UNC Cardiology News

The UNC McAllister Heart Institute receives funding to advance novel therapy for heart failure

A $1.9 million NIH grant will enable new studies of alpha-1-adrenergic receptors in the heart. Brian Jensen, MD, an associate professor in the division of cardiology and the department of pharmacology, will serve as principal investigator for research that considers how metabolic alterations provide cardioprotection.
The UNC McAllister Heart Institute receives funding to advance novel therapy for heart failure click to enlarge Dr. Brian Colwell Jensen (Photo credit: Chris Polydoroff)

Brian Jensen, MD, a member of the UNC McAllister Heart Institute has received a $1.9 million NIH R01 grant to expand recent findings that alpha-1A adrenergic receptors (ARs) protect the failing heart by providing more energy for heart muscle cells through more efficient glucose metabolism and enhanced mitochondrial function.

Epinephrine and norepinephrine are known to activate both alpha-1 and beta-ARs in the heart, and chronic stimulation of beta-ARs by elevated levels of these hormones contributes to heart failure. In contrast, activation of alpha-1-ARs protects the heart, though the mechanisms that account for this benefit are not completely understood.

“We are really excited to continue our exploration of the protective roles that the alpha-1A adrenergic receptor subtype plays in the failing heart,” said Jensen. “These receptors are activated by adrenaline (epinephrine) as part of the body’s chronic stress response to heart failure. We believe their activation may mitigate some of the harmful effects of chronic beta adrenergic receptor stimulation.”

Jensen’s team will use a safe oral drug to selectively stimulate alpha-1A-ARs in experiments. Drugs that target beta receptors (beta blockers) are central to the treatment of heart failure and the Jensen lab’s recent work lays the groundwork for the long-term goal of developing a novel therapy for heart failure that selectively stimulates the alpha-1A-AR.

“As a scientist, I’m energized by the opportunity to learn more about the way the heart works,” said Jensen. “As an advanced heart failure cardiologist, I’m motivated by the crucial need for more and better ways to help patients with heart failure."

"That thing that gives me the most professional gratification is seeing my patients live their life to the fullest"

In a podcast interview with Department of Medicine Chair Dr. Ron Falk, Dr. Patricia Chang discusses various aspects of heart transplant and what patients can expect, starting with evaluation for transplant, deciding between a ventricular assist device and transplant, through surgery, and into recovery and follow-up.  Listen to the podcast here and check out her earlier podcast interview on heart failure as well.

Chinese Cardiologists Visit UNC Medical Center as Part of AHA Collaboration

A delegation of medical professionals from across China toured Chapel Hill’s emergency department, cardiac catheterization lab and other facilities to learn about UNC’s STEMI system of care.
Chinese Cardiologists Visit UNC Medical Center as Part of AHA Collaboration click to enlarge Chinese cardiologists tour UNC Medical Center

Media Contact: Carleigh Gabryel, 919-864-0580, carleigh.gabryel@unchealth.unc.edu

December 11, 2017

CHAPEL HILL, NC – Time is muscle: a saying used by physicians to express the importance of quick treatment in patients experiencing ST-segment elevation myocardial infarction (STEMI), a very serious type of heart attack that can leave patients with chronic heart failure or send them into sudden cardiac arrest.  Guidelines established by the American Heart Association (AHA) -- including the Mission: Lifeline program -- recommend how a hospital should prepare for treatment of STEMI by developing a complete system of care. Now the AHA is working to implement those same guidelines in China with help from UNC cardiologists.

“For the last several years, the AHA has been engaged with the Chinese Society of Cardiology (CSC) in a variety of quality improvement projects in China,” said Louise Morgan, MSN, and director of international quality improvement for the AHA.

The China National Health and Family Planning Commission (NHFPC) invited the AHA to cooperate with the CSC on a project related to STEMI systems of care. In 2016 the formation of the project, Improving Care for Cardiovascular Disease in China (CCC), allowed the AHA to visit several Chinese hospitals and view their methods of treatment. In return the AHA invited a group of Chinese cardiologists to visit U.S. health care facilities.

“Part of the reason we’re in North Carolina is the state-wide effort of the Regional Approach to Cardiovascular Emergencies (RACE) initiative. And of course UNC’s Dr. Sidney Smith, with his wonderful relationships with the China cardiologists, was instrumental to bringing that China-U.S. connection together,” said Morgan.

Sidney Smith, Jr., MD, UNC professor of medicine and past president of the AHA, has been aiding the AHA in its work with the CSC.

“Hospitalizations from STEMI represent an increasing health burden for China,” he explained. “There are a number of highly effective therapies that can significantly improve outcomes and reduce recurrent events in patients, but adherence to evidence-based guidelines for cardiovascular care that implement these therapies for patients remains incomplete and highly variable.”

The CCC project aims to develop and implement an emergency medical system and hospital-based program to care for heart attack patients in China, where cardiovascular disease accounts for 45 percent of total deaths, as opposed to about 33 percent of deaths in the U.S.

During a visit to the UNC Medical Center Wednesday, about a dozen Chinese cardiologists from hospitals in Tianjin, Jiangsu, Hangzhou, Beijing and Shanghai toured an Orange County EMS ambulance, and toured UNC’s emergency department, helipad and cardiac catheterization lab. They also discussed UNC’s STEMI system of care with multiple UNC representatives.  Jason Katz, MD, associate professor of medicine and medical director of the Cardiac ICU, and Cristie Dangerfield, RN, BSN, and nurse manager of the Cardiac ICU, gave presentations about the management of patients who have been resuscitated from cardiac arrest. Kaitlin Strauss, RN, BSN, and coordinator of the medical center’s Chest Pain Center, explained UNC’s methods of gathering patient data, and noted they could improve that system by learning from Chinese methods, a benefit of the AHA partnership.

“I know that the AHA is working in collaboration with the Chinese Heart Association to enroll more hospitals in national data registries, and I think this work will help drive quality improvement for both patients with acute coronary syndromes, along with a variety of other cardiovascular diagnoses,” said Strauss.

Qinhua Jin, the associate director of the Cardiology Department at the military 301 Hospital in Beijing, also commented on areas she now believes her hospital could improve, starting with patient education.

“In China we have problems with the patient’s recognition of this kind of cardiovascular disease. They have symptoms and come to the hospital many hours later, delaying treatment. Patients also wait to undergo procedures until family members have signed consent forms, again prolonging much needed care,” said Jin.

The group also heard about the UNC Stroke Program from its director David Huang, MD, PhD, professor of medicine, along with Stroke Program Nurse Coordinator Nicole Burnett, RN, BSN. Xuming Dai, MD, PhD, clinical assistant professor of medicine and interventional cardiologist at UNC explained the treatment of patients who experience a STEMI while hospitalized for a different reason. Dai also interpreted the presentations.

After getting a glimpse into STEMI systems of care like UNC’s, the AHA and CSC will work to create similar programs for hospital systems across China.

“I think the group of cardiologists on this tour is starting to realize that there’s true opportunity to make a difference in China,” said Morgan.

UNC’s Cardiac Catheterization Lab Opens New Radial Lounge

UNC’s Cardiac Catheterization Lab Opens New Radial Lounge click to enlarge A view of UNC's new Radial Lounge

UNC's Cardiac Cath Radial Lounge is now open for patients!

What does this mean for patient care? Cardiac catheterization can be performed via two access points, one of which is the radial (wrist) artery. With radial access, a pressure wristband, also known as a TR band, is placed in the lab to stop the artery from bleeding, Minimal sedation is used for these procedures, so these patients typically walk back to their recovery bays, sometimes with a bathroom stop. These patients are alert and oriented, and only remain in recovery long enough to remove the TR band. This removal process takes 1.5-3 hours. In a traditional recovery room, these patients are confined to a stretcher and wall monitors. The radial lounge is a modernized recovery area, where the recovering patient can ambulate around a café like atmosphere while being monitored via wireless telemetry. Patients can help themselves to food and beverages in the nutrition center, and sit in a comfortable lounge chair, and even have the freedom to use the restroom independently.  This all leads to a more comfortable recovery period for our cardiac cath patients. Learn more about cardiac catheterization at UNC here.

UNC research in the spotlight at AHA 2017

The American Heart Association highlights UNC research presented at the 2017 American Heart Association Scientific Sessions on racial disparities in the management of non ST-segment elevation myocardial infarction. Study presenter Dr. Sameer Arora comments "Invasive strategy (angiography with intent to revascularize) has become the guideline-recommended standard for management of NSTEMI...The efficacy of this strategy has been widely accepted, but it appears to be utilized less when patients are black. Racial disparities in angio­graphy and revascularization would have the potential to negatively influence mortality outcomes for black patients."

Health benefits of exercise

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

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

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

More information about this event…

Same Day Deep Vein Thrombosis Clinic Opens in Meadowmont

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

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

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

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

Details:

UNC Heart and Vascular at Meadowmont

300 Meadowmont Village Circle

Suite 301

Chapel Hill, NC

Clinic Hours:

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

Contact:

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

Simple Genetic Test Promises Better Outcomes in Heart Stent Patients

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

November 2, 2017

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

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

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

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

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

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

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

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

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

 

Structural Heart Team Focus of Health Careers Symposium

The UNC Valve team played a lead role in this year's Health Careers Symposium, an event sponsored by UNC Health Care's Volunteer Association. On October 19, 2017, over 150 high school juniors and seniors interested in healthcare careers come from across North Carolina to UNC Medical Center for this annual event. UNC's Structural Heart Team was the focus for this year.

Visiting students were able to meet and learn from UNC Cardiology & Anesthesiology faculty, nurses, med students, nurse practitioners, cardiac perfusionists, and cath lab and echo techs. Drs. John Vavalle, Greg Means, Shiv Madan, and Bob Rayson led a hands-on pig heart dissection breakout. Roman Bazaar, RN and Staci Sernulka, RRT demonstrated transcatheter valve procedures and heart catheterization equipment. Dr. Thelsa Weickert and sonographer Ron Wofford demonstrated live echocardiography with an echo machine. The event concluded with a professional panel Q&A session with students about career advice, choosing a health care field, and work-life balance.

UNC's valve team offers innovative, minimally invasive approaches to treating aortic valve stenosis, mitral valve disease, and other disorders. Learn more about the valve treatments they offer.

Innovative Approach to Afib Gains Media Attention

Dr. Anil Gehi's grant-winning afib treatment project garnered attention from both local and national media. Check out the coverage from these sources: Triangle Business Journal, WUNC, EurekAlert!

When Time is Muscle: UNC Cardiologists Beat the Clock

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

By Kim Morris, UNC Department of Medicine

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

UNC Cardiology at the American Heart Association

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

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

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

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

More information about this event…

Skills of a Tar Heel, Luck of the Irish

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Record attendence for 2017 NC Cardiovascular Update

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Avoiding Unnecessary Hospitalization

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

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

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

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

Afib Transition Clinics vs Hospitalization

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

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

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

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

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

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

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

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

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

Click here to watch Gehi discuss the work with WRAL.

About UNC School of Medicine

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

About Bristol-Myers Squibb Foundation

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

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

 

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Qian Lab awards and publications

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

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

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

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

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

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

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

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

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

The McAllister Heart Institute presents Dr. Nikolaos Frangogiannis

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

More information about this event…

Staring down the widowmaker

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

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

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

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

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

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

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

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

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

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

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

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

Roger coded again shortly afterward.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

UNC Hospitals Cardiac Rehabilitation Program Certified by Industry Leader

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

August 31, 2017

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

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

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

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

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

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

 

 

Dr. Brian Jensen delivers Whitehead lecture

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

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

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

McAllister update

Recent news from our McAllister Heart Institute colleagues:

New research by Bautch lab

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

Carrie Neal honored for nursing excellence

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

Learn more about heart failure care at UNC.

First leadless transcatheter pacing device at UNC

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

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

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

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

AHA Mission: Lifeline Award for UNC Hospitals

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