adrenomedullin – a hormone involved in cardiovascular health. Deleting CXCR7 allows adrenomedullin to run rampant, triggering the development of an enlarged heart and the overgrowth of the lymphatic vessels that traffic immune cells and fluids throughout the body.

The study, published September 8 in the journal Developmental Cell, reveals that CXCR7 binds to the ligand adrenomedullin. The UNC research suggests that this relationship is important because CXCR7 has become a popular candidate for cancer-drug developers. The UNC paper also provides a novel and unexpected role for CXCR7 in lymphatic vessels, which are largely understudied, but play critical roles in inflammation, edema, and tumor metastasis.

“Our results suggest that inhibiting CXCR7 with a drug is also likely to influence the adrenomedullin peptide and may unexpectedly and negatively affect lymphatic vessels,” said senior study author Kathleen M. Caron, PhD, professor and chair of the department of cell biology and physiology. “Lymphatic vessels can function as highway conduits for the spread of cancer cells through the body, so being aware of how a potential drug might influence the function of these vessels is critically important.” 

Most receptor proteins act like molecular mailboxes that sit on the surface of the cell; they take in signaling molecules from nearby tissues and then transmit their messages into the cell, where specific commands are carried out, such as helping fight an infection or spurring tumor growth.

CXCR7 is different. It’s part of a rare class of proteins known as decoy receptors, which look like typical molecular mailboxes on the surface, but rather than transmitting messages, they chew them up like a trash compactor would. These decoy receptors destroy any excess signaling molecules in order to keep biological processes like inflammation and tissue development in check.

In 2007, several groups of biologists around the world began to knock out the CXCR7 gene in mice to try to understand its function. Because the CXCR7 gene is “turned on” in lymphocytes – a type of white blood cell – researchers expected the mice to have defects in their B and T cells, which would result in an underperforming immune system. Instead, the researchers discovered that the mutant mice had severe heart and valve defects and died shortly after birth.

KCaron-heartsCaron had previously seen the same defects in mouse models that contained three times the normal amount of the protein adrenomedullin. She began to contemplate the possible relationship between CXCR7 and adrenomedullin. Caron remembered literature from the 1990’s that had suggested a link between the two. Back then, CXCR7 was going by another name – RDC1 – so it wasn’t surprising to Caron that other researchers might not have made the same connection.

“One of the fun things about being in a field for a long time is you carry this historical literature with you,” said Caron, a member of the UNC Lineberger Comprehensive Cancer Center and the UNC McAllister Heart Institute. “I remembered that RDC1 was once thought to be an adrenomedullin receptor, and so we put together the pieces from that paper and the more recent findings to address a new and unexpected hypothesis.”

Caron asked Klara Klein, a graduate student in her laboratory, to help prove the connection once and for all. First, Klein performed a biochemistry experiment to show that the CXCR7 decoy receptor would bind and destroy the adrenomedullin peptide. Klein took cultured cells, made sure that they expressed the CXCR7 receptor, and then added adrenomedullin. She took out samples of the media at different times, measured the amount of adrenomedullin, and then calculated how much of the peptide was left. Klein found that the adrenomedullin was gradually depleted over time. In contrast, when she added the peptide to cells that didn’t express the CXCR7 receptor, the levels of adrenomedullin remained the same.

Klein then obtained a litter of CXCR7 mutant mice and confirmed that they did in fact have enlarged hearts. She also discovered that the mice had an overgrowth of lymphatic vessels. This made sense, if excessive adrenomedullin was implicated.

“The fact that these two types of mice had nearly identical effects suggested that adrenomedullin may be more than just another signal-triggering molecule,” Caron said. “It may be the CXCR7 receptor’s number one binding target.” Klein and Caron thought that if the main role of CXCR7 was to control the amount of adrenomedullin, then they should be able to reverse cardiovascular defects by reducing the amount of adrenomedullin. To do so, they mated the CXCR7 knockout mice with mice that had half the normal amounts of adrenomedullin. Caron’s team found that mice progeny had normal-sized hearts, and the lymphatic vessels of the mice were not overgrown.

“When you get rid of the CXCR7 receptor, you’re essentially getting rid of the brake that slows down adrenomedullin’s effects,” Caron said. “If they don’t have the brake, but at the same time you lay off the gas, then you normalize the size of the heart and lymphatic vasculature.”

Caron, who has had a long-term interest in the role of adrenomedullin in pregnancy, now wants to see how CXCR7 controls the dosing of this hormone in the placenta. She previously showed that adrenomedullin is responsible for recruiting the mother’s immune cells that infiltrate the placenta. Because dysregulation of the immune system during pregnancy underlies the majority of pregnancy complications – such as preeclampsia, preterm birth, and spontaneous abortion – understanding the role of the receptor in charge of tempering that innate immune response could lead to her lab’s next big breakthrough.

This research was supported by the American Heart Association and the National Institutes of Health.

Other UNC co-authors of the Developmental Cell paper include Natalie Karpinich, PhD; Scott Espenshied; Helen Willcockson; William Dunworth, PhD; Samantha Hoopes, PhD; Erich Kushner, PhD; and Victoria Bautch, PhD.

The UNC Center for Heart & Vascular Care implants UNC’s first ‘under-the-skin’ cardiac defibrillator

The subcutaneous implantable cardioverter defibrillator minimizes risks during implantation and reduces the risk of infection.

Chapel Hill, N.C. – July 31, 2014 – A newly developed ‘under-the-skin’ cardiac defibrillator was recently implanted in a patient from Creedmoor, N.C., by UNC electrophysiologist Jennifer Schwartz, MD, assistant professor and clinician in the UNC Center for Heart & Vascular Care. It is the first time the procedure has been performed at UNC Health Care.

The subcutaneous implantable cardioverter defibrillator (S-ICD) from Boston Scientific® is designed to detect an abnormal heart rhythm with thin, insulated wires, known as ‘leads’, that are placed under the skin, not inside the heart chambers, as is found with traditional implantable cardioverter defibrillators (ICDs). The S-ICD mimics an external defibrillator by providing an electric shock when a dangerous heart rhythm is detected.

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In the Gazette: Inspiring heart health in the ‘stroke belt’

Alice Ammerman, PhD, a professor of nutrition in public health and director of Carolina’s Center for Health Promotion and Disease Prevention, reached out to county health officials along with her colleagues and built a project that helps encourage healthy living in Lenoir County.
In the Gazette: Inspiring heart health in the ‘stroke belt’ click to enlarge Alice Ammerman, PhD

Lenoir County is tucked into the eastern part of the state, about 75 miles east of Raleigh, with a population of around 57,000. If you’re headed to the coast, you’re likely to pass through.

“We welcome everybody with open arms,” said Laura Lee Sylvester, the president of the Kinston-Lenoir County Chamber of Commerce. “That’s what makes us stand out – we really take care of each other, no matter who you are or where you live.”

The tight-knit community is also facing a health crisis. Located in what is recognized as the “stroke belt,” its residents experience significantly higher rates of cardiovascular disease, stroke and obesity rates compared to other parts of the state and nation.

Alice Ammerman, a professor of nutrition in public health and director of Carolina’s Center for Health Promotion and Disease Prevention (HPDP), took notice. She and her colleagues reached out to county health officials to learn more about the county’s specific needs and the initiatives already in place, and for nearly five years now, this community has been the focus of Heart Healthy Lenoir.

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The UNC Center for Heart & Vascular Care receives national recognition for providing quality cardiovascular and stroke care

This voluntary program is designed to recognize clinicians who have met standards demonstrating delivery of high-quality care to patients with cardiovascular disease and/or stroke. UNC Heart & Vascular was also recognized by the NCQA Heart/Stroke Program from 2011-2014.

FOR IMMEDIATE RELEASE

Media Contact: Laura Melega, (919) 843-8217, laura_melega@med.unc.edu

CHAPEL HILL, NC – The National Committee for Quality Assurance (NCQA) and the American Heart Association/American Stroke Association (AHA/ASA) have announced that the UNC Center for Heart & Vascular Care has received Recognition from the Heart/Stroke Recognition Program.

This voluntary program is designed to recognize clinicians who have met standards demonstrating delivery of high-quality care to patients with cardiovascular disease and/or stroke.  UNC Heart & Vascular was also recognized by the NCQA Heart/Stroke Program from 2011-2014.

To receive recognition, which is valid for three years, the UNC Center for Heart & Vascular Care submitted data that demonstrates performance that meets the Program’s key cardiovascular and stroke measures.  These measures include blood pressure and cholesterol control, among others.  When people with cardiovascular disease or who have had a stroke receive quality care as outlined by these measures, they are less likely to suffer additional complications, such as a second heart attack or stroke.

“Quality patient care translates into lives saved,” said Sidney Smith, MD, Professor of Medicine, University of North Carolina at Chapel Hill and Past President and Past Chief Science Officer of the American Heart Association. “This is why the American Heart Association/American Stroke Association is supporting a recognition program for clinicians providing quality care.  This program closes the gap by putting into practice AHA/ASA guidelines and statements to fight heart disease and stroke.”

More than 60 million Americans have one or more types of cardiovascular disease.  Cardiovascular disease is the leading cause of death in the United States, responsible for approximately 950,000 deaths each year.  Approximately 700,000 Americans suffer a stroke each year; stroke is the third-leading cause of death and a leading cause of severe, long-term disability.  Despite evidence that reducing cholesterol levels and controlling high blood pressure prevent further health complications, many cardiac and stroke patients are not treated effectively for these symptoms.

“Controlling blood pressure and quitting smoking are common-sense treatments for cardiovascular disease.  But the number of clinicians who don’t urge their patients who smoke to quit would surprise you,” said NCQA President Margaret E. O’Kane. “The Heart/Stroke Recognition Program identifies clinicians who follow these evidence-based guidelines.  The UNC Center for Heart & Vascular Care is to be commended for their achievement in earning Recognition.”

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations.  It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers, and researchers.

Sudden Unexpected Death in NC is being studied at the University of North Carolina

The SUDDEN study will collect medical information from North Carolinians who died from sudden unexpected death in an effort to define contributing disease processes and improve prevention.

The University of North Carolina at Chapel Hill School of Medicine is involved in a multi-year research study to understand the epidemiological and pathophysiological causes of sudden unexpected death in North Carolina.

Sudden unexpected death (SUD) is a malfunction of the heart that results in a rapid loss of blood flow through the body, leading to death.  It is a very rapid process and may have few or no known warning signs.  Upwards of 450,000 people in the United States die from SUD each year.  Despite notable improvements in the past two decades in treatment of coronary artery disease, efficiency of first responder systems, and advancements in resuscitation science, the overall survival rate for out-of-hospital arrest remains only 5-10%.

The Sudden Unexplained Death Registry in North Carolina (SUDDEN) is an ongoing research venture, initiated and managed by the Electrophysiology division of the UNC Center for Heart and Vascular Care.  The SUDDEN study will develop a database of all sudden expected deaths in North Carolina.  The researchers hope to determine SUD incidence rates for various populations, as well as more clearly define cardiac abnormalities and diseases that contribute to SUD in order to improve prevention in North Carolina.

While previous studies of SUD focused on small populations in the Northwestern United States, SUDDEN at UNC is studying a racially and socioeconomically diverse cohort of SUD victims in North Carolina.

Eugene H. Chung, MD, MSc, FACC, FHRS, Associate Professor, division of cardiology, is the principal investigator of the SUDDEN study.  Dr. Chung says that a broad community-based study is needed to determine the cause of SUD.

“North Carolina has a racially and socioeconomically diverse population that will allow us to better estimate the true incidence of sudden unexpected death in various populations,” explains Dr. Chung.  “Our focus will be statewide as we develop the database.

The impact of sudden unexpected death on society is incalculable. With an average of 32 SUD-related deaths each day in North Carolina, the survivors are often emotionally overwhelmed, and family economics may be immediately disrupted.  Families can be threatened by the unanticipated loss of livelihood, sometimes during the most productive years of an individual’s life. 

Paul Mounsey, MD, PhD, MRCP, FACC, Director, UNC Electrophysiology, is the chairman of the steering committee that directs day-to-day operations of the study.  "It is only by identifying people who suffer SUD that we will be able to monitor the changing patterns of SUD in our society.” says Dr. Mounsey.  “This is the number one killer in the United States. It deserves our attention.”

SUDDEN is being conducted with the assistance and support of the NC Office of the Chief Medical Examiner.  Experts from the University of North Carolina in epidemiology, emergency medicine, radiology, genetics and pathology are contributing to the ongoing management of the project.

The SUDDEN study is funded by individual donations from Cecil Sewell, Scott Custer, and Joe and Ann Lamb. Additional support is provided by the Heart and Vascular division of the University of North Carolina at Chapel Hill.

Learn more about SUD (also sometimes known as Sudden Cardiac Arrest) at the following links:

National Heart, Lung, and Blood Institute

American Heart Association

SUDDEN at UNC

UNC Hospitals honored with Mission: Lifeline quality achievement award for heart attack care

UNC Hospitals has received the Mission: Lifeline® Gold Receiving Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer severe heart attacks.
UNC Hospitals honored with Mission: Lifeline quality achievement award for heart attack care click to enlarge AHA Mission: Lifeline® Gold Receiving Quality Achievement Award

Each year in the United States, approximately 250,000 people have a STEMI, or ST-segment elevation myocardial infarction, caused by a complete blockage of blood flow to the heart that requires timely treatment. To prevent death, it’s critical to immediately restore blood flow, either by surgically opening the blocked vessel or by giving clot-busting medication.    

UNC Hospitals earned the award by meeting specific criteria and standards of performance for the quick and appropriate treatment of STEMI patients to open the blocked artery. Before patients are discharged, they are started on aggressive risk reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers, and they receive smoking cessation counseling if needed. Eligible hospitals must adhere to these measures at a set level for a designated period to receive the awards.

The American Heart Association’s Mission: Lifeline program helps hospitals, emergency medical services and communities improve response times so people who suffer from a STEMI receive prompt, appropriate treatment. The program’s goal is to streamline systems of care to quickly get heart attack patients from the first 9-1-1 call to hospital treatment.    

“UNC Hospitals is dedicated to improving the quality of care for our patients who suffer a heart attack, and the American Heart Association’s Mission: Lifeline program is helping us accomplish that goal through internationally respected clinical guidelines,” said George “Rick” Stouffer, MD, interim chief, division of UNC cardiology.  “We are pleased to be recognized for our dedication and achievements in cardiac care, and I am very proud of our team.”    

“We commend UNC Hospitals for this achievement award, which reflects a significant institutional commitment to improve the quality of care for their heart attack patients,” said A. Gray Ellrodt, MD, Chair of the Mission: Lifeline committee and Chief of Medicine at the Berkshire Medical Center in Pittsfield, Mass. “All too many heart attack patients in the United States still fail to receive appropriate treatment for their life-threatening condition within the recommended timeframes. We must all continue this important work to streamline and coordinate regional systems of care to save lives and prevent complications.”  

The American Heart Association’s Mission: Lifeline program helps hospitals and emergency medical services develop systems of care that follow proven standards and procedures for STEMI patients. The program works by mobilizing teams across the continuum of care to implement American Heart Association/American College of Cardiology Foundation clinical treatment guidelines.  For more information, visit heart.org/missionlifeline and heart.org/quality.

Frequent in-person home visits can reduce both readmission and death for patients with heart failure

Home-visiting programs and multidisciplinary heart failure clinic interventions can reduce hospital readmission and improve survival for patients with heart failure, according to research from RTI International and the University of North Carolina at Chapel Hill.

Monday, May 26, 2014

Home-visiting programs and multidisciplinary heart failure clinic interventions can reduce hospital readmission and improve survival for patients with heart failure, according to research from RTI International and the University of North Carolina at Chapel Hill.

The work, based on a report funded by the Agency for Healthcare Research and Quality (AHRQ), was published today in the Annals of Internal Medicine.

Heart failure is a leading cause of hospitalization and health care expenditures in the United States. Nearly 25 percent of patients hospitalized with heart failure are readmitted to the hospital within 30 days of discharge, according to data from AHRQ’s Healthcare Cost and Utilization Project. Hospital readmission can lead to additional health complications and unnecessary costs for patients, insurers and hospitals.

The Centers for Medicare & Medicaid Services began reducing reimbursements to hospitals with high readmission rates in 2012. All these factors have led hospitals, insurers, and other healthcare providers to create transitional care programs, which provide services, resources and education to reduce readmission. Heart failure is associated with the highest rate of hospital readmissions among Medicare patients, therefore many programs focus on this condition. 

“Hospitals and other healthcare systems are under increasing pressure to reduce unnecessary readmissions,” said Cynthia Feltner, professor in the department of internal medicine and researcher at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, and lead author of the article. “At the same time, what types of programs are most effective remains uncertain.”

Feltner led a team from the RTI-UNC Evidence-based Practice Center to examine the efficacy, comparative effectiveness and harms of transitional care programs for heart failure patients. Researchers conducted a systematic evidence review of 47 randomized controlled trials of programs that included home-visits, outpatient clinic visits, telemonitoring (monitoring physiological data remotely), telephone support, and educational programs.

Programs providing a series of home visits soon after hospital discharge can reduce 30-day readmission rates by 66%. Both home-visiting programs and multidisciplinary heart failure clinics visits can improve mortality and reduce all-cause readmission in the six months after hospitalization. Telephone support interventions do not appear to reduce all-cause readmission, but they can improve survival and reduce readmission related to heart failure. Programs focused on telemonitoring or providing only education did not appear to reduce readmission or improve survival.

The number and frequency of visits varied by program, but Feltner said face-to-face contact was a common theme among the most effective programs. The multidisciplinary heart failure clinic interventions included contact with physicians as well as dieticians, pharmacists and nurses.

“Hospitals and providers should consider focusing efforts on interventions that provide frequent in-person monitoring after discharge—specifically, home-visiting programs and multidisciplinary heart failure clinic interventions. This may be a challenge because these programs require more resources; however, they have the best evidence for reducing unnecessary readmissions and improve survival for patients with heart failure,” Feltner said.

The journal article is based on a report developed by the RTI-UNC Evidence-Based Practice Center, a collaboration between RTI International and the University of North Carolina at Chapel Hill. Daniel E. Jonas at UNC co-directs the RTI-UNC Evidence-based Practice Center with Meera Viswanathan at RTI.

Sheps Center contact: Sonya Sutton, ssutton@unc.edu, (919) 966-4118

UNC News Services contact: Thania Benios, thania_benios@unc.edu, (919) 962-8596

AHRQ Contact: Rachel Wagner, rachel.wagner@ahrq.hhs.gov, (301) 427-1258

 

Web-based and live counseling programs can reduce patients’ risk for heart disease

The work, by UNC researchers, adds to a growing body of evidence suggesting that nontraditional approaches to health care are becoming ever more important in managing health and disease.

Monday, May 26, 2014

Web-based and live counseling programs can effectively reduce the risk of heart disease for patients at high risk for the disease, and web-based programs are particularly cost effective, according to research from the University of North Carolina at Chapel Hill.

The work, published Monday in JAMA Internal Medicine, adds to a growing body of evidence suggesting that nontraditional approaches to health care are becoming ever more important in managing health and disease. 

“Following a healthy lifestyle and taking prescribed medications can reduce the risk for heart disease,” said Thomas Keyserling, MD, MPH, lead author of the study. “However, most providers do not have the skills and resources to help their patients achieve these goals. Delivering programs in nontraditional and cost-effective ways gives providers more options to keep patients healthy.”

Keyserling and Stacey Sheridan, MD, MPH, led a team from the UNC Center for Health Promotion and Disease Prevention for the study. Both Keyserling and Sheridan are faculty members in the division of general medicine and clinical epidemiology in UNC’s School of Medicine.

"These programs offer doctors two great resources to serve their patients,” said Sheridan. “The web program can be used to reach patients beyond the office and allows flexibility in the timing of counseling. The counselor intervention, on the other hand, offers the human interaction and can be personalized for those who need it."

They recruited project participants from five primary care practices in central North Carolina for a comparative effectiveness study. A total of 385 participants who did not have heart disease but who were at moderate to high risk for developing it were randomized into either the counselor-delivered or web-based formats of the same intervention.

The main outcome for the study was change in a calculated score, called the Framingham Risk Score, that predicts the chances of future heart disease events. This score was reduced substantially in both groups at four and 12 months follow-up. Also of note, several risk factors improved, including blood pressure, blood cholesterol levels, self-reported dietary intake, physical activity and medication adherence.

In addition to examining health outcomes, the researchers compared the costs of each approach. The in-person counseling session cost $207 per patient and the web-based program cost $110 per person.  Both interventions were cost effective by commonly accepted standards, especially the web-based format. Both intervention approaches were also very well received by participants, with 75 percent saying they would strongly recommend this program to others.

“We were pleased that the intervention appeared to be effective in both formats, highly acceptable to participants, and cost-effective,” said Keyserling. “This study provides support for the importance of combining lifestyle and medication interventions to reduce heart disease risk and for the cost-effectiveness of the web-based format.”

 

HPDP Contact: Sonya Sutton, ssutton@unc.edu, (919)966-4118

UNC News Services contact: Thania Benios, thania_benios@unc.edu, (919) 962-8596

 

 

 

UNC Hospitals Achieves New Status as Accredited Chest Pain Center

Hospitals that have received Society of Cardiovascular Patient Care (SCPC) accreditation have achieved a higher level of expertise in dealing with patients who arrive with symptoms of a heart attack, emphasizing the importance of treatment programs that provide more efficient and effective evaluation as well as rapid treatment of patients with chest pain and other heart attack symptoms.
UNC Hospitals Achieves New Status as Accredited Chest Pain Center click to enlarge Prashant Kaul, MD, Medical Director, UNC Chest Pain Center

Media Contact: Laura Melega, laura_melega@med.unc.edu, 919-843-8217 (919) 843-8

March 25, 2014

CHAPEL HILL, N.C. --  UNC Hospitals announces that it has received Chest Pain Center with Percutaneous Coronary Intervention (PCI) Accreditation from the Society of Cardiovascular Patient Care (SCPC), an international not-for-profit organization that focuses on transforming cardiovascular care by assisting facilities in their effort to create communities of excellence that bring together quality, cost and patient satisfaction.

Hospitals that have received SCPC accreditation have achieved a higher level of expertise in dealing with patients who arrive with symptoms of a heart attack. They emphasize the importance of standardized diagnostic and treatment programs that provide more efficient and effective evaluation as well as more appropriate and rapid treatment of patients with chest pain and other heart attack symptoms. They also serve as a point of entry into the healthcare system to evaluate and treat other medical problems, and they help to promote a healthier lifestyle in an attempt to reduce the risk factors for heart attack.

“Receiving this accreditation for UNC Hospitals is a testament to the hard work of people from many different areas, including, but certainly not limited to, our local EMS crews, Chatham Hospital, Emergency Services and Emergency Medicine, Cardiology, Cardiac Cath lab and Cardiac Services, UNC Heart & Vascular Nursing, Cardiac Rehab, and Laboratory Services,” says Prashant Kaul, MD, FACC, FSCAI, UNC Chest Pain Center Medical Director.

“This accreditation underlines our commitment to the highest standards of personalized cardiovascular care.  We look forward to effectively treating and educating patients to achieve the best possible outcomes.”

To become an Accredited Chest Pain Center with PCI, UNC Hospitals engaged in rigorous evaluation by SCPC for its ability to assess, diagnose, and treat patients who may be experiencing a heart attack. To the community served by UNC, this means that processes are in place that meet strict criteria aimed at:

  • Reducing the time from onset of symptoms to diagnosis and treatment
  • Treating patients more quickly during the critical window of time when the integrity of the heart muscle can be preserved
  • Monitoring patients when it is not certain that they are having a heart attack to ensure that they are not sent home too quickly or needlessly admitted to the hospital

“People tend to wait when they think they might be having a heart attack, and that’s a mistake,” states Tracey Blevins, RN, BSN, MBA, UNC Chest Pain Center Coordinator. “The average patient arrives in the emergency department more than two hours after the onset of symptoms, but what they don’t realize is that the sooner a heart attack is treated, the less damage to the heart and the better the outcome for the patient.”

The state-of-the-art UNC Chest Pain Center at UNC Hospitals encompasses the entire continuum of care for the heart patient and includes such focal points as dispatch, Emergency Medical System, emergency department, cath lab, UNC’s quality assurance plan, and community outreach program. By becoming an Accredited Chest Pain Center, the hospital has enhanced the quality of care for the cardiac patient and has demonstrated its commitment to higher standards.

About the Society of Cardiovascular Patient Care

The Society of Cardiovascular Patient Care (SCPC) is an international not-for-profit organization whose mission is to transform cardiovascular care by assisting facilities in their effort to create communities of excellence that bring together quality, cost and patient satisfaction. As the only cross-specialty Society, SCPC provides the support needed for hospital systems to effectively bridge existing gaps in treatment by providing the tools, education and support necessary to successfully navigate the changing face of healthcare.   For more information on SCPC, accreditation and certification opportunities, visit www.scpcp.org, or call toll free at 1-877-271-4176. 1-877-271-4

Simple Diagnosis - Complicated Solution

The UNC Center for Heart and Vascular Care collaborates with specialists in the Raleigh area to provide care for the most complex heart cases. (This feature was originally published in UNC Health Care's Well Magazine, Winter 2014 issue)

By Stephanie Soucheray-Grell

Written for UNC Health Care

Wednesday, February 26, 2014

Craig Wilkins was feeling tired, breathless and in need of a vacation. Although he attributed his tiredness to too many long and hectic hours at the office, the 56­-year­-old decided to see his family doctor in Cary, N.C., before leaving for a family trip.

Craig was otherwise healthy and had no history of heart disease, but his doctor discovered he had atrial fibrillation, a condition that can cause the heart to race, sometimes beating hundreds of times in one minute. These episodes, called tachycardias, were making Craig feel fatigued.

He said my heart was beating a mile a minute, that’s why I was so tired. My heart was wearing me  out.

An estimated 12 million people will have atrial fibril­lation by 2050, according to the Centers for Disease Control and Prevention. Atrial fibrillation is a type of arrhythmia that causes the heart to beat irregularly. It can be genetic or caused by scar tissue on the heart, diabe­tes, high blood pressure or  stress. An  aging  population, an increased survival rate following heart attacks and ris­ing rates of heart disease mean more Americans will be entering their 60s and 70s with arrhythmias, which are a leading cause of stroke and cardiac events, and can dra­matically alter a person’s quality of life.

For some, atrial fibrillation is annoying but not life threatening. For Craig, the condition had gone undetected for so long that he had developed congestive heart failure. “I was shocked when the doctor told me how serious it was,” says Craig.

Initially, Craig was given a course of blood thinners to prevent clots that could be lethal, followed by a cardio­version, an electrical shock to the heart, to reset the heart­ beat back to normal. Though this worked initially, his heart eventually returned to the abnormal heartbeat. After several attempts at cardioversion, Craig’s doctor tried anti­ arrhythmia  medication.

“They put me in the hospital and used a powerful anti­ arrhythmia drug,” says Craig, who stayed in the hospital for three days as doctors watched his heart.Two days after he was released, he returned to work and passed out at his desk.

Craig Wilkins“Two days out of the hospital and my heart not only went out of rhythm but went into a life­ threatening rhythm, and I passed out cold at my desk. I came around as my co­workers were reading the instructions on the defibrillator paddles.”

Because his heart kept falling out of rhythm despite several  attempts  to  regulate  it  with  electric  shock  and medications,Craig’s cardiologist referred him to Paul Mounsey, MD, FACC, director of electrophysiology at UNC Hospitals.

Working Together to Provide Top-Notch Care

UNC Health Care is on the cutting edge of treating complex arrhythmias. Now, specialists from Wake Heart & Vascular Associates, Rex Heart & Vascular Specialists, and the UNC Center for Heart and Vascular Care are joining to create the UNC Heart & Vascular Network.

“We are going to establish a network in Raleigh that enables patients and physicians to work together in Wake County for patients who have difficult-to-treat arrhythmias,”says Andy Kiser, MD, chief of the Division of Cardiothoracic Surgery. “This is a collaborative effort between the best doctors in the region. Our idea is to bring the service closer to the people so patients don’t have to travel so far to find collaborative care.”

Dr. Mounsey says opening the UNC Heart & Vascular Network will help many patients remove the barriers that block their access to the best care for their conditions.

“Half of our patients come from Wake County,” says Dr. Mounsey, “and many patients—both new and referrals—have to make a 60-mile round-trip drive to see us in Chapel Hill. What we’re looking for in the new network is to offer our services of highly complex procedures. Arrhythmias are a public health issue, and we’re seeing more patients in need of these services every year.”

Complex Solutions for Complex Arrhythmias

Treatment for arrhythmias typically includes medication called beta blockers, which help slow the heart down, or pacemakers, which are small implanted devices that keep the heart’s rhythm regulated with small electric shocks to the heart. For patients like Craig whose arrhythmia was not corrected with initial treatment options, surgery may be necessary to reset the heart’s rhythm. 

Kiser and Mounsey
Andy Kiser, MD (left), with Paul Mounsey, MD Courtesy Donn Young

Dr. Mounsey performed a cardiac ablation on Craig’s heart. In an ablation, doctors thread catheters through the arteries to the heart and use radiofrequency to destroy the damaged heart tissue causing the atrial fibrillation. Ablations are often successful, but in Craig’s case, a flutter continued even after the procedure. A second ablation was performed, but the location of where the flutter was originating meant ablation could not correct it.

Dr. Mounsey then collaborated with Dr. Kiser to perform the Convergent Procedure.

Traditionally, surgeons, like Dr. Kiser, have created scar pat- terns to disrupt the circuitry that causes atrial fibrillation arrhythmia, while electrophysiologists, like Dr. Mounsey, have performed ablations. With the Convergent Procedure, Drs. Mounsey and Kiser work side by side using miniature cameras, small catheters and electrodes to map out an individualized pattern that will work to reestablish normal rhythms in each patient.

Drs. Mounsey and Kiser have been performing the procedure since 2011, and they recently completed their 100th surgery. They have an 80 percent success rate, which is extremely high for complex arrhythmias.

Five years after Craig’s initial atrial fibrillation diagnosis and a year and a half after having the Convergent Procedure, he says his health is excellent. “I can’t believe how bad I used to feel,” says Craig. “I have energy and a desire to do things now.”

Craig felt so good, he left his IT job behind and made a career change, opening The Meat House, a neighborhood butcher and grocery franchise in Raleigh and Cary.Warning Signs

 A Coordinated Effort

Shah from Rex
Sidharth Shah, MD Courtesy Bryan Regan
Craig’s  case  is  a  good  example  of  the  patients  who  will benefit most from the UNC Heart & Vascular Network. Patients who live in the Raleigh area and their primary care physicians will have access to a group of cardiologists and services in their local communities, and for the most complex  cases, they  will  have  access to the leading research, technology and specialty care available at UNC Health Care.

With the creation of this new network, Drs. Kiser and Mounsey will work alongside Sidharth Shah, MD, a cardiac electrophysiologist in Raleigh. Dr. Shah performs cardiac ablations and works with cardiac devices, such as pacemakers and cardio defibrillators, and his work is closely associated with research opportunities and clinical trials.

“In the past we had to send our patients who were in the UNC or Rex system to other centers,” says Dr. Shah. “Now, we can keep them close to home.”

 


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Aortic Aneurysms: The Silent Killer

Ultrasound screening for aortic aneurysms is vital for patients at high risk

aneurysm diagram
An infrarenal abdominal aortic aneurysm.
celebritiesWhat do Albert Einstein, Lucille Ball, George C. Scott, and John Ritter have in common? They all died from aortic disease.  

Einstein and Scott suffered from abdominal aortic aneurysms while Ritter and Ball experienced aortic dissections, or a tear in the inner wall of their aortas.  More than 15,000 people a year die from ruptured aneurysms, with the incidence of aortic aneurysms tripling in the United States in the past 30 years, attributed to an aging population.  Abdominal aortic aneurysms are the third leading cause of sudden death in men over age 60.  

Aneurysms are often called a “silent killer,” because patients often have no symptoms until the aneurysm bursts.  Nearly 75 percent of all patients with a ruptured aneurysm die from the condition, which makes screening crucial for people at greatest risk.

What are aneurysms?Aortic Disease Risk Factors
Aneurysms are a ballooning and weakening of the arterial wall and occur in almost any artery in the body.  If an aneurysm grows large enough it may lead to rupture, internal bleeding, shock and even death.

Common types of aneurysms

Aortic aneurysms occur in the aorta, which delivers blood throughout the body from the heart to organs.  Thoracic aneurysms occur in the section of the aorta located in the chest, while abdominal aneurysms can occur in any section of the abdomen, including the intestines and kidneys.

Aortic Dissection

An aortic dissection begins when a tear forms in the innermost lining of the aortic wall. When the tear occurs, blood leaks into the aortic wall, causing separation of its layers. This leads to intense pressure in the aortic wall and a high risk of rupture. Aortic dissections may also limit the flow to several important organs including the heart, brain, liver, kidneys, intestines, spinal cord and legs.  Aortic dissection is a life-threatening emergency and is frequently fatal.

Aortic Screening
Early detection of aortic disease is proven to save lives.  Preventative screening in high-risk patient populations and treatment of individuals with aneurysms have saved thousands of lives each year.  

Each year approximately 200,000 people in the U.S. are diagnosed with abdominal aortic aneurysms. Because many do not experience symptoms, it’s estimated that more than one million people are living with an undiagnosed abdominal aortic aneurysm.  Fortunately, at least 95 percent of these aneurysms can be successfully treated if detected prior to rupture.

Finding and treating an aortic aneurysm before the aneurysm ruptures is vital for patient survival. 

Source: AAAneurysm Outreach


Get screened
Contact UNC Aortic Disease Management at 919-843-2867, or online at uncheartandvascular.org to find out about aortic disease screenings.

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Hope for Elijah

3-year-old boy Elijah Smith had 13 surgeries in his first 2 years of life to correct lymphatic malformations. If left untreated these malformations would have caused him serious problems in breathing, eating and speaking.


twoheartsWhen Elijah Smith of Wade, N.C., was born in December 2010 at Cape Fear Valley Hospital in Fayetteville, excess fluid had overrun his lymphatic vessels, engorging and distorting his neck and upper chest cavity.  Diagnosed at birth, Elijah suffered from lymphatic malformations (LMs), and he represented the most common type of patient with this condition -- a congenital case requiring an immediate, multidisciplinary course of treatment.   

Thought to be caused by errors in fetal development of lymphatic channels, the LMs afflicting Elijah had begun in the womb and gone undetected in multiple ultrasounds.  Marked by mass swelling distorting Elijah’s upper thoracic cavity, the malformed vessels could not efficiently transport tissue fluids back into the bloodstream via his lymph nodes.  If left untreated, the accumulated lymphatic fluid would have increasingly obstructed his airways.  Non-intervention would also have risked lifelong maxillofacial complications such as thickening of the tongue (macroglossia) and speech/eating challenges, as well as recurrent cellulitis, enlarged soft tissues and bones, and bleeds from the LMs themselves.

Elijah was referred to UNC Health Care shortly after birth in early 2011 for corrective treatment.  Over a two-year span, his team included clinical faculty from the Departments of Pediatrics, Pediatric Surgery, Otolaryngology/Head and Neck Surgery and Radiology.  UNC Professor of Pediatrics Dr. Timothy Weiner’s confirmation of Elijah’s diagnosis at birth was so brief that his case referral to UNC’s Department of Otolaryngology entailed escorting the Smith family directly over to Associate Professor and Pediatric Otolaryngology Chief Dr. Carlton Zdanski’s clinic.  

As Zdanski examined the fluid-filled cysts throughout the boy’s throat, he found dilated cysts in the back of the throat and deep in the chest that could cause breathing problems.  He knew immediately that UNC Health Care would be able to treat Elijah.

Dr. Zdanski explained to Elijah’s parents that the boy’s care would take multiple treatments over the next few years and eventual surgery to correct the skin and tissue below the cysts. Also, close surveillance was necessary in the event the cysts suddenly enlarged and compressed his throat or became infected.

Due to the invasive treatment Elijah’s case required for correcting the malformed lymph vessels, Zdanski referred him to UNC’s Vascular-Interventional Radiology (VIR) division for assistance and treatment.  Since Elijah’s first corrective treatment in early 2011, Vascular-Interventional Radiology Professor Dr. Joe Stavas has worked closely with the Smith family over the course of 13 outpatient procedures, conducting the most recent one in September 2013. Drs. Zdanski and Stavas collaboratively mapped out a long-term treatment plan with Elijah’s parents that included MRI scans, drainage and ablating the cysts to cause shrinkage.  These early steps would provide a basis for future surgery to remove extra skin and malformation tissue.  

Elijah has progressed through his first two years of life with relative ease, yet the challenges related to his throat and chest distortions range from limited swallowing to the emotional toll on his family due to stares and even cruel comments in public from others.  Fortunately, with each surgery, Elijah’s throat and airway obstructions have cleared, and the distortions in his lower neck have diminished.  His only setback during the course of treatment occurred at five and 10 months, when he underwent inpatient stays for infected and inflamed lesions. Two hours after Dr. Stavas conducted his last procedure on Elijah in September, the toddler was back at home in Wade.   

Elijah’s parents April and Tim are very involved in his care, and the entire UNCH team that cares for him have become very close to them.  Tim often brings reading materials for the doctors and April sends pictures of Elijah “just being a toddler” around the house. “We’ve seen him grow and be happy boy since this all began,” remarked Dr. Stavas.

With each of Elijah’s surgeries, April Smith observed how her son’s throat and chest area restored itself to more natural form, giving her greater peace for how he will progress as a healthy, growing child.

“We were lucky from the beginning, because Elijah didn’t have the severe lesions I’ve seen from photos of other children with this condition. Don’t get me wrong, it took us a good bit of strength to get through 13 surgeries in two years of my child’s life, but we’re really blessed as a family because of it all. He’s such a happy, playful 3-year-old now!”  

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Human Interactions, Robotic Solutions

The university's culture of collaboration is leading to new possibilities for diagnosing and attacking cancers – by using robots.

                               In medicine, the eureka moment rarely happens. Sometimes medical advances gain momentum from a simple gesture like an introductory email or a serendipitous meeting. Just ask Ron Alterovitz, PhD, assistant professor of computer science and head of the Computational Robotics Research Group in the Department of Computer Science at UNC.

Since arriving in Chapel Hill in 2009, Alterovitz’s group has been investigating new algorithms that can enable robotic tentacles to achieve depth and precision inside the human body. One of his devices – steerable needles he co-created as a graduate student at UC-Berkeley – is being developed to treat liver and prostate cancers.

Now Alterovitz is focused on a new surgical device – a snake-like, robotic set of concentric nested tubes made of nickel titanium. The device can be deployed from the tip of a bronchoscope, allowing physicians to reach farther than ever into the lungs to diagnose abnormal growths called nodules. It can also be deployed via the nose to surgically access tumors in the brain or nearby structures in the head. The robotic device has the potential to move through the body so precisely that it can avoid anatomical obstacles and reach its target within a millimeter.

These interdisciplinary, NIH-funded projects have been of interest to School of Medicine faculty members Richard Feins, MD, professor of surgery in the division of cardiothoracic surgery, and Brent Senior, MD, Nathaniel and Sheila Harris Distinguished Professor of Otolaryngology.

After receiving an email from Alterovitz upon his arrival at UNC, Dr. Feins, an early user of the superDimension lung navigation system, was immediately interested in hearing what Alterovitz had to say.  “As surgeons, most of what we do in terms of treatment involves getting where we need to go, so when Ron came to me with the concept of a steerable catheter that could get anywhere he preprogrammed it to go, it was exciting,” says Dr. Feins.

As surgeons, most of what we do in terms of treatment involves getting where we need to go, so when Ron came to me with the concept of a steerable catheter that could get anywhere he preprogrammed it to go, it was exciting.

Dr. Senior’s work with Alterovitz didn’t involve an email; it began at church. Dr. Senior was mentoring a student of Alterovitz’s at church when the two got to talking about their work at UNC. It soon became clear to Dr. Senior that he should meet Professor Alterovitz.

“I was excited to hear what he was doing because it really is exactly what we need to be thinking about for the future of what we do in skull-base surgery,” says Dr. Senior.

Two Lungs graphic for Robotic Research by Ron AlterovitzBranching out

“Think about the airway as a tree,” says Dr. Feins. “The limbs get smaller and smaller as you fan out. You’d like to climb out to grab an apple off one of the branches, but you can only go so far before you have to stop because the limbs are too small and will break. That’s sort of what we’re talking about with reaching peripheral lung lesions.”

Diagnosing peripheral-zone lung cancer is difficult. The nodules can be reached with a CT scan and biopsied, but doing so runs the risk of collapsing the lung. Furthermore, even when the lesion is reached, the amount of tissue that can be gathered may be limited, and therefore the sample is potentially inaccurate.

Snake-like robotic needles, attached to and deployed by the bronchoscope, may provide more accurate diagnoses. As curvilinear devices that can be programmed, the needles can snake their way through the parenchyma of the lung to access nodules in the peripheral zone, striking their target with precision.

“If the nodule identified in the CT scan is on the peripheral zone, and the bronchial tubes are so small that you can’t use existing devices like the superDimension, then that’s where these robots can work,” says Alterovitz.

Early-stage diagnosis through biopsies of peripheral nodules has the potential to save lives. And in the immediate term, that’s the focus of Alterovitz and Dr. Feins. The long-term goal, however, is to actually treat the tumors. Dr. Feins uses the analogy of the early days of cardiology.

“Cardiology was primarily a diagnostic specialty,” says Dr. Feins. “They did angiograms and saw what was wrong with the patient, and then they’d have to send the patient to the surgeon. Eventually they found therapeutic options. They could dilate the arteries or put stents in the arteries. Those therapies changed the whole dynamic. I think it’s possible that if we can get the technology to precisely where we need it to go, not only can we make a diagnosis, but we can add therapeutics like localized radiation, localized chemotherapy, or even localized freezing or radio-frequency ablation.”

Skull Graphic for Robotic Research by Ron AlterovitzHigh-priced real estate 

The pituitary gland sits squarely in the middle of the skull. Flanking it on either side are the carotid arteries, which control blood flow to the brain. The cranial nerves surrounding the pituitary control vision, movement of the eyeballs, sensation to the face and jaw, and other functions critical to everyday life.

“I tell my residents that we’re dealing in high-priced real estate,” says Dr. Senior. “You have to be very exact. Critical nerves are a millimeter or two from the target area we’re trying to reach.”

According to cadaver studies, tumors in this region are common. Although rarely cause for concern, some abnormalities require operations. A century ago, surgeries in the pituitary were highly invasive, requiring the face to be fileted open. The procedures resulted in high mortality and complication rates. Today, after a series of advances, endoscopic procedures, which include dissection inside the nasal cavity, are relatively safe. UNC Hospitals performs roughly 100 such procedures per year.

Although utilizing the surgeon’s fine finger motion has proved effective thus far, there’s room for further improvement, according to Dr. Senior. Robotic technology coming from the Computational Research Group is poised to allow surgeons performing this procedure to reduce dissections and increase precision within the target area.

“The beauty of Ron’s work is that we may be able to go through natural openings and do minimal expansion of them, and then pinpoint directly into where the tumor is located by using a roadmap system,” says Dr. Senior. “Because the robot has such fine ability to position and move instruments, theoretically it would be safer as well.”

The beauty of Ron’s work is that we may be able to go through natural openings and do minimal expansion of them, and then pinpoint directly into where the tumor is located by using a roadmap system. Because the robot has such fine ability to position and move instruments, theoretically it would be safer as well.

The device can be outfitted with a variety of applications at its tip, including a camera, gripper, suctioner, and irrigator. Up to four devices with different tips could be deployed simultaneously during a procedure, with the idea that the devices could be used together by the surgeon as part of a treatment of the tumor.

Dr. Senior is optimistic about the possible advances. “Our goal with these surgeries is 0 percent mortality, 0 percent morbidity,” he says. “We don’t want any complications. Of course, we’ll never reach that, but I think that the robot will help to move us in the right direction, and it will be a stepping stone into other areas of the skull base as well. We have seen amazing advances in these surgeries in the last 20 years, and I believe that the robot will keep chipping away at those numbers and continue to improve the quality of life of our patients after the procedures.”

Learning new languages

As the collaborators continue to trade technical expertise to advance their work, Alterovitz and his lab scour medical journals for the relevant research that will aid them in the medical applications of their robots.

“Building up your vocabulary takes time, but it’s required to get up to speed,” he says.

Alterovitz talks at length with the physicians to learn about the specific procedures. Despite the challenges of learning another discipline, the give-and-take provides all parties with a better understanding of each other’s work.

“I’m in awe of what Ron does,” says Dr. Feins. “For Ron, the world of computer science is very easy. But the medicine part of what we’re doing – a lobectomy, for example – can be difficult for him to understand. I’m exactly the opposite.”

Dr. Feins and Alterovitz maintain an open dialogue. They sometimes speak for hours, hashing out the complications and challenges of their project. For them to be successful, it’s essential, Dr. Feins says, for Alterovitz to feel comfortable asking questions.

“I don’t want him to have any fear about asking, ‘What do you mean by this?,’” says Dr. Feins. “I might have to tell him you can’t put a hose that big down the airway because the patient won’t be able to breathe. And he may have to tell me that we can’t make a right-angle turn. It’s a good back and forth.”

Alterovitz enjoys the process.

“That’s the fun part about this line of work – learning about these procedures, how the physicians do them, what’s important to them as they do them, and how we can translate what they want to do into technology,” says Alterovitz.

Alterovitz isn’t a complete newcomer to medicine. After finishing his PhD at Berkeley, he received an NIH award that gave him the opportunity to work in a medical research group at UCSF Medical Center, where he was embedded with medical physicists and radiation oncologists. Dr. Senior has watched Alterovitz learn medical concepts and admires his commitment to building his medical knowledge base.

“I have to say, I was honestly impressed that he has taken it as far as he has already,” Dr. Senior says. “He has a lot more insight into the anatomy and our procedures than I would expect a computer scientist to have. He’s really done quite well in terms of getting a good, established knowledge base.”

At the start of their collaboration, Dr. Senior invited Alterovitz’s students into the cadaver lab to perform dissections. He showed them the current endoscopic instrumentation so that they could get a sense of the distances, the tightness of the space, and the current complexities of the surgeries they do.

“I think that was a very valuable thing for them,” continues Dr. Senior. “Their knowledge of the anatomy is sort of like a black box with some obstacles in it. So we were able to give them a view of the anatomy in a very true and biologic and physiologic way.”

Alterovitz acknowledges that building his medical knowledge is a work in progress.

“I’ve been learning as I go,” he says. “I almost wish I had a little more formal training. But it’s been helpful that I have great collaborators.”

Lung Graphic for Robotic Research by Ron AlterovitzCulture of collaboration

Prior to arriving at UNC, Alterovitz’s collaborative work with a UC-San Francisco Medical Center team and Johns Hopkins University mechanical engineers led to the development of steerable needles for improving the precision of prostate brachytherapy. When needles are inserted – and located accurately – in the prostate gland, radioactive seeds are deployed. The seeds distribute high doses of radiation to the tumor and only low doses to the surrounding healthy issues – so low that side effects are minimal.

Although UCSF Medical Center was located just across San Francisco Bay, Alterovitz recalls the challenges presented by the distance between Berkeley, where he lived and worked, and his collaborators near Haight-Ashbury. He had to take both a train and a bus any time he traveled to meetings with them, and it was difficult to set up gatherings spontaneously.

Such logistical impediments, Alterovitz admits, can slow research down. He has found the opposite situation at UNC, which he considers the perfect location for his work.

“A big reason this research can go forward is that here the School of Medicine and the College of Arts & Sciences are located on the same campus,” says Alterovitz. “It’s a simple thing, but it’s a huge benefit for this line of research because I can simply walk to the hospital to meet with my clinical collaborators, and we can even meet somewhat spontaneously.”

Dr. Feins feels fortunate to have such a close connection to other areas of the university.

“Proximity is critical,” says Dr. Feins. “Traditionally, in highly creative places, you have a critical mass of people that are in proximity to each other. Look back at the enclaves of painters in France, for example.”

Being geographically close has allowed Dr. Senior’s lab meetings with Alterovitz and his students to occur often.

“We’re literally right down the road from each other – and my lab is halfway between us,” says Dr. Senior. “So we’ve been able to meet very easily. It’s been absolutely great.”

Proximity alone doesn’t foster a collaborative atmosphere – silos often stand side-by-side and never meet. Rather, a shared spirit of creativity found across the campus helps to break down those silos and bring different sets of expertise together.

 “UNC has a tremendous culture of collaboration,” says Dr. Feins. “We’re able to collaborate very easily and readily, and without a lot of the things that other centers worry about, such as what’s patentable. It’s vitally important to have that proximity and culture and even, some would say, architecture – places where you can get together and talk – to foster that. That’s what allows for a creative environment, which is the reason we’re all here.”

Dr. Senior echoes those sentiments.

“I’ve worked at a lot of places,” says Dr. Senior, “and the collaborative spirit that I get from the people here is fantastic. Ron is an expert in robotics and the computer science required to make these advances possible. I’m an expert at the disease and getting us into the area where the tumors are located. My neurosurgeon colleague upstairs is the expert at the actual tumor. It’s all of us bringing our expertise together that makes advances in medicine possible.”

by Zach Read
zread@unch.unc.edu

Prashant Kaul, MD, honored by the American College of Cardiology as an "Up & Coming" physician

Dr. Kaul was honored by the ACC in the December 2013 issue of CardioSource World News

Prashant Kaul, MD, FACC, FSCAI, was honored by the American College of Cardiology as an "Up & Coming" physician in their December 2013 issue of CardioSource World News.

Dr. Kaul is an Assistant Professor of Medicine in the Division of Cardiology and Medical Director of the UNC Chest Pain Center.  Nominated for the honor by Rick Stouffer, MD, interim chief, Division of Cardiology, the article talks about Dr. Kaul's medical specialties, training, awards, his family, and his hobbies, including his involvement in the UNC Cricket Club.

To review the full issue of CardioSource World News, click here. (select page 16 for Dr. Kaul's article)

Congratulations Dr. Kaul!

Seven UNC Heart & Vascular doctors listed in The Best Doctors in America® 2014

These doctors are also listed in the December 2013 issue of Business North Carolina Magazine, as part of its annual compilation of the best doctors in North Carolina.

Seven doctors affiliated with the UNC Center for Heart and Vascular Care are included in the latest compilation of The Best Doctors in America® database. Only five percent of doctors in America earn this prestigious honor, decided by impartial peer review.

The UNC Heart & Vascular physicians included in 2014 are:

Kirkwood Adams, MD

Mark Farber, MD

Anil Gehi, MD

Larry Klein, MD

Paul Mounsey, MD, PhD

Brian Rayala, MD

Sidney Smith, MD

These seven physicians are also listed in the December 2013 issue of Business North Carolina Magazine, as part of its annual compilation of the best doctors in North Carolina.

To learn more about The Best Doctors in America® 2014 database, as well as the complete listing of all UNC physicians included, click here.

To learn more about the Business North Carolina Magazine compilation of best doctors in NC, click here.

Patient's heart story is one of celebrations and setbacks

Seventeen-year-old cardiac patient, Courtney, has celebrated many victories and felt the sting of setbacks on her journey to receiving a new heart. In 2013, Courtney was placed with a ventricular assist device (VAD) at N.C. Children's Hospital, but the celebration was temporary. Now, Courtney's family looks ahead to the next challenge: a heart transplant.


Courtney
, 17, is like most teenagers. She likes to spend time with her friends. She enjoys playing the piano. She loves her 1-year-old rat terrier puppy. She hopes to get into her dream college and start life as an independent young adult.

But Courtney also deals with health concerns most teenagers never think about—not least of which is a question important to her immediate future: when am I going to get my heart transplant?

A lifetime journey

Courtney was born at a community hospital in Tarboro, N.C. in 1996. A few days after her parents, Debi and Scott, took her home from the hospital, they noticed her breathing was loud and that she had difficulty eating and breathing at the same time.

“We took her to the pediatrician, and they sent her to Pitt Memorial Hospital in Greenville,” says Debi. “They heard some murmurs in her heart and at that point, the pulmonologist at Pitt referred her to the pediatric pulmonology and cardiology team at UNC. It wasn’t a big emergency at that point. There was no NICU or PICU. It was just a watch her and wait kind of thing.”

Courtney was diagnosed with an atrial septal defect, a congenital heart defect that's commonly called “a hole in the heart.” The pediatric cardiology team at UNC repaired it in May 1997, but in January of 1998, Courtney went into heart failure.

“The doctors in the PICU back then just did everything in their power with medicines and treatments to keep Courtney’s heart going without having to transplant,” says Debi. “And because of the doctors and the therapies and, of course, prayer, her heart regained function.”

In the years since, Courtney has been a frequent visitor to N.C. Children’s Hospital, visiting pulmonologists, cardiologists, audiologists, neurosurgeons and neurologists, endocrinologist, orthopaedists, geneticists and even dentists. But it wasn't until the summer of 2013 that her condition became more serious once again.

In June, Courtney was admitted for surgery to replace the mitral valve in her heart. Cardiothoracic surgeon, Michael Mill, MD, didn’t have to perform a full replacement, however, and was instead able to fix her existing mitral valve.

“We went home,” says Debi. “Courtney started applying for jobs. She got her driver’s license. She turned 17. We thought she was on her way to having a bright future.”

As summer wore on, however, Courtney wasn't feeling quite herself.

“Sometime in August, she started getting really tired again,” says Debi. “We went to her doctor here [in Nashville, N.C.], and they sent us to Chapel Hill. Lo and behold, she was in heart failure.”

Courtney was admitted to pediatric intensive care, her family devastated as they watched her condition deteriorate by the day. Desperate to save her life, Courtney's medical team at UNC tried something they don't often attempt with pediatric patients: they implanted a left ventricular assist device (LVAD).

Usually a treatment reserved for adults, the LVAD, a pump that keeps Courtney's left ventricle functioning, is a temporary solution until Courtney can get a heart transplant. Adults can live with LVADs for up to two years.

“It was a big moment for everyone,” remembers Debi of the successful surgical procedure. “It was a big moment for us as parents, because she survived as a result of this pump. We were all celebrating, but I was more focused on celebrating the fact that they had saved my child.”

Courtney's doctors were impressed with the bravery she showed in the face of such a serious a situation.

“The evening of her surgery, she woke up calmly, her breathing tube in place, and asked for a pen and paper,” remembers Courtney's cardiothoracic surgeon, Jennifer Nelson, MD. “On that paper, the first thing she wrote was, 'Thank you. Courtney'. I still have a picture of that note. Every time I look at it, I am blown away by her bravery.”

“It made me cry. It made her mom cry. It was awesome," adds Courtney's crical care doctor, Benny Joyner, MD.

“Within a week, she was sitting up, attempting to eat, and within a month, she was walking."

Courtney’s LVAD is connected to her at all times. It hooks up to a controller that functions using batteries or an electrical outlet. Courtney puts the machine in a backpack that she takes with her everywhere she goes.

“Showers are difficult. Getting from point A to point B is more difficult,” says Debi. “But at the same, we’re so thankful. I’m just so glad she had an option.”

“It’s hard going through all of this,” says Courtney. “I’m missing a lot in my personal life. I could have done more extracurricular activities if it wasn’t for this health stuff. I wish I could spend more time with my friends.”

But, says Debi, even though it’s hard for Courtney, the family maintains a positive outlook on her medical challenges.

“We could have a poor-me attitude or sulk about it,” says Debi. “But Courtney’s been dealing with something all the time, for the past 17 years."

“Courtney is no ordinary young lady,” adds Dr. Joyner. “Her journey has been a difficult one, with time spent in and out of the hospital for a variety of ailments. But all the while she's maintained a stellar school record and a love for math.”

“Courtney is one of the most gracious, kind-hearted, 'glass-half-full' patients I have ever cared for,” adds Dr. Nelson. “It was incredibly inspirational to see Courtney improve after receiving her VAD. Watching her get up to walk after weeks of struggling just to turn in bed was a great moment for our whole team. Before long, her mother showed us videos of Courtney dancing along with Dance, Dance Revolution in the hospital. It was hard to hold back tears.”

The road ahead

Unfortunately, Courtney’s heart journey, which began at UNC almost two decades ago, won’t end with her transplant at N.C. Children's Hospital. The family’s insurance company won’t cover the transplant in-network at UNC. It comes as a hard pill to swallow for the family.

“Our relationships at N.C. Children’s are priceless,” says Debi. “We know the campus with our eyes closed. We’re so comfortable her medical team. We trust them. They’ve known Courtney for 17 years, and they would do anything to keep her alive.”

“I have a great bond with my nurses” adds Courtney. “I’m Facebook friends with a lot of them, and we have great relationships with each other.”

Debi especially appreciates how the Children's Hospital staff treats the whole patient, rather than just the diagnosis.

Courtney and her family prepare for the next step in her heart journey: a transplant.“It’s so wonderful what they do to engage their patients,” says Debi. “There are so many things Courtney has to look forward to instead of just dreading all the tests and blood draws. It makes a big difference, they treat her on a personal level—and they take care of the family. We're important to them, too.”

“They made sure we knew where to get food, and they made sure to take care of her brother and us. Even if it’s just bringing us an extra cup of ice cream that they have in the freezer, they always took care of us.”

As Courtney faces a heart transplant at a different hospital, her mom feels sure that, despite leaving the comfort of N.C. Children’s Hospital, the staff at the new hospital will grow to love Courtney, too.

“The transplant process is moving along,” says Debi. “It’s not an emergency. Courtney could live with the LVAD for up to two years, but we know Courtney is ready to put this whole thing behind her.”

And even with the transplant, Courtney's heart journey won't be over.

“We know that a transplant isn’t a fix-all. It has to be cared for with medicine, procedures, tests,” says Debi. “We’ve been educated pretty well about it. But we have no choice. It will give her another 15 years or more to reach her goals. We know that a new heart doesn’t last forever, but we'll get to that when we get there. Right now, we want her quality of life to be the very best possible.”

In the meantime, as Courtney waits for her new heart, she looks forward to the future it will provide.

“I just want to be able to finish high school and go to college,” says Courtney. “I want to become a teacher at the deaf school. I love sign language—I taught myself using YouTube and books.”

As they reflect on Courtney’s heart journey to-date, the family is filled with gratitude.

“We thank everyone at the hospital for everything they’ve done,” says Debi. “Courtney wouldn't be alive without that heart working for her.”

UNC researcher earns American Heart Association award

Wolfgang Bergmeier, PhD, will use the $400,000 award to study the role of blood platelets in inflammation and injury.
UNC researcher earns American Heart Association award click to enlarge Wolfgang Bergmeier

Media contact: Mark Derewicz, 919.923.0959, mark.derewicz@unch.unc.edu

January 22, 2014

Wolfgang Bergmeier, PhD, associate professor of biochemistry and biophysics, won an Established Investigator Award from the American Heart Association to continue researching hemostasis and the role that blood platelets play in the health of blood vessels during inflammation and at sites of injury.

Hemostasis is a process by which blood stays within damaged blood vessels. In 2013, Bergmeier’s lab characterized the critical role that platelets play in that process. His team found that platelets respond to inflammation differently than they do during injury. That is, there are distinct cellular signaling pathways involved in each condition. The finding has implications for the development of antithrombotic agents, such as bloodthinners.

Dr. Bergmeier, who is a member of the UNC Lineberger Comprehensive Cancer Center and the McAllister Heart Institute at UNC, was also honored with a Contributions to Hemostasis Investigator Recognition Award from the International Society on Thrombosis and Haemostasis.

The American Heart Association established investigator award supports mid-career investigators who show unusual promise, have an established record of accomplishments, and have demonstrated a commitment to cardiovascular or cerebrovascular science through publications and scientific accomplishments.

The award carries an amount of $80,000 for each of the next five years. Bergmeier will use the money to supplement the salary of a research fellow in his lab, as well as for supplies necessary to conduct research.

UNC Cardiac Catheterization Lab reduces average radiation dose to physicians and staff by 25 percent

When technologist Mike Wolter, RT, moved from Vascular Interventional Radiology (VIR) to the Cardiac Catheterization Lab in the fall of 2012, he was reviewing radiation doses in the lab and wondered if a small reduction in the frame rate would make a difference in the long-term total radiation dose to which the cath lab employees were exposed. Here's what he found.

There are many medical reasons for needing an x-ray: broken bones, trauma to an internal organ, cancer diagnosis and treatment. The list goes on and on. During each of these x-rays, the patient is exposed to radiation.

Treatment in the cardiac catheterization lab is no different. During a typical procedure, a patient is brought into the procedure room and assisted onto a procedure table, x-ray scanning is performed to guide the physician and technologists during the procedure, and then the patient is transferred from the procedure table and taken to a room to recover.

However, the physicians and technologists do not leave the lab after one patient. They are in the lab all day, all week, all month, for many, many years. They are exposed to more radiation than any single patient will probably receive in their lifetime.

How do we keep these dedicated health care workers safe from radiation exposure?

The UNC Cardiac Catheterization Lab and Electrophysiology Lab have always been highly aware of radiation safety for its workers, and have maintained excellent radiation levels throughout the years, always much lower than the regulatory dose limit in the United States. 

Over the past year, small changes have been made in the Cardiac Catheterization lab, which is on track to reduce the average dose of radiation to physicians and staff by 25 percent in 2013, as compared to the previous four years.

When technologist Mike Wolter, RT (pictured on right), moved from Vascular Interventional Radiology (VIR) to the Cardiac Catheterization Lab Mike Wolterin the fall of 2012, he was reviewing radiation doses in the lab and wondered if a small reduction in the frame rate would make a difference in the long-term total radiation dose to which the cath lab employees were exposed. Also, would it make a difference in the image quality that the physicians needed to treat the patients? Could he lower the frame rate AND achieve a useable image?

Having worked in VIR for many years, and having learned a great deal about radiation safety from VIR physician Robert Dixon, MD, Wolter decided to make some small changes in the cath lab. 

The frame rate is the number of x-ray frames per second needed to view images of a moving object in real time. For example, when x-rays are performed to assess a broken bone, the bone is completely still with no movement involved. In the cath lab, the x-rays are assessing moving organs: the heart, kidneys, blood vessels, etc. Thus, an x-ray in the cath lab must take multiple frames per second to accurately show the moving organ/vessel.

Fluoroscopy is the medical term for the type of imaging that shows a continuous x-ray image on a monitor, which is what is used in the UNC cath lab. During a fluoroscopy procedure, an x-ray beam is passed through the body. The image is transmitted to a monitor so the movement of a body part, medical instrument or contrast agent in the body, like x-ray dye, can be seen in detail.

Wolter says, “Everybody focuses on fluoro-time (the actual length of time in which the patient is exposed to an x-ray beam).  However, it isn’t a direct representation of how much x-ray is being used. Of course, we want to cut down on fluoro-time, but I was taught to look at total patient dose during a procedure.”

Wolter started by suggesting a few things here and there and putting in his own settings for the patient frame rate, checking constantly to confirm that the physicians were able to use the images provided by the reduced frame rate. By reducing the number of frames per second, less radiation is produced.

Bradford Taylor, Associate Radiation Safety Officer for UNC Environment, Health & Safety, stresses that the goal with radiation is to use “the lowest amount to give an acceptable, diagnostic image.”

Taylor’s job is to make sure that employees at UNC are exposed to as little radiation as possible, making sure that they meet federal guidelines for radiation exposure as well as the guidelines mandated by the UNC School of Medicine and UNC Health Care.

The U.S. regulatory dose limit for radiation is 5,000 millirem/year (50 mSv/year). The average background radiation received by Americans each year is about 600 millirem (6 mSv), coming from a variety of natural sources (radon and thoron) and man-made sources such as consumer products, nuclear medicine procedures, and, of course, medical x-ray systems. 

From 2009-2012, the physicians in the UNC cath lab received an average annual radiation dose of 579 millirem. The technologists and staff in the cath lab received an average annual dose 172 millirem. Physicians, technologists and staff wear dosimeter badges that measure the radiation they are exposed to each day, and the badges are collected monthly.

Taylor has some helpful tips to remember when discussing radiation exposure.

Physicians will (most likely) always have higher doses.

Taylor explains, “Physicians get the highest dose. End of story. The procedures require them to be located closest to the patient where the doses are highest.” 

The farther a person is from a radiation source, the less they absorb. Technologists have more flexibility than the physician to step back from the radiation source during a procedure, and the distance does not need to be large to make a difference. Doubling the distance between a person and a radiation source reduces the radiation by a factor of four. If a technologist is 12 inches from the radiation source, and steps back an extra 12 inches, their dose will be four times less.

Always find out what dose calculation is being used.

Taylor says, “There are two standard measurements in dose reading: DDE and EDE. DDE is the deep dose reading of radiation. This is the exact reading from the dosimeter badges, which do not take into account any protection offered by the lead apron. EDE is the effective dose reading of radiation. This number is closer to the actual amount of absorbed radiation as it takes into account lead shielding.”

The UNC cath lab average annual dose of 579 millirem and 172 millirem from 2009-2012 is the DDE dose reading. By applying the EDE equation, which takes into account lead shielding, the average annual dose for UNC physicians and technologists/staff in the cath lab drops to 174 millirem and 52 millirem, respectively.

Don’t jump to conclusions when learning about increases or decreases in radiation exposure

Taylor recommends caution when reading about radiation exposure in the media or other sources. He says, “There are many factors that must be considered when evaluating radiation exposure. You need to find out the dose calculation being used (DDE vs. EDE). You also need to know the number of cases per year that are being performed. If volume is increasing in a particular lab, then that could be one reason why radiation is increasing."

He adds, “The opposite could also be true. If a decrease in the average dose of radiation is discovered, it could be simply that fewer procedures are being performed.”

Of the procedural cost centers reviewed in the UNC cath lab from 2009-2012:

  • 47% of procedures had an increase in total volume
  • 25% of procedures had a decrease in total volume
  • 28% of procedures had the same total volume

If this growth trend continues while the total radiation dose is being decreased, it is quite an accomplishment for the UNC Cath lab.

Best Practices in the UNC Cardiac Catheterization Lab

Since Wolter began reducing the patient x-ray frame rate in the Cath lab, the physicians and other technologists have agreed that it was a good decision, with everyone taking an active role to continually improve radiation safety.

Wolter explains, “Sometimes, the frame rate is increased to where it was previously, and the physicians will say, ‘That’s just too fast.’ They’ve adjusted to the lower frame rate very well with excellent patient results.”

Every physician and technologist wears a lead apron, which is very effective in protecting workers from up to 90% of the radiation to which they are exposed. Many also wear lead around their neck to protect their thyroid and other sensitive areas in the neck.

Wolter also decided to add some extra lead shielding in the procedure rooms. He added a second lead drape to protect the chest, in addition to lead shielding below the patient table to protect the legs and feet of the physicians and technologists.

no lead for legsyes lead for legsno abdomen shieldyes abdomen shield

Pictured from left: Cath Lab procedure table without the second lead drape protecting the legs; Cath Lab procedure table with the additional lead drape in place (notice the large gap is now sealed off); Cath Lab table without the lead chest shield; Cath Lab table with the additional lead chest shield in place, which adds 12-15 more inches of vertical protection.

In the first three months that Wolter implemented these changes (4thquarter 2012), the average radiation dose dropped by 35%. The fourth quarter 2013 radiation dose levels are still being processed, but if these trends continue, the Cath lab will have ended 2013 with a 25 percent yearly reduction in the average dose of radiation for physicians, technologists and staff.

Wolter says, “If we want to have successful, lifetime careers treating patients in a cardiac catheterization lab setting, we need to be vigilant about making it safe for everyone.”

UNC Cardiovascular Disease Fellowship Program has successful matching for 2014-2015

The National Resident Matching Program announced the five matching physicians for the UNC Cardiovascular Disease Fellowship Program for 2014-2015.

The UNC Cardiovascular Disease Fellowship Program has received their five matching physicians for 2014-2015 from the National Resident Matching Program (NRMP or The MATCH), successfully matching for all of the available positions in the program.

For the second consecutive year, the fellowship program matched with candidates selected in their top ten, showing the continued strength and growth of the program.  The new class of fellows will begin their training at UNC in July 2014.

The new 2014-2015 Cardiovascular Disease fellows are:

AKINNIRAN ABISOGUNAbisogun

RESIDENCY:  Brown University

MEDICAL SCHOOL:  Rutgers, Robert Wood Johnson Medical School

UNDERGRADUATE:  The College of William and Mary

 

SARAH CICCOTTO

Ciccotto

 RESIDENCY:  University of Maryland Medical Center

 MEDICAL SCHOOL:  University of Maryland Medical Center

 UNDERGRADUATE:  Bucknell University

 

KAMAL HENDERSON

Henderson

RESIDENCY:  Washington University School of Medicine

MEDICAL SCHOOL:  University of Alabama School of Medicine

UNDERGRADUATE:  Alabama Agricultural and Mechanical University

 

EVELEEN RANDALL

Randall

RESIDENCY:  Beth Israel Deaconess Medical Center – Harvard Medical School

MEDICAL SCHOOL:  University of North Carolina at Chapel Hill

UNDERGRADUATE:  University of North Carolina at Chapel Hill

 

SZYMON WIERNEK

Wiernek

RESIDENCY:  Norwalk Hospital – Yale University Program

GRADUATE SCHOOL:  Medical University of Silesia, School of Medicine, Katowice, Poland

MEDICAL SCHOOL:  Medical University of Silesia, School of Medicine, Katowice, Poland

You are all ‘Heart Heroes’: American Heart Month - February 2014

February is American Heart Month. All month long, the UNC Center for Heart and Vascular Care will be celebrating your hard work and dedication to treating patients with cardiovascular disease.

Heart Heroes

The UNC Heart and Vascular theme for American Heart Month 2014 is Heart Heroes.

You are all heroes to your patients, providing them with compassionate care and life-saving procedures.  You are continually researching to find new and better ways to treat cardiovascular disease.

We want to share your Heart Hero stories with the UNC community and the general public.  We need your help.  I am looking for feedback from anyone: faculty, fellows, residents, technologists, managers, administrative assistants...if you are part of UNC Heart and Vascular, I'd love to hear about your Heart Hero story.

  • Send us patient success stories. 
  • Tell us about your innovative research or procedure.
  • Let us know about a colleague who you think is a true Heart Hero.
  • Involved in collaborative work across Heart and Vascular?  Let us know about it.
  • Have great cardiovascular lifestyle or diet tips? Share them with us.

Each week in February, the UNC School of Medicine Vital Signs newsletter and UNC Health Care Employee News will be sharing our Heart Hero stories, and we need your story ideas because you are the ones making the difference in the lives of our patients.

Contact Laura Melega, Communications Specialist, with any Heart Hero story idea at , (919) 843-8217, or stop by her cubicle on the 6th floor of Burnett-Womack (6038-E). 

Schedule of Events

We have many events planned for February, and we hope you’ll show your support for American Heart Month.  More events to come as we get closer to February! 

Monday, February  3 - UNC Center for Heart and Vascular Healthy Heart Initiative – 11:00am-1:00pm – NC Children’s Hospital Lobby

Stop by for free information on how to improve your cardiovascular health.  Information will include heart healthy diets, symptoms of heart disease, and where to find treatment that is right for you. And don’t forget to pick up your free American Heart Month pin and learn about our GO RED FOR WOMEN Photo Booth!

Friday, February 7 – GO RED FOR WOMEN Photo Booth – 11:00am-1:00pm - NC Children’s Hospital Lobby Stage

February 7 is National WEAR RED DAY. Show your support for women’s heart health by stopping by the GO RED FOR WOMEN Photo Booth!  Bring your co-workers to get your photo taken for a UNC Health Care slide show highlighting our support for women’s heart health.  Can’t wear Red to work?  No problem!  Bring a red sweater, jacket, hat, scarf to slip on, or simply wear your American Heart Month pin (which is RED and will be available at the booth!).  Show your support for women’s heart health and stop by the Photo Booth.

Friday, February 14 – Atrial Fibrillation: Live Facebook chat with Heart and Vascular experts from UNC Center for Heart and Vascular Care and Rex Healthcare - Time TBD (Date subject to change)

Faculty physicians from the new UNC Heart Rhythm Specialists at Rex will be available during this live Facebook chat to talk about atrial fibrillation and the multiple treatment options for A-Fib that are available at UNC and Rex.  If you or a loved one is at risk for cardiovascular disease or is currently struggling with atrial fibrillation, join us during the live chat.

February 18-21 - Heart Month Employee Appreciation 

Be on the lookout for some heart-healthy goodies that will be delivered to your unit this week!  Please know that you are all appreciated for your hard work and dedication.  Thank you!

Tuesday, February 25 - UNC Employee Health Fair – 10:00am-3:00pm - NC Women's Hospital Lobby

Get screened for cardiovascular disease!  It is one of the most important things you can do to maintain your cardiovascular health. Exams include cholesterol and blood pressure screenings, weight and waist measurements with BMI (Body Mass Index), as well as medical counseling and educational information, including risk factors and lifestyle modifications. No appointment is necessary, and all appointments are free of charge to UNC Health Care and UNC School of Medicine employees. Stop by the Employee Health Fair and get screened!

Wednesday, February 26 - 8:30am-9:00am - UNC Mallwalkers 'Heels in Motion' Program -  The Streets at Southpoint

Ross Simpson, MD, Director of the Lipid Prevention Clinic at UNC, will be talking about the importance of cholesterol management.  UNC Mallwalkers at The Streets at Southpoint has been helping local residents live healthier lifestyles since 2002. The program has provided community members with the opportunity to stretch their legs and exercise in safe and comfortable environments. Since its inception, the mallwalking program at Southpoint has grown to more than 1,200 members who have logged more than 250,000 miles.  Know a friend or family member who might want to sign-up?  Click here for more information.

New guidelines for management of high blood pressure released

Dr. Sidney Smith of UNC is a member of the expert panel that wrote the new guidelines.
New guidelines for management of high blood pressure released click to enlarge Dr. Sidney Smith

Media contact:  Tom Hughes, 919-966-6047,

Wednesday, December 18, 2013

A new guideline for the management of high blood pressure, developed by an expert panel and containing nine recommendations and a treatment algorithm (flow chart) to help doctors treat patients with hypertension, was published online by JAMA.

"These new guidelines provide reliable, evidence-based recommendations that can reduce the burden of stroke and heart disease in our country," said Dr. Sidney Smith, a member of the expert panel that wrote the new guidelines and professor of cardiology at the University of North Carolina School of Medicine.

"The challenge now is to see that these new guidelines are implemented by physicians and patients. Doing so will reduce the burden of stroke and heart disease facing the more than 75 million patients in our country with high blood pressure," Smith said.

Hypertension is the most common condition seen in primary care and leads to heart attack, stroke, kidney failure, and death if not detected early and treated appropriately. “Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults,” according to information in the article.

The report, the “2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults,” is from panel members appointed to the Eighth Joint National Committee.

The guideline addresses three questions related to high BP management:

1) At what BP should medication be started in patients with hypertension?
 
2) What BP goal should patients achieve to know they are enjoying proven health benefits from their medication?
 
3) What are the best choices for medications to begin treatment for high blood pressure?
 
The nine recommendations in the guideline answer those three questions. In summary, “There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years.”

“There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes.”

The authors emphasize important differences from the past versions of the guideline. For development of these recommendations, “evidence was drawn from randomized controlled trials (RCTs), which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important health outcomes,” the authors write. These guidelines also sought to establish “similar treatment goals for all hypertensive populations except when evidence … supports different goals for a particular subpopulation.”

Also, rather than defining hypertension, the panel addressed threshold blood pressure for starting treatment. The report recommends beginning treatment for people aged 60 and older at a blood pressure of 150/90, and treating to below that level based on trial evidence, but the authors emphasize that “this evidence-based guideline has not redefined high BP and the panel believes that the 140/90 mm Hg definition from Joint National Committee 7 remains reasonable.” Lifestyle interventions should be used for everyone with blood pressures in this range.

They add that with each strategy, clinicians should regularly assess BP, encourage evidence-based lifestyle and adherence interventions, and adjust treatment until goal BP is attained and maintained. “For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized. These lifestyle treatments have the potential to improve BP control and even reduce medication needs.”

“The recommendations from this evidence-based guideline from panel members appointed to the Eighth Joint National Committee offer clinicians an analysis of what is known and not known about BP treatment thresholds, goals, and drug treatment strategies to achieve those goals based on evidence from RCTs. However, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient. We hope that the algorithm will facilitate implementation and be useful to busy clinicians. The strong evidence base of this report should inform quality measures for the treatment of patients with hypertension,” the authors conclude.

   

The Top Ten Heart and Vascular News Stories of 2013

As we near the end of 2013, find out which Heart and Vascular news stories were most popular with our online readers.

Let's count down the Top Ten Heart and Vascular News Stories of 2013...

#11 - The UNC Comprehensive Vein Clinic expands, adding interventional radiologists to treat varicose veins and other venous diseases - June 2013 - **ADDED BONUS STORY - With a mere 26 readers less than #10, it deserved inclusion on this list.**

Physicians and nurse practitioners from the Vascular Interventional Radiology division of the UNC School of Medicine have joined the UNC vascular surgeons in offering comprehensive vein treatment services at the UNC Comprehensive Vein Clinic, conveniently located in Chapel Hill at Meadowmont Village’s UNC Center for Heart and Vascular Care.

#10 - New Faculty and Staff Join UNC Center for Heart and Vascular Care - August 2013

Introduction of new faculty and staff from all four divisions of UNC Heart and Vascular: Cardiothoracic Surgery, Cardiology, Vascular Interventional Radiology, and Vascular Surgery.

#9 - UNC Hospitals offers free screenings for persons at risk of life-threatening arterial disease and aortic aneurysms - August and September 2013

Physicians and nurses from the UNC Center for Heart and Vascular Care will provide free screenings for peripheral arterial disease (PAD) and abdominal aortic aneurysm (AAA) on Saturday, September 21, from 9:00am to 1:00pm in the Procedural Recovery Unit (PRU) on the second floor of N.C. Memorial Hospital.

#8 - Mending A Broken Heart - May 2013

The cardiovascular research of award-winning Li Qian, PhD, of the UNC McAllister Heart Institute, included at #2 on the American Heart Association “Top Ten Advances in Heart Disease and Stroke Research” during 2012

#7 - UNC is Treating Prostate Enlargement Without Surgery - October 2013

Vascular interventional radiologists in the UNC Center for Heart and Vascular Care are some of the first in the nation to use a catheter-based procedure to treat men with an enlarged prostate.  Called prostatic artery embolization (PAE), the new technique is minimally-invasive for patients. It requires no open surgery, meaning less pain, no hospital admission, and for many patients, an almost immediate improvement in their symptoms.

#6 - CICU and CTICU implement new staffing models to improve patient care and efficiency- October 2013

In July 2013, the Cardiac Intensive Care Unit (CICU) and the Cardiothoracic Surgical Intensive Care Unit (CTICU) implemented new staffing models to improve patient care and efficiency.  Jason Katz, MD, MHS, Medical Director of the CICU and CTICU & Critical Care Service, spearheaded the effort to make these changes.

#5 - Meet the 2013-2014 Fellows and Integrated Residents in the UNC Center for Heart and Vascular Care - July 2013

Introduction of fellows and integrated residents in all four divisions of UNC Heart and Vascular: Cardiothoracic Surgery, Cardiology, Vascular Interventional Radiology, and Vascular Surgery.

#4 - Trial begins on “off-the-shelf” stent graft for pararenal aortic aneurysm - January 2013

Mark Farber, MD, Director of UNC Aortic Disease Management in the UNC Center for Heart and Vascular Care, investigates stent graft that may be an improvement over other stent grafts used for aortic aneurysms in that it does not need to be customized for the patient, thus earning the nickname as an “off-the-shelf” graft.

#3 - Cardiac Catheterization Lab and Electrophysiology Lab Construction and Renovation - November 2012 **This is a great example of the power of the Internet.  While this story was originally posted in November 2012, it was viewed so often in 2013 that it landed at #3 on the list!**

For the past two years, the Cardiac Catheterization labs and Electrophysiology labs have been undergoing a dramatic transformation.  And now, much of the work has been completed.  And the results are amazing.

#2 - The DASH Diet Named Best Diet Overall by U.S. News & World Report - February 2013

Alan Hinderliter, MD, of the UNC Center for Heart and Vascular Care was an investigator in the Duke University ENCORE trial, which evaluated the effectiveness of the DASH diet on cardiovascular health.

And the Number One Heart and Vascular News Story of 2013 is....

#1 - Unique multidisciplinary treatment for vascular malformations at UNC Health Care - December 2012 - **The UNC Malformations Clinic received a confirmed new patient from this story, after the patient "googled" their condition from their home and found this story.**

Vascular interventional radiologist Joseph Stavas, MD, professor of radiology in the UNC School of Medicine, and clinician in the UNC Center for Heart and Vascular Care, works with UNC physicians from 14 different departments to provide comprehensive care for vascular malformations.


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UNC Heart and Vascular Interventional Radiologists offer help and support to the community

For the second year in a row, the Vascular Interventional Radiology division combined teamwork building, outreach and service, all into one at Urban Ministries (UM) in Durham (http://www.umdurham.org/) in November 2013. UM is a community support facility in downtown Durham that offers food, shelter, and counseling for those in need.

Members of the VIR division brought their kindness, humor, and dedication to serving others to UM and fed dinner to 275 members of the greater Durham-Chapel Hill community.  

Ari Isaacson, MD, Assistant Professor in the VIR division, participated last year while he was a VIR Fellow.   He was very happy to be able to participate again this year.

Members of the division that participated in the outreach are faculty Hyeon Yu, Ari Isaacson, Robert Dixon, and Joe Stavas and fellow Eric McCloney.  Abdominal Imaging faculty member Lauren Burke also volunteered.

 VIR homeless docsisaacson stirringDixon and Burke on lineYu stirring

Pictured from left to right: VIR faculty Robert Dixon, Joseph Stavas, Ari Isaacson, and Hyeon Yu; Dr. Isaacson working in the kitchen; Robert Dixon and Lauren Burke serving food; Dr. Yu working in the kitchen

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Media Coverage - November 2013

Carolina Week News - Trans Fats - featuring Ross Simpson, MD (from 11:28-13:50)

(for more information on trans fats, click here)

 

'Arts for Hearts' raises money for UNC Cardiology

Daily Tar Heel

Pharmaceutical Devices


Pat Robertson donates to UNC after successful heart surgery - featuring UNC Cardiothoracic Surgery

Raleigh News & Observer

Twitter: @univgazette - reaching 737 followers

 

UNC Kenan-Flagler presents alumni awards - featuring Cam Patterson, MD

Kenan-Flagler online news

Kenan-Flagler Blog

San Francisco Chronicle

PR Web

Insurance News Net

Twitter - retweeted 4 times reaching 39,584 followers

@uncheartvasculr

@KenanFlagler

 

Shift In Cholesterol Advice Could Double Statin Use - featuring Sidney Smith, MD

See full article on media coverage here

Twitter: @nprnews - retweeted four times reaching 2,127,761 followers

National Public Radio (NPR) 

NPR Blog

All Things Considered, National Public Radio **AUDIO**

The People's Pharmacy, National Public Radio **AUDIO from 27:59-34:32**

Delmarva Public Radio, WSDL/WSCL, Delaware/Maryland

WYPR, Maryland, NPR

New Hampshire Public Radio

 

Risk calculator for cholesterol appears flawed - featuring Sidney Smith, MD

The New York Times

The Boston Globe

Time Magazine

Columbus (OH) Dispatch

NBC News


How Good Is the New ACC/AHA Risk Calculator? - featuring Sidney Smith, MD

 Medscape

 

Experts defend new heart attack prevention advice - featuring Sidney Smith, MD

Newsday

 

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Presentations and Publications - November 2013

Presentations

"Collegiate Athlete with an Abnormal QT Interval on ECG"

Eugene Chung, MD, ACC Sports Cardiology Summit, October 2013

 

"Cases in PH, Dilemmas, from WHO Group 2"

Lisa Rose-Jones, MD, 5th Annual North Carolina Research Triangle Pulmonary Hypertension Symposium, November 8, 2013, Durham, NC

 

"Porsche By Design exhibition at NC Art Museum - American Cars and Hot Rods Meetup"

Jenni Hughes, MSN, RN,CCRN-CSC, Program Manager, Aortic Disease Management, November 9, 2013, Raleigh, NC

 

"Left Atrial Appendage Closure for Stroke Prophylaxis in Patients with Atrial Fibrillation"

Eugene Chung, MD, Cardiovascular Grand Rounds, November 11, 2013, Chapel Hill, NC

 

"Acute Heart Failure: A New Era or Same Old Problems?"

 Kirkwood Adams, MD (Moderator), AHA Scientific Sessions, November 17, 2013, Dallas, TX

 

"New Guideline Recommendations for Prevention and Control of Cardiovascular Risk Factors: From Diabetes to LDL Cholesterol Control"

Sidney Smith, MD, AHA Scientific Sessions, November 18, 2013, Dallas, TX

 

"Joint AHA/Brazilian Society of Cardiology Session: New Trends for Prevention and Diagnosis of Cardiovascular Disease"

Sidney Smith, MD, (Moderator), AHA Scientific Sessions, November 18, 2013, Dallas, TX

 

"Ventricular Tachycardia Events Are Associated with Admissions for Infection or Heart Failure in Patients with Left Ventricular Assist devices and Implantable Cardio-Defibrillators"

TJ O'Neill, MD (Fellow, Cardiology), AHA Scientific Sessions, November 18, 2013, Dallas, TX

 

"A Novel Implantable Cardio-Defibrillator Programming Strategy for Patients with Left Ventricular Assist Devices Reduces Shocks"

TJ O'Neill, MD (Fellow, Cardiology), AHA Scientific Sessions, November 18, 2013, Dallas, TX

 

"Guidelines: Is Contextualization Necessary?"

Sidney Smith, MD, AHA Scientific Sessions, November 19, 2013, Dallas, TX


"Medicare Part D Medication Use in a Community Cohort with Hypertension: The Atherosclerosis Risk in Communities (ARIC) Study"

Carla Sueta, MD, PhDAHA Scientific Sessions, November 19, 2013, Dallas, TX

 

"Current Role of AHA and ACC in Guidelines Development"

Sidney Smith, MDAHA Scientific Sessions, November 20, 2013, Dallas, TX

 

"Clinical Practice Guidelines for Prevention: Next Steps"

Sidney Smith, MD,  (Panelist), AHA Scientific Sessions, November 20, 2013, Dallas, TX

 

"VAD-Related Infections"

Jason Katz, MD, MHSAHA Scientific Sessions, November 20, 2013, Dallas, TX

 

Publications

Living in a medically underserved county is an independent risk factor for major limb amputation.

McGinigle KL, Kalbaugh CA, Marston WA.

J Vasc Surg. 2013 Nov 16. doi:pii: S0741-5214(13)01741-2. 10.1016/j.jvs.2013.09.037. [Epub ahead of print]

 

Biomarker Guided Therapy for Heart Failure: Focus on Natriuretic Peptides.

Pruett AE, Lee AK, Patterson JH, Schwartz TA, Glotzer JM, Adams KF.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

Adams et al. Respond to "Body Mass Index and Mortality"

Adams KF, Leitzmann MF, Ballard-Barbash R, Albanes D, Harris TB, Hollenbeck A.

Am J Epidemiol. 2013 Nov 11. [Epub ahead of print] No abstract available.

 

Soluble ST2 in Ambulatory Patients With Heart Failure: Association With Functional Capacity and Long-Term Outcomes.

Felker GM, Fiuzat M, Thompson V, Shaw LK, Neely ML, Adams KF, Whellan DJ, Donahue MP, Ahmad T, Kitzman DW, Piña IL, Zannad F, Kraus WE, O'Connor CM.

Circ Heart Fail. 2013 Nov 1;6(6):1172-1179. Epub 2013 Oct 8.

 

Advanced Therapies for End-Stage Heart Failure.

Katz JN, Waters SB, Hollis IB, Chang PP.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

Left atrial thrombus after appendage ligation with LARIAT.

Baker MS, Paul Mounsey J, Gehi AK, Chung EH.

Heart Rhythm. 2013 Nov 7. doi:pii: S1547-5271(13)01163-6. 10.1016/j.hrthm.2013.10.024. [Epub ahead of print] No abstract available.

 

The Effect of Anxiety and Depression on Symptoms Attributed to Atrial Fibrillation.

Thompson TS, Barksdale DJ, Sears SF, Mounsey JP, Pursell I, Gehi AK.

Pacing Clin Electrophysiol. 2013 Nov 11. doi: 10.1111/pace.12292. [Epub ahead of print]

 

Genetics and Heart Failure: A Concise Guide for the Clinician.

Skrzynia C, Berg JS, Willis MS, Jensen BC.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

Heart factory or fiction?: cardiac progenitor cells and regeneration.

Jensen BC, Patterson C.

Circulation. 2013 Nov 12;128(20):2181-2. doi: 10.1161/CIRCULATIONAHA.113.006262. Epub 2013 Oct 18. No abstract available.

 

Survival After Shock Therapy in Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy-Defibrillator Recipients According to Rhythm Shocked: The ALTITUDE Survival by Rhythm Study.

Powell BD, Saxon LA, Boehmer JP, Day JD, Gilliam FR 3rd, Heidenreich PA, Jones PW, Rousseau MJ, Hayes DL.

J Am Coll Cardiol. 2013 Oct 29;62(18):1674-9. doi: 10.1016/j.jacc.2013.04.083. Epub 2013 Jun 27.

 

Pulmonary Hypertension: Types and Treatments.

Rose-Jones LJ, McLaughlin V.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

RE-LYing on Dabigatran for Periprocedural Anticoagulation: Is It Safe?

Bamimore A, Mounsey JP.

Pacing Clin Electrophysiol. 2013 Nov;36(11):1325-7. doi: 10.1111/pace.12217. Epub 2013 Jul 22. No abstract available.

 

Platelet-targeted gene therapy with human factor VIII establishes haemostasis in dogs with haemophilia A.

Du LM, Nurden P, Nurden AT, Nichols TC, Bellinger DA, Jensen ES, Haberichter SL, Merricks E, Raymer RA, Fang J, Koukouritaki SB, Jacobi PM, Hawkins TB, Cornetta K, Shi Q, Wilcox DA.

Nat Commun. 2013 Nov 19;4:2773. doi: 10.1038/ncomms3773.

 

The Ubiquitin Ligase CHIP Prevents SirT6 Degradation through Noncanonical Ubiquitination.

Ronnebaum SM, Wu Y, McDonough H, Patterson C.

Mol Cell Biol. 2013 Nov;33(22):4461-72. doi: 10.1128/MCB.00480-13. Epub 2013 Sep 16.

 

Orthostatic change in blood pressure and incidence of atrial fibrillation: results from a bi-ethnic population based study.

Agarwal SK, Alonso A, Whelton SP, Soliman EZ, Rose KM, Chamberlain AM, Simpson RJ Jr, Coresh J, Heiss G.

PLoS One. 2013 Nov 11;8(11):e79030. doi: 10.1371/journal.pone.0079030.

 

2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson J, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW.

Circulation. 2013 Nov 12. [Epub ahead of print] No abstract available.

 

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Stone NJ, Robinson J, Lichtenstein AH, Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW.

Circulation. 2013 Nov 12. [Epub ahead of print] No abstract available.

 

2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Eckel RH, Jakicic JM, Ard JD, Hubbard VS, de Jesus JM, Lee IM, Lichtenstein AH, Loria CM, Millen BE, Miller NH, Nonas CA, Sacks FM, Smith SC Jr, Svetkey LP, Wadden TW, Yanovski SZ.

Circulation. 2013 Nov 12. [Epub ahead of print] No abstract available.

 

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Lloyd-Jones DM, Blum CB, McBride P, Eckel RH, Schwartz JS, Goldberg AC, Shero ST, Gordon D, Smith SC Jr, Levy D, Watson K, Wilson PW.

J Am Coll Cardiol. 2013 Nov 7. doi:pii: S0735-1097(13)06028-2. 10.1016/j.jacc.2013.11.002. [Epub ahead of print] No abstract available.

 

2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Eckel RH, Jakicic JM, Ard JD, Miller NH, Hubbard VS, Nonas CA, de Jesus JM, Sacks FM, Lee IM, Smith SC Jr, Lichtenstein AH, Svetkey LP, Loria CM, Wadden TW, Millen BE, Yanovski SZ.

J Am Coll Cardiol. 2013 Nov 7. doi:pii: S0735-1097(13)06029-4. 10.1016/j.jacc.2013.11.003. [Epub ahead of print] No abstract available.

 

2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Goff DC Jr, Lloyd-Jones DM, Bennett G, O'Donnell CJ, Coady S, Robinson J, D'Agostino RB Sr, Schwartz JS, Gibbons R, Shero ST, Greenland P, Smith SC Jr, Lackland DT, Sorlie P, Levy D, Stone NJ, Wilson PW.

J Am Coll Cardiol. 2013 Nov 7. doi:pii: S0735-1097(13)06031-2. 10.1016/j.jacc.2013.11.005. [Epub ahead of print] No abstract available.

 

Stage B: What is the Evidence for Treatment of Asymptomatic Left Ventricular Dysfunction?

Reed BN, Sueta CA.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

Stage A: Can Heart Failure Be Prevented?

Danelich IM, Reed BN, Sueta CA.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

A Practical Guide to the Treatment of Symptomatic Heart Failure with Reduced Ejection Fraction (HFrEF).

Reed BN, Sueta CA.

Curr Cardiol Rev. 2013 Nov 17. [Epub ahead of print]

 

Long-term clinical outcomes with the use of a modified provisional Jailed-Balloon stenting technique for the treatment of nonleft main coronary bifurcation lesions.

Depta JP, Patel Y, Patel JS, Novak E, Yeung M, Zajarias A, Kurz HI, Lasala JM, Bach RG, Singh J.

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UNC Center for Heart and Vascular Care is "a recognizable presence" at American Heart Association Scientific Sessions 2013

The American Heart Association Scientific Sessions 2013 were held in Dallas, TX from Nov. 16-20, 2013.

The UNC Center for Heart and Vascular Care had multiple presenting authors at the American Heart Association (AHA) Scientific Sessions 2013, held in Dallas, TX from November 16-20.

AHA Scientific Sessions is the leading cardiovascular meeting for basic, translational, clinical and population science in the United States, with more 18,000 cardiovascular experts from more than 105 countries, in addition to more than 1.5 million virtual professional attendees.

Programming is designed to improve patient care by communicating the most timely and significant advances in prevention, diagnosis and treatment of cardiovascular disease from many different perspectives. Sessions includes five days of comprehensive, unparalleled education, all from the world’s leaders in cardiovascular disease.

Jennifer Schwartz, MD, says, "I would like to applaud everyone involved in AHA. We are clearly moving towards being a recognizable presence at national meetings. I hope we can highlight this and continue this momentum. It's exciting to see fellows presenting and it could not be done without faculty mentorship and participation."

Presenting Authors from the UNC Center for Heart and Vascular Care included: (in alphabetical order)

  • Kirkwood Adams, MD - Moderator, Acute Heart Failure: A New Era or Same Old Problems?
  • Jason Katz, MD, MHS - VAD-Related Infections

Brian Jensen, MD, added, "Fantastic.  Let’s recognize [Dr. Katz's] central role in leading the resurgence of our investigator-initiated clinical research enterprise."

  • TJ O'Neill, MD (Fellow, Cardiology) - Ventricular Tachycardia Events Are Associated with Admissions for Infection or Heart Failure in Patients with Left Ventricular Assist devices and Implantable Cardio-Defibrillators

A Novel Implantable Cardio-Defibrillator Programming Strategy for Patients with Left Ventricular Assist Devices Reduces Shocks

Dr. Katz added, "We had several great VAD presentations here at the AHA. [Dr. O'Neill] presented both of his posters on the novel ICD programming protocol...and there was a ton of buzz about them. Very well-received and lots of interest in moving forward with a multicenter, collaborative prospective study."

  • Sidney Smith, MD - Current Role of AHA and ACC in Guidelines Development

Guidelines: Is Contextualization Necessary?

New Guideline Recommendations for Prevention and Control of Cardiovascular Risk Factors: From Diabetes to LDL Cholesterol Control

Panelist, Clinical Practice Guidelines for Prevention: Next Steps

Moderator, Joint AHA/Brazilian Society of Cardiology Session: New Trends for Prevention and Diagnosis of Cardiovascular Disease

  • Carla Sueta, MD, PhD - Medicare Part D Medication Use in a Community Cohort with Hypertension: The Atherosclerosis Risk in Communities (ARIC) Study
  •  Ramsey Wehbe, MD (former UNC Medical School student) - Obesity is Associated with Increased Mortality and Hospitalization in Patients Supported with a Continuous-Flow Left Ventricular Assist Device

Dr. Katz added, "[Dr. Wehbe] presented our work on obesity and VADs in an oral abstract presentation. He did an incredible job and brilliantly fielded questions from the moderators, as well as David Farrar (Head of Research at Thoratec)."

Study Authors also include: Sarah Waters, Amanda Bowen, Kimberly Guise, Eugene Chung, Anil Gehi, Brian Jensen, Patricia Chang, Paul Mounsey, Jennifer Schwartz, Jerome Federspiel, Anna Kucharska-Newton, Jo Rodgers, Sally Stearns, Aparna Veeramachaneni, and Brett Sheridan.

 

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FDA Says Trans Fats Aren't Safe in Food

Ross Simpson, MD, of the UNC Center for Heart and Vascular Care spoke to the media about trans fats
FDA Says Trans Fats Aren't Safe in Food click to enlarge Ross Simpson, MD, PhD

In November 2013, the Food and Drug Administration (FDA) made a preliminary determination that "partially hydrogenated oils (PHOs), the primary dietary source of artificial trans fat in processed foods, are not “generally recognized as safe” (GRAS) for use in food."

Ross Simpson, MD, PhD, of the UNC Center for Heart and Vascular Care and Director of the UNC Lipid Prevention Clinic, spoke to Carolina Week News about the use trans fats in foods and the cardiovascular health implications of trans fats.

Carolina Week News - (video from minute 11:28-13:50)

The FDA has opened a 60-day Comment Period on Measure to Further Reduce Trans Fat in Processed Foods.

To read more about the proposed FDA ban on trans fats, click here.

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New cholesterol guidelines published by the American College of Cardiology and the American Heart Association

Sidney Smith, MD, of the UNC Center for Heart and Vascular Care served as one of the guideline writers
New cholesterol guidelines published by the American College of Cardiology and the American Heart Association click to enlarge Sidney Smith, MD

In November 2013, the American College of Cardiology and the American Heart Association, by request of the National Heart, Lung and Blood Institute, published revised guidelines for treatment of high cholesterol levels.  Sidney Smith, MD, of the UNC Center for Heart and Vascular Care served as one of the guideline writers and spoke extensively to the media about the guidelines.

National Public Radio - Shift In Cholesterol Advice Could Double Statin Use

Broadcast Summary: "The new study throws out the notion that a specific blood cholesterol level should automatically trigger treatment with cholesterol-lowering drugs. Also out the window is any notion of treating patients with drugs until their so-called bad cholesterol hits a specific target – one that for most people is all but impossible to achieve by diet alone. Instead, the new guidelines groups adults into four categories most likely to benefit from cholesterol-lowering drugs. They include people with heart disease and diabetes, as well as people with high levels of LDL cholesterol, the bad kind. The guidelines also explicitly tell doctors not to bother with drugs other than statins, saying they're the only ones proven to reduce the risk of heart attacks and strokes."

This story was broadcast on NPR stations across the country, including: Delmarva Public Radio, WSDL/WSCL, Delaware/Maryland, and WYPR, Maryland

All Things Considered, NPR - November 13, 2013 (Audio)

The People's Pharmacy, NPR - November 16, 2013 (Audio, from minute 27:59-34:32)

When the risk calculator for the revised cholesterol guidelines appeared to be flawed, Dr. Smith again spoke extensively with the media about the calculator.

The New York Times - Risk calculator for cholesterol appears flawed

This story was published across the country, including: The Boston Globe, Time Magazine, the Columbus (OH) Dispatch, and NBC News.

Medscape included an article entitled, "How Good Is the New ACC/AHA Risk Calculator?" in which Dr. Smith commented about the risk calculator, saying that they "intend to move forward with the implantation of these guidelines," but if there is something that can make them better, they will do it. "If we think there are some minor changes or some alterations in therapeutic strategies, we'll do it," said Smith."

In a Newsday article, Dr. Smith explained the process the committee used to create the Risk Calculator.

Story summary:  Dr. Sidney C. Smith Jr., a former Heart Association president from the University of North Carolina at Chapel Hill, said dozens of heart experts spent nearly five years carefully reviewing top-quality studies to develop the guidelines and the formula and let other major medical groups review it before adopting it.  "We think that we've come up with a good risk instrument" and intend to move forward to implement the guidelines, he said. The formula doesn't prescribe or mandate that someone take a drug, just flag people whose heart risks are high enough that they should consider it.  "You should have that conversation with your physician. This is not computer medicine," Smith said.


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Recent UNC Nursing News and Accomplishments

  • UNC Health Care was the #1 academic health care center IN THE COUNTRY for HCAHPS scores in 2011 and 2012.  This was announced at the 2013 University Health Care System Consortium (UHC) meeting in October 2013. 

The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. While many hospitals have collected information on patient satisfaction, prior to HCAHPS there was no national standard for collecting or publicly reporting patients' perspectives of care information that would enable valid comparisons to be made across all hospitals.

Mary Tonges, RN, PhD, FAAN, Senior VP and Chief Nursing Officer, UNC Health Care System, said in an email, "IT DOESN”T GET BETTER THAN THIS!!  Please be sure to let your staff know and extend our sincere thanks.  Wow, what you do for our patients."

  • The Cardiothoracic ICU (CTICU) has gone 400+ days (and counting) without a VAP (ventilator-associated pneumonia).

They join the Cardiac Intensive Care Unit in reaching an outstanding milestone in reducing VAP in patients.

  • The 2013 Fiscal Year Nursing Annual Report has been released, and you can view the entire report here.

Make sure to check out pages 20-21 to recognize Heart and Vascular nurse Ellenita Kornegay, named as a Nurse of the Year and pages 22-23 to recognize Heart and Vascular health unit coordinator Vanessa Moore as an Assistive Personnel of the Year.


 

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Year In Review - UNC Medical Foundation

Each year, supporters of UNC Cardiovascular Medicine receive an update about our various activities, awards, grants, conferences, and new faculty. Here is a sampling of what our donors and supporters are hearing about this year.

UNC and the American Heart Association celebrate a 40-year Partnership

On December 11, 2012, a select group of friends and supporters of UNC Cardiovascular Medicine and the American Heart Association gathered at the Medical Biomolecular Research Building (MBRB) on UNC’s campus to celebrate the 40-year partnership between the American Heart Association (AHA) and the University of North Carolina School of Medicine.  Guests at this intimate event were treated to an Liu in labinsider’s research tour, led by Mauricio Rojas, MD, and Jiandong Liu, PhD, of the Mouse and Zebra Fish Core research facilities - both of which are integral to the cutting edge cardiovascular research at Carolina.

Jiandong Liu, PhD, holds up a specimen in the Zebra Fish Core Research Facility during the UNC-AHA research tour Rojas

Mauricio Rojas, MD, discusses his cardiovascular research in the Mouse Core Research Facility

 


Cody DeenCody Deen, MD, will serve as Chief of Staff of Chatham Hospital beginning in January 2014

Cody Deen, MD, of the UNC Center for Heart and Vascular Care was nominated for and has accepted the role of Chief of Staff of Chatham Hospital for a two-year term starting in January 2014.  Dr. Deen is the medical director of Cardiac Rehab at Chatham Hospital, and he sees patients at Chatham Primary Care.  Nominated by Dr. James Davis, MD, of Chatham Primary Care, Dr. Deen's "personality, community presence, leadership, and ability to work with multiple parties to resolve problems and move innovation forward" were cited as reasons for his nomination.

 Awards 

Sid SmithSidney C. Smith, Jr. MD, receives the 2013 Joseph Stokes, III, MD Award from the American Society for Preventive Cardiology.  This prestigious award honors those who have made significant contributions in the field of preventive cardiology through research, teaching, clinical activity and leadership.  Dr. Smith is a past president of the American Heart Association (AHA) and the World Heart Federation (WHF).

 

schwartz 1Jennifer Schwartz, MD, was honored as a Fellow of the Heart Rhythm Society.  The Fellow of the Heart Rhythm Society (FHRS) credential exemplifies advanced training, certification, and commitment to the field of electrophysiology. 

 

Charles Burke, MD, Division Chief, Vascular Interventional Radiology, has Burkebeen inducted as a Fellow in the Society of Interventional Radiology (SIR). This honor, achieved by fewer than 10 percent of SIR members, goes to members who have been recognized by the society as a leading contributor in educational, investigational, organizational or professional aspects of interventional radiology. 

 

Mounsey 1J. Paul Mounsey, MD, PhD, MRCP, FACC, has been awarded the Sewell Family/McAllister Distinguished Professorship in electrophysiology.  The professorship is designed to recognize an outstanding clinician, teacher, and scholar for the Division of Cardiology and the UNC McAllister Heart Institute within the School of Medicine who is a recognized leader in the field of electrophysiology.


The Rita and Eric Bigham Cardiology Special Project Fund brings young Afghan girl to UNC for life-saving cardiac care

MaryamIn Summer 2013, Rita and Eric Bigham of Chapel Hill partnered with UNC Cardiovascular Medicine and the Medical Foundation of North Carolina to provide medical treatment for Maryam, a little girl from Afghanistan, who suffers from a heart defect.

Maryam underwent heart surgery at UNC Hospitals on Tuesday, July 9, and came through it well, said her surgeon, Michael R. Mill, MD, Division of Cardiothoracic Surgery. Dr. Mill corrected a narrowing of Maryam's aorta (a surgical procedure called resection of coarctation of the aorta) and closed a fetal blood vessel, the ductus arteriosus, that had not closed normally when Maryam was a newborn (that surgery is called division of a patent ductus arteriosus (PDA).

BighamsRita Bigham, a retired school teacher, has an enduring passion for work with children, medical volunteerism, and philanthropic investment. Eric Bigham was a dedicated scientist during his impressive tenure at GlaxoWellcome. Rita and Eric are active volunteers at UNC Hospitals in areas ranging from the Cardiac Intensive Care Unit, the N.C. Children’s Hospital, Adult Rehab, and the Lineberger Comprehensive Cancer Center.  At the Bigham household, service is a family affair – even her dog Pippin has contributed more than 1,000 service hours at UNC as a therapy dog.

The cost of Maryam’s cardiac care was covered by the Rita and Eric Bigham Cardiology Special Project Fund, established through the Medical Foundation of North Carolina.  Remaining funds and new contributions will be used to support additional children in the future, as well as other cardiology-related causes at UNC. 

UNC is First in N.C. to Use New Minimally-Invasive Procedure to Reduce the Risk for Stroke

In June 2013, the UNC Center for Heart and Vascular Care became the first in North Carolina to successfully close a left atrial appendage, which is a part of the heart where blood clots and strokes come from, using the Lariat® procedure.  

The new Lariat® procedure is a minimally-invasive alternative to reduce stroke risk in people with atrial fibrillation who cannot tolerate blood thinners. For these AF patients – who account for 25 percent of all AF patients - it can essentially eliminate their risk for stroke, which is five times more likely in AF patients.

Not only did UNC perform the first Lariat® procedure in North Carolina, they also performed the second Lariat procedure in North Carolina on the same day.  No other hospital in North Carolina offers this technology.

New Faculty and Staff Join UNC Center for Heart and Vascular Care

The UNC Center for Heart and Vascular Care is pleased to welcome these new faculty and staff members.

Adult Cardiac Surgery

James Morris, MD, is joining the division of cardiothoracic surgery in August as a Clinical Associate Professor of Surgery.  Dr. Morris will practice at High Point Regional, the largest component of the High Point Regional Health System.  Dr. Morris is coming to UNC from the Christine Lynn Heart and Vascular Institute in Boca Raton, FL, where he served as the Medical Director.  Previous appointments also include the Roper Saint Francis Health System in Charleston and the Mayo Clinic.

Cardiology

Xuming Dai, MD, PhD, has joined Interventional Cardiology as an Assistant Professor of Medicine. Dr. Dai finished his interventional cardiology fellowship in June at the University of North Carolina.  He completed his residency at the Long Island Jewish Medical Center and received his medical degree from the Second Military Medical University in China.

(F. Roosevelt) Rosey Gilliam, MD, FACP, FACC, has joined UNC Electrophysiology as a Professor of Medicine.  With more than 30 years of experience in EP and implantable cardiac devices, Dr. Gilliam brings a wealth of knowledge and expertise to UNC.  Dr. Gilliam served as the Director of the Electrophysiology Section of the Cardiology Division at Duke University for many years, and comes to UNC from Cardiology Associates of Northeast Arkansas.

Lisa Rose-Jones, MD, is continuing in UNC cardiology in a subspecialty fellowship position in heart failure and as part-time faculty as a Clinical Instructor in the division of cardiology.  Dr. Rose-Jones completed her cardiology residency in June at the University of North Carolina and graduated with her doctorate from the University of Virginia Medical School.

Vascular Interventional Radiology

Ari Isaacson, MD, has joined Heart and Vascular as an Assistant Professor of Radiology.  Dr. Isaacson finished his VIR fellowship in June at the University of North Carolina and will continue to make an excellent addition to the UNC Center for Heart and Vascular as a VIR faculty member.  Dr. Isaacson received his medical degree from the USC School of Medicine and spent four years in the Navy after medical school, including a deployment in Iraq.  He completed his residency at the University of North Carolina.

Cardiology and Heart Surgery ranked as 'High Performing' specialty area by U.S. News & World Report

In 2013, the U.S. News & World Report “Best Hospitals” issue recognized Cardiology & Heart Surgery as a “high performing” specialty area.  This is the second year in a row that Cardiology & Heart Surgery were ranked on the ‘Best Hospitals’ list.

This year, there were only 180 hospitals in the country in named as “high-performing” in the “Cardiology & Heart Surgery” specialty, so the inclusion of our Cardiology & Heart Surgery programs for two consecutive years is an impressive accomplishment.

2013 North Carolina Cardiovascular Update held Sept. 6-7, 2013 at the Friday Center

The 2013 North Carolina Cardiovascular Update as held at the Friday Center in Chapel Hill on Sept. 6-7.  The event featured the 12th Annual Ernest and Hazel Craige Lecture, given this year by guest faculty Spencer B. King, III, MD, President, Saint Joseph's Heart and Vascular Institute and Professor of Medicine, Emeritus, Division of Cardiology, Emory University School of Medicine.  Dr. King's lecture was entitled, "Stable Ischemic Heart Disease: Is the Role For Revascularization Changing?" 

Guest faculty lecturer Joel Schneider, MD, Wake Heart and Vascular Specialists also presented. Faculty lecturers from the UNC Center for Heart and Vascular Care and UNC School of Medicine include Patricia Chang, Xuming Dai, Cody Deen, Anil Gehi, Roosevelt "Rosey" Gilliam, Prashant Kaul, Andy Kiser, Paul Mounsey, Marschall Runge, Brett Sheridan, George "Rick" Stouffer, and Michael Yeung.

Heart Failure Management 2013: Personalized Medicine to Optimize Care, July 18-21, 2013, Amelia Island, FL

UNC faculty contributing to this event include Kirkwood Adams, MD (co-director of the event): Patricia Chang, MD, MHS, Eugene Chung, MD, Anil Gehi, MD, Jana M. Glotzer, MSN, ACNPBrian Jensen, MD, Jason Katz, MD, MHS, Paul Mounsey, MD, PhD, William Stansfield, MD, Carla Sueta, MD, PhD, and Sarah Waters, ANP-BC.

UNC Heart Rhythm Specialists at Rex scheduled to open in November 2013

A new outpatient electrophysiology (EP) clinic serving the complex arrhythmia needs of Wake and the surrounding counties is scheduled to open in November 2013 on the main Raleigh campus of Rex Healthcare.  UNC Heart Rhythm Specialists at Rex will be full-service, capable of handling new and returning patients needing care and management related to atrial fibrillation.  A full complement of diagnostic services will be available through the clinic and Rex Healthcare labs and diagnostic suites.   The clinic will utilize the combined services of physicians from North Carolina Heart and Vascular and UNC faculty physicians from the UNC Center for Heart and Vascular Care.  For procedures, the clinic will refer patients to both UNC and Rex, with the location based on a variety of factors, including the complexity of treatment needed, patient acuity, capacity, and patient preference.

Sid Shah, MD, of North Carolina Heart and Vascular (formerly Wake Heart and Vascular) will soon be accepting new patients at UNC Heart Rhythm Specialists at Rex.  UNC Center for Heart and Vascular Care faculty physicians Paul Mounsey, MD, director, UNC Heart Rhythm Services, Eugene Chung, MD, Anil Gehi, MD, and Jennifer Schwartz, MD, will also be accepting new patients at the clinic.   New UNC faculty member Jim Hummel, MD, will join the clinic in January 2014, allowing further expansion and integration of EP services.

ShahHummelMounsey 1Chung 1Gehi 1schwartz 1

 Physicians at UNC Heart Rhythm Specialists at Rex (from left): Sid Shah, MD, Jim Hummel, MD, Paul Mounsey, MD, Eugene Chung, MD, Anil Gehi, MD, and Jennifer Schwartz, MD


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Media Highlights - 2013

Read about all of the UNC Heart and Vascular physicians and nurses in the media this year
Media Highlights - 2013 click to enlarge UNC Center for Heart and Vascular Care IN THE NEWS

January

Hillary Clinton hospitalized with blood clot - featuring Dr. Cam Patterson: The Global Post (Canada) and "The Two Way" National Public Radio

FDA Clears nContact’s Cardiac Ablation Device, EPi-Sense® With Embedded Sensors - featuring Dr. Paul Mounsey: Reuters, Diagnostic and Interventional Cardiology, and Cardiac Rhythm News

Setting the stage for a new paradigm in treatment of heart failure - featuring Dr. Cam Patterson: New England Journal of Medicine, Science Daily, and UNC General Alumni Association

"Open Road,  Open Heart." - featuring Dr. Hemant Solomon, who practices at UNCPN’s Sanford Specialty Clinic and Dr. Andy Kiser: "Central Carolina Health” magazine, Winter 2013 - click for full article

February

"Healing the Stubborn Wounds" - featuring UNC Wound Healing Center: Well Magazine, Winter 2013

"Love Your Heart" - featuring Dr. Paul Mounsey: WRAL-TV, February 18, 2013

Image Guide Ablation Therapy – featuring Dr. Matthew Mauro: The Oncologist Journal, Society for Translational Oncology

Mall-walking program marks 10th anniversary – featuring Dr. Paula Miller: The Herald-Sun (Durham),

Message to NCGA: Focus on Chronic Disease Prevention! - featuring Dr. Ross Simpson: NC Spin – Statewide News Show

Cardio Notes: Links Between Heart-Brain Diseases – featuring Dr. Cam Patterson: MedPage Today

March

Mummies show signs of heart disease – featuring Dr. Cam Patterson: USA Today

Spraying Away Chronic Wounds - featuring Dr. William Marston: Ivanhoe Broadcast News reaching 80 million U.S. households

New drug improves on standard blood thinner Plavix – featuring Dr. Cam Patterson: USA Today

Cardiac Rhythm Management - featuring Drs. Paul Mounsey, Andy Kiser, Anil Gehi, Eugene Chung, and Jennifer Schwartz: The Triangle Physician (cover story)

April

Patients who have STEMI heart attacks while hospitalized more likely to die - featuring Dr. Rick Stouffer: Science Daily, Triangle Business Journal and The Journal of the American Heart Association

Father/daughter physician runners offer aid after Boston Marathon Bombing - featuring Dr. Joseph Stavas: Boston GlobeNew York Daily News, BBC Radio and Los Angeles Times

AHA Lists Year's Big Advances in CV Research - featuring Dr. Sidney Smith and the research of Dr. Li Qian: MedPage Today

Collaborative Convergent Epicardial and Endocardial Atrial Fibrillation Ablation - featuring Dr. Paul Mounsey and Dr. Andy Kiser: EP Lab Digest

May

UNC Health Care staff forms peer mentoring program for amputees - featuring the UNC Center for Heart and Vascular Care Nursing Staff on 5 Anderson Vascular Acute Care Unit: News 14 Carolina

Drug May Treat Resistant HTN in ESRD Patients - featuring Dr. Alan Hinderliter: Renal and Urology News

Boston Marathon Bombing Aftermath and Recovery - featuring Dr. Joseph Stavas: Triangle Business Journal, Your Health Radio, WNCT-TV, Greenville, NC

June

Afghan girl to receive treatment for heart condition at NC Children's Hospital - featuring UNC Cardiovascular Medicine donors, Rita and Eric Bigham: Health Canal and UNC Health Care News, Daily Tar Heel, Sandhills Tribune, Pinehurst, NC and Follow-up article featuring UNC Cardiovascular Medicine, The Pilot Newspaper, Moore County, NC

July

Statins Have Few Side Effects, But Should More People Be Taking Them? - featuring Dr. Sidney Smith: Time Magazine

Randy Travis Gets an LVAD, Future Uncertain - featuring Dr. Cam Patterson: MedPage Today

UNC is First in N.C. to Use New Minimally-Invasive Procedure to Reduce the Risk for Stroke - featuring Drs. Paul Mounsey, Eugene Chung, Andy Kiser, and Alan Hinderliter: WPTF News Radio - 680/850AM and WCHL News Radio - 97.9FM

UNC Hospitals applies for radiology equipment - featuring Vascular Interventional Radiology: Triangle Business Journal and Durham Herald-Sun

ACA Delays Decisions in Cardiology - featuring Dr. Cam Patterson: MedPage Today

The Hybrid Ablation for Atrial Fibrillation Combines Surgery and Catheter Ablation — Featuring Video Interview with Dr. Andy Kiser: Stop Afib.org

Heart and Vascular's Burke inducted as Fellow in the Society of Interventional Radiology - featuring Dr. Charles Burke: University Gazette

Lamberth and Shirley Mitchell: Losing Teeth, but Keeping Spirit and Faith - featuring UNC Wound Care: UNC Health Care: Family House Diaries

Heart and Vascular's Schwartz and Weres inducted as Fellows of the Heart Rhythm Society - featuring Dr. Jennifer Schwartz and Melanie Weres, NP: University Gazette

Durham health care angel fund hauls in $5.1M - featuring Dr. Cam Patterson: Triangle Business Journal and Durham Herald-Sun

August

Recognizing a Heart Attack - featuring Dr. Prashant Kaul: UNC Well Magazine

Black patients undergo aortic valve replacement significantly less frequently than white patients - featuring Dr. Michael Yeung: Cardiovascular News International

UNC Physician Elected President of the Association of Professors of Cardiology - featuring Dr. Cam Patterson: UNC Well Magazine

Convergent Care - featuring Dr. Andy Kiser: UNC Endeavors

Chatham Hospital Q&A - featuring Dr. Cody Deen: Chatham Economic Development Corporation

September

UNC Hospitals hosts Legs for Life Free Screening - featuring Vascular Interventional Radiology and Aortic Disease Management: University Gazette, WRAL-TV Online, WNCN-TV Online, and The Times-News (Burlington, NC)

Li Qian receives New Scholar in Aging Award from Ellison Medical Foundation - featuring Dr. Li Qian, McAllister Heart Institute: Durham Herald-Sun, University Gazette (page 5), UNC Voices, blog of the Health Sciences Library, Science and Technology Health (Portuguese)

Stopping the Heart Failure Patient Bounce-Back - Kirkwood Adams, MD (mentioned as expert): Medscape Online (VIDEO)

Collaborative Experience Using the LARIAT System for Left Atrial Appendage Closure - featuring Matthew Baker, MD (Fellow), J. Paul Mounsey, BM BCh, PhD, MRCP, FACC, Andy C. Kiser, MD, Eugene H. Chung, MD, FACC:  EP Lab Digest, Cath Lab Live, and Cardiovascular Live

October

NHLBI hands off hypertension guidelines to ACC, AHA – featuring Sidney Smith, MD: Family Practice News, Clinical Endocrinology News, Clinical Neurology News, Journal of Family Practice, and E-Cardiology News

Tarheels leaving their footprint in Malawi – featuring Joseph Fulton, MD: World Camp for Kids

Platelet imaging can enable detection of blood clots in vivo – featuring Timothy Nichols, MD:  Medical Physics Web and Academia Online

European hypertension guidelines help fill U.S. void – featuring Sidney Smith, MD:  Clinical Endocrinology News

November

Carolina Week News - Trans Fats - featuring Ross Simpson, MD: Carolina Week (from 11:28-13:50)

'Arts for Hearts' raises money for UNC Cardiology: Daily Tar Heel and Pharmaceutical Devices

Pat Robertson donates to UNC after successful heart surgery - featuring UNC Cardiothoracic Surgery: Raleigh News & Observer

UNC Kenan-Flagler presents alumni awards - featuring Cam Patterson, MD: Kenan-Flagler Blog, San Francisco Chronicle, and Twitter - retweeted 4 times reaching 39,584 followers - @uncheartvasculr and @KenanFlagler

Shift In Cholesterol Advice Could Double Statin Use - featuring Sidney Smith, MD: National Public Radio (NPR), NPR Blog, All Things Considered, National Public Radio **AUDIO**, The People's Pharmacy, National Public Radio **AUDIO from 27:59-34:32**, and Twitter: @nprnews - retweeted four times reaching 2,127,761 followers

Risk calculator for cholesterol appears flawed - featuring Sidney Smith, MD: The New York Times, The Boston Globe,Time Magazine, Columbus (OH) Dispatch, and NBC News

How Good Is the New ACC/AHA Risk Calculator? - featuring Sidney Smith, MD: Medscape

Experts defend new heart attack prevention advice - featuring Sidney Smith, MD: Newsday

 

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Li Qian receives New Scholar in Aging Award from Ellison Medical Foundation

Qian’s lab plans to investigate the fundamental events underlying the progression of various cardiovascular diseases as well as to discover the basic mechanisms of cell reprogramming.
Li Qian receives New Scholar in Aging Award from Ellison Medical Foundation click to enlarge Li Qian, PhD
Li Qian receives New Scholar in Aging Award from Ellison Medical Foundation click to enlarge Dr. Li Qian at work in her laboratory in the McAllister Heart Institute.

Media contact: Laura Melega, 919-843-8217, laura_melega@med.unc.edu

Wednesday, Sept. 11, 2013

Li Qian, PhD, an assistant professor in the University of North Carolina School of Medicine, has received a 2013 New Scholar in Aging Award from the Ellison Medical Foundation.

Qian’s research focuses on developing innovative approaches to regenerate or repair an injured heart. The goal of her lab is to understand the molecular specification and maturation of heart muscle cells to improve efficiency and clinical applicability of cellular reprogramming in heart disease.

Qian’s lab plans to investigate the fundamental events underlying the progression of various cardiovascular diseases as well as to discover the basic mechanisms of cell reprogramming. Qian uses in vivo modeling of cardiac disease in the mouse, including myocardial infarction (MI), cardiac hypertrophy, chronic heart failure and congenital heart disease (CHD), taking advantage of traditional mouse genetics and newly developed reprogramming technologies.  

The award provides funding of $100,000 per year for a four-year period.

Qian joined the Department of Pathology and Laboratory Medicine and the McAllister Heart Institute in 2012.

The foundation’s New Scholar awards provide support for newly independent investigators in the first three years after their postdoctoral training, when they are establishing their laboratories. These awards support bright young scientists during their early years, enabling them to staff their labs, collect preliminary data and organize research programs of sufficient momentum to obtain ongoing support from other sources.

The Ellison Medical Foundation is a non-profit organization that supports basic biomedical research on aging relevant to understanding lifespan development processes and age-related diseases and disabilities. The foundation aims particularly to stimulate new, creative research that might not be funded by traditional sources or that is often underfunded in the U.S.

More information about the foundation’s New Scholar award program and other funding activities is available at http://www.ellisonfoundation.org/index.jsp.

UNC Hospitals recognized for quality in cardiac care

Hospital among first to receive new designation for delivering quality and cost-efficient cardiac procedures

Tuesday, August 13, 2013

CHAPEL HILL, N.C. – Blue Cross and Blue Shield of North Carolina has recognized UNC Hospitals as one of the first hospitals in the nation to receive a Blue Distinction Center+SM designation in the area of cardiac care, as part of the Blue Distinction Centers for Specialty Care® program.  Blue Distinction Centers are hospitals shown to deliver quality specialty care based on objective, transparent measures for patient safety and health outcomes that were developed with input from the medical community.  This year, the national program has added a new designation level, Blue Distinction Centers+, to recognize hospitals that deliver both quality and cost-efficient specialty care.

In 2006, the Blue Distinction Centers for Specialty Care program was developed to help patients find quality providers for their specialty care needs while encouraging healthcare professionals to improve the care they deliver.  To receive a Blue Distinction Center+ for Cardiac CareSM designation, a hospital must demonstrate success in meeting both general quality and safety criteria (such as preventing hospital-acquired infections) and cardiac-specific quality measures (related to lower rates of complications and death following cardiac surgery; and non-surgical procedures, such as cardiac stent placement) and, additionally, must show better cost efficiency relative to their peers.  Quality is key: only those facilities that first meet Blue Distinction’s nationally established, objective quality measures will be considered for designation as a Blue Distinction Center+.  UNC Hospitals is proud to be recognized by BCBSNC for meeting the rigorous cardiac care selection criteria set by the Blue Distinction Centers for Specialty Care program.

“UNC Hospitals is dedicated to making our cardiac care among the best in the country, and this designation is a testament to the diligence of our entire heart and vascular team.  We are committed to providing the highest quality cardiac care as safely and efficiently as possible,” said Cam Patterson, MD, Physician-in-Chief of the UNC Center for Heart and Vascular Care and Chief of the UNC Division of Cardiology.  “We are pleased to be recognized for our dedication and achievements in improving the outcomes of our cardiac patients.”

Cardiovascular disease is the leading cause of death in the United States, claiming nearly 600,000 lives each year.  Cardiac procedures, including bypass and cardiac stent placement, are among the most common major medical procedures provided by the US health care system, with more than 1 million procedures performed annually. These cardiac related procedures cost the nation more than $28 billion annually.  The Blue Distinction Centers for Specialty Care program seeks to reduce this burden, by empowering patients with the knowledge and tools to find both quality and value for their cardiac care needs.

“We are pleased to be working with hospitals that share our commitment to high quality care in North Carolina,” said Lisa Cade, vice president of network management for BCBSNC. “Through the Blue Distinction Specialty Care Program, customers are able to take control of their health and find great care at a reasonable price.”

Research shows that Blue Distinction Centers+ demonstrate better quality and improved outcomes for patients, with lower rates of complications following certain cardiac procedures and lower rates of healthcare associated infections, compared with their peers. Blue Distinction Centers+ are also 20 percent more cost-efficient for those same procedures.

The Blue Distinction Centers for Specialty Care program identifies hospitals delivering quality care in bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacements, spine surgery, and transplants.  These specialty areas comprise approximately 30 percent of inpatient hospital expenditures.  For more information about the program and for a complete listing of the designated facilities, please visit www.bcbs.com/bluedistinction.


About the UNC Health Care and the UNC Center for Heart and Vascular Care:
The UNC Health Care System is a not-for-profit integrated health care system owned by the State of North Carolina and based in Chapel Hill, North Carolina. It exists to further the teaching mission of the University of North Carolina and to provide state-of-the-art patient care at modern hospitals for children, women, neurologic and psychiatric patients, cancer, and general adult patient care.  The Center for Heart and Vascular Care at UNC encompasses all clinical care of patients with cardiovascular diseases. The physicians are a collaborative group of vascular and cardiac surgeons, cardiologists, and vascular interventional radiologists, joined by a dedicated nursing staff and support personnel.  For more information, please visit the Center for Heart and Vascular Care’s website at www.uncheartandvascular.org.  For more information about UNC Health Care, please visit www.unchealthcare.org.

About BCBSNC:
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.74 million members, including approximately 1 million served on behalf of other Blue Plans. For generations, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina was recognized as one of the World’s Most Ethical Companies by Ethisphere Institute in 2012 and 2013. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Visit BCBSNC online at bcbsnc.com. All other marks are the property of their respective owners.

About BCBSA:
The Blue Cross and Blue Shield Association is a national federation of 38 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for 100 million members – one-in-three Americans.  For more information on the Blue Cross and Blue Shield Association and its member companies, please visit www.BCBS.com.  We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA.

Blue Distinction® Centers met overall quality measures for patient safety and outcomes, developed with input from the medical community. Blue Distinction® Centers+ also met cost measures that address consumers’ need for affordable healthcare. Individual outcomes may vary. National criteria is displayed on www.bcbs.com.  A Local Blue Plan may require additional criteria for facilities located in its own service area.  To find out which services and providers (including hospital based physicians) are covered under your policy, or to learn about Local Blue Plan Criteria, contact your Local Blue Plan; and contact your provider before making an appointment to verify its current Network and Blue Distinction Centers status. Each hospital’s Cost Index is calculated separately, based on data from its Local Blue Plan. Hospitals in portions of CA, ID, NY, PA, and WA may lie in areas served by two Local Blue Plans, resulting in two Cost Index figures; and their own Local Blue Plans decide whether all hospitals in these areas must meet Blue Distinction Centers+ national criteria for one or both Cost Index figures. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for damages, losses, or non-covered charges resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers.  To find out more, contact your Local Blue Plan.
Ins        

Afghan girl departs for home after heart surgery at UNC

A North Carolina nonprofit organization and a UNC Hospitals volunteer partnered to bring an 8-year-old girl with congenital heart problems to UNC for medical treatment.

Media contact: Stephanie Mahin, 919-966-2860, smahin@unch.unc.edu

Updated Wednesday, Aug. 7, 2013

Maryam, an 8-year-old girl from Afghanistan, departed from Raleigh-Durham International Airport (RDU) on Saturday, Aug. 3, on her way back home after spending six weeks in North Carolina.

She underwent heart surgery at UNC Hospitals on Tuesday, July 9, and came through it well, said her surgeon, Michael R. Mill, MD.

Dr. Mill corrected a narrowing of Maryam's aorta (a surgical procedure called resection of coarctation of the aorta) and closed a fetal blood vessel, the ductus arteriosus, that had not closed normally when Maryam was a newborn (that surgery is called division of a patent ductus arteriosus (PDA)). For more details about her surgery, see this story.

Solace for the Children, a not-for-profit foundation based in Mooresville, N.C., brought Maryam and five other Afghan children to North Carolina for a six-week program that included specialized medical care, cultural enrichment and team-building activities.

Maryam, came to N.C. Children's Hospital at UNC to receive treatment for congenital heart defects. She had her first appointment with pediatric heart doctors at UNC in early July and then had a catheter-based procedure first, before having heart surgery on July 9.

Each child lived with a host family during their stay in the United States. The N.C. Children's Hospital paired Maryam with 6-year-old Hannah Saye of Pinehurst, who acted as Maryam's "Heart Sister." Hannah had open heart surgery days after birth to repair a congenital heart abnormality.

Maryam's care was paid for with donations to a fund created by the generosity of Chapel Hill residents Rita and Eric Bigham, long-time UNC Hospitals volunteers.

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Maryam arrives at RDU


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Inpatients who have STEMI heart attacks more likely to die than outpatients

A new study by UNC researchers finds that patients who suffer a STEMI heart attack while hospitalized are 10 times more likely to die than patients who suffer a STEMI outside the hospital.
Inpatients who have STEMI heart attacks more likely to die than outpatients click to enlarge George A. Stouffer, MD

Media contact: Tom Hughes, 919-966-6047, tahughes@unch.unc.edu

Tuesday, April 16, 2013

CHAPEL HILL, N.C. – If you suffer a heart attack while walking down the street and are taken to the hospital quickly, your chances of survival are very good. But if you have a heart attack while already in the hospital for something else, you are 10 times more likely to die.

That surprising finding comes from a study by University of North Carolina School of Medicine researchers. Their study, which is the first to systematically examine outcomes among hospital inpatients who suffer a type of heart attack called an ST elevation myocardial infarction (STEMI), was published on April 4, 2013 in the Journal of the American Heart Association.

“We found that the survival rate for outpatients brought to UNC Hospitals for STEMI treatment was slightly more than 96 percent,” said George A. Stouffer, MD, distinguished professor in the UNC School of Medicine and senior author of the study. “But the survival rate for inpatients who suffered a STEMI was much lower, only 60 percent.”

Part of the difference is explained by the fact that people who suffer a STEMI while hospitalized are, as a group, older and sicker than people who suffer a STEMI outside the hospital. But even after adjusting the statistical analysis to account for this, there were still important differences in survival, Stouffer said.

Another possible explanation:  Hospital emergency departments are trained to react very quickly when a patient with a suspected STEMI is brought in. For that reason, the time from a STEMI outpatient’s arrival to treatment with angioplasty, referred to as “door to balloon time,” averages about 45 minutes at UNC Hospitals.

"In contrast, when patients who are in the hospital for a non-cardiac condition have a STEMI, the onset is not usually heralded by chest pain and thus health care providers may not suspect that a coronary artery has occluded. As a result, the time it takes for restoration of coronary blood flow for inpatients is much slower and more variable," Stouffer said.

These results are based on 48 cases of STEMI among inpatients at UNC Hospitals between Jan. 1, 2007 and July 31, 2011, compared to 227 patients with outpatient STEMI treated at UNC Hospitals during the same time period. UNC Hospitals received the American Heart Association’s Gold Level Performance Achievement Award in 2012 for its care of STEMI patients and has a very active STEMI program. The inpatient STEMI survival rates at hospitals that have not received such AHA recognition may be worse.

Nationwide, there are approximately 11,000 cases of STEMI a year among hospital inpatients, which would translate into approximately 4,300 deaths based on extrapolating data from this study.

First author of the study is Xuming Dai, MD, a fellow in interventional cardiology at UNC. The other authors are Joseph Bumgarner, MD, Andrew Spangler, MD, Dane Meredith, MPH, and Sidney C. Smith Jr, MD, professor of cardiology at UNC and a past president of the American Heart Association.

Owens wins multi-year “Pathway to Independence” K99/R00 grant award

Congratulations to A. Phil Owens, III, PhD, a post-doctoral trainee in the Mackman lab at the UNC McAllister Heart Institute. With this award, Dr. Owens will have support to transition from a mentored research environment with Dr. Nigel Mackman to an independent laboratory setting. Dr. Owens’ research focuses on abdominal aortic aneurysm (AAA) and the role of coagulation and platelets in protecting AAA from ruptures.

The four- to five-year grant provided by the NIH allows for one to two years of mentored post-docotoral research, followed by up to three years of independent research provided the researcher is on a path to tenure at his or her institution.

Dr. Owens’ research on AAA is significant for many reasons. AAA is a dilation of the aorta which may result in catastrophic rupture and death. This cardiovascular disease is estimated to affect almost 10% of people over the age of 50 with an estimated 1 out of every 250 people affected. As such, between 15,000 and 30,000 Americans die every year due to this disease. Despite decades of research, there are no clinically approved drug regimens for this disease. Since this affects elderly populations, these patients are commonly on antithrombotic therapies for other cardiovascular diseases.

“Our preliminary data indicate that the activation of coagulation may be beneficial to prevent catastrophic rupture of the aorta resulting in death in these patients,” said Dr. Owens. “A better understanding of the role of the coagulation system and platelets in AAA may prevent an increased risk of rupture for AAA patients by prohibiting the use of antithrombotic drug therapies in these patients.”

Read more about the work of Dr. Owens and others in the Mackman lab online.

Newly approved blood thinner may increase susceptibility to some viral infections

A study led by UNC researchers indicates that a newly approved blood thinner that blocks a key component of the human blood clotting system may increase the risk and severity of certain viral infections, including flu and myocarditis.
Newly approved blood thinner may increase susceptibility to some viral infections click to enlarge Nigel Mackman, PhD

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Monday, April 1, 2013

CHAPEL HILL, N.C.  – A study led by researchers at the University of North Carolina indicates that a newly approved blood thinner that blocks a key component of the human blood clotting system may increase the risk and severity of certain viral infections, including flu and myocarditis, a viral infection of the heart and a significant cause of sudden death in children and young adults.

For the past 50 years, people with the heartbeat irregularity, atrial fibrillation, and others at increased risk for forming potentially life-threatening blood clots have been given the anticoagulant drug warfarin. Recently, the U.S. Food and Drug Administration approved the use of the blood-thinner Dabigatran etexilate (called Pradaxa™) for atrial fibrillation patients. The drug inhibits thrombin, the body’s central coagulation activator of the blood clotting system.

In blocking thrombin activity, the drug disturbs the protease cascade of molecular events that normally occurs in coagulation. While clot formation is reduced, the new study shows it may also cause an unintended consequence. “Our findings show that blocking thrombin reduces the innate immune response to viral infection,” says study senior author Nigel Mackman, PhD, the John C. Parker Distinguished Professor of Medicine in the division of hematology and director of the UNC McAllister Heart Institute. “The use of the new generation of blood thinners might increase the risk and severity of flu and myocarditis.”

A report of the research appears in the March 2013 issue of The Journal of Clinical Investigation.

Mackman points out that viral infections such as dengue fever trigger activation of the coagulation system but it was considered a bad thing.  He says studies on bacterial infections have found that the last product of the “clotting cascade” (the process that occurs in blood clot formation) – fibrin – helps activate immune cell macrophages that boosts the immune system.

“But it seems that the antiviral mechanism of the clotting system is not via fibrin but rather via thrombin; namely, its activation of protease activated receptor proteins such as PAR-1,” says Mackman. “The new study was aimed at finding out if PAR-1 plays any role in virus infections, a question of importance to the use of Pradaxa™ and the development of antithrombotic drugs that target PAR-1 on platelets.”

To find the answer, Mackman and colleagues used mice in which the PAR-1 gene is deleted and subjected then to infection with a virus that causes myocarditis. They found that loss of PAR-1 mediated signaling after infection with the cardiotrophic virus resulted in increased viral buildup in the heart, cardiac injury and, later, increased impairment of heart function.

Moreover, the absence of PAR-1 signaling was associated with a slower response to the virus of the innate immune soon after viral infection. The innate immune system provides early defense against disease causing organisms. The defense is almost immediate.

The researchers treated normal mice with Pradaxa™. They showed that thrombin inhibition increased cardiac virus load and cardiac injury after viral infection in a similar manner to a deficiency of PAR-1. In addition, they infected the PAR-1 deficient mice with influenza A and found that PAR-1 signaling was important in controlling the virus load in the lung in the early phase after infection. These results suggest that thrombin and PAR-1 mediate important early antiviral signals after infection.  

“Pradaxa™ inhibits clot formation by reducing fibrin deposition and platelet aggregation.” said Mackman. “Importantly, Pradaxa™ might not only facilitate significant lifesaving effects in reducing cardiac death but may also interfere with other processes in the body.

“The results we generated were completely unexpected and in fact our hypothesis was that PAR-1 deficient mice would be protected from viral myocarditis because they would have reduced inflammation,” Mackman added. “We are now determining if the traditional long term anticoagulant warfarin has the same effect on viral infection or is this specific to the new blood thinner.”

The majority of the study was a collaboration between the Mackman group at UNC and the Charité – Universitätsmedizin in Berlin, Germany, and other groups at UNC, including at the Gillings School of Global Public Health, and across the USA.

The first-author is Silvio Antoniak, PhD, a postdoctoral researcher in Mackman’s lab. Other co-authors from Mackman’s lab were A. Phillip Owens III, PhD; Martin Baumnacke, MD; and Julie C. Williams, PhD.

The study was supported by the Myocarditis Foundation through a research grant to Silvio Antoniak. Additional funds were provided by the National Heart, Lung and Blood Institute (NHLBI), a component of the National Institutes of Health.


Sidney C. Smith, Jr. MD, receives the 2013 Joseph Stokes, III, MD Award from the American Society for Preventive Cardiology

The award honors those who have made significant contributions in the field of preventive cardiology through research, teaching, clinical activity and leadership.
Sidney C. Smith, Jr. MD, receives the 2013 Joseph Stokes, III, MD Award from the American Society for Preventive Cardiology click to enlarge Sidney C. Smith, Jr, MD

Thursday, March 28, 2013

CHAPEL HILL, N.C. -- Sidney C. Smith, Jr, MD, professor of Medicine in the University of North Carolina School of Medicine and clinician in the UNC Center for Heart and Vascular Care, received the 2013 Joseph Stokes, III, MD Award from the American Society for Preventive Cardiology on March 22, 2013.

This prestigious award honors those who have made significant contributions in the field of preventive cardiology through research, teaching, clinical activity and leadership.  It commemorates Joseph Stokes, III, MD, a cardiologist and epidemiologist who was co-principal investigator of the Framingham Heart Study, a now decades-long study designed to identify the common factors or characteristics that contribute to cardiovascular disease by following its development over a long period of time in a large group.

Dr. Smith received his medical degree from Yale Medical School and completed his medical internship, residency, and cardiology fellowship at the Peter Bent Brigham (now Brigham and Women’s) Hospital/Harvard Medical School in Boston, MA. Dr. Smith is a past president of the American Heart Association (AHA) and the World Heart Federation (WHF).  Among his many honors include the AHA Physician of the Year Award, AHA Distinguished National Leadership Award, AHA Gold Heart Award, AHA Eugene Drake Award and the NHLBI/NIH Award of Special Recognition. Dr. Smith has authored or co-authored more than 350 published papers and chapters and has served on the editorial boards for the Journal of Cardiovascular Medicine, Journal of Clinical and Experimental Cardiology, Journal of the American College of Cardiology and Circulation. Each year since 1998, he has been elected to Best Doctors in America.

"Sid Smith's lifelong mission to understand how we can interrupt the biggest health care concern of our age -- heart disease -- has brought deserved recognition to him and to the University of North Carolina," says Cam Patterson, MD, MBA, Physician-in-Chief, UNC Center for Heart and Vascular Care. "But more importantly, it has saved lives-- hundreds of thousands of lives. Sid deserves all the recognition he can get."

Setting the stage for a new paradigm in treatment of heart failure

New evidence shows the root of heart failure lies in misfolded proteins in the heart’s cells, according to UNC researchers. The finding may pave the way for dramatically new treatment approaches.
Setting the stage for a new paradigm in treatment of heart failure click to enlarge L-R: Cam Patterson, MD, MBA, and Monte Willis, MD, PhD

Media contact: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

Wednesday, Jan. 30, 2013

CHAPEL HILL, N.C. – Despite a substantial increase in the number of people suffering the debilitating and often deadly effects of heart failure, treatments for the condition have not advanced significantly for at least 10 years. An analysis by researchers at the University of North Carolina School of Medicine shows new breakthroughs could be closer than we thought.

The analysis points to striking similarities between heart cells in patients with heart failure and brain cells in patients with Alzheimer’s disease, raising the possibility that some treatment approaches being developed for Alzheimer’s may also help reverse the damage from heart failure.

“We know that Alzheimer’s is a process of wear and tear on the brain, and the same sort of wear and tear affects the heart,” said Cam Patterson, MD, MBA, UNC’s chief of cardiology. “The good news is now that we recognize that — and can understand how the wear and tear actually affects proteins in the heart — it offers us a new chance to identify strategies to reverse that wear and tear. It’s like providing a key to preventing aging of the heart.”

The analysis, co-authored by Patterson and Monte Willis, MD, PhD, associate professor of pathology and laboratory medicine at UNC, appears in the Jan. 31, 2013 issue of the New England Journal of Medicine.

The researchers say a variety of recent studies point to one conclusion: misfolded proteins in heart cells are a key factor in the process of heart failure. “There’s a convergence of data pointing to this being a real problem,” said Patterson.

The analysis brings together three main lines of evidence. First, studies of heart tissue from patients with heart failure reveal large accumulations of misfolded proteins within damaged heart cells, similar to the accumulations found in the brain cells of patients with Alzheimer’s. Second, recent studies using mice show heart problems can result from defects in the body’s quality-control system for monitoring and maintaining proteins. Finally, studies of a rare genetic disorder link severe heart problems to misfolding of two proteins, known as desmin and CryAB.

The new conclusion opens enticing avenues for possible treatments. Scientists studying Alzheimer’s and other neurological disorders have long focused on ways to correct or prevent protein misfolding, and have even developed drugs that accomplish this feat. “This raises the possibility that that same type of strategy, and maybe even some of those compounds, will be beneficial in heart failure,” said Patterson. “It’s an entirely new treatment paradigm.”

Heart failure, in which the heart fails to pump as effectively as it should, is a chronic, debilitating and often deadly condition affecting millions of adults in the United States. It can result from heart attacks, coronary heart disease and many other causes. Increases in heart attack survival rates mean more people are living with the debilitating effects of heart failure, including fatigue, shortness of breath and increased mortality.

Trial begins on “off-the-shelf” stent graft for pararenal aortic aneurysm

Mark Farber, MD, Director of UNC Aortic Disease Management in the UNC Center for Heart and Vascular Care, investigates stent graft that may be an improvement over other stent grafts used for aortic aneurysms in that it does not need to be customized for the patient, thus earning the nickname as an “off-the-shelf” graft.
Trial begins on “off-the-shelf” stent graft for pararenal aortic aneurysm click to enlarge The Zenith p-Branch stent graft has pivoting renal “windows”, allowing it to fit more patients who have been diagnosed with a pararenal aortic aneurysm (PRAA). Photo credit: Cook® Medical, Inc.

A trial to test an “off-the-shelf” stent graft for abdominal aortic aneurysms is underway at the University of North Carolina-Chapel Hill.   Mark Farber, MD, director of Aortic Disease Management in the UNC Center for Heart and Vascular Care, is the sponsor and investigator for this trial.

The trial will study the kidney and abdominal organ – or visceral - function following the endovascular procedure to repair a pararenal aortic aneurysm (PRAA) using the Zenith p-Branch® Pararenal Endovascular Graft, manufactured by Cook® Medical, Inc.

Currently, only three medical centers in the United States have access to the Zenith p-Branch through special investigator programs.  In the next few months, the trial will expand to additional medical centers with Dr. Farber serving as the National Principal Investigator for the U.S. company-sponsored clinical trial.

An aortic aneurysm is a swelling in a section of the aorta, which is the human body’s main artery and provides oxygen-rich blood from the heart to the body. An aneurysm stretches and weakens the aorta, and if left untreated, the aneurysm can burst, causing severe bleeding that can quickly lead to death.   A pararenal aortic aneurysm is in the section of the aorta located below the diaphragm.

The Zenith p-Branch stent graft may be an improvement over other stent grafts used for aortic aneurysms in that it does not need to be customized for the patient, thus earning the nickname as an “off-the-shelf” graft.  The Zenith p-Branch stent graft has two different designs, with different locations for the pivoting renal “windows”, allowing it to fit more patients.

“This trial may ultimately allow for the minimally invasive treatment of patients with complex aneurysmal disease without the need for waiting,” says Dr. Farber.  “Its unique design may allow us to treat patients that otherwise have no options other than open surgery or watchful waiting."

The Zenith p-Branch trial at UNC is studying pararenal aortic aneurysms (PRAA), which are aneurysms that typically involve or approach the renal arteries.  Historically, the morbidity and mortality rates associated with the repair of a PRAA have been relatively high.

The Zenith p-Branch stent graft is guided to the spot of the aneurysm via a catheter placed into the patient’s groin.  This endovascular technique is minimally-invasive, allowing patients, in general, to return home sooner with less pain, faster healing, and generally provides the least amount of disruption to their lives.

During this study, once the stent graft is in place, the graft’s orientation and configuration is evaluated with respect to kidney function and device performance. Detailed imaging is performed prior to and after endovascular repair so important data concerning the stent graft can be studied.  Using this data, it may be possible to determine changes in kidney function with respect to the Zenith p-Branch’s design characteristics.

The first patient received the Zenith p-Branch stent graft at UNC earlier this year, and eight patients have been treated so far with the device. Dr. Farber says, “Feasibility and early results show promise for Zenith p-Branch repair of PRAA.  This initial result for ‘off-the-shelf’ devices demonstrates possible treatment for up to 60 to 70 percent of patients with PRAA.”

Dr. Farber adds, “Additional device modifications and design may be required for other types of aortic aneurysms.”

Testing of the Zenith p-Branch stent graft will continue at UNC at least through July 2015.  To be part of the p-Branch study at UNC, contact Dianne Glover, RN, Research Program Manager for the UNC Aortic Disease Center, at (919) 843-1278 or dianne_glover@med.unc.edu.

A Fighting Spirit and a Grateful Heart: UNC Wound Care patient goes home for the holidays

Blair Keagy, MD, treated patient Patricia Griffith using hyperbaric oxygen therapy (HBOT) in UNC's state-of-the-art hyperbaric treatment facility.
A Fighting Spirit and a Grateful Heart: UNC Wound Care patient goes home for the holidays click to enlarge Blair Keagy, MD, treated patient Patricia Griffith for her soft tissue radionecrosis
A Fighting Spirit and a Grateful Heart: UNC Wound Care patient goes home for the holidays click to enlarge Patricia Griffith, patient in the UNC Wound Center, was treated with hyperbaric oxygen therapy (HBOT)

After two bouts of skin cancer, 82-year old Patricia Griffith was no stranger to pain, hospitals, and doctors.  When she developed soft tissue radionecrosis in her right leg as a result of her cancer treatments, she was ready to fight.

Unfortunately, the medical care she received in her hometown of Greenville, NC to treat her soft tissue radionecrosis just wasn’t working.

“I made five trips to the ER,” says ‘Miss Patricia’.  “I spent weeks in and out of a treatment boot, but nothing worked.”

Finally, her dermatologist in Greenville made a referral that made all the difference.  He sent Patricia to the UNC Wound Healing & Podiatry Center, part of the UNC Center for Heart and Vascular Care.

Soft tissue radionecrosis means that the soft tissues of the body that are exposed to radiation treatment are damaged and begin to die.  Once the tissue is damaged, there is no longer any blood flow, oxygen or nutrients getting to the damaged tissue, even after radiation treatment has ended.  This can make treatment very challenging.

Patricia is used to dealing with challenges. When Patricia found out she had skin cancer, she immediately received treatment.  Upon finishing treatment, she received the news that a new skin cancer had been discovered.  She then received Mohs-laser therapy and had surgery in Greenville.  The operation was a success for the cancer, but Patricia says, “The surgery almost killed me.  You know what they used to say, don’t you?  ‘The surgery was a success but the patient died’.  That’s how I felt.”

When Patricia arrived at the UNC Wound Healing Center in August 2011, she met with William Marston, MD, Medical Director of the Wound Clinic, and Blair Keagy, MD, whom Patricia saw almost daily during her treatments.  Patricia was started on hyperbaric oxygen therapy (HBOT) in our state-of-the-art hyperbaric treatment facility.  During this treatment, patients relax in a hyperbaric chamber pressurized at 2.4 atmospheres and breathe 100% oxygen, allowing their bodies to absorb a higher-than-normal concentration of oxygen, which speeds up the healing process. The treatment has been found very effective in treating soft tissue radionecrosis.

The UNC Wound Healing Center has earned a #1 designation for patient satisfaction, in part due to their goal of identifying all underlying factors leading to poor wound healing, allowing formulation of the most comprehensive, personalized plan of care for the treatment of the chronic, non-healing wound.

Miss Patricia has nothing but praise for the clinic as her wound is finally making progress toward being completely healed.  She has been a strong advocate of the Wound Center treatments that have continued for over 14 months.  Patricia says, “I often teased the nurses that I should sit in on interviews when they hired someone new!”

“These are wonderful nurses,” Patricia says.  “And the volunteers go way above and beyond to assist you.  One of them made an audio CD of a book since I couldn’t bring my book in the HBOT chamber.”

In the HBOT chamber itself, Patricia was treated by HBO technicians Robert Hall, Ryan Mullis, and Sam Benton.  “The ‘boys’ are so helpful,” says Patricia.  “I had many rough days in the beginning, and they always cheered me up.”

“Dr. Keagy, Dr. Marston, and my PA, Kelli Haas, are top-notch, super-duper, A-number one!” says Patricia with a grin.

After tackling yet another challenge with the help of the UNC Wound Center, Patricia happily returned home to Greenville the week before Thanksgiving with a much-improved leg and grateful heart.

A Fighting Spirit and a Grateful Heart: UNC Wound Care patient goes home for the holidays

Blair Keagy, MD, treated patient Patricia Griffith using hyperbaric oxygen therapy (HBOT) in UNC's state-of-the-art hyperbaric treatment facility.
A Fighting Spirit and a Grateful Heart: UNC Wound Care patient goes home for the holidays click to enlarge Blair Keagy, MD, treated patient Patricia Griffith for her soft tissue radionecrosis
A Fighting Spirit and a Grateful Heart: UNC Wound Care patient goes home for the holidays click to enlarge Patricia Griffith, patient in the UNC Wound Center, was treated with hyperbaric oxygen therapy (HBOT)

After two bouts of skin cancer, 82-year old Patricia Griffith was no stranger to pain, hospitals, and doctors.  When she developed soft tissue radionecrosis in her right leg as a result of her cancer treatments, she was ready to fight.

Unfortunately, the medical care she received in her hometown of Greenville, NC to treat her soft tissue radionecrosis just wasn’t working.

“I made five trips to the ER,” says ‘Miss Patricia’.  “I spent weeks in and out of a treatment boot, but nothing worked.”

Finally, her dermatologist in Greenville made a referral that made all the difference.  He sent Patricia to the UNC Wound Healing & Podiatry Center, part of the UNC Center for Heart and Vascular Care.

Soft tissue radionecrosis means that the soft tissues of the body that are exposed to radiation treatment are damaged and begin to die.  Once the tissue is damaged, there is no longer any blood flow, oxygen or nutrients getting to the damaged tissue, even after radiation treatment has ended.  This can make treatment very challenging.

Patricia is used to dealing with challenges. When Patricia found out she had skin cancer, she immediately received treatment.  Upon finishing treatment, she received the news that a new skin cancer had been discovered.  She then received Mohs-laser therapy and had surgery in Greenville.  The operation was a success for the cancer, but Patricia says, “The surgery almost killed me.  You know what they used to say, don’t you?  ‘The surgery was a success but the patient died’.  That’s how I felt.”

When Patricia arrived at the UNC Wound Healing Center in August 2011, she met with William Marston, MD, Medical Director of the Wound Clinic, and Blair Keagy, MD, whom Patricia saw almost daily during her treatments.  Patricia was started on hyperbaric oxygen therapy (HBOT) in our state-of-the-art hyperbaric treatment facility.  During this treatment, patients relax in a hyperbaric chamber pressurized at 2.4 atmospheres and breathe 100% oxygen, allowing their bodies to absorb a higher-than-normal concentration of oxygen, which speeds up the healing process. The treatment has been found very effective in treating soft tissue radionecrosis.

The UNC Wound Healing Center has earned a #1 designation for patient satisfaction, in part due to their goal of identifying all underlying factors leading to poor wound healing, allowing formulation of the most comprehensive, personalized plan of care for the treatment of the chronic, non-healing wound.

Miss Patricia has nothing but praise for the clinic as her wound is finally making progress toward being completely healed.  She has been a strong advocate of the Wound Center treatments that have continued for over 14 months.  Patricia says, “I often teased the nurses that I should sit in on interviews when they hired someone new!”

“These are wonderful nurses,” Patricia says.  “And the volunteers go way above and beyond to assist you.  One of them made an audio CD of a book since I couldn’t bring my book in the HBOT chamber.”

In the HBOT chamber itself, Patricia was treated by HBO technicians Robert Hall, Ryan Mullis, and Sam Benton.  “The ‘boys’ are so helpful,” says Patricia.  “I had many rough days in the beginning, and they always cheered me up.”

“Dr. Keagy, Dr. Marston, and my PA, Kelli Haas, are top-notch, super-duper, A-number one!” says Patricia with a grin.

After tackling yet another challenge with the help of the UNC Wound Center, Patricia happily returned home to Greenville the week before Thanksgiving with a much-improved leg and grateful heart.

UNC's Cam Patterson elected President of the Association of Professors of Cardiology

The mission of the APC is to lead the effort to train cardiovascular specialists.
UNC's Cam Patterson elected President of the Association of Professors of Cardiology click to enlarge Cam Patterson, MD, MBA

Media contact: Laura Melega, (919) 843-8217, laura_melega@med.unc.edu

Monday, Nov. 5, 2012

Chapel Hill, N.C. – The chief of cardiology in the University of North Carolina School of Medicine has been elected president of the Association of Professors of Cardiology.

Cam Patterson, MD, MBA, associate dean, Health Care Entrepreneurship, physician-in-chief, UNC Center for Heart and Vascular Care, and chief, Division of Cardiology, was selected by his peers to serve as president of the APC through 2014.

Patterson is an Ernest and Hazel Craige Distinguished Professor of Medicine at UNC.  Most recently, he was named as the recipient of the 2012 Judah Folkman Award from the North American Vascular Biology Association.

Patterson’s research focus is the investigation of the processes of angiogenesis, cardiac failure, and atherosclerosis.

The Association of Professors of Cardiology promotes the professional development of its members, leads the effort to train cardiovascular specialists, and strives to be the voice of academic cardiology.

Endovascular Aortic Repair Devices approved by the FDA Following Testing at UNC

Endovascular Aortic Repair Devices approved by the FDA Following Testing at UNC click to enlarge Mark Farber, MD, Director, UNC Aortic Disease Management
Endovascular Aortic Repair Devices approved by the FDA Following Testing at UNC click to enlarge RELAY (R) Thoracic Stent Graft

Two endovascular aortic repair devices tested in clinical trials at the University of North Carolina School of Medicine have been approved by the U.S. Food and Drug Administration (FDA) for use in the United States.

Mark Farber, MD, Director, UNC Aortic Disease Management and Associate Professor of Surgery and Radiology in the UNC School of Medicine, served as the national principal investigator for both clinical trials.

Endovascular repair of aortic injury or disease involves the aorta, which is the human body’s main artery and provides oxygen-rich blood from the heart to the rest of the body. Aortic disease or injury can stretch, weaken, or damage the aorta, and if left untreated, can be fatal.

In an endovascular repair, the physician makes small incisions in the patient’s groin, through which catheters will be threaded into the patient’s blood vessels.  Through these incisions, the aortic repair device is guided to the point of the disease or injury, then fastened in place to reinforce the aorta.  Endovascular procedures typically require a 1-2 day hospital stay, compared to a week or longer for an open repair.

The RELAY ® Thoracic Stent Graft with PLUS Delivery System

The RELAY device is specifically designed to treat thoracic aortic aneurysms, which occur in the aorta as it passes through the chest.  Each year, more than 15,000 people in the United States are diagnosed with a thoracic aortic aneurysm, making it the 13th leading cause of death in the country.

The RELAY device offers a wide range of sizes and ease of use to help to expand the use of this minimally-invasive treatment to a broader segment of patients. It is manufactured by Bolton Medical.

The U.S. study included more than 120 endovascular patients at 30 hospitals across the country.

Dr. Farber states, “The RELAY Thoracic Stent Graft allows for precision and conformability, especially in patients with more challenging anatomies. As a physician, I find that the RELAY device makes it easier for me to offer this life-saving treatment to a broader population of patients suffering from thoracic aortic aneurysm.”

The Conformable TAG® Thoracic Endoprosthesis

The TAG device is used for endovascular repair of a traumatic thoracic aortic transection.  A transection is a tear in the wall of the aorta.  Over 8,000 people each year experience a transection of their aorta, involving profuse bleeding and high mortality rate. It is most often caused by a severe injury to the chest as a result of a motor vehicle accident, crushing of the chest, or a high fall.

Prior to the successful clinical trial led by Dr. Farber, the only treatment option for traumatic thoracic aortic transection was open surgical repair.  This minimally-invasive endovascular repair of traumatic thoracic aortic transection reduces recovery time and pain for patients who have experienced this type of transection.

As the national principal investigator for the TAG® trial, Farber says, “We gained a great deal of insight and knowledge from the traumatic transection trial…Through the research, we were able to illustrate the TAG device’s capabilities and help to demonstrate that thoracic endografts can offer patients with traumatic aortic transection a less invasive alternative to open surgical repair.”

It is manufactured by Gore® Medical.

With these newly-approved devices, patients experiencing aortic disease or injury have more life-saving options available.   At UNC, 99% of all aortic patients receive their devices through this minimally-invasive endoscopic surgery.

About UNC Aortic Disease Management

Aortic Disease Management is part of the UNC Center for Heart and Vascular Care.  It is one of the leading centers in the United States, and one of only a few centers in the entire country to offer comprehensive minimally invasive treatment of complex aortic disease.  Aortic Disease Management leads the way in conducting clinical trials for the advancement of leading-edge aortic treatments. As a result of that commitment to developing new procedures and treatments, greater than 95% of patients with aortic problems at UNC who require procedures can now be treated with minimally invasive techniques.

For the convenience of our referring physicians and their staff, the UNC Center for Heart and Vascular Care Open Access physician referral service facilitates consultation and collaboration with our team of Heart and Vascular physicians, coordinates all admissions and transfers through a single phone call, and guarantees immediate acceptance for patients. Contact Open Access at 866-862-4327.

Endovascular Aortic Repair Devices approved by the FDA Following Testing at UNC

Two endovascular aortic repair devices tested in clinical trials at the University of North Carolina School of Medicine have been approved by the U.S. Food and Drug Administration (FDA) for use in the United States.
Endovascular Aortic Repair Devices approved by the FDA Following Testing at UNC click to enlarge Mark Farber, MD

Contact: Laura Melega, UNC Center for Heart and Vascular Care
Laura_melega@med.unc.edu, (919) 843-8217

Thursday, Sept. 27, 2012

CHAPEL HILL, N.C. -- Two endovascular aortic repair devices tested in clinical trials at the University of North Carolina School of Medicine have been approved by the U.S. Food and Drug Administration (FDA) for use in the United States.

Mark Farber, MD, Director, UNC Aortic Disease Management and Associate Professor of Surgery and Radiology in the UNC School of Medicine, served as the national principal investigator for both clinical trials.

Endovascular repair of aortic injury or disease involves the aorta, which is the human body’s main artery and provides oxygen-rich blood from the heart to the rest of the body. Aortic disease or injury can stretch, weaken, or damage the aorta, and if left untreated, can be fatal.

In an endovascular repair, the physician makes small incisions in the patient’s groin, through which catheters will be threaded into the patient’s blood vessels.  Through these incisions, the aortic repair device is guided to the point of the disease or injury, then fastened in place to reinforce the aorta.  Endovascular procedures typically require a 1-2 day hospital stay, compared to a week or longer for an open repair.

The RELAY ® Thoracic Stent Graft with PLUS Delivery System

The RELAY device is specifically designed to treat thoracic aortic aneurysms, which occur in the aorta as it passes through the chest.  Each year, more than 15,000 people in the United States are diagnosed with a thoracic aortic aneurysm, making it the 13th leading cause of death in the country.

The RELAY device offers a wide range of sizes and ease of use to help to expand the use of this minimally-invasive treatment to a broader segment of patients. It is manufactured by Bolton Medical.

The U.S. study included more than 120 endovascular patients at 30 hospitals across the country.

Dr. Farber states, “The RELAY Thoracic Stent Graft allows for precision and conformability, especially in patients with more challenging anatomies. As a physician, I find that the RELAY device makes it easier for me to offer this life-saving treatment to a broader population of patients suffering from thoracic aortic aneurysm.”

The Conformable TAG® Thoracic Endoprosthesis

The TAG device is used for endovascular repair of a traumatic thoracic aortic transection.  A transection is a tear in the wall of the aorta.  Over 8,000 people each year experience a transection of their aorta, involving profuse bleeding and high mortality rate. It is most often caused by a severe injury to the chest as a result of a motor vehicle accident, crushing of the chest, or a high fall.  

Prior to the successful clinical trial led by Dr. Farber, the only treatment option for traumatic thoracic aortic transection was open surgical repair.  This minimally-invasive endovascular repair of traumatic thoracic aortic transection reduces recovery time and pain for patients who have experienced this type of transection.

As the national principal investigator for the TAG® trial, Farber says, “We gained a great deal of insight and knowledge from the traumatic transection trial…Through the research, we were able to illustrate the TAG device’s capabilities and help to demonstrate that thoracic endografts can offer patients with traumatic aortic transection a less invasive alternative to open surgical repair.”

It is manufactured by Gore® Medical.

With these newly-approved devices, patients experiencing aortic disease or injury have more life-saving options available.   At UNC, 99 percent of all aortic patients receive their devices through this minimally-invasive endoscopic surgery.  

About UNC Aortic Disease Management
Aortic Disease Management is part of the UNC Center for Heart and Vascular Care.  It is one of the leading centers in the United States, and one of only a few centers in the entire country to offer comprehensive minimally invasive treatment of complex aortic disease.  Aortic Disease Management leads the way in conducting clinical trials for the advancement of leading-edge aortic treatments. As a result of that commitment to developing new procedures and treatments, greater than 95% of patients with aortic problems at UNC who require procedures can now be treated with minimally invasive techniques.  

For the convenience of our referring physicians and their staff, the UNC Center for Heart and Vascular Care Open Access physician referral service facilitates consultation and collaboration with our team of Heart and Vascular physicians, coordinates all admissions and transfers through a single phone call, and guarantees immediate acceptance for patients. Contact Open Access at 866-862-4327.

Related links

Mark Farber, MD, Director, UNC Aortic Disease Management and Associate Professor of Surgery and Radiology, UNC School of Medicine – Photo and Biography

RELAY ® Thoracic Stent Graft with PLUS Delivery System – Device Animation and Photos

RELAY ® Thoracic Stent Graft with PLUS Delivery System – Bolton Medical media release

Conformable TAG Thoracic Endoprosthesis – GORE Medical media release

Conformable TAG Thoracic Endoprosthesis – FDA media release


Heart and Vascular Nurses Honor Colleague with Service and Donations to Local Charity

In honor and support of Deirdre Maisano, Nurse Manager of the CTICU, staff from 3 Anderson recently volunteered their time and donated supplies to support a local charity.

On Aug. 12, various staff from 3 Anderson sponsored and volunteered with the Coalition to Unchain Dogs to build a fence for three dogs in Durham.  Named Kippy, Sheba, and Bones, the dogs received vaccines, spay/neuter procedures and a new fence was built, and all supplies were paid for by the 3 Anderson staff.  It was an amazing experience for everyone involved!

Jacci Harden, Nursing Director for the Center for Heart & Vascular Care, says, “It was such a wonderful day and am certain you will share in my pride for our staff.  I hope you enjoy this video as much as we enjoyed volunteering in honor of Deirdre.”

Maisano has been undergoing treatment and recovery for a brain tumor since late June.

Study shows higher healing rate using unique cell-based therapy in chronic venous leg ulcers

A unique living human cell formula is applied on leg ulcers in a topical spray, providing 52 percent greater likelihood of wound closure than patients treated with compression bandages only.
Study shows higher healing rate using unique cell-based therapy in chronic venous leg ulcers click to enlarge William Marston, MD

Media contacts:
Laura Melega, 919-843-8217, laura_melega@med.unc.edu
Tom Hughes, 919-966-6047, tahughes@unch.unc.edu

Thursday, August 2, 2012

CHAPEL HILL, N.C. -- Treating chronic venous leg ulcers with a topical spray containing a unique living human cell formula provides a 52 percent greater likelihood of wound closure than treatment with compression bandages only.

That's the conclusion of a new study conducted in part at the University of North Carolina School of Medicine and published online by The Lancet this week. 

The Phase II clinical trial, which investigates the efficacy of HP802-247 from Healthpoint® Biotherapeutics, was designed to determine effectiveness of certain cell concentrations and dosing frequencies of HP802-247, when combined with standard care in treatment of chronic venous leg ulcers.

William Marston, MD, professor of surgery in the UNC School of Medicine and medical director of the UNC Wound Healing Clinic, is an investigator in the study and one of the article authors.

Venous leg ulcers are caused by impaired circulation in the vein system of the legs from blockages or damage.  Typically, venous leg ulcers become chronic wounds if, after three months of standard treatment, they fail to heal.  Chronic venous leg ulcers appear as open lesions and need specialized medical care.  An estimated 1-2 million Americans suffer from venous leg ulcers.

HP802-247 is a living human cell formula consisting of skin cells (keratinocytes and fibroblasts), which release growth factors into the wound on a cellular level for tissue regeneration, along with fibrinogen, which forms a “cellular web” for blood clotting and elasticity.  During the study, 228 patients were enrolled at 28 medical centers in the United States, including UNC.  Two different cell concentrations and two separate dosing frequencies were tested with standard care, in addition to a control group, over a 12-week period.  

Dr. Marston says, “In the past, some chronic venous leg ulcers were treated with skin grafts, which occasionally could break down and also required the patient to heal a partial thickness wound at the skin graft harvest site.  During this study, unique living cells were sprayed on the patient’s wound, which interacted with the patient’s cells for improved wound healing.”

“In the study, we determined the best dosing of the fibroblast/keratinocyte preparation that markedly accelerated the rate of healing of the wounds. We are currently preparing a Phase III pivotal trial to start late this year,” adds Dr. Marston.

The citation for the Phase II study manuscript is: Kirsner RS, Marston WA, Snyder RJ, Lee TD, Cargill DI, Slade HB. A Multicentre Randomised Dosing Trial of Spray-Applied Cell Therapy With Human Allogeneic Fibroblasts and Keratinocytes for the Treatment of Chronic Venous Leg Ulcers. Lancet 2012; pending.

The study was funded by Healthpoint® Biotherapeutics.

Patterson, Willis co-edit new book entitled Translational Cardiology

Cam Patterson, MD, MBA, Physician-in-Chief of the Center for Heart and Vascular Care and Chief of the Division of Cardiology, and Monte S. Willis, MD, PhD, Associate Professor in the Department of Pathology and Laboratory Medicine, are the co-editors of a new book that discusses the molecular basis of cardiac metabolism, cardiac remodeling, translational therapies and imaging techniques.
Patterson, Willis co-edit new book entitled Translational Cardiology click to enlarge Cam Patterson, MD, MBA
Patterson, Willis co-edit new book entitled Translational Cardiology click to enlarge Monte S. Willis, MD, PhD

The book is called Translational Cardiology.

Translational Cardiology is published by Springer and is a product of Humana Press. The book is targeted to cardiologists, cardiovascular surgeons, and pathologists as well as translational biomedical researchers in a wide range of disciplines. The publisher says the book “provides an up-to-date introduction to the role circadian rhythms, cardiac plasticity, and mechanotransduction play in the heart, while at the same time introducing new developments in cellular, viral, and non-biologic therapies that are in the process of being developed. Translational Cardiology simplifies the complexity of the molecular basis of disease by focusing on patient-oriented disease mechanisms and therapies.”

More information on the book is available here.

Three UNC specialties nationally ranked by U.S. News

Overall, eleven specialties at UNC Hospitals were recognized as nationally ranked or high performing by U.S. News & World Report in its annual "America's Best Hospitals" issue.
Three UNC specialties nationally ranked by U.S. News click to enlarge Congratulations to our three nationally ranked specialties at UNC Hospitals!

Three UNC Health Care specialties were ranked in top 50 of the 2012 U.S. News & World Report “Best Hospitals” issue:

  • Gynecology - #34
  • Ear, Nose & Throat - #42
  • Cancer, #43

 

worldnews.png

Additionally, the following specialty areas at UNC Hospitals were designated by U.S. News as “high performing,” representing the top 25 percent of hospitals in their specialty nationally.

  • Cardiology & Heart Surgery
  • Diabetes & Endocrinology
  • Gastroenterology
  • Geriatrics
  • Nephrology
  • Neurology & Neurosurgery
  • Pulmonology
  • Urology


This is the 20th year in a row that multiple specialties at UNC Hospitals have been included in U.S. News & World Report Best Hospitals list. Only 3 percent of hospitals in the United States meet the U.S. News Best Hospitals criteria.

The U.S. News rankings are just one measure of success. UNC's most recent awards and honors can be viewed here.

Heart and Vascular begins offering Stress Test Services at Caswell Family Medical Center

The Center for Heart and Vascular Care is now offering stress tests to cardiac patients at Caswell Family Medical Center as part of a community clinic partnership that began in 2008.
Heart and Vascular begins offering Stress Test Services at Caswell Family Medical Center click to enlarge Rick Stouffer, MD

The UNC Center for Heart and Vascular Care is now offering stress test services to cardiac patients at Caswell Family Medical Center (CFMC) in Yanceyville, NC as part of a community clinic partnership that began in 2008. CFMC is a Community Health Center whose ‘mission is to serve our community with compassionate, customer-centered health care.’

CFMC is accredited by The Joint Commission and was one of the first ambulatory care centers in the United States to become designated JCAHO as a Primary Care Medical Home. Rick Stouffer, MD, Director of the Cardiac Catheterization Laboratories and Interventional Cardiology, and Gwen Cole, LPN, treat cardiac patients at CFMC twice a month, evaluating patients with a wide variety of cardiovascular disorders.

The Center for Heart and Vascular Care has an echocardiography machine at CFMC that Dr. Stouffer uses to obtain ultrasound imaging without patients having to travel to Chapel Hill. Beginning last month, Dr. Stouffer began offering stress tests at CFMC.

This is the first time this service has been offered in Caswell County. Dr. Stouffer is dedicated to bringing cardiovascular services into community clinics and ensuring adequate cardiovascular care for all populations. Through his leadership, the Center for Heart and Vascular Care also partners with Piedmont Health to provide free cardiac health services and education once a month to Piedmont Health’s primary care patients at the Carrboro Community Health Center.

UNC Hospitals qualifies for American Heart Association’s Mission: Lifeline Gold Level Performance Achievement Award for heart attack care

The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients that effectively improves the survival and care of STEMI (ST Elevation Myocardial Infarction) patients.

Media Contact:   Laura Melega, laura_melega@med.unc.edu, (919) 843-8217

Tuesday, July 10, 2012

CHAPEL HILL, N.C. — UNC Hospitals recently qualified for the Gold Level Performance Achievement Award from the American Heart Association’s (AHA) 2012 Mission: Lifeline program. The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients that effectively improves the survival and care of STEMI (ST Elevation Myocardial Infarction) patients.

Every year, almost 250,000 people experience the STEMI type of heart attack – the deadliest type of heart attack. Unfortunately, a significant number don't receive prompt reperfusion therapy, which is critical in restoring blood flow. Mission: Lifeline seeks to save lives by closing the gaps that separate STEMI patients from timely access to appropriate treatments. Mission: Lifeline is focusing on improving the system of care for these patients and at the same time improving care for all heart attack patients.

“We are extremely proud of the UNC team of Interventional Cardiologists, Emergency Department physicians, coronary intensive care unit nurses, staff in the Cardiac Catheterization Laboratory, Performance Improvement staff, and Emergency Medical Services (EMS) personnel who earned this award through teamwork and their dedication to saving lives,” says Cam Patterson, M.D., Physician-in-Chief of the UNC Center for Heart and Vascular Care and Chief of the UNC Division of Cardiology.

Hospitals involved in Mission: Lifeline strive to improve care in both acute treatment measures and discharge measures. Systems of care are developed that close the gap of timely access to appropriate, life-saving treatments. Before they are discharged, patients are started on aggressive risk reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers in the hospital and receive smoking cessation counseling.

Hospitals that receive the Mission: Lifeline Gold Performance Achievement Award have demonstrated for 24 consecutive months that at least 85 percent of eligible STEMI patients (without contraindications) are treated within specific time frames upon entering the hospital and discharged following the American Heart Association’s recommended treatment guidelines.

“UNC Hospitals is dedicated to making our cardiac unit among the best in the country, and the American Heart Association’s Mission: Lifeline program is helping us accomplish that by making it easier for our professionals to improve the outcomes of our cardiac patients,” said George A. Stouffer, M.D., Director of the UNC Cardiac Catheterization Laboratories and Interventional Cardiology.  “We are pleased to be recognized for our dedication and achievements in cardiac care.”

UNC is first in U.S. to use new device to treat complex abdominal aortic aneurysms

On Monday, June 18, 2012, the UNC Center for Heart & Vascular Care’s Aortic Disease Management team became the first in the U.S. to successfully treat a complex abdominal aortic aneurysm (AAA) with the Zenith® Fenestrated AAA Endovascular Graft.
UNC is first in U.S. to use new device to treat complex abdominal aortic aneurysms click to enlarge Dr. Mark Farber, left, and Dr. Marc Camacho, right, prep the patient for the procedure.
UNC is first in U.S. to use new device to treat complex abdominal aortic aneurysms click to enlarge A close-up illustration of the Zenith® Fenestrated AAA Endovascular Graft after it has been attached to the wall of the aorta.

Media contact: Laura Melega, (919) 843-8217, laura_melega@med.unc.edu

Tuesday, June 19, 2012

CHAPEL HILL, N.C. -- The UNC Center for Heart & Vascular Care’s Aortic Disease Management team is the first in the nation to use a new FDA-approved device to successfully treat a complex abdominal aortic aneurysm (AAA).

Mark A. Farber, MD, Director of UNC’s Aortic Disease Management and Endovascular Clinic, and associate professor of surgery and radiology in the UNC School of Medicine, performed the endovascular surgery on Monday, June 18, 2012 at UNC Hospitals in Chapel Hill.

An abdominal aortic aneurysm (AAA) is caused by a weakening or thinning of the aortic wall as it passes through the abdomen. The AAA is an actual bulge in the aorta, the largest artery in the body.  The abdominal aorta and iliac arteries supply blood to the body’s pelvis and legs.  

Dr. Farber served as UNC's principal investigator of the clinical trial for the FDA-approved Zenith® Fenestrated AAA Endovascular Graft, manufactured by Cook Medical, Inc. The graft is delivered via a small incision in the groin, then threaded through a blood vessel to the aneurysm site.  

In the past, invasive abdominal surgery for treatment of a complex AAA was the primary option, but advancements in non-invasive endovascular surgery provide more treatment options for an AAA.  Using the custom-manufactured graft, the patient’s pain, complications, length of hospital stay, and recovery time are all significantly reduced.  

According to the FDA website, “The graft is delivered to the aneurysm in the aorta by way of a long, flexible delivery tube. The doctor uses fluoroscopy, a type of x-ray, to guide the graft. The graft is attached to the wall of the aorta by the self-expanding stents. Blood flow can then continue through the aorta without filling the aneurysm. This is intended to prevent further growth and possible rupture of the aneurysm.”

Finding and treating an AAA before the aneurysm ruptures is vital for patient survival.  Former presidential candidate Bob Dole had an abdominal aortic aneurysm in 2001 and was successfully treated during vascular surgery.  Albert Einstein, George C. Scott, and Conway Twitty all died from aortic aneurysms.

The UNC Center for Heart & Vascular Care’s Aortic Disease Management is one of the leading centers in the Southeast, and one of only a few centers in the entire United States to offer comprehensive minimally invasive treatment of complex aortic disease.  Aortic Disease Management leads the way in conducting clinical trials for the advancement of leading-edge aortic treatments. As a result of that commitment to developing new procedures and treatments, 95 percent of aortic health patients at UNC who require procedures can now be treated with minimally invasive techniques.  
For the convenience of our referring physicians and their staff, the UNC Center for Heart & Vascular Care Open Access physician referral service facilitates consultation and collaboration with our team of Heart & Vascular physicians, coordinates all admissions and transfers through a single phone call, and guarantees immediate acceptance for patients. Contact Open Access at 866-862-4327.

William Marston of the UNC Center for Heart and Vascular Care begins Phase 3 Study of Autologous Stem Cells

Dr. Marston's study of autologous stem cells is for the treatment of patients with Critical Limb Ischemia to reduce the need for amputations.
William Marston of the UNC Center for Heart and Vascular Care begins Phase 3 Study of Autologous Stem Cells click to enlarge Dr. William Marston

Dr. William Marston, Medical Director of the UNC Wound Management Center, met with the REVIVE clinical trial steering committee last month as he begins the Phase 3 study of autologous stem cells for the treatment of patients with critical limb ischemia. Aastrom Biosciences is the REVIVE study sponsor.

Critical limb ischemia (CLI) is a severe, chronic cardiovascular disease causing severe obstruction of the arteries, which decreases blood flow to the extremities - specifically the hands, feet and legs. Symptoms include severe pain, skin ulcers, and sores in addition to “rest pain”, which patients often feel at night while lying horizontally. Individuals with peripheral arterial disease (PAD) often have critical limb ischemia, which needs immediate, comprehensive treatment by a vascular specialist or surgeon.

The UNC Center for Heart & Vascular Care is one of the two lead research sites for the clinical trial, along with Dartmouth/Mary Hitchcock Medical Center. According to Aastrom Biosciences, the REVIVE study will “assess the efficacy and safety of ixmyelocel-T in the treatment of no-option patients with critical limb ischemia.” Ixmyelocel-T is a patient-specific, multicellular therapy targeted to address the underlying causes of CLI. As the investigational treatment is an autologous stem cell therapy, bone marrow from the patients is treated with ixmyelocel-T then injected back into the patient. One of the many properties of ixmyelocel-T is tissue remodeling.

As the Division Chief for UNC Vascular Surgery, Dr. Marston is part of the REVIVE steering committee and is working in tandem with Dr. Joseph Fulton, Assistant Professor of Vascular Surgery at UNC and principal investigator for the REVIVE clinical trial. 80 treatment centers have qualified to enroll patients in the Phase 3 trial. 594 patients with CLI will be followed for 18 months. Patients accepted into this study have no option for revascularization, meaning the restoration of blood circulation to their extremities cannot be achieved through surgical means, and they also have existing tissue loss due to CLI. The primary endpoint of the trial will be amputation-free survival at 12 months.

Dr. Marston’s passion for limb preservation and wound care for his patients at UNC is evident through his involvement in the REVIVE trial. “If the treatment is successful," Marston says, "this study may lead to the first FDA approval for a stem cell product to treat cardiovascular disease.” By treating cardiovascular disease at a cellular level, it could lessen the need for future amputations on patients with CLI and other cardiovascular diseases. Joann Belanger, RN and Director of the UNC Wound Center, says, “Dr, Marston is reducing amputations by treating our patients’ chronic wounds using multiple non-surgical techniques.” Tim Mayleben, president and chief executive officer at Aastrom Biosciences says, “We are grateful to our investigators for their commitment to enrolling patients as quickly as possible in this important trial." Patients in the REVIVE study through the UNC Center for Heart & Vascular Care will continue to be treated through the end of 2013.

Collaboration leads to success during the first VT ablation with pLVAD in place

Dr. Eugene H. Chung of the UNC Center for Heart and Vascular Care performs UNC’s first ventricular tachycardia (VT) ablation with a percutaneous ventricular assist device (pLVAD) in place.
Collaboration leads to success during the first VT ablation with pLVAD in place click to enlarge Dr. Eugene H. Chung

VT is a rapid rhythm of the heart originating in the ventricles, the lower chambers of the heart, and can be a potentially deadly rhythm disturbance. During a VT ablation, a catheter is inserted into the veins or arteries in the leg that is capable of delivering small radiofrequency burns to the location of origin of the VT to alleviate any further episodes.

What made this VT ablation unique was the use of a pLVAD during the ablation procedure. The pLVAD is a mechanical device that is temporarily implanted in the heart via a femoral artery to augment the pumping function of the heart. When in VT, this patient's blood pressure dropped precipitously. The pLVAD allowed Dr. Chung's team to maintain his cardiac output and blood pressure while studying the VT from both inside (endocardial) and outside (epicardial) the heart.

“This case called for the EP Lab, Heart Catheterization Lab, CICU, Anesthesia, and Cardiothoracic Surgery to work together" said Dr. Chung.

"Thanks to the collaboration of all departments involved, we brought a new technology to one of our most complex procedures that increased the efficacy of the ablation and enhanced patient safety. The patient had a great end result.”

Center for Heart & Vascular Care & Prosthetics/Orthotics initiate amputee peer visitation program

This program is designed to provide an additional resource to help the Center for Heart & Vascular Care and the Prosthetics/Orthotics department to meet the emotional needs of their patients following an amputation.

Jacci Harden, Nursing Director for the Center for Heart & Vascular Care, says, “I am proud of the entire team for putting this together and hopeful that it will increase the overall satisfaction and emotional well-being of our patients experiencing such a life altering procedure.”

There are now two individuals with amputations from the volunteer services department that will be volunteering their time to visit patients who have had an amputation. These volunteers have received training in providing effective peer visits and are excited to offer their story and experience as an amputee to patients that are coping with their recent amputation.

This program is being targeted for vascular patients initially. Cathy Rodrigues, CCM for vascular surgery, will be evaluating patients with new amputations for their desire to have a peer visit. She will contact the volunteers to come visit the patient; however, staff are welcome to notify patients of this program as well. Staff having patients who are requesting a peer visit can contact Cathy Rodrigues. All contact information for these volunteers is located on 5 Anderson. This program is similar in structure to programs offered at UNC for patients that have experienced a burn or stroke. If there are any questions/concerns, you may contact Kathy Prichard (kprichard@unch.unc.edu), Cathy Rodrigues (carodrig@unch.unc.edu), or Jill Barham (jbarham@unch.unc.edu) from the Prosthetics/Orthotics department.

UNC receives $10 million commitment for art collection, heart disease research

Dr. Hugh A. “Chip” McAllister Jr. of Houston has made a $10 million commitment to the University of North Carolina at Chapel Hill that will include a collection of nearly 50 works of art for the Ackland Art Museum and expand an endowment dedicated to heart disease research at the School of Medicine.

Thursday, April 12, 2012

CHAPEL HILL, N.C. – Dr. Hugh A. “Chip” McAllister Jr. of Houston has made a $10 million commitment to the University of North Carolina at Chapel Hill that will include a collection of nearly 50 works of art for the Ackland Art Museum and expand an endowment dedicated to heart disease research at the School of Medicine.

The gift was announced today (April 12). McAllister is a 1966 School of Medicine alumnus.

“This gift will transform our teaching, research and public service in multiple ways,” said Chancellor Holden Thorp. “It provides a new educational experience for our students and the entire community through some of the best examples available of American art and contemporary sculpture. Equally important, the gift will support the groundbreaking and life-saving cardiovascular research conducted by our faculty in the School of Medicine.”

The portion of the commitment benefiting the Ackland Art Museum — valued at $5.5 million — is the single largest gift of art in the museum’s history. Included in the gift will be signature works by 19th-century painters Albert Bierstadt and Thomas Moran; examples by members of the Taos School, such as Oscar Berninghaus, E. L. Blumenschein and Joseph Sharp; and contemporary sculpture by Willem de Kooning, Allan Houser, Jesus Moroles and Reuben Nakian. Several examples of American Indian pottery and textiles also are included.

“We’re very fortunate to receive such a wonderful gift,” said Emily Kass, museum director.  “This art will add important breadth to our American collection, particularly in the area of art depicting the west and southwestern United States. These works offer students, alumni, faculty, researchers and visitors a new and profound experience of American art at the Ackland.”

In all, McAllister’s commitment will include more than 150 paintings, sculptures and artifacts. Pieces not going to the Ackland will be sold, with the proceeds — $2.5 million — going to expand an existing endowment supporting the UNC McAllister Heart Institute at the School of Medicine and early career cardiovascular medicine researchers. McAllister also is committing $2 million to support the institute. Recognized nationally and internationally as one of the most prominent cardiac pathologists in the United States before his retirement from the Texas Heart Institute in Houston in 2000, McAllister now has contributed more than $18 million to the University over the past 15 years, primarily to the institute.

“Chip is a great friend of the School of Medicine who deeply believes in and supports our faculty and students as they explore and discover treatments and cures for heart disease. For that, we are forever grateful,” said Dr. William L. Roper, dean of the School of Medicine and chief executive officer of UNC Health Care. “What is remarkable about this gift is that it will ensure the preservation of and accessibility to great American art, while also bettering the health of our citizens here in North Carolina and beyond.”

“I deeply admire and respect UNC-Chapel Hill as an institution,” said McAllister. “I’m happy to be able to support its extraordinary mission to serve the people of North Carolina. Being able to share my love of American art while simultaneously helping to eradicate the most deadly disease in the U.S. fulfills a dream for me.”

After graduating from Davidson College, McAllister completed medical school at UNC in 1966 and then began a military career as an intern at Walter Reed Army Medical Center in Washington, D.C. After training at the Armed Services Institute of Pathology, he served as the institute’s chair of cardiac pathology until his retirement at the rank of colonel in 1984.

McAllister then joined the Texas Heart Institute as the founding chair of the department of cardiac pathology and served until his retirement in 2000. His father, Hugh A. McAllister Sr., received a medical degree from UNC in 1935 and practiced obstetrics and gynecology in Lumberton. They are the only father and son to serve as presidents of the UNC Medical Alumni Association and to receive the School of Medicine’s Distinguished Medical Alumni Award. In honor of Chip McAllister’s many contributions to cardiovascular medicine and to the University, the UNC McAllister Heart Institute was named in his honor in 2009.

The institute provides a world-class environment for basic, preclinical and applied cardiovascular research that attracts more than $15 million annually in research funding. Executive Director Dr. Cam Patterson has led the institute since 2000 and has more than 120 publications to his credit. Patterson is a member of several editorial boards, including Circulation and the Journal of Clinical Investigation. He received the 2012 Judah Folkman Award for outstanding contributions from vascular biologists. In addition to his role at the McAllister institute, Patterson is chief of the division of cardiology, physician-in-chief of the Center for Heart and Vascular Care and associate dean for health care entrepreneurship. He received his master of business administration from Kenan-Flagler Business School in 2008.

Researchers in more than 45 labs at the institute work in areas such as blood vessel formation, cardiac stem cells, genetics, blood clotting and metabolism to advance the care of patients with diseases of the heart, blood and circulation. The institute added 17 labs in the past year. Investigators include Dr. Arjun Deb, the first UNC winner of the prestigious Katz Basic Science Research Award of the American Heart Association; Dr. Nigel Mackman, director, the recipient of the highest honor from the American Heart Association for research in arteriosclerosis, thrombosis and vascular biology; and Dr. Marschall Runge, executive dean of the School of Medicine and medicine department chair who won the 2010 Distinguished Clinical Scientist Award from the American College of Cardiology.

The Ackland Art Museum, an academic unit, serves broad local, state and national constituencies. The museum’s permanent collection consists of more than 16,000 works of art, featuring North Carolina’s premier collections of Asian art and works of art on paper (drawings, prints and photographs), as well as significant collections of European masterworks, 20th-century and contemporary art, African art and North Carolina pottery. The Ackland organizes more than a dozen special exhibitions a year.

A supercharged protein reduces damage from heart attack

UNC researchers tap into the body’s own repair system to protect heart cells after an attack. The approach could also help prevent cardiac damage in cancer patients.
A supercharged protein reduces damage from heart attack click to enlarge Following heart attack, heart cells are stressed due to lack of oxygen. When SuperFAK (in green) is expressed in the heart, it is further activated and protects heart cells from oxidative stress (in red).

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Thursday, March 1, 2012

CHAPEL HILL, N.C. – Researchers from the University of North Carolina at Chapel Hill reduced damage from a heart attack by 50 percent by enhancing a protective protein found in mice and humans. The study, in which mice were bred to make a supercharged version of the protein focal adhesion kinase, or FAK, appeared March 1 in the online edition of the journal Arteriosclerosis, Thrombosis and Vascular Biology.

“This study shows that we can enhance existing cell survival pathways to protect heart cells during a heart attack,” said Joan Taylor, PhD, associate professor in UNC’s department of pathology and laboratory medicine and a member of the UNC McAllister Heart Institute. Taylor added that the findings could lead to new treatment approaches for heart attacks and may have broad implications for scientists seeking to manipulate the body’s natural defensive systems.

During a heart attack, oxygen-deprived heart cells emit signals that activate the usually inert protein FAK, like the cry of a damsel in distress awakening her sleeping knight. If the gallant FAK arrives in time, it can save the cell and reduce permanent damage to the heart.

Taylor and her colleagues were intrigued by FAK’s protective abilities. “We thought if we could activate FAK to a greater extent, then we could better protect those heart cells,” said Taylor. Based on their previous studies that defined the signals induced by FAK in heart cells, they reasoned that expression of FAK set to an “always-on” position would eventually suffer uncontrolled inflammation and heart failure.  “Simply having more of a good thing isn’t always better,” said Taylor. “The dynamics of the protein’s activities are important to appropriately transmitting those survival signals.”

The researchers then adjusted their formula to create a new protein they called “SuperFAK.” To enhance its protective abilities without the harmful side effects, SuperFAK was primed for activation—ready to rush to the scene at the slightest provocation from stressed heart cells—but remained under the control of the mice’s natural feedback systems that would shut it off when the crisis passed.

Mice with SuperFAK showed a much stronger FAK response during a heart attack than mice with the natural protein, and three days later had about 50 percent less heart damage. Critically, SuperFAK deactivated at the appropriate time, so the eight-week follow-up revealed no detrimental effects.

The findings offer evidence that, rather than simply activating or de-activating key proteins, researchers can benefit from a more nuanced approach that taps into the body’s natural feedback loops. “I think folks could use this idea to exploit mutations in other molecules—by thinking about how to modify the protein so that it can be under natural controls,” said Taylor. “Negative feedback loops are important because they ‘reset’ the system.”

The findings also may help researchers augment FAK in patients undergoing chemotherapy. Some chemotherapy drugs are known to break down FAK, leaving patients’ hearts more vulnerable to damage.

Co-authors included Zhaokang Cheng, Laura A. DiMichele, Zeenat S. Hakim, Mauricio Rojas and Christopher P. Mack. The research was supported by grants from the National Institutes of Health and the American Heart Association.

Are you HeartAware? Check your risk!

February is Heart Month. Heart-health assessment can be as easy as taking the HeartAware Risk Screening offered by the Heart and Vascular Centers at UNC and Rex. Unlike some diseases, cardiovascular disease can largely be predicted and prevented.

More than 79 million Americans have heart disease and many don't know it. Visit http://www.uncrexheartaware.com to complete your risk assessment now! You can learn more and read a list of "Questions and Answers" about the assessment and your options for a free follow-up appointment at the UNC Center for Heart & Vascular Care's website.

The HeartAware online evaluation takes only seven minutes and provides information about your personal risk for heart disease. Answer a few simple questions and HeartAware will provide you with a report of your risk factors and recommendations for improving and maintaining a healthy lifestyle.

Cardiac awareness and information about heart disease on the HeartAware website are provided by the National Heart Organization.

Paul Mounsey, BM BCh, PhD, MRCP, FACC

Paul Mounsey, BM BCh, PhD, MRCP, FACC is Professor and Director of Electrophysiology in the Department of Medicine, Division of Cardiology. He is an expert on cardiac electrophysiology including invasive and non-invasive treatment of cardiac arrhythmias, pacer and defibrillator implantation and lead extraction, and biventricular ablation of all forms of heart arrhythmias including SVT & VT.

To set up an interview with Dr. Mounsey, contact:

Tom Hughes
Media Relations/Social Media Strategist
UNC Health Care Communications, Marketing and External Affairs
984-974-1151 Office
919-923-6964 Mobile


Sidney C. Smith, MD

Sidney C. Smith, MD is Professor in the Department of Medicine. He is an expert on interventional cardiology, coronary angioplasty, valvular heart disease, coronary heart disease, and preventive cardiology.

To set up an interview with Dr. Smith, contact:

Tom Hughes
Media Relations/Social Media Strategist
UNC Health Care Communications, Marketing and External Affairs
984-974-1151 Office
919-923-6964 Mobile


ROCK off: Study establishes molecular link between genetic defect and heart malformation

The study also shows that treatment with a drug that regulates cell shape rescues the cardiac defect, pointing to therapeutic avenues that could one day benefit Noonan syndrome patients.
ROCK off: Study establishes molecular link between genetic defect and heart malformation click to enlarge A single cell carrying a Noonan syndrome associated mutation in which cell adhesion and cell shape changes have been rescued (as shown in green). Credit: Joan M. Taylor and Frank L. Conlon, UNC-Chapel Hill.

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Monday, Feb. 6, 2012

CHAPEL HILL, N.C.  – UNC researchers have discovered how the genetic defect underlying one of the most common congenital heart diseases keeps the critical organ from developing properly. According to the new research, mutations in a gene called SHP-2 distort the shape of cardiac muscle cells so they are unable to form a fully functioning heart.

The study also shows that treatment with a drug that regulates cell shape rescues the cardiac defect, pointing to therapeutic avenues that could one day benefit Noonan syndrome patients. The results, which were produced in a frog model of the disease, appeared online January 25, 2012, in the journal Development.

Genetic studies have shown that SHP-2 plays a critical role in human physiology and disease. Interestingly, different mutations in different portions of SHP-2 result in three different diseases – Noonan syndrome, a severe congenital heart disease; juvenile myelo-monocytic leukemia, a lethal form of cancer; and Leopard syndrome, a rare condition with skin, facial and cardiac abnormalities. This observation has intrigued a number of researchers, including senior study author Frank Conlon, PhD.

“I’ve wondered how it is that one mutation gives heart disease and doesn’t affect your white blood cells, and another will wipe out your white blood cells and leave your heart alone,” said Conlon, an associate professor of genetics and a member of the UNC McAllister Heart Institute. He and others have explored this mystery by creating transgenic animals -- fruit flies, mice, or in Conlon’s case, frogs -- that possess a mutated form of SHP-2.

When Conlon and his team genetically engineered frogs to contain the very same defects seen in humans with Noonan syndrome, they found that the frogs did in fact develop cardiac defects. But when they created them with a mutation seen in humans with leukemia, there were no heart defects. The researchers then performed 3D modeling on the animals to assess the nature of the anatomical defects, and discovered that actin filaments – proteins responsible for giving structure to the cardiac muscle cells -- were the ones affected.

Conlon and his collaborator Joan Taylor, PhD, an associate professor of pathology and laboratory medicine at UNC, then tested whether they could reverse the heart malformation using a drug called fausidil that had been shown to improve cardiac function in animal models of heart failure. The drug blocks a protein called ROCK that resides in the same neighborhood – or pathway – of intracellular processes as SHP-2.

The researchers dissolved the drug in the mutant frogs’ water tank and found that it did correct the cardiac defects. Their findings connect the dots between Noonan syndrome’s underlying genetic defect and the resulting cardiac malformations.

“The human mutations could have been linked to anything, proliferation or cell death, and what this study does is it links it to cell shape changes, which are mediated by this important molecule ROCK,” said Conlon. “Our lab studies heart development and heart disease, so we are interested in how this one set of mutations specifically target that one organ. Why the heart? We still have to figure that out.”

The research was funded in by the National Institutes of Health and the American Heart Association. Study co-authors from UNC were Yvette Langdon, PhD; Panna Tandon, PhD; Erika Paden; and Jennifer Duddy.

Benefits of statin therapy may extend beyond lowering lipids

A study led by researchers from the University of North Carolina at Chapel Hill School of Medicine has identified a molecular pathway that leads to the formation of abnormal blood clots. They turned it off using a popular class of cholesterol-lowering drugs, statins.
Benefits of statin therapy may extend beyond lowering lipids click to enlarge This image shows how formation of a blood clot cuts off the blood supply. Credit: Nigel Mackman, PhD, UNC McAllister Heart Institute.

Media contact: Les Lang (919) 966-9366, llang@med.unc.edu

Wednesday, Jan. 4, 2012

CHAPEL HILL, N.C. – People with high cholesterol are at risk of heart attack and stroke because atherosclerotic plaques within their arteries can rupture triggering the formation of a blood clot called an occlusive thrombus that cuts off the blood supply to their heart or brain.

For years, scientists have studied the cause of this abnormal clotting. Now, a study led by researchers from the University of North Carolina at Chapel Hill School of Medicine has identified a molecular pathway that leads to this abnormal blood clotting. The researchers then turned off the pathway by using a popular class of cholesterol-lowering drugs, statins.

The research was performed using humans, monkeys and mice with highly elevated blood lipid levels. It indicated that elevated levels of oxidized low density lipoprotein (LDL) induces a molecule called “tissue factor” that triggers clotting. The study appears online in the January 3, 2012 issue of the Journal of Clinical Investigation.

“Statins have been shown to have antithrombotic activity in several previous studies. However, I believe our study is the first to elucidate how statins reduce the activation of the blood clotting process independently of their lipid lowering activity, said senior study author Nigel Mackman, PhD, FAHA. Mackman is the John C. Parker Distinguished Professor of Hematology in the Department of Medicine and Director of the UNC McAllister Heart Institute.

Additionally, Mackman noted that statins “only target the ‘bad and inducible tissue factor’, not the good one used in normal clotting, and therefore should not be associated with the increased bleeding risk that is a typical side effect of anticoagulant drugs currently on the market.”

Mackman has spent the last twenty-five years studying tissue factor, the number one initiator of clotting in the body. Tissue factor normally resides outside the blood vessels, only coming into contact with blood after an injury, such as cutting your finger. However, it is expressed at high levels under certain abnormal conditions, such as inside atherosclerotic plaques, and gets turned on in a special subset of blood cells called monocytes. Mackman wondered if this was the cause for the abnormal clotting seen in patients with high cholesterol.

To test his hypothesis, Mackman and his colleagues analyzed humans, monkeys and mice with high cholesterol. They found that all three groups have elevated levels of tissue factor in the circulation.

Then the researchers treated the mice and monkeys with simvastatin, a drug widely used to treat high blood cholesterol levels. They showed that simvastatin reduced levels of oxidized low density lipoprotein and circulating tissue factor which normalized coagulation without altering plasma cholesterol levels. These results suggest that oxidized low density lipoproteins induce tissue factor expression on monocytes and this contributes to formation of an occlusive thrombus after plaque rupture.

“Though statin therapy is primarily prescribed to lower cholesterol, some added benefits are its anti-inflammatory and antithrombotic activities,” said Mackman. “In terms of drug development, I think we should be trying to better understand the antithrombotic activities of statins so we can develop safer antithrombotic drugs that target the expression of inducible tissue factor.”

The research was funded largely by the National Heart, Lung and Blood Institute, a component of the National Institutes of Health. The majority of this work was performed by A. Phillip Owens III, PhD.  Other study co-authors from Dr. Mackman’s lab at UNC were Silvio Antoniak, PhD; Julie C. Williams; and Jianguo Wang, PhD.

UNC Hospitals Center for Heart & Vascular Care at Meadowmont offers new services, spaces

Since expanding in April 2011, the UNC Hospitals Center for Heart & Vascular Care at Meadowmont has grown to over 14,000 sq. feet and now offers more services than ever before.

The Meadowmont location now allows patients easier access to both heart and vascular services in the same place.  We strive to accommodate same day appointments for our providers as well as for diagnostics.

Services

  • Anticoagulation Clinic staffed by a PharmD
  • Aortic health
  • Arrhythmia monitoring
  • Cardiology Clinic with access to 20 cardiologists
  • Device monitoring and interrogation
  • Echocardiography, rest and stress testing
  • Electrocardiography
  • Heart and ambulatory blood pressure monitoring
  • Laboratory services
  • Nuclear imaging
  • Nuclear stress testing
  • Peripheral vascular ultrasound
  • Vascular Clinic with access to five vascular surgeons
  • Vascular access services provided by vascular interventional radiologists

Clinic Highlights

  • 18 exam rooms
  • 5 procedural rooms
  • 3 Pre- and post-procedural rooms
  • Device Clinic
  • Full Phlebotomy Lab
  • Peripheral Vascular Suite of 3 diagnostic rooms
  • Vascular Interventional Suite with procedure room
  • Vein Center

 

About the Heart and Vascular Center at Meadowmont

  • The center is open from 8 a.m. - 5 p.m. Monday through Friday
  • Free parking
  • New patient and referral appointments are available generally without a delay
  • Referring Physicians may utilize Open Access - the UNC Heart and Vascular Center’s One Call access for admissions, transfers, and consultations

 

Address:
300 Meadowmont Village Circle, Ste. 313
Chapel Hill, NC 27517
(approx. 3 miles from UNC Hospitals)

Phone: (919) 966-7244

Web: http://www.uncheartandvascular.org/index.php

Cell molecule identified as central player in the formation of new blood vessels

The molecule is the protein Shc (pronounced SHIK), and new blood vessel formation, or angiogenesis, is seriously impaired without it.
Cell molecule identified as central player in the formation of new blood vessels click to enlarge Control endothelial cells embedded in fibrin gel sprout and form new capillary-like tubes whereas Shc knockout endothelial cells fail to form new vessels.

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Monday Nov. 28, 2011

CHAPEL HILL, N.C. – Scientists at the University of North Carolina at Chapel Hill School of Medicine have identified a cellular protein that plays a central role in the formation of new blood vessels. The molecule is the protein Shc (pronounced SHIK), and new blood vessel formation, or angiogenesis, is seriously impaired without it.

The study, which appeared online Nov. 16, 2011 in the journal Blood, was led by associate professor of cell and molecular physiology at UNC, Ellie Tzima, PhD, who is also a member of the university’s Lineberger Comprehensive Cancer Center and the McAllister Heart Institute.

“Angiogenesis is the formation of new blood vessels from existing blood vessels and it’s a process that’s important during embryonic development and in the development of diseases such as cancer,” Tzima said. “So understanding the molecular mechanisms of how blood vessels form is important from the basic science perspective and for understanding and treating disease.”

Vascular networks form and expand by sprouting, similar to the way trees grow new branches. The process allows fresh oxygen and nutrients to be delivered to tissues, whether in a developing embryo or a cancerous tumor. Blood vessel formation is spurred by a variety of chemical signals that zoom along complex pathways. Some are cues that come from growth factors, others from the tissue matrix that the cells sit on. This extracellular matrix (ECM) serves the cell in a number of ways, such as supporting the cell’s structure, helping to regulate cell-to-cell communication.

The protein Shc, is known to regulate a number of important molecular signaling pathways, but its role in angiogenesis has remained unknown until now, Tzima says. She also points out that Shc is evolutionarily conserved, which indicates its essential importance across species.

“We hypothesized that Shc would be the central player that accepts signals from all of the stimuli that have been previously shown to be important for regulating blood vessel formation and would process them and regulate the cell’s response,” Tzima said. “And that is what we found – that Shc coordinates signals, those coming from growth factors as well as from the extracellular matrix.”

Tzima suggests that we imagine the cell as a complex highway network with electronic toll plazas through which cars with a transponder can whiz at highway speeds without slowing down. The system works because the transponder’s personalized signal is relayed to a computer system that calculates the toll and charges the car’s account in a flash. “Shc is the toll plaza, the checkpoint through which signals crucial to blood vessel formation must pass and get coordinated for proper angiogenesis to occur.”

In the study, Tzima and her team found that Shc is required for angiogenesis in zebrafish, mouse and human endothelial cell culture models of blood vessel formation.
“The animal studies gave us the broad perspective that Shc may be important to this process,” said graduate student and study first-author Daniel T. Sweet. “Zebrafish and mice have previously been used to explore blood vessel formation in vivo. We found that without Shc, blood vessel formation is impaired.”

“Then for a closer look we used a cell culture model to determine which endothelial cell processes require Shc for angiogenesis. We found it mediates signals from growth factor receptors and extracellular matrix receptors,” Sweet said.  “Shc is important for the crosstalk between these processes, meaning that they need to “talk” to each other in order to properly form a tube or to sprout and migrate. That’s the exciting thing about this paper.”

Tzima notes that elegant genetic models of mice have been used to understand important cellular processes, including angiogenesis. “But if you want to think about designing therapeutics it becomes much more important to understand the molecular mechanism. And this was the strength of the study.  We went all the way down to molecular interactions that allowed us to figure out this new angiogenesis pathway.”

UNC co-authors with Tzima and Sweet are Zhongming Chen, David M. Wiley, and Victoria L. Bautch. The research was supported by grants from the National Heart, Lung and Blood Institute, American Heart Association and Ellison Medical Foundation.

Scarring a necessary evil to prevent further damage after heart attack

Researchers have long sought ways to avoid scarring of the heart after a heart attack. But now new research from the University of North Carolina at Chapel Hill School of Medicine shows that interrupting this process can weaken heart function even further.
Scarring a necessary evil to prevent further damage after heart attack click to enlarge Epicardial cells (blue) form a single layer in the adult uninjured heart (panel A, arrowheads) but expand and give rise to cardiac fibroblasts in the injured heart (panel B, arrowheads). Image source: Arjun Deb, MD.

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Tuesday, Nov. 15, 2011

CHAPEL HILL, N.C. – After a heart attack, the portions of the heart damaged by a lack of oxygen become scar tissue. Researchers have long sought ways to avoid this scarring, which can harden the walls of the heart, lessen its ability to pump blood throughout the body and eventually lead to heart failure. But new research from the University of North Carolina at Chapel Hill School of Medicine shows that interrupting this process can weaken heart function even further.

In a study appearing online November 15, 2011, in the EMBO journal, the investigators observed that cells in the outer layer of the heart generated scar tissue. But when they blocked these cells from doing so, they essentially demonstrated that when fixing a broken heart, timing may be everything.

“We now know that scarring is a good thing, because it prevents a precipitous decline in heart function immediately after heart injury,” said Arjun Deb, MD, senior study author and assistant professor of medicine and cell and molecular physiology at the UNC School of Medicine. “The question is not whether, but when it makes the most sense to manipulate the cells of the heart to decrease scarring and enhance regeneration.” Deb is also a member of the UNC McAllister Heart Institute and the UNC Lineberger Comprehensive Cancer Center.

Regeneration happens naturally in lower organisms like zebrafish – the striped, thumb-sized inhabitants of household aquariums – but for some reason not in higher organisms like humans. Years ago researchers noticed that a thin outer layer of cells on the surface of the heart muscle – known as the epicardium – was playing an important role in regenerating the zebrafish heart after injury. But what role the epicardium might have in an injured mammalian heart was an open question.

By studying a mouse model of cardiac injury, Deb and his colleagues found that the epicardium of the mammalian heart was also activated after a heart attack. But unlike in zebrafish where the epicardium contributed to generation of heart muscle cells, in the mouse the epicardium generated fibroblasts, the fibrous cells that underlie scar tissue.

The researchers then found that a protein called Wnt1, which they had formerly shown to enhance function of human vascular stem cells, was driving stem cells within the epicardium to become fibroblasts. They wondered if interrupting this molecular pathway could ameliorate scarring and improve heart function. Surprisingly, when they interrupted Wnt1 signaling in genetically engineered mice, the mutants developed heart failure within 2 weeks after cardiac injury.

“There are clearly evolutionary parallels between the zebrafish and the mouse, but there must be some sort of a selection pressure in mammals to respond to heart injury by scarring, because if we interrupt this process then the heart quickly fails following injury,” said Deb. “In organisms where there is a high pressure of blood flow, these cells may need to turn into scar tissue to maintain the tensile strength of the heart wall and prevent catastrophic rupture,” speculates Deb.

Now Deb and his colleagues are genetically manipulating the stem cells residing in the epicardium at later time points to see if they can coax them to stop turning into fibroblasts and start forming heart-regenerating myocytes. If so, the approach could prove to be an invaluable way to help patients recover from a heart attack.

The research was funded by the National Institutes of Health and Ellison Medical Foundation. Study co-authors from UNC were Jinzhu Duan, PhD (first author), Costin M. Gherghe, MD, PhD, Dianxin Liu, PhD, Eric Hamlett, Luxman Srikantha, Laurel Rodgers, PhD, Jenna N. Regan, Mauricio Rojas, MD, MPH, and Monte Willis, MD, PhD.


UNC cardiologist named 2012 Judah Folkman Award recipient

Cam Patterson, MD, MBA, division chief of cardiology at the University of North Carolina at Chapel Hill School of Medicine, has been named the recipient of the 2012 North America Vascular Biology Association Judah Folkman Award in Vascular Biology.
UNC cardiologist named 2012 Judah Folkman Award recipient click to enlarge Cam Patterson, MD, MBA

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Thursday, Oct. 6, 2011

CHAPEL HILL, N.C. - Cam Patterson, MD, MBA, division chief of cardiology at the University of North Carolina at Chapel Hill School of Medicine, has been named the recipient of the 2012 North America Vascular Biology Association Judah Folkman Award in Vascular Biology.

The award recognizes outstanding contributions from vascular biologists who are at mid-career (within fifteen years of their first faculty appointment). Patterson is the Ernest and Hazel Craige Distinguished Professor of Cardiovascular Medicine and professor in the departments of pharmacology and cell and developmental biology. He is also associate dean for health care entrepreneurship and physician-in-chief for the UNC Center for Heart and Vascular Care.

In its announcement, the association states the Folkman Award “recognizes Patterson’s significant contributions to our understanding of the molecular mechanisms that control angiogenesis,” blood vessel development. Among other areas, this includes “groundbreaking work” in vascular endothelial growth factor (VEGF) cell receptor signaling.  

Moreover, group notes that the basic research findings emerging from Patterson’s laboratory are already making their way toward clinical trials involving new therapies aimed at cardiovascular blood vessel growth.

Patterson will present the Judah Folkman Award Lecture during the NAVBO Workshops in Vascular Biology 2012 to be held in Pacific Grove, California at the Asilomar Conference Grounds on Thursday, Oct. 18, 2012. At a ceremony following the lecture, Patterson will receive a plaque to commemorate the event and a monetary award.

Moses Judah Folkman, MD was a Harvard Medical School professor best known for his research on tumor angiogenesis, the process by which a tumor attracts blood vessels to nourish and sustain its existence. Folkman founded the field of angiogenesis research, which has led to the discovery of a number of therapies based on inhibiting or stimulating new blood vessel development.

UNC shares $6 million Leducq award to study heart failure

A collaborative network of European and North American scientists, including from the University of North Carolina at Chapel Hill School of Medicine, have been awarded a total of $6 million over five years to explore the biology of heart failure and to find new therapies for it.
UNC shares $6 million Leducq award to study heart failure click to enlarge Cam Patterson, MD, MBA

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Monday, Oct. 3, 2011

CHAPEL HILL, N.C. – A collaborative network of European and North American scientists, including from the University of North Carolina at Chapel Hill School of Medicine, have been awarded a total of $6 million over five years to explore the biology of heart failure and to find new therapies for it.

The grant was awarded by Fondation Leducq Transatlantic Networks of Excellence Program, headquartered in Paris, France. Fondation Leducq is a French non-profit health research foundation, which is designed to promote collaborative research involving centers in North America and Europe in the areas of cardiovascular and neurovascular disease.

“Proteotoxicity: an unappreciated mechanism of heart disease and its potential for novel therapeutics” is the title of this network’s award-winning project.  “Proteotoxicity” refers to potential health consequences due to the failure of cells to degrade and clear intracellular aggregated proteins. This may include misshapen or misfolded proteins that could, for instance, disrupt intracellular messages and impede chemical reactions.

“Recent discoveries suggest that the failure to clear aggregated proteins is a major factor in hereditary and acquired cardiac and skeletal muscle diseases,” said Network of Excellence Core member, Cam Patterson, MD, MBA, Ernest and Hazel Craige Distinguished Professor of Medicine and cardiology division chief at UNC. “This network is the first to harness the synergy between skeletal and cardiac muscle research in the emerging area of cardiac protein turnover and proteotoxicity by including experts in both fields.”

The project’s 3 main research aims are to (1) define the role of proteotoxicity in clinically relevant models of heart failure, (2) determine the networks of genes and gene products operating in cardiac muscle cell protein degradation and aggregation, (3) explore novel interventions to reduce and/or block proteotoxicity in animal models of cardiomyopathy and heart failure.

Sharing the new award with Patterson at UNC are network members Jeff Robbins, PhD at Cincinnati Children’s Hospital in Ohio; Mathias Gautel, MD, PhD at King’s College in London, England; Lucie Carrier, PhD, at the University Medical Center Hamburg-Eppendorf, in Hamburg, Germany; Marco Sandri, MD, PhD at the Venetian Institute of Molecular Medicine and University of Padova, Padova, Italy; and Joseph A. Hill, MD, PhD at the University of Texas Southwestern Medical Center, Dallas, Texas.

Since 2004 when grants were first awarded under the Transatlantic Networks of Excellence in Cardiovascular Research Program, 31 collaborative networks have been selected for Leducq support, representing more than 300 investigators at 115 institutions in 17 countries, with research interests spanning from heart failure to cerebral hemorrhage.

Paula F. Miller, MD

Paula F. Miller, MD is an associate professor, the Director of Cardiac Rehabilitation, and the Director of Women's Heart Program in the Department of Medicine. She is an expert in general cardiology with interest in prevention, stress and general echocardiography, cardiovascular fitness counseling, and womens' heart health.
Paula F. Miller, MD click to enlarge Paula F. Miller, MD

To set up an interview with Dr. Miller, contact:

Tom Hughes
Media Relations/Social Media Strategist
UNC Health Care Communications, Marketing and External Affairs
984-974-1151 Office
919-923-6964 Mobile


Crystal Wiley Cené, MD, MPH

Crystal Wiley Cené, MD, MPH, is an assistant professor in the Department of Medicine and an expert in cardiovascular disease, health disparities, social context of disease, and community-based participatory research.
Crystal Wiley Cené, MD, MPH click to enlarge Crystal Wiley Cené, MD, MPH

To set up an interview with Dr. Cené, contact:

Tom Hughes
Media Relations/Social Media Strategist
UNC Health Care News Office
(984) 974-1151 Office
(919) 923-6964 Mobile
Tom.Hughes@unchealth.unc.edu


A second chance for Jakeina

UNC heart surgeon Dr. Andy Kiser reflects on the remarkable story of one of his patients, Jakeina Sutton of Rose Hill, N.C., a 16-year-old who recently received a heart and kidney transplant. For Jakeina, this was her second heart transplant.
A second chance for Jakeina click to enlarge Members of UNC Women's Volleyball Team visit Jakeina Sutton in her room at UNC Hospitals. Photo by Tom Hughes.

Thursday, July 14, 2011

CHAPEL HILL, N.C. - How could this young lady need a heart transplant?  This was my first thought when I walked into the Emergency Room to see Jakeina for the first time.  Had it not been for the IV pump she carried I would have thought I was in the wrong room.

Jakeina and her family had been called to Chapel Hill from their home in Rose Hill for a potential heart and kidney transplant. Unfortunately, the transplant did not proceed and Jakeina had to return home. Jakeina had been born with an inherited heart disorder that causes it to fail. At four months of age, Jakeina underwent her first heart transplant by Dr. Michael Mill, the Director of Pediatric Cardiac Surgery at UNC. She recovered quickly and, for sixteen years, lived a normal life.  She joined a dance club, played volleyball, tennis, and soccer, and enjoyed her childhood in a near normal way.  

However, over the last three months, Jakeina had found herself more short of breath.  Her cardiologist at UNC, Dr. Elman Frantz,, discovered that her transplanted heart had begun to fail due to chronic rejection.  Additionally, the medication she had been taking for so long had caused her kidneys to begin to fail.  Jakeina needed another heart transplant and this time a kidney transplant.  On June 15, Jakeina was called back to Chapel Hill. She underwent successful retransplantation of her heart and twelve hours later had a new kidney transplanted.

As was expected, she recovered quickly and before long was roaming the halls with her younger brother and mother.  Before returning home, she was visited by the UNC volleyball team and their head coach. They were each one inspired by Jakeina’s attitude and enthusiasm about returning home and playing volleyball again.  In fact, she has a special invitation to participate in the UNC volleyball camp this summer.  God has blessed Jakeina with not one, but two, heart transplants. 

She is an example of courage and determination to her friends, her family, and to UNC.

Andy C. Kiser, MD, is Chief of the Division of Cardiothoracic Surgery.

Kiser named chief of Cardiothoracic Surgery

Andy C. Kiser, M.D., has been named chief of the UNC Division of Cardiothoracic Surgery, effective July 1, 2011. Dr. Kiser is a cardiothoracic surgeon who joined UNC as professor of surgery on Nov. 1, 2010. He is recognized as an international leader in arrhythmia surgery, having pioneered the paracardioscopic procedures to treat atrial fibrillation.
Kiser named chief of Cardiothoracic Surgery click to enlarge Andy C. Kiser, M.D.

He is a Fellow of the American College of Surgeons, American College of Cardiology, and the American College of Chest Physicians.

Dr. Kiser, a native of Moore County, N.C., earned his M.D. degree at UNC-Chapel Hill and completed his training in both General and Cardiothoracic Surgery at UNC, finishing in 2000. He practiced cardiac and thoracic surgery in Pinehurst until he joined the UNC faculty in November 2010. Since his return to UNC, Dr. Kiser has increased his clinical activity in minimally invasive cardiac and thoracic surgery, heart failure, and transplantation.

He replaces Michael R. Mill, M.D., who led the division as interim chief from 1998 to 1999 and as chief from 2000 to 2011.

Dr. Mill came to UNC in 1988 to be director of the UNC Heart and Heart-Lung Transplant programs. He performed both the first heart-lung transplant and the first pediatric heart-lung transplant in North Carolina. He has served as Director of the UNC Comprehensive Transplant Center since 1994 and has performed 150 heart transplants, including 50 pediatric heart transplants, here. He also started the mechanical cardiac assist device program at UNC. He specializes in pediatric cardiac surgery and will continue to serve as a faculty member and attending physician at UNC.

“The Department of Surgery especially appreciates the 13 years that Dr. Mill has provided strong leadership for the division, and his continued direction of the congenital heart surgery program,” said Anthony Meyer, chairman of the UNC Department of Surgery.

Dr. Mill has been active on regional and national levels with Carolina Donor Services, the United Network for Organ Sharing, the Society of Thoracic Surgeons, the Thoracic Surgery Directors Association, the American Association for Thoracic Surgery, the Congenital Heart Surgeons Society, and the Southern Thoracic Surgical Association. He helped the American Board of Thoracic Surgery develop the requirements for the first specialty certification in congenital cardiac surgery and in 2009 became one of the first physicians to earn that certification.

Dr. Mill was director of the UNC cardiothoracic surgery residency program during his time as chief. He served on the Residency Review Committee for Thoracic Surgery of the Accreditation Council for Graduate Medical Education, and participated in writing the requirements for the six-year integrated residency in cardiothoracic surgery, which enables medical-school graduates to enter a cardiothoracic residency straight from medical school and streamline their surgical training. (Previously, the path to becoming a cardiothoracic surgeon included about eight years of training after medical school.)

While Dr. Mill was chief, UNC added a six-year integrated residency in cardiothoracic surgery, which is now in its second year.

Dr. Mill earned an M.D. at the University of Colorado and did his residency in General Surgery there. He completed a residency in Thoracic Surgery and a fellowship in Heart and Heart-Lung Transplantation at Stanford University, where he trained with pioneering heart surgeon Norman Shumway.

Dr. Meyer said he would work with Dr. Kiser “to continue to further the goals of the Division of Cardiothoracic Surgery.” There are seven surgeons and six physician extenders in the division, which offers advanced treatments for a wide range of diseases and problems.

The division “is committed to caring for patients with complex cardiovascular problems such as aortic dissection, advanced heart failure, chronic atrial fibrillation, and lung or esophageal cancer,” Dr. Kiser said. “Collaboration is important, both within UNC Hospitals and statewide. Our vision is to develop more clinical partnerships with our colleagues.”

The division is part of the UNC Center for Heart and Vascular Care, which now has a one-call referral service (866-862-4327) to enable physicians to arrange consultations as well as admissions and transfers of patients to UNC Hospitals for care.

UNC Hospitals qualifies for American Heart Association’s Mission: Lifeline Recognition for heart attack care

The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients that effectively improves the survival and care of STEMI (ST Elevation Myocardial Infarction) patients.
UNC Hospitals qualifies for American Heart Association’s Mission: Lifeline Recognition for heart attack care click to enlarge For more information, see www.heart.org/quality.

Media contact:  Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

Monday, June 27, 2011

CHAPEL HILL, N.C. – UNC Hospitals recently qualified for the American Heart Association’s Mission: Lifeline Silver Performance Achievement Award. The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients that effectively improves the survival and care of STEMI (ST Elevation Myocardial Infarction) patients.
     
Every year, almost 250,000 people experience the STEMI type of heart attack. Unfortunately, a significant number don't receive prompt reperfusion therapy, which is critical in restoring blood flow.  Mission: Lifeline seeks to save lives by closing the gaps that separate STEMI patients from timely access to appropriate treatments. Mission: Lifeline is focusing on improving the system of care for these patients and at the same time improving care for all heart attack patients.
   
Hospitals involved in Mission: Lifeline strive to improve care in both acute treatment measures and discharge measures. Systems of care are developed that close the gap of timely access to appropriate, life-saving treatments. Before they are discharged, appropriate patients are started on aggressive risk reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers in the hospital and receive smoking cessation counseling.
   
Hospitals that receive the Mission: Lifeline Silver Performance Achievement Award have demonstrated for 12 consecutive months that at least 85 percent of eligible STEMI patients (without contraindications) are treated within specific time frames upon entering the hospital and discharged following the American Heart Association’s recommended treatment guidelines. 
   
“UNC Hospitals is dedicated to making our cardiac unit among the best in the country, and the American Heart Association’s Mission: Lifeline program is helping us accomplish that by making it easier for our professionals to improve the outcomes of our cardiac patients,” said Cam Patterson, MD, MBA, Chief of Cardiology at UNC Hospitals and Physician-in-Chief of the UNC Center for Heart & Vascular Care. “We are pleased to be recognized for our dedication and achievements in cardiac care.”


About UNC Hospitals
UNC Hospitals is an 803-bed public, academic medical center operated by and for the people of North Carolina. The Hospitals' mission is to provide high quality patient care, to educate health care professionals, to advance research and to provide community service. UNC Hospitals includes North Carolina Cancer Hospital, North Carolina Children's Hospital, North Carolina Memorial Hospital, North Carolina Neurosciences Hospital, and North Carolina Women's Hospital. Each year UNC Hospitals cares for patients from all 100 counties in North Carolina and several surrounding states.

About Mission: Lifeline
The American Heart Association’s Mission: Lifeline program helps hospitals and emergency medical services develop systems of care that follow proven standards and procedures for STEMI patients. The program works by mobilizing teams across the continuum of care to implement American Heart Association/American College of Cardiology clinical treatment guidelines. For more information, visit heart.org/missionlifeline and heart.org/quality.

Mackman appointed Director of the UNC McAllister Heart Institute

The School of Medicine is pleased to announce the appointment of Nigel Mackman, PhD, FAHA, as the new Director of the UNC McAllister Heart Institute (MHI).

Dr. Mackman, the John C. Parker Distinguished Professor of Hematology in the Department of Medicine, has served as Associate Director of the UNC MHI  since 2009.  Dr. Mackman came to UNC in 2007 from The Scripps Research Institute in La Jolla , CA where he worked for 20 years.

Dr. Mackman’s research focuses on hemostasis, thrombosis and crosstalk between coagulation and inflammation. In particular, he studies tissue factor, which is the primary cellular initiator of blood coagulation. His research has been recognized by the American Heart Association (AHA) and the International Society of Thrombosis and Hemostasis. He won the AHA Louis N. Katz Basic Science prize in 1991, presented the prodigious AHA Sol Sherry Distinguished Lecture in Thrombosis in 2009 and received the AHA Jeffery M. Hoeg Arteriosclerosis, Thrombosis and Vascular Biology Basic Science Award in 2011. Currently, he is Chair of the ATVB Council of the American Heart Association.

The school is confident that Dr. Mackman will provide the vision and leadership that will establish the UNC MHI as a leading cardiovascular center with excellence in research.  The UNC MHI will continue to strengthen and develop its cross-disciplinary collaborations and interactions with other departments and centers on campus.

Stavas inducted into SIR as a Fellow

Joseph Stavas, MD, professor of Radiology, has been inducted into Society of Interventional Radiology (SIR) as a Fellow. The induction took place on March 30, during SIR's 36th Annual Scientific Meeting in Chicago.
Stavas inducted into SIR as a Fellow click to enlarge Joseph Stavas, MD

"Being named a Society of Interventional Radiology Fellow is the highest recognition by one's peers and acknowledges sustained outstanding performance," said SIR President Timothy P. Murphy, M.D., FSIR, who represents the society's nearly 4,700 doctors, scientists and allied health professionals dedicated to improving health care through minimally invasive treatments.

Stavas earned his medical degree from the Creighton University and did specialty training at the University of Minnesota and University of California, San Diego.

SIR is a national organization of physicians, scientists and allied health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapeutic interventions. More information about the Society of Interventional Radiology, interventional radiologists and how to find an interventional radiologist in your area can be found online at www.SIRweb.org.

Project TICKER underway; first newsletter published

Project TICKER (Teamwork to Improve Cardiac Kids' End Results), which began in September of last year, aims to implement a patient- and family-centered safe practice infrastructure for pediatric congenital heart disease patients at N.C. Children’s Hospital.

The Project TICKER plans to do this by (1) implementing a robust communication and teamwork foundation for the general care of the inpatient pediatric congenital heart disease service line using a tailored training program, TeamSTEPPS and (2) designing and implementing integrated clinical pathways (ICPs) for two of the most common congenital heart disease diagnoses using the specific teamwork tools of TeamSTEPPS and evidence‐based standardized care.

The project is funded by a $580,000, two-year grant from the Agency for Healthcare Research and Quality (AHRQ). Tina Schade Willis, MD, assistant professor of anesthesiology is principal investigator for the project. Co-investigator Michael Mill, MD, professor of surgery and chief of the UNC cardiothoracic surgery division, is the lead surgical content expert for the project and Scott Buck, MD, associate professor of cardiology and another co-investigator on the project, is the lead cardiology content expert, providing cardiology expertise for clinical pathways design and teamwork units across the service line.

Since September, the team has focused specifically on the first goal of the project - to train all personnel involved in the Pediatric Cardiac Service Line in TeamSTEPPS. So far, all areas - the Pediatric Cardiac OR, Pediatric ICU, Children’s Intermediate Cardiac Care (CICC), and the Newborn Critical Care Center – have participated in training and expect to have all staff trained by the end of June.

Additionally, since Project TICKER aims to take a family-centered approach to medical care, five patient families are acting as advisors to the project. Dr. Willis led the first family advisor meeting in March.

With TeamSTEPPS training near completion, the group is beginning to work toward their second goal – to design and implement ICPs, which are essentially patient care plans. The ICPs are designed to improve quality by decreasing unnecessary variations in care and standardizing best practices. Frontline staff, patients, and the families advisors will all play an important role the development of these clinical pathways.

To read more about the TeamSTEPPS training and the family advisors for the project, please take a look at the first issue of the Project TICKER newsletter, which was published in April.

Be on the lookout for more news about the project over the next few months.

Family House Diaries: A New Heart + A New Kidney = A New Life

A new heart and a new kidney give a 28-year-old Wilson woman, unwell since age 7, a second chance at life. Crystal Sharpe becomes the 11th recipient of a heart and kidney transplant at UNC Hospitals.
Family House Diaries: A New Heart + A New Kidney = A New Life click to enlarge Crystal Sharpe, at left, and her mother, Patricia Sanders.

Media contact: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

Wednesday, May 18, 2011

Written by Elizabeth Swaringen for UNC Health Care

CHAPEL HILL, N.C. – Crystal Sharpe’s smile radiates energy, even over the telephone.  A new heart and a new kidney will do that.

Sharpe, 28, of Wilson, N.C., received a new heart and a new kidney on March 27, becoming the 11th heart-kidney transplant patient at UNC Hospitals. Unwell since age 7, Crystal is ready to get on with living.

“I don’t think this was a hard journey,” said Crystal, matter-of-factly. “I know God had my back.  I know the surgeries had to be done. I really feel like I have more energy. I’m ready to get on with life.”

Crystal, a dynamo at 4’ 6” and 64 pounds, became a patient at UNC Hospitals in 2008 because her only kidney was growing weaker. She had lost her right kidney in 1989 to Wilm’s tumor, a rare kidney cancer in children.

Crystal started dialysis in January 2009 and in August contracted Stevens-Johnson Syndrome (SJS), a rare disorder in which skin and mucous membranes react severely to medications or infection. Already on the kidney transplant list, Crystal joined the heart transplant list with congestive heart failure in October 2010. 

Crystal had completed two years at N.C. A&T State University in Greensboro and was working as a Wal-Mart manager when she got sicker. She moved back home to Wilson, to her primary caregiver, her mother, Patricia Sanders.

“Whenever she’s sick, I’m right there, always have been,” said Patricia, 49, who would spend weekdays in Greensboro and weekends in Wilson caring for her brother who had cancer. “I love my family, and I do whatever it takes to care for them.”

Crystal’s condition worsened and on Jan. 4 she was admitted to UNC Hospitals. Patricia came with her and when not at Crystal’s side, stayed at SECU Family House, a 40-bedroom hospital hospitality house minutes from UNC Hospitals.  Family House provides comfortable, convenient and affordable housing for seriously ill adult patients and their family member caregivers.

“Everything about Family House is good,” Patricia said. “I met a lot of different people there, and we were able to comfort each other.  And the variety of people and organizations voluntarily cooking is a special treat.”

On March 26, Patricia was in Wilson when the call came that donor organs were available.

“That very day we had held a fundraiser for Crystal with family and friends,” Patricia remembers. “We raised about $1,800. Crystal’s sister, Syreeta, carried a plate of food to UNC. Crystal ate it and about an hour and 15 minutes later she got the call there was a donor.”

Three carloads of family and friends with Patricia leading the way came to UNC Hospitals to see Crystal before the heart transplant surgery, which would be followed by the kidney transplant once Crystal stabilized. After visiting until the wee hours of March 27, all left but Patricia, who was with Crystal when word came that both the heart and the kidney – which had to come from the same donor – were for Crystal.

“When you need both a heart and a kidney it can be an ordeal to make sure everything matches up,” said Andy C. Kiser, MD, professor of surgery in the Division of Cardiothoracic Surgery at the UNC Center for Heart and Vascular Care, who implanted the new heart. “It took us a few hours to make sure everything was going to work.”

By the time Dr. Kiser came to share the good news, both Crystal and Patricia had fallen asleep. Patricia figures she had been up about 36 hours since she was up at day break the day before cooking for the fundraiser.

“I’ll never forget their reaction,” Dr. Kiser said. “Her Mom woke up first, then Crystal. They are a very Christian family with a lot of faith in the Lord. They were extremely grateful and gratified and not the least bit apprehensive, although it was major surgery. When you have dealt with a chronic disease most of your life, you deal with life and death on a different level from most people. You see the surgery, however major, as another chance at life.”

And that’s what Crystal has done. She returned home on April 14 and looks forward to returning to her college studies in child development.

“She should begin to start living a normal life,” Dr. Kiser said. “She doesn’t have to do dialysis anymore, but we do have to continue monitoring her heart and kidney to make sure they are working as they should. She has such a wonderful attitude and a strong support network in her family. She is very dear to a lot of the staff because she was in the hospital so long. We are very optimistic she will do fine.”

And the smile? 

“As sick as she was, she never gave up, and she has always had a smile on her face,” said Patricia. “Now, it might just be a little bigger or a little deeper, if that’s possible.”

New implantable cardiac pacemaker approved for use in MRI

The FDA has approved for use in MRI a new implantable cardiac pacemaker, Medtronic’s RevoMRI SureScan Pacing System.

Dear faculty and staff,


The FDA has approved for use in MRI a new implantable cardiac pacemaker, Medtronic’s RevoMRI SureScan Pacing System. The Centers for Medicare and Medicaid Services have also approved billing for MR services for patients with this device.  Please note that at the present time, this is the only approved pacemaker for use in MRI, so prior to anticipated MR scanning, it is essential that we are certain the patient has this device.

Richard Semelka
Director MR Services

UNC, Feins win grant to study surgery simulation training

The Agency for Healthcare Research and Quality (AHRQ) has awarded a three-year, $1.05 million grant to the University of North Carolina at Chapel Hill to study use of simulators for cardiac surgery training.
UNC, Feins win grant to study surgery simulation training click to enlarge Richard H. Feins, M.D.

The multi-institution project will study whether resident physicians who are learning cardiothoracic surgery can become safer surgeons by using surgery simulators to acquire skills before they operate on people. Richard H. Feins, M.D., a thoracic surgeon in the Division of Cardiothoracic Surgery at UNC, is principal investigator of the project, which will involve cardiothoracic surgery residents at UNC and physicians and residents at seven other institutions:

Massachusetts General Hospital (Jennifer Walker, M.D.); Mayo Clinic (Harold Burkhart, M.D.), Johns Hopkins University (John Conte, M.D.), University of Rochester (George Hicks, M.D.), Stanford University (James Fann, M.D.), Vanderbilt University (Jonathan Nesbitt, M.D.), University of Washington (Nahush Mokadam, M.D.).

In most surgical training, technical skills are taught by apprenticeship: residents learn surgery in the operating room, doing parts or all of real operations on real patients. Dr. Feins' study intends to show that training in cardiac surgical techniques can be improved by using surgery simulation technology combined with a rigorous, simulation-based curriculum.

The project will determine the effectiveness of using simulator-based training of resident surgeons in component tasks and overall procedures based on six modules: three types of cardiac surgical operations and three significant adverse events that can occur during cardiac surgery. The procedures will be taught using a computer-controlled, tissue-based cardiac surgery simulator which has been shown to realistically duplicate the actual patient undergoing cardiac surgery. The simulators are mannequins with computer-controlled pig hearts placed inside the chest area.

Assessment data from each site will be entered into a study database which will be developed and managed at the University of North Carolina. While the study will test the hypothesis that cardiac surgery residents can be trained to be safer surgeons by using appropriate simulator-based training, the results should apply equally well across a broad spectrum of surgical practice.

AHRQ is part of the U.S. Department of Health and Human Services. The grant period is May 1, 2011, to April 30, 2014.

A 2011 article in Endeavors, UNC's research magazine, describes the simulation training. Read the article here.

FDA approves pacemaker for use in MRI

The FDA has approved for use in MRI a new implantable cardiac pacemaker, Medtronic’s RevoMRI SureScan Pacing System.

The Centers for Medicare and Medicaid Services have also approved billing for MR services for patients with this device.  Please note that at the present time, this is the only approved pacemaker for use in MRI, so prior to anticipated MR scanning, it is essential that we are certain the patient has this device.

Mackman to give the Jeffrey M. Hoeg Lecture at ATVB Spring Meeting

Nigel Mackman, PhD, FAHA, is the John Parker Distinguished Professor of Medicine in the Division of Hematology/Oncology. He is also Associate Director of the UNC McAllister Heart Institute. He will give the honorary lecture at the 2011 Spring Arteriosclerosis, Thrombosis and Vascular Biology meeting in April.
Mackman to give the Jeffrey M. Hoeg Lecture at ATVB Spring Meeting click to enlarge Dr. Nigel Mackman

The Jeffrey M. Hoeg Arteriosclerosis Award for Basic Science and Clinical Research was established in 1999. The award recognizes an established investigator in the prime of his/her career who has made an outstanding contribution to further understanding of the pathophysiology of atherosclerosis and/or for the development of treatment strategies for its prevention through basic and clinical research efforts.

The award honors the memory of Jeffery M. Hoeg, chief of the Section of Cell Biology within the Molecular Branch of the National Heart, Lung and Blood Institute. He was an extraordinary research scientist and physician who, in the prime of his career, was working on the field of lipoprotein metabolism and atherosclerosis. Dr. Hoeg died in July 1998 after a courageous battle with cancer.


Scientists identify molecule that can increase blood flow in vascular disease

UNC researchers have discovered that a molecule called Wnt1 can improve the function of endothelial progenitor cells, increasing the blood flow to organs that previously had been cut off from the circulation.
Scientists identify molecule that can increase blood flow in vascular disease click to enlarge Human endothelial progenitor cells grown in the lab (left) and forming capillary tube like structures (right).

Media contact:  Les Lang, (919) 966-9366, llang@med.unc.edu

Thursday, March 10, 2011

CHAPEL HILL, N.C. – Circulating through the bloodstream of every human being is a rare and powerful type of cell, one that can actually create new blood vessels to bypass blockages that cause heart attacks and peripheral artery disease. Though everyone has these cells – called endothelial progenitor cells – they are often dysfunctional in people prone to vascular disease.

Now researchers at the University of North Carolina at Chapel Hill have discovered that a molecule – called Wnt1 – can improve the function of endothelial progenitor cells, increasing the blood flow to organs that previously had been cut off from the circulation. The finding could enhance clinical trials already testing these powerful cells in patients hospitalized with cardiac arrest.

“The premise of these trials is that these cells will supply the ischemic organ with new blood vessels and allow the damaged organ to function better,” said senior study author Arjun Deb, MD, assistant professor of medicine in the UNC School of Medicine. “But because you are isolating these cells from the patients themselves, you know that the cells are dysfunctional -- so the approach is almost flawed from the very beginning. We want to see how we can improve the function of these cells so they can do their job better.”

The study, published online Feb. 14, 2011, in the FASEB (Federation of American Societies for Experimental Biology) Journal, is the first to show that the Wnt1 protein, one of a family of 19 such molecules, can stimulate blood vessel formation.

A number of studies in the past few years have suggested that genes that play an important role during early development and get “turned off” during adulthood may also get “turned on” or expressed again in response to injury, such as heart attack.

Deb, who studies the Wnt family of developmental genes, looked to see if any of its members follow this same pattern. He found that one gene in particular, Wnt1, was expressed during development of blood vessels, shut off during adulthood and then re-expressed in angiosarcoma, a cancer of endothelial cells.

Deb wanted to see what would happen if he put the Wnt1 protein on human endothelial progenitor cells. He found that treating these special cells with Wnt1 not only greatly increased their function but also their number. Next, Deb and his colleagues investigated what effect the protein would have on a mouse model of peripheral artery disease, an illness in humans caused by decreased blood flow to the extremities. They found that treating these animals with a single injection of the Wnt1 protein resulted in almost three fold increase in blood flow in the affected areas.

“We found that Wnt1 is a novel proangiogenic molecule, something that has never been shown before,” said Deb. “It gives us hope that injecting the Wnt1 protein -- or molecules that stimulate the Wnt1 signaling pathway -- into ischemic tissues in humans could improve blood flow and assert a therapeutic effect.”
 
Approximately 1 in 4 deaths in adults in the US are secondary to heart disease and as many as 15 percent of Americans age 65 and older have peripheral artery disease. In the future, Deb plans to use his findings to identify such small molecules or drug candidates that could reverse the endothelial progenitor cell dysfunction observed in so many patients with vascular disease.

The research was funded by the National Institutes of Health and Ellison Medical Foundation. Study co-authors were Costin M. Gherghe, MD, PhD, postdoctoral fellow in Deb’s lab; Jinzhu Duan, PhD, postdoctoral fellow in Deb’s lab; Jucheng Gong, lab manager in Deb’s lab; Mauricio Rojas, MD, MPH, director of mouse cardiovascular models core lab; Nancy Klauber-Demore, MD, associate professor of surgery; and Mark Majesky, PhD, Professor of Pediatrics, University of Washington, Seattle.

Smith leads World Heart Federation

Dr. Sidney Smith, Professor of Medicine/Cardiology, began serving a two-year term as President of the World Heart Federation (WHF) in January 2011.
Smith leads World Heart Federation click to enlarge Sidney Smith, MD

The WHF, based in Geneva, is a non-governmental organization focused on coordinating the programs of its 204 member cardiovascular societies and foundations worldwide in the global fight against heart disease and stroke, with an emphasis on low and middle income countries. The American Heart Association and the American College of Cardiology are member organizations representing the United States.

Dr. Smith’s tenure as president will include presiding at the 2012 WHF World Congress of Cardiology in Dubai, United Arab Emirates, in 2012. The WHF held its last Congress in 2010 in Beijing, China. One of Dr. Smith’s major goals for the WHF is to bring cardiovascular disease to the forefront of the global health agenda through a partnership with the Non-Communicable Disease Alliance. He will also attend a United Nations summit in September 2011 to discuss the global problem of cardiovascular disease. In addition major programs in international guidelines have been initiated.

While serving as president Dr. Smith will continue to be clinically active, working at UNC as an attending physician and seeing his regular patients.


Just in time for Valentine’s Day: UNC researchers identify a gene critical for heart function

It's a gene called DOT1L, and if you don’t have enough of the DOT1L enzyme, you could be at risk for some types of heart disease. These findings by UNC researchers appear in the journal Genes and Development.
Just in time for Valentine’s Day: UNC researchers identify a gene critical for heart function click to enlarge Hearts from a wild type control mouse (left) and from a DOT1L-deleted mouse displaying dilated cardiomyopathy (right) . In the absence of DOT1L hearts become severely enlarged, compromising heart function.

Media contact: Les Lang, (919) 966-9366, llang@med.unc.edu

Friday, Feb. 4, 2011

CHAPEL HILL, N.C. – Everyone knows chocolate is critical to a happy Valentine’s Day. Now scientists are one step closer to knowing what makes a heart happy the rest of the year.

It’s a gene called DOT1L, and if you don’t have enough of the DOT1L enzyme, you could be at risk for some types of heart disease. These findings from a study led by researchers at the University of North Carolina at Chapel Hill School of Medicine appear in the Feb. 1, 2011 issue of the journal Genes and Development.

The team created a special line of mice that were genetically predisposed to dilated cardiomyopathy, a condition in which the heart expands like a balloon, causing its walls to thin and its pumping ability to weaken. About one in three cases of congestive heart failure is due to dilated cardiomyopathy, a condition that also occurs in children.

These mice lack DOT1L. The big discovery came when the researchers were able to prevent the mice from developing the disease by re-expressing a single downstream target gene, Dystrophin.

“We saw this phenotype in the heart and it could be attributed to anywhere between 1 and 1,000 genes. But when we just added back this one gene, the heart function was completely rescued,” said the study’s lead author, Anh Nguyen, a graduate student in the lab of biochemist Yi Zhang, PhD, at UNC’s Lineberger Comprehensive Cancer Center. “It was very surprising to us,” Nguyen added. “Normally you’d think you’d have to add in a number of genes to really see that effect.”

The researchers discovered that the gene depends on the enzyme DOT1L to activate it. If DOT1L levels fall too low, Dystrophin ceases to perform its function, eventually leading to heart disease.

“We’ve identified a new function of DOT1L, which has been linked to leukemia before, but never linked to heart defects,” said Zhang, Kenan Distinguished Professor of biochemistry and biophysics and an Investigator of the Howard Hughes Medical Institute.

Learning how the DOT1L affects Dystrophin could eventually help to improve diagnosis and treatment of patients with dilated cardiomyopathy and other conditions. “The more we know about the protein, the better we can use it,” Zhang said.

The protein could be a target for gene therapy, for example. “If you could manipulate the function of DOT1L, then you could essentially regulate everything else downstream, including Dystrophin or other genes,” explained Nguyen.

In addition to their experiments using mice, the team examined samples of human heart tissue. Patients with dilated cardiomyopathy had lower levels of DOT1L than patients with no underlying heart condition, suggesting that the protein’s role in humans is similar to its role in mice.

The findings also have potential relevance for Duchenne muscular dystrophy, which is caused by defects in Dystrophin function. About 90 percent of people with muscular dystrophy develop dilated cardiomyopathy; this study suggests perhaps low levels of DOT1L could be a common factor in both conditions.

The study’s collaborators include Xiao Xiao, PhD, Fred Eshelman Distinguished Professor of Gene Therapy in the division of molecular pharmaceutics in the UNC School of Pharmacy, Da-Zhi Wang, PhD, of Harvard Medical School, and Taiping Chen, PhD, of Norvartis Institutes for Biomedical Research.

Taylor

While infant daughter, Taylor, was hospitalized for nearly two months after open heart surgery, mom, Tori, had to return home to Greensboro to work and care for her other children, but caregivers at N.C. Children's Hospital kept her part of her daughter's care across the miles.

Heartwarming: Nurses keep Greensboro mom connected to her baby from afar

Taylor was born with breathing problems so severe she was airlifted from her hometown hospital in Greensboro, N.C., to N.C. Children's Hospital in Chapel Hill, N.C.

Taylor had surgery that same day and open-heart surgery less than a week later. She then spent nearly two months at the Children's Hospital—first in the pediatric intensive care unit (PICU) and then the cardiac intermediate care center (CICC) on 5 Children's—recovering from her surgeries.

Her mother, Tori, could not stay in Chapel Hill with her newborn daughter but had to return home to work and care for her other children. Yet, thanks to the nurses at the Children's Hospital, she felt a part of Taylor's care and recovery, even when she could not be at her baby's bedside.

"They told me everything; I did not have to ask," says Tori. "They called and kept me informed every day, and that means a lot when you cannot be with your baby 24 hours a day. They would even call me in the middle of the night if they needed to."

Tori adds she also appreciates the level of care Taylor received.

"The nurses were wonderful," says Tori. "They took great care of her. UNC is a great hospital. They take very good care of their patients."

Today 11-months-old Taylor is a thriving girl who enjoys trying to keep up with her older brother and sister. Her most recent ultrasound in July, according to Tori, was excellent, and her cardiologist, Dr. Scott Buck, was able to decrease her medication.

"The cardiologist said it looks perfect, even better than the last ultrasound, which was also really good," reports Tori. "In fact, everything is going great with Taylor. She had a rough time there for a while, but everyone did an excellent job, and it's really easing up now."

Easing up health wise, perhaps, but Taylor is really giving her mom the runaround these days.

"She just started crawling this past weekend," laughs Tori. "She's was a little bit behind development-wise, which was expected because of all the time spent in the hospital, but she's just taking off."

Taylor doesn't have to travel far for follow-up care. She is able to see N.C. Children's Hospital cardiologists at their office in Greensboro.

"It is really nice to be able to see her UNC doctors so close to home," says Tori.

And the news keeps getting better. Tori reports Taylor's next follow-up visit is in October, during which Dr. Buck hopes to take her off of one of her medications, leaving her with just one.

More about Taylor

Hometown: Greensboro, NC; Guilford County — about 100 miles roundtrip
Diagnosis: Congenital heart defect; transposition of the great arteries
Primary pediatric specialties: Cardiology; cardiothoracic surgery; anesthesiology
Other pediatric specialties seen: Critical care medicine; general pediatrics; occupational therapy; speech therapy for feeding
Frequency of visits: Every three months at UNC's pediatric cardiology satellite clinic in Greensboro.
Favorite caregivers: Melissa Illig, PICU nurse, plus Casey, Kathy, Terri, and Lindy, also PICU nurses
Sara Dietz, speech therapist
Everyone in pediatric cardiology and cardiothoracic surgery, including surgical nurse practitioner, Karla Brown, and Dr. Michael Mill
Favorite thing about N.C. Children's Hospital: "They kept me inform of everything that was going on with her. I had to leave the hospital at night, but if anything was going on, even if it was 1:30 in the morning, they would call." ~ Taylor's mom, Tori


Cardiology care at N.C. Children's Hospital

The pediatric cardiology group practices through the N.C. Children's Heart Center centered at North Carolina Children's Hospital. It is the largest children's heart program in the state, offering innovative treatment to more than half of the state's pediatric heart patients.

The division's extramural clinical program is comprised of regional outreach clinics in several North Carolina cities, including outpatient clinics in Burlington, Cary, Fayetteville, Fort Bragg, Greensboro, Raleigh, Rutherfordton and Wilmington. Learn more about pediatric cardiology at UNC.

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Arjun Deb awarded Louis N. and Arnold M. Katz Basic Science Research Prize for Young Investigators

The Louis N. and Arnold M. Katz Prize is one of the oldest and prestigious awards offered by the American Heart Association and encourages new investigators to continue research careers in basic cardiovascular science.
Arjun Deb awarded Louis N. and Arnold M. Katz Basic Science Research Prize for Young Investigators click to enlarge Arjun Deb, MD

Media contact: Les Lang, 919-966-9366, llang@med.unc.edu

Tuesday, Nov. 30, 2010

CHAPEL HILL, N.C. -- On Nov. 16, 2010, at the annual American Heart Association meeting in Chicago, Arjun Deb, MD, was awarded the Louis N. and Arnold M. Katz Basic Science Research Prize for Young Investigators. Deb is an assistant professor of medicine and of cell and molecular physiology, and a member of the McAllister Heart Institute and the Lineberger Comprehensive Cancer Center.

The Louis N. and Arnold M. Katz Prize is one of the oldest and prestigious awards offered by the American Heart Association and encourages new investigators to continue research careers in basic cardiovascular science. This award recognizes research involving biochemical, cellular, molecular and genetic studies in basic cardiovascular science. This is the first time in the history of the award that a researcher from the University of North Carolina has won the first prize. Winner of the prize receives a plaque and $1,500.

Deb’s laboratory is broadly interested in understanding the biology of adult stem cells and specifically how they can be targeted to enhance organ regeneration and repair. He was awarded the Katz prize for his work: "Wnt1 mediated dynamic injury response activates the epicardium and is critical for mammalian cardiac repair."

In July, 2008, Deb received a New Scholar Award in Aging from the Ellison Medical Foundation for his investigation into the role of cardiac stem cells in the biology of aging of the adult heart.



CICU wins Beacon Award

The Cardiac Intensive Care Unit (CICU) has received the Beacon Award for Critical Care Excellence from the American Association of Critical Care Nurses! Only 315 of the estimated 6,000 intensive care units in the United States have earned this award. Congrats to our team in the CICU!

The award is specifically designated to recognize the nation’s top pediatric, progressive, and adult critical care units across a multitude of hospitals. The recognition itself is priceless, as it represents extraordinary commitment to high-quality critical care standards, and dedication to the exceptional care of patients and their families.

The Beacon Award requires success in the following areas, as measured again evidence-based national criteria:

  • Recruitment and retention
  • Education, training and mentoring
  • Research and evidence-based practice
  • Patient outcomes
  • Leadership and organizational ethics
  • Healing environment

The CICU joins the Cardiothoracic Intensive Care Unit at UNC Hospitals, which also received the Beacon Award (its second) earlier this year. Congratulations again to both units for their great work!

 


UNC Hospitals receives performance achievement award from American College of Cardiology Foundation

UNC Hospitals is one of only 26 hospitals nationwide to receive this award, which recognizes our commitment and success in implementing a higher standard of care for heart attack patients.

Media contact: Tom Hughes, 919-966-6047, tahughes@unch.unc.edu
 
Wednesday, August 25, 2010

CHAPEL HILL — UNC Hospitals has received the American College of Cardiology Foundation’s NCDR ACTION Registry–GWTG Silver Performance Achievement Award for 2010 – one of only 26 hospitals nationwide to do so.

The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients, and signifies that UNC Hospitals has reached an aggressive goal of treating coronary artery disease patients with 85 percent compliance to core standard levels of care outlined by the American College of Cardiology/American Heart Association clinical guidelines and recommendations.

To receive the ACTION Registry–GWTG Silver Performance Achievement Award, UNC Hospitals consistently followed the treatment guidelines in ACTION Registry–GWTG for 12 consecutive months. These include aggressive use of medications like cholesterol-lowering drugs, beta-blockers, ACE inhibitors, aspirin, and anticoagulants in the hospital.

“The American College of Cardiology Foundation and the American Heart Association commend UNC Hospitals for its success in implementing standards of care and protocols. The full implementation of acute and secondary prevention guideline-recommended therapy is a critical step in saving the lives and improving outcomes of heart attack patients,” Gregg C. Fonarow, MD, ACTION Registry-GWTG Steering Committee Chairperson and Director of Ahmanson-UCLA Cardiomyopathy Center.

“The time is right for UNC Hospitals to be focused on improving the quality of cardiovascular care by implementing ACTION Registry–GWTG. The number of acute myocardial infarction patients eligible for treatment is expected to grow over the next decade due to increasing incidence of heart disease and a large aging population,” said Cam Patterson, MD, MBA, UNC’s chief of cardiology and director of the UNC McAllister Heart Institute.

Created by the merger of the American College of Cardiology Foundation’s NCDR ACTION Registry® and the American Heart Association’s Get With The Guidelines-CAD program, ACTION Registry–GWTG combines the best of both programs into a single, unified national registry. The new registry joins the robust data collection and quality reporting features of the ACTION Registry with the collaborative models, unique tools, and quality improvement techniques of the GWTG-CAD program. With the collective strengths of these two programs, ACTION Registry–GWTG empowers health care provider teams to consistently treat heart attack patient according to the most current, science-based guidelines; and establishes a national standard for understanding and improving the quality, safety, and outcomes of care provided for patients with coronary artery disease, specifically high-risk STEMI and NSTEMI patients.

Genetics underlie the formation of the body’s back-up bypass vessels

The new knowledge could help inform the current development of what are called collaterogenic therapies – drugs or procedures that can cause new collaterals to form and enlarge before or after a person suffers tissue damage from a blocked artery in the heart, brain, or peripheral tissues.
Genetics underlie the formation of the body’s back-up bypass vessels click to enlarge Cerebral arterial circulation showing the left brain hemisphere of a C57BL/6 mouse and the right hemisphere of BALB/c mouse. Note the difference typical for these strains in number of collaterals (red stars). Image source: Faber lab.

Media contacts: Les Lang, (919) 966-9366, llang@med.unc.edu or Tom Hughes, (919) 966-6047,  tahughes@unch.unc.edu

Thursday, August 19, 2010

CHAPEL HILL – Researchers at the University of North Carolina at Chapel Hill School of Medicine have uncovered the genetic architecture controlling the growth of the collateral circulation – the “back-up” blood vessels that can provide oxygen to starved tissues in the event of a heart attack or stroke.

The new knowledge could help inform the current development of what are called collaterogenic therapies – drugs or procedures that can cause new collaterals to form and enlarge before or after a person suffers tissue damage from a blocked artery in the heart, brain, or peripheral tissues.

“This has really been the holy grail in our field, how to get new collaterals to form in a tissue with few in the first place” said senior study author James E. Faber, PhD, professor of cell and molecular physiology at UNC. “Our thesis has been that if we can figure out how these endogenous bypasses are formed in the first place in healthy tissues, what mechanisms and genetic pathways drive this, and collaterals abundance varies so widely in healthy individuals, then we may have our answer.”

The results of the research, published in the August 20, 2010, issue of the journal Circulation Research, is the first to pinpoint a portion of the genome associated with variation in the density and diameter of collateral vessels.

“This may well be the seminal paper in one of the most important mysteries in vascular biology: the mechanisms controlling collateral formation in the arterial tree,” wrote Stephen Schwartz, a professor of physiology at the University of Washington, in a review of the study for Faculty 1000.

The UNC research, conducted in animal models, combined classical genetic mouse crosses with a new genomic technology called association mapping to identify the section of DNA involved, starting with the whole genome, narrowing it down to several hundreds of genes and finally landing on nine candidates on mouse chromosome 7.

The researchers are now looking at these genes to see if any one of them is responsible for variation in collateral formation.  Faber says they also cannot discount the possibility that it is not genes that are the deciding factor, but rather regulatory DNA or RNA elements that also reside in that same section of the genome.  Either way, Faber hopes they can discover a sequence that could one day be used to predict who is most likely to develop a severe heart attack, stroke, or peripheral limb disease so those individuals can either modify their lifestyle or receive collaterogenic drugs to acquire new and potentially life-saving collateral vessels.

The UNC research was funded by the National Institutes of Health. Study co-authors from UNC include Shiliang Wang, Hua Zhang, Xuming Dai and Robert Sealock.


UNC Hospitals qualifies for American Heart Association’s Mission: Lifeline Recognition for heart attack care

The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients that effectively improves the survival and care of STEMI (ST Elevation Myocardial Infarction) patients.

Media contact: Tom Hughes, 919-966-6047, tahughes@unch.unc.edu

Thursday, August 5, 2010

CHAPEL HILL — UNC Hospitals recently qualified for the American Heart Association’s Mission: Lifeline Bronze Performance Achievement Award. The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients that effectively improves the survival and care of STEMI (ST Elevation Myocardial Infarction) patients.

“UNC Hospitals is dedicated to making our cardiac unit among the best in the country, and the American Heart Association’s Mission: Lifeline program is helping us accomplish that by making it easier for our professionals to improve the outcomes of our cardiac patients,” said Cam Patterson, MD, MBA, UNC’s chief of cardiology and director of the UNC McAllister Heart Institute. “We are pleased to be recognized for our dedication and achievements in cardiac care.”

Every year, almost 400,000 people experience the STEMI type of heart attack. Unfortunately, a significant number don't receive prompt reperfusion therapy, which is critical in restoring blood flow. Mission: Lifeline seeks to save lives by closing the gaps that separate STEMI patients from timely access to appropriate treatments. Mission: Lifeline is focusing on improving the system of care for these patients and at the same time improving care for all heart attack patients.

Hospitals involved in Mission: Lifeline strive to improve care in both acute treatment measures and discharge measures. Systems of care are developed that close the gap of timely access to appropriate, life-saving treatments. Before they are discharged, appropriate patients are started on aggressive risk reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers in the hospital and receive smoking cessation counseling.

Hospitals that receive the Mission: Lifeline Bronze Performance Achievement Award have demonstrated for 90 consecutive days that at least 85 percent of eligible STEMI patients (without contraindications) are treated within specific time frames upon entering the hospital and discharged following the American Heart Association’s recommended treatment guidelines.

VIDEO: Cardiothoracic ICU receives the Beacon Award for Critical Care Excellence

The Cardiothoracic ICU (CTICU) has received the Beacon Award for Critical Care Excellence from the American Association of Critical Care Nurses for the second time!

This award requires success in the following areas, as measured again evidence-based national criteria:

  • Recruitment and retention
  • Education, training and mentoring
  • Research and evidence-based practice
  • Patient outcomes
  • Leadership and organizational ethics
  • Healing environment


"It is the day-to-day actions and teamwork in the CTICU that have contributed to making the Beacon award a reality again," said Deirdre Maisano, RN, BSN, CTICU nurse manager. "It is only thanks to everyone on the CTICU team that this is possible."

Out of an estimated 6,000 Intensive Care units in the United States, there have been only 315 units recognized for excellence with the Beacon Award, and of those, only 52 units have achieved the award more than once.

Congrats and thanks to everyone in the CTICU for your excellent work and care!


 

UNC receives $3.1 million to study alternative strategies to reduce heart disease and stroke

UNC's Center for Health Promotion and Disease Prevention has received a two-year, $3.1 million grant from the Centers for Disease Control and Prevention to research alternative ways to reduce the risk for cardiovascular disease.
UNC receives $3.1 million to study alternative strategies to reduce heart disease and stroke click to enlarge Tom Keyserling, M.D.
UNC receives $3.1 million to study alternative strategies to reduce heart disease and stroke click to enlarge Tom Keyserling, M.D.

The project will compare the effectiveness of a web-based program to that of a counselor-based program; both will focus on improving diet, physical activity and appropriate use of medication. The study will be based in five family practices in the North Carolina Family Medicine Research Network.

“Cardiovascular disease, including heart attacks and stroke, continues to be the leading cause of death in the U.S.,” said Tom Keyserling, M.D., associate professor at the UNC School of Medicine and the principal investigator of the study. “Lifestyle and appropriate use of medication can greatly reduce the risk of cardiovascular disease, yet both are underused.”

The project is one of four initiatives at CDC Prevention Research Centers awarded almost $10 million in 2009 Recovery Act funding. The comparative effectiveness research studies examine alternative public health strategies to improve health and/or reduce the risk for chronic disease.

Keyserling said as well as assessing the interventions’ impact on participants’ health, the study will measure outcomes such as cost effectiveness, acceptability and feasibility.

Stacey Sheridan, M.D., assistant professor at the medical school and adjunct assistant professor at the UNC Gillings School of Global Public Health, will co-lead the project.

For more information on the study, go to http://bit.ly/cRkgTs.


 


UNC Hospitals' 5 Anderson unit joining Center for Heart & Vascular Care

Starting July 1, 5 Anderson will officially join the Center for Heart and Vascular Care. The 15-bed unit primarily houses vascular patients and this transfer will further our collaborative care model.

We are looking forward to this change to help us further our goal of providing the best care and the best service to patients with cardiovascular diseases. On behalf of the inpatient nursing team I would like to formally welcome 5 Anderson to the Center for Heart and Vascular Care.

– Meghan McCann RN, MSN, director, Heart & Vascular and Inpatient Oncology Services



Conference: Heart Failure Management

This conference, which will take place in Amelia Island, FL, July 15 - 18 is designed for cardiologists, family medicine physicians, general internists, nurses and nurse practitioners, physician assistants, pharmacists, hospitalists and cardiology technicians.

The contemporary management of heart failure is characterized by a combination of evolving strategies and newer approaches that are based on recent research advances. The material presented will have an interdisciplinary focus and will be of interest to physicians and other health professionals who care for patients with heart failure.

Visit http://www.med.unc.edu/cme/events/heart-failure-2010/view for more information.



Benson R. Wilcox, M.D., 1932-2010

Benson Reid Wilcox, M.D., a distinguished heart surgeon who served 29 years as chief of the UNC Division of Cardiothoracic Surgery, died May 11, 2010, at his home after a courageous battle with brain cancer. He was 77.
Benson R. Wilcox, M.D., 1932-2010 click to enlarge Benson Reid Wilcox, M.D.

Dr. Wilcox, a native of Charlotte who earned his A.B. and M.D. degrees at UNC, served as chief of cardiothoracic surgery at UNC from 1969 to 1998. During that period, which was a time of dramatic advances in heart and lung surgery, UNC Hospitals began offering coronary artery surgery, heart and lung transplantation, successful surgery for congenital heart defects in newborn infants, and a comprehensive program for the treatment of lung and esophageal cancer.


He held important leadership posts in national medical organizations and was especially interested in the training of future surgeons. He was co-author of three books and an author of numerous medical journal articles and book chapters.
A memorial service is planned for Friday, May 14, at 2 p.m. in Gerrard Hall on the UNC campus. Gerrard Hall is on Cameron Avenue, across from the Old Well, between Memorial Hall and the South Building.

Read Dr. Wilcox's obituary here



 



Benson R. Wilcox, M.D., 1932-2010

Benson Reid Wilcox, M.D., a distinguished heart surgeon who served 29 years as chief of the UNC Division of Cardiothoracic Surgery, died May 11, 2010, at his home after a courageous battle with brain cancer. He was 77.
Benson R. Wilcox, M.D., 1932-2010 click to enlarge Benson Reid Wilcox, M.D.

Dr. Wilcox, a native of Charlotte who earned his A.B. and M.D. degrees at UNC, served as chief of cardiothoracic surgery at UNC from 1969 to 1998. During that period, which was a time of dramatic advances in heart and lung surgery, UNC Hospitals began offering coronary artery surgery, heart and lung transplantation, successful surgery for congenital heart defects in newborn infants, and a comprehensive program for the treatment of lung and esophageal cancer.


He held important leadership posts in national medical organizations and was especially interested in the training of future surgeons. He was co-author of three books and an author of numerous medical journal articles and book chapters.
A memorial service is planned for Friday, May 14, at 2 p.m. in Gerrard Hall on the UNC campus. Gerrard Hall is on Cameron Avenue, across from the Old Well, between Memorial Hall and the South Building.

Read Dr. Wilcox's obituary here



 



UNC project takes on heart disease in heart of U.S. ‘stroke belt’

A new $10 million grant will help researchers at the University of North Carolina at Chapel Hill and East Carolina University collaborate with health-care practitioners and community leaders in Lenoir County to tackle heart disease, the county’s leading cause of death.

A new $10 million grant will help researchers at the University of North Carolina at Chapel Hill and East Carolina University collaborate with health-care practitioners and community leaders in Lenoir County to tackle heart disease, the county’s leading cause of death.

The UNC-ECU project aims to better understand the causes of cardiovascular health disparities and test innovative solutions. It is one of 10 Centers for Population Health and Health Disparities funded by a five-year grant from the National Heart, Lung and Blood Institute, one of the National Institutes of Health. The 10 centers are also supported by the National Cancer Institute and the Office of Behavioral and Social Science Research.

Lenoir County is on the “buckle” of the “stroke belt,” a name given to a region of the southeastern United States recognized by public health authorities for its high incidence of stroke and other forms of cardiovascular disease. The county’s hypertension and cardiovascular disease rates are among the highest in the country, and many residents lack access to adequate medical care or opportunities that promote good health.

The project will be based at the UNC Center for Health Promotion and Disease Prevention. The center’s director, Alice Ammerman, Dr.PH., professor of nutrition at the UNC Gillings School of Global Public Health, is project co-leader along with Dr. Cam Patterson, chief of  the division of cardiology in the UNC School of Medicine and director of the UNC McAllister Heart Institute. Patterson and Drs. Darren DeWalt and Tom Keyserling, assistant and associate professors, respectively, in the UNC School of Medicine, will lead three related research projects within the center. The ECU team is led by Doyle M. Cummings, Pharm.D., a pharmacist and professor of family medicine, and Stephanie Jilcott, Ph.D., assistant professor of public health.

“This project gives us the opportunity to bring together a multidisciplinary research team with a wide variety of community partners in Lenoir County to tackle hypertension and heart disease from prevention to treatment,” Ammerman said.

“Cardiovascular disease is the leading cause of death in America, and our goal at UNC is to change that statistic by finding ways to prevent it and treat it,” said Patterson, whose specialty is determining genetic factors of the disease. “This project allows us to demonstrate our dedication to that goal, and we are especially grateful to the people of Lenoir County for helping us lead the way.”

The research will help determine genetic factors associated with cardiovascular disease risk and how clinical and public health communities can more effectively work together to reduce people’s risk of heart disease through medication, diet and physical activity. The project will also offer an intensive weight loss intervention for participants who are overweight.

The study will also include a partnership with a non-profit call center, Connect Inc., adding lifestyle and medication adherence coaching to its current focus on jobs, employment and benefits counseling. The project will explore opportunities to create jobs while promoting health, including local food production and distribution systems in Lenoir County.

Research support will be provided by the N.C. Translational and Clinical Sciences Institute at UNC. Interventions that prove effective will be disseminated through the center of excellence for training and research translation within the UNC Center for Health Promotion and Disease Prevention.

The project is guided by a community advisory committee and researchers will work with local decision makers to implement policy and environmental changes to sustain long-term health improvements.

Multimedia note: For a graphic illustrating Lenior County’s position in the “stroke belt,” go to:
http://www.hpdp.unc.edu/news/stroke-mortality-in-lenoir-count-nc
.



UNC project takes on heart disease in heart of U.S. ‘stroke belt’

A new $10 million grant will help researchers at the University of North Carolina at Chapel Hill and East Carolina University collaborate with health-care practitioners and community leaders in Lenoir County to tackle heart disease, the county’s leading cause of death.

A new $10 million grant will help researchers at the University of North Carolina at Chapel Hill and East Carolina University collaborate with health-care practitioners and community leaders in Lenoir County to tackle heart disease, the county’s leading cause of death.

The UNC-ECU project aims to better understand the causes of cardiovascular health disparities and test innovative solutions. It is one of 10 Centers for Population Health and Health Disparities funded by a five-year grant from the National Heart, Lung and Blood Institute, one of the National Institutes of Health. The 10 centers are also supported by the National Cancer Institute and the Office of Behavioral and Social Science Research.

Lenoir County is on the “buckle” of the “stroke belt,” a name given to a region of the southeastern United States recognized by public health authorities for its high incidence of stroke and other forms of cardiovascular disease. The county’s hypertension and cardiovascular disease rates are among the highest in the country, and many residents lack access to adequate medical care or opportunities that promote good health.

The project will be based at the UNC Center for Health Promotion and Disease Prevention. The center’s director, Alice Ammerman, Dr.PH., professor of nutrition at the UNC Gillings School of Global Public Health, is project co-leader along with Dr. Cam Patterson, chief of  the division of cardiology in the UNC School of Medicine and director of the UNC McAllister Heart Institute. Patterson and Drs. Darren DeWalt and Tom Keyserling, assistant and associate professors, respectively, in the UNC School of Medicine, will lead three related research projects within the center. The ECU team is led by Doyle M. Cummings, Pharm.D., a pharmacist and professor of family medicine, and Stephanie Jilcott, Ph.D., assistant professor of public health.

“This project gives us the opportunity to bring together a multidisciplinary research team with a wide variety of community partners in Lenoir County to tackle hypertension and heart disease from prevention to treatment,” Ammerman said.

“Cardiovascular disease is the leading cause of death in America, and our goal at UNC is to change that statistic by finding ways to prevent it and treat it,” said Patterson, whose specialty is determining genetic factors of the disease. “This project allows us to demonstrate our dedication to that goal, and we are especially grateful to the people of Lenoir County for helping us lead the way.”

The research will help determine genetic factors associated with cardiovascular disease risk and how clinical and public health communities can more effectively work together to reduce people’s risk of heart disease through medication, diet and physical activity. The project will also offer an intensive weight loss intervention for participants who are overweight.

The study will also include a partnership with a non-profit call center, Connect Inc., adding lifestyle and medication adherence coaching to its current focus on jobs, employment and benefits counseling. The project will explore opportunities to create jobs while promoting health, including local food production and distribution systems in Lenoir County.

Research support will be provided by the N.C. Translational and Clinical Sciences Institute at UNC. Interventions that prove effective will be disseminated through the center of excellence for training and research translation within the UNC Center for Health Promotion and Disease Prevention.

The project is guided by a community advisory committee and researchers will work with local decision makers to implement policy and environmental changes to sustain long-term health improvements.

Multimedia note: For a graphic illustrating Lenior County’s position in the “stroke belt,” go to:
http://www.hpdp.unc.edu/news/stroke-mortality-in-lenoir-count-nc
.



Air-pollution expert explains how to take care of your lungs during ozone season

April's warm, sunny days mark the beginning of ozone season. UNC Health Care expert David Peden, M.D., the director of the Center for Environmental Medicine, Asthma and Lung Biology at the UNC School of Medicine, explains what his research shows about ozone pollution and how you can protect yourself.
Air-pollution expert explains how to take care of your lungs during ozone season click to enlarge David B. Peden, MD, MS

Written by Sara Peach for UNC Health Care

It's a harmless-looking pale blue gas, a relative of the oxygen molecule that sustains life. In the upper atmosphere, a layer of it protects us from the sun's harmful rays.

But ozone molecules, composed of three oxygen atoms, can trigger breathing problems when they form near the ground, said David Peden, MD, director of the Center for Environmental Medicine, Asthma and Lung Biology at the UNC School of Medicine.

Ozone pollution is more common during “ozone season,” which begins in April and peaks in the warm summer months. Ozone forms on hot, sunny days when pollutants from car exhaust, power plants, gas stations and industrial facilities undergo chemical reactions in sunlight. Meanwhile, the stagnant weather systems that often form in summer can trap pollution around a community.

More than half of North Carolina's residents live in counties where ozone levels sometimes reach unhealthy levels, according to the N.C. Department of Environment and Natural Resources. Children, people with respiratory diseases and healthy adults who exercise or work outdoors are at risk.

Peden investigates the health effects of ozone at the Environmental Protection Agency Human Studies Facility located on the UNC-CH campus. His team uses controlled chambers to expose volunteers to varying levels of air pollutants. That research has shown that exposure to ozone inflames the lungs, which can aggravate other breathing problems. 

“Those changes can exacerbate other issues,” he said. “The person is subsequently more likely to have an asthma attack or be more reactive to allergens.”  Those responses often do not appear until the day after ozone exposure, he said.

In addition, Peden said that a study of southern California children suggested that long-term, chronic exposure to ozone may affect lung development. Ozone may also be linked to cardiovascular disease, an area of research that Peden is now pursuing.

To protect themselves on elevated-ozone days, Peden said individuals should avoid outdoor air in the afternoon, when ozone levels peak.

“Do most of your vigorous outdoor work in the morning or in the evening, after the ozone has decreased,” he said.

But Peden said health experts learned an important lesson about ozone pollution from the 1996 Summer Olympics. During the games, Atlanta city officials aggressively restricted downtown traffic. A group of researchers found that during the 17 days of the games, ozone pollution decreased. Meanwhile, the number of severe asthma attacks fell by 40 percent.

That study, Peden said, shows the importance of public health measures, such as pollutant regulations, to protecting air quality.

“If we're going to really address this, it's going to be through public-policy efforts,” he said.

More tips for healthy lungs:

  • Check your weather forecast for ozone predictions. In North Carolina, a Code Orange day means the air is unhealthy for sensitive people. A Code Red ozone day indicates that everyone should avoid breathing outdoor air.
  • If you have access to an indoor gym, exercise there when ozone levels are high. Or try walking inside a mall or other enclosed space.
  • If you have asthma, work with your doctor to keep it under control throughout the year so that you have fewer problems during ozone season. Peden said some studies suggest that eating food rich in antioxidants, such as blueberries, beans and pecans, may reduce the effects of ozone exposure.
  • It's likely that breathing other pollutants can make ozone exposure worse, Peden said. So keep away from cigarette smoke, and try to quit if you are a smoker.


Air-pollution expert explains how to take care of your lungs during ozone season

April's warm, sunny days mark the beginning of ozone season. UNC Health Care expert David Peden, M.D., the director of the Center for Environmental Medicine, Asthma and Lung Biology at the UNC School of Medicine, explains what his research shows about ozone pollution and how you can protect yourself.
Air-pollution expert explains how to take care of your lungs during ozone season click to enlarge David B. Peden, MD, MS

Written by Sara Peach for UNC Health Care

It's a harmless-looking pale blue gas, a relative of the oxygen molecule that sustains life. In the upper atmosphere, a layer of it protects us from the sun's harmful rays.

But ozone molecules, composed of three oxygen atoms, can trigger breathing problems when they form near the ground, said David Peden, MD, director of the Center for Environmental Medicine, Asthma and Lung Biology at the UNC School of Medicine.

Ozone pollution is more common during “ozone season,” which begins in April and peaks in the warm summer months. Ozone forms on hot, sunny days when pollutants from car exhaust, power plants, gas stations and industrial facilities undergo chemical reactions in sunlight. Meanwhile, the stagnant weather systems that often form in summer can trap pollution around a community.

More than half of North Carolina's residents live in counties where ozone levels sometimes reach unhealthy levels, according to the N.C. Department of Environment and Natural Resources. Children, people with respiratory diseases and healthy adults who exercise or work outdoors are at risk.

Peden investigates the health effects of ozone at the Environmental Protection Agency Human Studies Facility located on the UNC-CH campus. His team uses controlled chambers to expose volunteers to varying levels of air pollutants. That research has shown that exposure to ozone inflames the lungs, which can aggravate other breathing problems. 

“Those changes can exacerbate other issues,” he said. “The person is subsequently more likely to have an asthma attack or be more reactive to allergens.”  Those responses often do not appear until the day after ozone exposure, he said.

In addition, Peden said that a study of southern California children suggested that long-term, chronic exposure to ozone may affect lung development. Ozone may also be linked to cardiovascular disease, an area of research that Peden is now pursuing.

To protect themselves on elevated-ozone days, Peden said individuals should avoid outdoor air in the afternoon, when ozone levels peak.

“Do most of your vigorous outdoor work in the morning or in the evening, after the ozone has decreased,” he said.

But Peden said health experts learned an important lesson about ozone pollution from the 1996 Summer Olympics. During the games, Atlanta city officials aggressively restricted downtown traffic. A group of researchers found that during the 17 days of the games, ozone pollution decreased. Meanwhile, the number of severe asthma attacks fell by 40 percent.

That study, Peden said, shows the importance of public health measures, such as pollutant regulations, to protecting air quality.

“If we're going to really address this, it's going to be through public-policy efforts,” he said.

More tips for healthy lungs:

  • Check your weather forecast for ozone predictions. In North Carolina, a Code Orange day means the air is unhealthy for sensitive people. A Code Red ozone day indicates that everyone should avoid breathing outdoor air.
  • If you have access to an indoor gym, exercise there when ozone levels are high. Or try walking inside a mall or other enclosed space.
  • If you have asthma, work with your doctor to keep it under control throughout the year so that you have fewer problems during ozone season. Peden said some studies suggest that eating food rich in antioxidants, such as blueberries, beans and pecans, may reduce the effects of ozone exposure.
  • It's likely that breathing other pollutants can make ozone exposure worse, Peden said. So keep away from cigarette smoke, and try to quit if you are a smoker.


Antoniak receives postdoctoral fellowship from the Myocarditis Foundation

Dr. Silvio Antoniak has received a Postdoctoral Fellowship from the Myocarditis Foundation. Dr. Antoniak is a member of the Mackman Lab in the Division of Hematology/Oncology and UNC McAllister Heart Institute.

Antoniak received his Ph.D from the Freie University in Berlin. He investigated the contribution of tissue factor and the coagulation cascade to thrombosis and inflammation during myocarditis. His recent work at UNC has focused on the role of protease-activated receptors (PARs) in cardiovascular disease. The goal of his fellowship from Myocarditis Foundation is to investigate the role of PAR-1 in virus-induced myocarditis. He will determine if pharmacological inhibition of this receptor could be a new therapeutic approach in the treatment of the devastating disease.



Antoniak receives postdoctoral fellowship from the Myocarditis Foundation

Dr. Silvio Antoniak has received a Postdoctoral Fellowship from the Myocarditis Foundation. Dr. Antoniak is a member of the Mackman Lab in the Division of Hematology/Oncology and UNC McAllister Heart Institute.

Antoniak received his Ph.D from the Freie University in Berlin. He investigated the contribution of tissue factor and the coagulation cascade to thrombosis and inflammation during myocarditis. His recent work at UNC has focused on the role of protease-activated receptors (PARs) in cardiovascular disease. The goal of his fellowship from Myocarditis Foundation is to investigate the role of PAR-1 in virus-induced myocarditis. He will determine if pharmacological inhibition of this receptor could be a new therapeutic approach in the treatment of the devastating disease.



FDA issues black box warning on clopidogrel (Plavix)

There was a recent update to the package insert for clopidogrel (Plavix) that includes a black box warning for use in patients who are poor metabolizers.

Clopidogrel is a prodrug which is metabolized to the active form of the drug by the CYP 450 enzyme system in the liver. Recent research suggests that genetic variation at the CYP450 2C19 locus may result in decreased metabolic activation of clopidogrel and translate into increased risk of adverse cardiovascular events.

The clinical labs at UNC are working to provide testing that will identify carriers of the variant alleles, and this test will be available shortly. Individuals who have two normal alleles at the CYP450 2C19 locus (approximately 65 percent) can continue to take clopidogrel without any change. Individuals who have two abnormal alleles at the CYP450 2C19 locus (approximately 2 - 4 percent) are poor metabolizers and the subject of the black box warning. Individuals with one abnormal allele have intermediate metabolism of clopidogrel to the active metabolite.

The best strategy for platelet inhibition in patients who are poor or intermediate metabolizers was not mandated by the black box warning and is left to the discretion of the treating physician. The Division of Cardiology has established a protocol for clinical decision-making in patients being treated with clopidogrel, which we are happy to share with you.

In addition, we are available to see any patient in consultation. Lastly, since there are limited data on the best anti-platelet treatment in patients with impaired clopidogrel metabolism, the Division of Cardiology, along with the Department of Pathology, the Division of Hematology and the Institute of Pharmacogenomics and Individualized Therapy (IPIT) has launched the UNC Clopidogrel Pharmacogenomics Project. This project is currently enrolling patients in a clinical research study to explore the effects of increased clopidogrel doses on platelet inhibition in patients who are poor or intermediate metabolizers. For questions, call Joe Rossi or Rick Stouffer at 843-5206.

FDA issues black box warning on clopidogrel (Plavix)

There was a recent update to the package insert for clopidogrel (Plavix) that includes a black box warning for use in patients who are poor metabolizers.

Clopidogrel is a prodrug which is metabolized to the active form of the drug by the CYP 450 enzyme system in the liver. Recent research suggests that genetic variation at the CYP450 2C19 locus may result in decreased metabolic activation of clopidogrel and translate into increased risk of adverse cardiovascular events.

The clinical labs at UNC are working to provide testing that will identify carriers of the variant alleles, and this test will be available shortly. Individuals who have two normal alleles at the CYP450 2C19 locus (approximately 65 percent) can continue to take clopidogrel without any change. Individuals who have two abnormal alleles at the CYP450 2C19 locus (approximately 2 - 4 percent) are poor metabolizers and the subject of the black box warning. Individuals with one abnormal allele have intermediate metabolism of clopidogrel to the active metabolite.

The best strategy for platelet inhibition in patients who are poor or intermediate metabolizers was not mandated by the black box warning and is left to the discretion of the treating physician. The Division of Cardiology has established a protocol for clinical decision-making in patients being treated with clopidogrel, which we are happy to share with you.

In addition, we are available to see any patient in consultation. Lastly, since there are limited data on the best anti-platelet treatment in patients with impaired clopidogrel metabolism, the Division of Cardiology, along with the Department of Pathology, the Division of Hematology and the Institute of Pharmacogenomics and Individualized Therapy (IPIT) has launched the UNC Clopidogrel Pharmacogenomics Project. This project is currently enrolling patients in a clinical research study to explore the effects of increased clopidogrel doses on platelet inhibition in patients who are poor or intermediate metabolizers. For questions, call Joe Rossi or Rick Stouffer at 843-5206.

Runge honored by American College of Cardiology

Marschall S. Runge, MD, PhD, received the 2010 Distinguished Scientist Award on March 15, 2010.

Marschall S. Runge, MD, PhD, Charles Addison and Elizabeth Ann Sanders Distinguished Professor, Chairman of Medicine and Vice Dean for Clinical Affairs, was selected by the Awards Committee and the Board of Trustees of the American College of Cardiology to receive “The 2010 Distinguished Scientist Award” in recognition of his contributions to the advancement of scientific knowledge in the field of cardiovascular diseases. This award has been given since 1982, and past recipients of this include the world’s leading cardiovascular investigators over the past three decades. He received the award on March 15, 2010, at the annual ACC Convocation in Atlanta.

 

Runge honored by American College of Cardiology

Marschall S. Runge, MD, PhD, received the 2010 Distinguished Scientist Award on March 15, 2010.

Marschall S. Runge, MD, PhD, Charles Addison and Elizabeth Ann Sanders Distinguished Professor, Chairman of Medicine and Vice Dean for Clinical Affairs, was selected by the Awards Committee and the Board of Trustees of the American College of Cardiology to receive “The 2010 Distinguished Scientist Award” in recognition of his contributions to the advancement of scientific knowledge in the field of cardiovascular diseases. This award has been given since 1982, and past recipients of this include the world’s leading cardiovascular investigators over the past three decades. He received the award on March 15, 2010, at the annual ACC Convocation in Atlanta.

 

Deb awarded the 2010 American College of Cardiology (ACC) Foundation/William F. Keating, Esq. Endowment Award

The award provides one year of research support for outstanding cardiovascular scholars.

Arjun Deb, MD, assistant professor of medicine and cell & molecular physiology in the UNC School of Medicine, is the 2010 recipient of the American College of Cardiology (ACC) Foundation/William F. Keating, Esq. Endowment Award for Hypertension and Peripheral Vascular Disease.
 
The award provides $65,000 for one year of research support, beginning July 1, 2010. The purpose of the award is to recognize and provide financial support for research efforts by outstanding young cardiovascular scholars. This award is to encourage junior faculty in the early phases of their careers in the field of cardiovascular research.
 
Deb is a member of the UNC McAllister Heart Institute and the Lineberger Comprehensive Cancer Center.
 
Deb will use the fellowship funds to study the role of Wnt signaling in regulating the function of human endothelial progenitor cells in vascular disease. Learn more about Deb's lab at http://www.unc.edu/~adeb/DebLab.
 
Deb joined UNC two years ago and completed clinical and research training at the Mayo Clinic and Duke University.
 

Deb awarded the 2010 American College of Cardiology (ACC) Foundation/William F. Keating, Esq. Endowment Award

The award provides one year of research support for outstanding cardiovascular scholars.

Arjun Deb, MD, assistant professor of medicine and cell & molecular physiology in the UNC School of Medicine, is the 2010 recipient of the American College of Cardiology (ACC) Foundation/William F. Keating, Esq. Endowment Award for Hypertension and Peripheral Vascular Disease.
 
The award provides $65,000 for one year of research support, beginning July 1, 2010. The purpose of the award is to recognize and provide financial support for research efforts by outstanding young cardiovascular scholars. This award is to encourage junior faculty in the early phases of their careers in the field of cardiovascular research.
 
Deb is a member of the UNC McAllister Heart Institute and the Lineberger Comprehensive Cancer Center.
 
Deb will use the fellowship funds to study the role of Wnt signaling in regulating the function of human endothelial progenitor cells in vascular disease. Learn more about Deb's lab at http://www.unc.edu/~adeb/DebLab.
 
Deb joined UNC two years ago and completed clinical and research training at the Mayo Clinic and Duke University.
 

Video: Obese 3-year-olds show early warning signs for future heart disease

A study by University of North Carolina at Chapel Hill researchers found that obese children as young as 3 years old have elevated levels of C-reactive protein, a marker of inflammation that in adults is considered an early warning sign for possible future heart disease.

A study by University of North Carolina at Chapel Hill researchers found that obese children as young as 3 years old have elevated levels of C-reactive protein, a marker of inflammation that in adults is considered an early warning sign for possible future heart disease.

In addition, the study found elevated levels of two other inflammatory markers – the ratio of ferritin/transferrin saturation (F/T) and the absolute neutrophil count (ANC) – in obese children. Elevated F/T levels started at age 6 and elevated ANC levels were found starting at age 9.

“These findings were a surprise to us,” said lead author Asheley Cockrell Skinner, Ph.D., an assistant professor of pediatrics in the UNC School of Medicine. “We’re seeing a relationship between weight status and elevated inflammatory markers much earlier than we expected.”

“Most adults understand that being overweight or obese isn’t good for them,” Skinner said. “But not as many people realize that it may be unhealthy for young children to be overweight.”

It can be very difficult for parents to tell when their child is overweight, Skinner said. “Especially with younger children and smaller children, because they’re so short it only takes seven or eight pounds to change them from being a healthy weight to being overweight,” she said.

The study was published online March 1 by the journal Pediatrics. Skinner and fellow Department of Pediatrics researchers Eliana Perrin, M.D., M.P.H., Michael Steiner, M.D. and Frederick Henderson, M.D. arrived at these findings after analyzing data collected as part of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006.

Their analysis included data from 16,335 children ages 1-17 years, who were grouped into four categories based on their body mass index (BMI): healthy weight, overweight, obese and very obese. Under this scheme, a 3.5-year-old who is 39 inches tall and weighs 34 pounds would be in the healthy weight category while a child of the same age and height weighing 43 pounds would be considered very obese. In the group of children analyzed, nearly 70 percent were healthy weight, 15 percent were overweight, 11 percent were obese and 3.5 percent were very obese.

Among very obese children ages 3-5, more than 40 percent (42.5 percent) had elevated CRP compared to only approximately 17 percent of healthy weight children. Among older children the difference was even more pronounced. In ages 15-17, 83 percent of the very obese had elevated CRP compared to 18 percent of the healthy weight. The study concludes that weight status and elevated inflammatory markers are strongly related, even in young children, and further research should examine the impact of long-term, low-grade inflammation in overweight and obese children.

“In this study we were unable to tease apart whether the inflammation or the obesity came first, but one theory is that obesity leads to inflammation which then leads to heart and vessel disease later on,” said Perrin, senior author of the study. 

“A lot more work needs to be done before we figure out the full implication of these findings. But this study tells us that very young, obese children already have more inflammation than children who are not obese, and that’s very concerning. It may help motivate us as physicians and parents to take obesity at younger ages more seriously,” Perrin said.

Cam Patterson, M.D., M.B.A., UNC’s chief of cardiology and director of the UNC McAllister Heart Institute, said he found it alarming that inflammation associated with obesity is present even in the youngest children. “But that doesn’t mean young kids are going to start having heart attacks,” he said. “What it does mean is that the inflammatory process that damages blood vessels around the heart may begin much earlier than we have realized.

“There is a ray of hope here, though,” said Patterson, who was not involved in the study. “This study suggests that we may be able to reduce the long-term adverse consequences of inflammation on the heart if we can introduce measures that reduce the frequency of childhood health problems such as obesity and other triggers of inflammation.”

Media contact: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

 

Video: Obese 3-year-olds show early warning signs for future heart disease

A study by University of North Carolina at Chapel Hill researchers found that obese children as young as 3 years old have elevated levels of C-reactive protein, a marker of inflammation that in adults is considered an early warning sign for possible future heart disease.

A study by University of North Carolina at Chapel Hill researchers found that obese children as young as 3 years old have elevated levels of C-reactive protein, a marker of inflammation that in adults is considered an early warning sign for possible future heart disease.

In addition, the study found elevated levels of two other inflammatory markers – the ratio of ferritin/transferrin saturation (F/T) and the absolute neutrophil count (ANC) – in obese children. Elevated F/T levels started at age 6 and elevated ANC levels were found starting at age 9.

“These findings were a surprise to us,” said lead author Asheley Cockrell Skinner, Ph.D., an assistant professor of pediatrics in the UNC School of Medicine. “We’re seeing a relationship between weight status and elevated inflammatory markers much earlier than we expected.”

“Most adults understand that being overweight or obese isn’t good for them,” Skinner said. “But not as many people realize that it may be unhealthy for young children to be overweight.”

It can be very difficult for parents to tell when their child is overweight, Skinner said. “Especially with younger children and smaller children, because they’re so short it only takes seven or eight pounds to change them from being a healthy weight to being overweight,” she said.

The study was published online March 1 by the journal Pediatrics. Skinner and fellow Department of Pediatrics researchers Eliana Perrin, M.D., M.P.H., Michael Steiner, M.D. and Frederick Henderson, M.D. arrived at these findings after analyzing data collected as part of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006.

Their analysis included data from 16,335 children ages 1-17 years, who were grouped into four categories based on their body mass index (BMI): healthy weight, overweight, obese and very obese. Under this scheme, a 3.5-year-old who is 39 inches tall and weighs 34 pounds would be in the healthy weight category while a child of the same age and height weighing 43 pounds would be considered very obese. In the group of children analyzed, nearly 70 percent were healthy weight, 15 percent were overweight, 11 percent were obese and 3.5 percent were very obese.

Among very obese children ages 3-5, more than 40 percent (42.5 percent) had elevated CRP compared to only approximately 17 percent of healthy weight children. Among older children the difference was even more pronounced. In ages 15-17, 83 percent of the very obese had elevated CRP compared to 18 percent of the healthy weight. The study concludes that weight status and elevated inflammatory markers are strongly related, even in young children, and further research should examine the impact of long-term, low-grade inflammation in overweight and obese children.

“In this study we were unable to tease apart whether the inflammation or the obesity came first, but one theory is that obesity leads to inflammation which then leads to heart and vessel disease later on,” said Perrin, senior author of the study. 

“A lot more work needs to be done before we figure out the full implication of these findings. But this study tells us that very young, obese children already have more inflammation than children who are not obese, and that’s very concerning. It may help motivate us as physicians and parents to take obesity at younger ages more seriously,” Perrin said.

Cam Patterson, M.D., M.B.A., UNC’s chief of cardiology and director of the UNC McAllister Heart Institute, said he found it alarming that inflammation associated with obesity is present even in the youngest children. “But that doesn’t mean young kids are going to start having heart attacks,” he said. “What it does mean is that the inflammatory process that damages blood vessels around the heart may begin much earlier than we have realized.

“There is a ray of hope here, though,” said Patterson, who was not involved in the study. “This study suggests that we may be able to reduce the long-term adverse consequences of inflammation on the heart if we can introduce measures that reduce the frequency of childhood health problems such as obesity and other triggers of inflammation.”

Media contact: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

 

UNC study: Obese 3-year-olds show early warning signs for possible future heart disease

A study by University of North Carolina at Chapel Hill researchers found that obese children as young as 3 years old have elevated levels of C-reactive protein, a marker of inflammation that in adults is considered an early warning sign for possible future heart disease.

Media contact: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

Monday, March 1, 2010

CHAPEL HILL – A study by University of North Carolina at Chapel Hill researchers found that obese children as young as 3 years old have elevated levels of C-reactive protein, a marker of inflammation that in adults is considered an early warning sign for possible future heart disease.

In addition, the study found elevated levels of two other inflammatory markers – the ratio of ferritin/transferrin saturation (F/T) and the absolute neutrophil count (ANC) – in obese children. Elevated F/T levels started at age 6 and elevated ANC levels were found starting at age 9.

"These findings were a surprise to us,” said lead author Asheley Cockrell Skinner, Ph.D., an assistant professor of pediatrics in the UNC School of Medicine. “We’re seeing a relationship between weight status and elevated inflammatory markers much earlier than we expected.”

"Most adults understand that being overweight or obese isn’t good for them,” Skinner said. “But not as many people realize that it may be unhealthy for young children to be overweight.”

It can be very difficult for parents to tell when their child is overweight, Skinner said. “Especially with younger children and smaller children, because they’re so short it only takes seven or eight pounds to change them from being a healthy weight to being overweight,” she said.

The study was published online March 1 by the journal Pediatrics. Skinner and fellow Department of Pediatrics researchers Eliana Perrin, M.D., M.P.H., Michael Steiner, M.D. and Frederick Henderson, M.D. arrived at these findings after analyzing data collected as part of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006.

Their analysis included data from 16,335 children ages 1-17 years, who were grouped into four categories based on their body mass index (BMI): healthy weight, overweight, obese and very obese. Under this scheme, a 3.5-year-old who is 39 inches tall and weighs 34 pounds would be in the healthy weight category while a child of the same age and height weighing 43 pounds would be considered very obese. In the group of children analyzed, nearly 70 percent were healthy weight, 15 percent were overweight, 11 percent were obese and 3.5 percent were very obese.

Among very obese children ages 3-5, more than 40 percent (42.5 percent) had elevated CRP compared to only approximately 17 percent of healthy weight children. Among older children the difference was even more pronounced. In ages 15-17, 83 percent of the very obese had elevated CRP compared to 18 percent of the healthy weight. The study concludes that weight status and elevated inflammatory markers are strongly related, even in young children, and further research should examine the impact of long-term, low-grade inflammation in overweight and obese children.

“In this study we were unable to tease apart whether the inflammation or the obesity came first, but one theory is that obesity leads to inflammation which then leads to heart and vessel disease later on,” said Perrin, senior author of the study. 

“A lot more work needs to be done before we figure out the full implication of these findings. But this study tells us that very young, obese children already have more inflammation than children who are not obese, and that’s very concerning. It may help motivate us as physicians and parents to take obesity at younger ages more seriously,” Perrin said.

Cam Patterson, M.D., M.B.A., UNC’s chief of cardiology and director of the UNC McAllister Heart Institute, said he found it alarming that inflammation associated with obesity is present even in the youngest children. “But that doesn’t mean young kids are going to start having heart attacks,” he said. “What it does mean is that the inflammatory process that damages blood vessels around the heart may begin much earlier than we have realized.

“There is a ray of hope here, though,” said Patterson, who was not involved in the study. “This study suggests that we may be able to reduce the long-term adverse consequences of inflammation on the heart if we can introduce measures that reduce the frequency of childhood health problems such as obesity and other triggers of inflammation.”

 

VIDEO: 5 Things Every Woman Should Know About Heart Health

Nearly 500,000 women in the U.S. die from heart disease each year. It is the number one killer of all women. However, women who have heart attacks tend not to seek help from doctors as quickly as men do. Women often wait an hour longer than men to seek help, and that hour can sometimes be too late.

Dr. Paula Miller, Cardiac Rehabilitation Director of the UNC Heart Center, says it's time that women take heart and take care of their cardiovascular health. In this video, she explains five things every woman should know about heart health.

VIDEO: 5 Things Every Woman Should Know About Heart Health

Nearly 500,000 women in the U.S. die from heart disease each year. It is the number one killer of all women. However, women who have heart attacks tend not to seek help from doctors as quickly as men do. Women often wait an hour longer than men to seek help, and that hour can sometimes be too late.

Dr. Paula Miller, Cardiac Rehabilitation Director of the UNC Heart Center, says it's time that women take heart and take care of their cardiovascular health. In this video, she explains five things every woman should know about heart health.

Egan named "Tar Heel of the Week"

Thomas M. Egan, M.D., of the UNC Division of Cardiothoracic Surgery is featured as the "Tar Heel of the Week" in a News & Observer story about Dr. Egan and his pioneering lung transplant research, which would make more donor lungs usable for transplant by treating the lungs ex-vivo (outside the body) to improve their health before transplant.

Read the story here.

Egan named "Tar Heel of the Week"

Thomas M. Egan, M.D., of the UNC Division of Cardiothoracic Surgery is featured as the "Tar Heel of the Week" in a News & Observer story about Dr. Egan and his pioneering lung transplant research, which would make more donor lungs usable for transplant by treating the lungs ex-vivo (outside the body) to improve their health before transplant.

Read the story here.

VIDEO: Artist donates work to UNC Heart Center

Artist Murry Handler, a patient of Dr. Paula Miller of the UNC Heart Center, donated a piece of artwork titled "Spring Fall" to the Heart Center to show his appreciation for the care he's received over the years.

 

VIDEO: Artist donates work to UNC Heart Center

Artist Murry Handler, a patient of Dr. Paula Miller of the UNC Heart Center, donated a piece of artwork titled "Spring Fall" to the Heart Center to show his appreciation for the care he's received over the years.

 

MHI Seminar Series: Andrew C. Dudley, PhD, Harvard Medical School

Dr. Dudley will present "Unique Properties of Tumor Endothelial Cells" as a part of the McAllister Heart Institute seminar series.
When Jan 12, 2010
from 12:00 PM to 01:00 PM
Where G202 MBRB
Contact Name Ryan K. Terrell
Add event to calendar vCal
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More information about this event…

MHI Seminar Series: Andrew C. Dudley, PhD, Harvard Medical School

Dr. Dudley will present "Unique Properties of Tumor Endothelial Cells" as a part of the McAllister Heart Institute seminar series.
When Jan 12, 2010
from 12:00 PM to 01:00 PM
Where G202 MBRB
Contact Name Ryan K. Terrell
Add event to calendar vCal
iCal