UNC Cardiology News

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.
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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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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.