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Duke Heart Pulse – Week Ending 12-20-20

December 20, 2020 / Leave a comment

Chief’s message:

Our final pre-holiday weekly Pulse for 2020 makes me think back a year from now. Last year as we celebrated the New Year we would not have imagined that 2020 would bring a global pandemic that stresses and puts our health care systems in our country at the center of public health battle. It is in this tumult, that the Duke Heart Community responded with much more involvement and innovation in clinical care and multiple organized research grants nationally and locally in an attempt to continue to move the scientific field forward, and many outreach efforts to improve our community health in hopes of better days.

It is with your relentless commitment and resilience that we have endured and worked as a group. This has been highlighted over the last week as the Pfizer-BioNTech Covid-19 arrived across the country and groups mobilized to get frontline and essential groups vaccinated. At Duke and we worked as hard as possible to ensure all of our groups were informed, registered, and appropriately getting in line to get vaccination slots. But this was not without angst as we were ensuring we register, get our groups aligned and communicated to how and when people will get the vaccine. It’s hard to be patient at the end of a 10-month pandemic. We were encouraged by the increase in vaccinations given even today on Sunday, with many of our that our trainees and staff and faculty starting to move through the process.

It is with this background, that I was most struck this week by the CT surgery final faculty meeting with Peter Smith as Division Chief. As the Division Chief for CT surgery at Duke for the last 25 years, it is hard to put into words what he has meant to the group. For 2 hours we heard from all parts of our health system, network, clinical practice, research infrastructure and most importantly numerous faculty and staff as to the affect he has had on our Heart Center. We are glad he will be around support our group and Ed Chen and the CT surgery group, and look forward to his continued leadership.

I am proud of the work our staff, fellows, and faculty have done to care for our patients. As we look forward into 2021, we are aware of the need for your continued partnership, local leadership for the health of your community, and the importance of keeping our patients involved and engaged in our science. We are ever grateful for all of our people, the people that make Duke Heart. We will need all of your continued collaboration and support in this upcoming year.

Highlights of the week:

Duke Heart Talent Show ‘Spectacular’ Held

As this crazy year began winding down and vaccine planning ramped up, a different sort of challenge was thrown down – with several brave souls stepping up for the first-ever Duke Heart talent show… The event was held via Zoom on Friday evening. Contestants representing areas within the Division of Cardiology competed in short videos demonstrating the wide range of talents (or lack thereof, depending on who you ask) in front of a panel of judges and an audience of 75+ colleagues. Our co-hosts were Manesh Patel, Vanessa Blumer and Sipa Yankey; our judges were Kevin Friede, Zack Wegermann, Navid Nafissi and Angela Lowenstern.

The event kicked off with a surprise visit by “the Masked Santa” and moved on to the cooking talent of John Alexander, (in photos he was accompanied by Mango, the African lovebird); Alexander had – prior to the Zoom event –delivered his Slow Cooker Red Lentil Cauliflower Curry direct to the homes of each of our four judges as well as instructions on how to reheat, etc. The curry was a hit!

Next up were:

Chris Granger & Tilley, with an impressive juggling performance
Beckett Mentz, 8, in a convincing performance of the aftershave scene from Home Alone
Members of the Duke Heart Failure Team singing the 12 Days of COVID with a cameo performance by Joe Rogers
Tony Carnicelli on acoustic guitar with a twist on Let It Be
Adam Barnett, accompanied by adorable daughter Lily, playing classical piano
Schuyler Jones reading hiaku
Mikael “Mik” Templeton, from our interventional team, on saxophone with The Christmas Song (chestnuts roasting on an open fire).
The Adult Congenital team’s “Kazoo Khoir” in a rousing performance of Rudolph the Red-Nosed Reindeer. Rich Krasuski with some wonderful ad libs.
Future Tik Tok star Manesh Patel, encouraging vaccination for COVID-19, with cameos by Anna Lisa Crowley, Jacob Schroder and Carmelo Milano
Sipa Yankey rapping his day-in-the-pandemic-life experiences with “Ain’t No Thrombus“

The showstopper of the evening proved to be a stunning rendition of ‘Ave Maria’ featuring the gorgeous voice of Ashli Carnicelli accompanied Tony Carnicelli on acoustic guitar; the judges agreed this was the winning performance.

Thanks to all who were able to join our Zoom event. The commentary in the ‘chat’ was a vital part of the evening – it was great to see so many members of our team and we hope that coming together in this way helped you celebrate the holidays and one another. To quote Tracy Wang via chat at the end, “Needed the pick me up, thanks to all; this was special…. happy holidays!”

We especially appreciate the generosity of our contestants – we know it took effort to pull your videos together on short notice. We thank our judges and the hosts for the evening – you did a great job with commentary and keeping things lively.

Great job, everyone, and happy holidays to you and yours. Thanks for making Duke Heart such a special place at Duke.

7200 Moved Successfully!

The Cardiac Stepdown Unit on Duke North 7200 moved to Duke North 7700 with a capacity for 12 patients on Friday, Dec. 18. Thanks to everyone who helped make this a successful, seamless move! In one of the photos you can see the code response for move with Greg Flynn. Also shown are Faith Williams, Diane Sauro, and Sarah Kirby. Another photo shows the team debrief. Many, many thanks everyone!

Commendation for Lisa Duncan and 7100/7200 Team

Special thanks to Lisa Duncan, 7100 Nurse Manager and Clinical Leads Antoniette Embler, Brittany Stephenson, and Katherine Adams for their leadership on 7200. This leadership team opened 7200 in the fall of 2017 by hiring and onboarding a team of nurses to complement the existing 7100 team. During their tenure, the unit received top performance accolades from senior leadership for Patient Experience metrics on several occasions (unit cleanliness and staff responsiveness to name a few). In FY20, the unit excelled with quality metrics, having no CAUTI or CLABSI infections or hospital acquired pressure injuries. As the coverage for 7200 has now transitioned, we want to acknowledge the efforts and contribution of the 7100/7200 leadership team and staff under Lisa’s guidance for their care of patients and their loved ones, and support of the Hospital’s capacity needs.

Informatics Expert Joe Kelly Earns Black Belt

Congratulations to Joe Kelly, Duke Heart’s Director of Cardiovascular Informatics & PI/QI, for earning his black belt in karate – specifically in the Shito-Ryu Motobu-Ha style.

According to Joe, it usually takes about 10 years to get a black belt in this style. “We also practice Jiu Jitsu (Hakko-Ryu), and Kobudo (weapons – Ryu Kyu Kobudo Hozon ShintoKai), he said. “All these are from the island of Okinawa.”

His testing/demonstration was done via Zoom (see photo). The Zoom panel photo shows Sensei Devorah Dometrich who is a 9th Degree Black belt (10 is highest) and was the first female Okinawan 7th Degree black belt in 1997.

During the testing, Joe had to perform and then show application for the exact same Kata (forms) that have been done for over 200 years and derived from other Kata that date as early as 600 C.E.

According to Joe, his sensei will often have kids with special needs in the class for children; he teaches special needs classes in Durham County, and anyone of any shape-age-weight, provided they can partake of physical activity, can make adjustments and take the classes.

“I picked the Dojo because they are not at all “macho” or “rough” but instead are humble and excellent teachers,” he added.

Please join us in congratulating Joe on this accomplishment! He will soon be teaching classes via Zoom, so if you’re interested, drop him a note.

Way to go, Joe!!!

7200 Earns Top Performer Status

Congrats to the team of 7200 for earning Inpatient Responsiveness Top Performer Status for Sept. – Nov. 2020.

Zoom Retirement Party Held for Karen Craig

A virtual retirement celebration was held via Zoom for Karen Craig of the CardioPulmonary Rehab team on Wednesday evening, Dec. 16. Craig is retiring from Duke on December 31^st. It is hoped that we’ll be able to offer a celebration in-person sometime in the future, but the team gathered this week via Zoom to share stories and reflect on Karen’s remarkable contributions throughout her career.

Zoom guests were asked to prepare a few words to share with Karen, and creative Zoom backgrounds that reminded people of Karen were encouraged, many of which can be seen in this screen shoot.

Congrats, Karen!

Steve Guerrant Retirement Celebrated

Steve Guerrant, who has served Duke University Hospital for 29 years and has been the Engineering Specialist in the Duke Electrophysiology Lab for 13 years, is retiring this month from Duke; he was celebrated this week on the unit. His knowledge of EP equipment, lab construction, and troubleshooting will be sorely missed. His ability to share knowledge and teach EP staff members the equipment side of EP is one-of-a-kind. He has been an integral part of the EP team and we are all grateful to have worked with him. Many thanks to Jill Engel for photos and Elizabeth Watts for helping Pulse share this news!

Lowers Named CardioPulmonary Rehabilitation Manager

We are excited to share that Sean T. Lowers, PT, DPT, CCS has accepted the Manager, Clinical Services position with our CardioPulmonary Rehabilitation team. The announcement was made last week by Brian Wofford, Vice President of Heart Operations for Durham County.

In his announcement, Wofford offered special thanks to our HR, Recruitment, and Interview teammates for an efficient and effective recruitment process. Lowers started in his new role on Tuesday, December 15^th in order to maximize the formal handoff between him and Karen Craig before her retirement on December 31st.

“We will miss Karen more than words can express, but Sean has been a pivotal member of the team both as a Physical Therapist and Clinical Services Coordinator,” said Wofford. “His experience and work with Karen has prepared him to lead the team through our next chapter, and I am personally excited for what is in store for all of us.”

Lowers’ previous position on the team was Clinical Services Coordinator, Rehabilitation; as he transitions, leadership is changing the scope of his previous role. The replacement position will have a Cardiac Rehabilitation focus instead of a focus on Pulmonary Rehabilitation and we anticipate the job to be posted soon.

Please join us in congratulating Sean on his promotion!

Shout-out to Banks & the Fellows Team

We received a great note this weekend from Cary Ward regarding Adam Banks, which led to additional observations about the Cardiology Fellows team:

“I first want to give a shout out to Adam Banks for helping the DHP team with a patient who was very sick with mitral regurgitation and needed a diagnostic cath in preparation for surgery. The patient was frightened and anxious and intermittently refusing care. She had even signed out AMA the week before. Adam was able to develop a rapport with the patient who then agreed to cath and eventually a balloon pump. This took a lot of time and emotional energy on Adam’s part and he could have easily taken the easy way out instead by reporting back that she was not willing to sign consents. We were all very appreciative of all the extra time he took with her.

After noticing Adam’s contributions in the beginning of the week, I began to see all the other times in which the fellows ensure that our patients get excellent care: Chris Wrobel managing the DHP team all week while needing little input from me … Alyson Corley spending most of her CCU call resuscitating one of our patients…Toi Spates and others helping the nurses with an off service patient who had fallen in 7200…Kelly Arps who cared for a very sick AS patient all Friday night…the list goes on.

And then on Friday we watched the talent show in which Tony Carnicelli and Adam Barnett showed off incredible musical talent, the emcees were hilarious and Sipa performed “Ain’t No Thrombus.”

During this holiday, I feel grateful to work with such an amazingly talented and vibrant group of young people, and want them to know how incredibly valued they are.

Happy Holidays to all the fellows!”

Indeed, we have a gifted team of fellows, faculty and staff comprising Duke Heart. Thank you to all!

Good Catch, Spikes!

Jasmine Spikes received a Good Catch Award on December 11; the “catch” occurred on October 22 – the award reads, “For ensuring patient safety by recognizing that a patient had a red identity flag and that the patient’s identity had not yet been confirmed during a recent admission from the ED. She immediately contacted unit leadership for support on how to handle the situation. It was determined that the patient identity was not verified while in the ED and the patient’s identity was subsequently confirmed.”

Thank you to Antoniette Embler, Clinical Team Lead for Cardiology Stepdown 7100/7200, for sharing this with Pulse!

Shout Out to Siffring & Perfusion Team!

Travis Siffring and our Perfusion team have two publications in the latest issue of The Journal of ExtraCorporeal Technology, the official journal of AmSECT, as well as a prominent accolade from the JECT editor:

Academic Perfusion at Its Best and New Tradition:

Our ﬁnal Journal of ExtraCorporeal Technology issue for 2020 showcases the myriad of ways that our clinical perfusion community conducts academic work that contributes to our practices. The impressive work published here not only shares the knowledge they have generated but also will, I hope, inspire others to partake in the enrichment of our clinical skills and enhancement of our profession.

The ﬁrst example of such an enhancement that I would like to highlight is that of AmSECT, our sponsoring society, now have a published set of standards and guidelines for pediatric congenital perfusion! Molly Oldeen and her co-authors have meticulously compiled a much needed, previously non-existent set of standards and guidelines for our colleagues practicing pediatric and congenital perfusion. AmSECT’s service to these perfusionists is now on par in this regard with what it provides to adult perfusionists. Furthermore, these standards and guidelines were reviewed and endorsed by both the Congenital Heart Surgeons and Congenital Cardiac Anesthesia societies. With its co-publication in the World Journal for Pediatric and Congenital Heart Surgery, these standards and guidelines will be widely available and shared broadly within this specialty. My congratulations to Molly Oldeen and her co-authors who are all well-known, long-time contributors to AmSECT, for their latest accomplishment!

Another group of perfusionists I would like to congratulate and highlight in this issue is Travis Siffring and his Duke University team. They have two publications in this issue, not only showing us a new optimized perfusion strategy for Norwood reconstructions but also demonstrating how perfusionists can participate in investigating and innovating along with their physician partners and then share their ﬁndings in their respective profession’s journals. The work shared in this issue ﬁrst describes their early in vitro evaluation of their sustained total all-region perfusion technique. This is followed by their second article describing the clinical implementation of this technique from the perfusionists’ perspective. Also referenced in their work is a third publication by their physician colleagues who described the surgical technique aspect of this effort. Siffring and co-authors should be commended not only for their contributions in developing this technique but also for making that extra effort to share their relevant efforts with our perfusion community through these articles. This is clinically driven academic perfusion done right!

A PDF of the full message from JECT Editor-in-Chief Raymond K. Wong, PhD, CCP, is available here. The full issue is available now, online, to AmSECT members.

Way to go, Perfusion!!!!

Thoughts on “LV”

It comes as no surprise that the people we work with each day make a pretty significant impact in our work lives. In healthcare, the work is personal and especially so when we become ‘the patient’. The retirement of Lavetta “LV” Staton spurred the following note to her, which was shared this week with Pulse. It’s printed here with permission of the writer, name withheld:

“LV,

I have thought about this for 5 years but have never had the right opportunity to share it with you. Now you are retiring.

In 2016 I had chest pain, got a stress test, and then a cath. It turned out to be normal.

As familiar as I am with health care and the Duke Cath Lab it is still a humbling and anxiety producing experience to be on the other side of the table as a patient.

I am privileged and got to choose Sunil Rao to be the attending but it was your being there that made me feel comfortable and that I was in good hands.

You were familiar, professional, competent, and kind. Thank you. Somehow I don’t remember anybody else.

All the best in your retirement!”

The work we do together is important; our skills and expertise matter. But at the end of the day, how you treat people makes a bigger impression.

COVID-19 Updates:

All the latest official DUHS information regarding coronavirus/COVID-19 response at the following locations:

NOTE: Today is our last issue of Pulse for 2020. We will return on Jan. 10. Enjoy the holidays!

Upcoming Opportunities/Save the Date:

Cardiology Grand Rounds

Dec. 22: No Cardiology GR. Happy Holidays!

Dec. 29: No Cardiology GR. Happy Holidays!

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged.

Duke Heart in the News:

December 14 — Rob Califf

CNBC/Squawk on the Street

Historic vaccination effort underway

https://bit.ly/3mwEEIL

*clip begins @ 10:33:40

December 15 — Rob Califf

Bloomberg Surveillance

Data Show Vaccine is Safe

https://bit.ly/38oyGVd

*clip begins @ 08:19:28

This story also carried on Bloomberg Radio

Duke Heart Week Ending December 13th

December 13, 2020 / Leave a comment

Updates of the week:

Sondej Leaving Duke Heart in January; Heading to OneMedical

Sean Sondej will be leaving his role as Associate Vice President of Heart & Vascular Services for Duke University Health System (DUHS) to accept a position with One Medical as Vice President of Strategic Partnerships. The announcement was made Friday by William Fulkerson, MD, Executive Vice President of DUHS.

“We are truly sorry to see Sean leave our team, but we’re also happy for him as he begins a new career challenge,” said Fulkerson. “As many of you know, One Medical is one of our clinically integrated partners and a valued member of our growing network.”

Sean has been a member of the Duke family for more than 17 years, starting as an administrative fellow in 2003. His talents were quickly recognized, and he advanced here to fulfill many important roles, including partnering with physician and nursing leaders to lead our Heart Center CSU during a critical period of growth. Instrumental in creating our Heart Care Plus collaboration with WakeMed and working with many other local hospitals to expand high quality care in their communities, Sean is admired as a relationship-builder, a strategic thinker and an effective leader of great character. Throughout his career at Duke, he has mentored many colleagues and developed the people around him, including sponsoring our MINDS affinity group to support our young professionals.

Sean leaves behind a strong team, and I’m grateful to Jill Engel for agreeing to serve as Interim AVP of Heart & Vascular Services. Over the next two months, we’ll be working with Sean to ensure a smooth transition.

Sean will be with us until the end of January 2021. He and his family are planning to remain here in Durham, and we look forward to staying connected and working with him in his new role.

The announcement concluded with Fulkerson thanking Sean for his work here at Duke and for helping to build a team that will continue to deliver the highest quality care to our patients and families for many years to come.

Congratulations, Sean!

CVRC Announces Annual Mandel Awards

The Duke Cardiovascular Research Center (CVRC) has recently announced their annual Mandel Awards. The team made three awards in the Seed program, two awards in the Fellow program, and one in the Scholar program. We are pleased to share the projects and scholars receiving funding for the 2021 project period (Jan. 1- Dec. 31, 2021):

Mandel Scholar Award

Dennis Abraham, MD

Project: Mechanosensitive TREK-1 modulates myofibroblast driven fibrosis

According to the CDC, nearly one in three people in the US suffer from Hypertension and are at risk for developing the dreaded

complication of congestive heart failure. Once heart failure develops, hypertensive patients are at risk of becoming debilitated and dying prematurely. Both death and debilitation remain largely unchecked amongst hypertensive patients who develop a form of heart failure called Heart Failure with Preserved Ejection Fraction (HFpEF), due to the lack of effective drug therapies. A key event in the development of HFpEF is scar tissue formation produced by cardiac cells called fibroblasts. In response to conditions like Hypertension, fibroblasts are activated (myofibroblasts) to produce scar tissue (fibrosis) that causes the heart to become stiff. Our lab has found that the potassium channel TREK-1 has a profound influence on scar tissue formation after hypertensive injury. In this proposal, we will examine how TREK-1 affects the activation of fibroblasts in response to conditions that mimic an injured heart. If successful, we anticipate discoveries that may lead to therapeutic strategies to mitigate cardiac stiffness and the development of HFpEF.

Mandel Fellow Awards

Qiao Zhang, PhD, mentored by George Truskey, PhD

Project: Clinically relevant human microphysiological system disease model to investigate the effects of cellular force disruption in Cardiovascular diseases and Hutchinson-Gilford Progeria Syndrome

Cardiovascular disease (CVD) is the leading cause of death among persons aged 65 and older in the United States and the risk of developing CVD increases with age. Understanding the role of aging in the development of CVD can help early diagnosis and treatment to reduce the likelihood of subsequent serious events such as development of ischemia and stroke. Hutchinson-Gilford Progeria syndrome (HPGS) is rare but fatal disease that happens to young children and cause premature aging. Children with HGPS develop CVD and die of complications from CVD at an average of 13 years. The cause of HPGS is by the accumulation of progerin, a modified form of the nuclear envelope protein lamin A which produces an irregularly shaped cell nucleus. The nucleus is under force balance and performed as olive shape with smooth edges. Irregular nuclear shape shown in HPGS cells indicates a disruption of force balance on nucleus, which will cause alterations in gene expression and subsequently contribute to the progression of atherosclerosis in HGPS. Restoring the force balance on the nucleus may correct some of the phenotypes caused by accumulation of progerin. As progerin accumulation has been shown to increase with normal aging, the findings from this proposal could also help reveal the role of progerin accumulation in aging blood vessels.

Gayathri Viswanathan, PhD, mentored by Sudarshan Rajagopal, MD PhD

Project: Chronic thromboembolic pulmonary hypertension (CTEPH) and Pulmonary arterial hypertension (PAH)

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease of the pulmonary vasculature characterized by persistent thrombotic occlusion or stenosis of the pulmonary arteries resulting in pulmonary hypertension (PH). CTEPH is a serious and often fatal disease. Although pulmonary thromboendarterectomy (PTE) remains the treatment of choice for patients with CTEPH (Fig. 1), not all patients will benefit from or receive this highly specialized surgery. Patients whose CTEPH is deemed inoperable are candidates for medical therapy, for which only riociguat, a soluble guanylate cyclase stimulator, is FDA-approved. Thus, there is a significant unmet need for novel medical therapies for CTEPH. At this time it is not known what specific receptors are expressed in CTEPH thrombus and how they contribute to thrombus proliferation. Directly addressing this knowledge gap would aid in our long-term goal of developing novel medical therapies for CTEPH. The overall objective for this application is to identify up- and down-regulated GPCRs in thrombus isolated from CTEPH patients who have undergone PTE surgery and test the effects of targeting those receptors in culture models of thrombus. We will do this by performing GPCR profiling globally using single cell RNA sequencing (scRNAseq). These studies will allow us to differentiate receptor expression in different cell types, such as myofibroblasts, endothelial cells and immune cells that compose the thrombus. We will then test the effects of modulating signaling through these receptors in ex vivo models of CTEPH thrombus. The expected outcomes of this project is a deeper mechanistic understanding of the cells that contribute to and dysregulated signaling in CTEPH. This will aid in our long-term goal of developing novel CTEPH medical therapies.

Mandel Seed Awards

Laura Wingler PhD

Project: A High-Throughput Discovery Platform for Deep Mutational Scanning of GPCR Kinases

G protein-coupled receptors (GPCRs) are the targets of numerous drugs used in the treatment of cardiovascular diseases such as hypertension (e.g., beta-blockers targeting b-adrenergic receptors and angiotensin receptor blockers [ARBs] targeting angiotensin receptors). Typically, activation of GPCRs initiates numerous events within cells, but it has now become clear that certain drugs selectively trigger only some of these myriad cellular effects. This exciting revelation means it may be possible to design new drugs with finely tuned profiles (e.g., improved effectiveness and reduced side effects). However, we will not be able to leverage this phenomenon rationally until we understand the molecular-level details of how GPCRs “turn on” each of the three main families of proteins that they directly interact with in the cell. Recent breakthroughs in GPCR structural biology have begun to provide such insights for two of these protein families, but understanding of the third key family, GPCR kinases (GRKs), has lagged far behind. This is principally due to the fact that the interactions between GPCRs and GRKs are relatively brief and unstable, making it difficult to “capture” and study activated GRKs. To circumvent this technical challenge, we propose a unique approach to elucidate the changes that GRKs undergo. During the funding period, we will develop a high-throughput system to generate millions of GRK mutants and screen for those that assume activated states even before they interact with GPCRs. Successful completion of our specific aims will deliver a toolkit of GRK mutants whose activated states can be readily studied using powerful structural biology methods. This will provide a critical missing “piece of the puzzle” as to why certain GPCR drugs turn on different effects in the cell. Ultimately, this information could inform the development of next-generation cardiovascular drugs with optimized therapeutic profiles.

Ravi Karra, MD and Dennis Ko, MD PhD

Project: Genetic Regulators of Human Cardiomyocyte Proliferation

The human heart was once considered to be static, but recent work has challenged this dogma. The human heart is now known to be capable of a low-level of muscle turnover. While cardiac cycling occurs at a low rate, the absolute amount of heart tissue that is replaced over a lifetime could be substantial. However, no tools exist to understand the relative contribution of cardiac turnover to cardiovascular disease. Here, we will use human genetics to 1) understand how the risk for heart failure relates to heart muscle turnover and 2) identify new markers that can be used to track how cardiac turnover impacts cardiovascular disease

Sudha Shenoy PhD, collaborating with Jonathan Campbell, PhD

Project: Ubiquitin-dependent signaling bias at the glucagon family receptors and its impact on pancreatic β cell function

Note: This team received funding last year, and made significant progress. However, additional progress was prevented by the pandemic and accompanying Duke research curtailment. This led reviewers to prioritize funding for this team and their high caliber work.

Type 2 diabetes (T2D) and associated insulin resistance contribute to the etiology of atherosclerosis and constitute major risk factors leading to morbidity and mortality from cardiovascular disease. The peptide hormone glucagon and the class B seven-transmembrane G protein-coupled receptors that are activated by glucagon play a fundamental role in regulating blood glucose levels. These receptors, namely the glucagon receptor (GCGR) and the glucagon-like peptide 1 receptor (GLP-1R) also regulate insulin release from pancreatic beta cells and are currently major targets for developing new treatments and drugs for T2D. Glucagon binding elevates the second messenger cAMP through the activation of G proteins, and furthermore, the activated receptors are subjected to desensitization and internalization through recruitment of additional proteins, namely, GPCR kinases, ꞵ-arrestin and RAMPs. GLP-1R agonists enhance insulin secretion and reduce food intake, which promotes glucose lowering and reductions in body weight in patients with T2D. Glucagon agonists also increase satiety and induce energy expenditure, suggesting the combination of GCGR and GLP-1R agonism could have additive effects on weight reduction and further improve glycemia. Consequently, the GCGR is an emerging target in anti-diabetic therapy, particularly in the development of GCGR/GLP-1R co-agonists. However, there still remains an incomplete understanding of the signaling mechanisms invoked by either the GCGR or the GLP-1R, which limits the drug discovery to tackle T2D and associated morbidity. In this context, we have now identified that GCGR is subjected to ubiquitin-dependent regulation. Ubiquitin is a small protein that acts as a signaling code when appended to active protein complexes. Our data suggests that ubiquitination of the GCGR increases signaling through G proteins, whereas ligand binding causes de-ubiquitination, leading to decreased G protein coupling and increased ꞵ-arrestin binding and activity. There is limited information on the regulation of GLP-1R by ubiquitination. Thus, our studies will test the role of GCGR and GLP-1R ubiquitination in the propagation of signaling via these transducers and identify the molecular mechanism(s) that link ubiquitin-dependent signaling to cellular function.

Congratulations to all Mandel funding recipients!!

Shout-out to Spates

In a note from Sudarshan Rajagopal to Anna Lisa Crowley this week, we received a shout-out for Toi Spates:

“Just wanted to give a shout out to Toi Spates who helped last week when a patient decompensated overnight. She did a great job getting in touch with the patient’s family and managing the situation.”

Great work, Toi!

“LV” Retirement Celebration Held

We mentioned last week that Lavetta “LV” Staton was retiring – the Cath Lab hosted a socially-distanced gathering to celebrate & thank her this week. Hat tip to Jill Engel and Elizabeth Watts for sharing the following photos with us this week. According to Watts, “LV has been at Duke for 28 years and a member of the Cath Team since 1997. Her charisma and commitment to her patients and team will be sorely missed. She has touched many lives along the way and we are all grateful to have worked with her.”

We will miss you, LV!!!

Duke Emergency Alert Test: Wednesday, Dec. 16

Duke University & Duke University Health System will conduct a test of the DukeAlert system on Wednesday, December 16 using all existing channels. Regular tests that had been scheduled for March and October were postponed due to the pandemic… but, with winter upon us, we need to ensure all new students, faculty and staff understand how they would hear about an emergency incident at Duke. To read more about this, check out the article from Duke Today: https://today.duke.edu/2020/12/dukealert-test-scheduled-dec-16

DUHS Well-being Survey: Please Complete!

A survey link was sent to all Duke Health team members last week; the survey is to better understand how everyone is holding up during this challenging year. If you have not yet taken it, please look for it in Outlook – it came from survey@smdhr.com — and complete it this week; it’s short and will take less than five minutes.

NOTE: The survey is being administered by a 3rd party survey partner (SMD) in order to maintain confidentiality; it is safe to open the link. The survey will ask specific questions to understand how DUHS can improve things that may increase our resilience and well-being. The effort will also check how we’re doing with our effort to increase our diversity, inclusion and belonging. We will use your thoughts to guide these efforts going forward. Please participate – thank you!!

COVID-19 Updates:

All the latest official DUHS information regarding coronavirus/COVID-19 response at the following locations:

NOTE: A reminder that Pulse will not be published on Dec. 27 or Jan. 3 so that we may enjoy some time off.

Upcoming Opportunities/Save the Date:

Cardiology Grand Rounds

Dec. 22: No Cardiology GR. Happy Holidays!

Dec. 29: No Cardiology GR. Happy Holidays!

Radiothon for Duke Children’s Dec. 15-16

The annual Radiothon for Duke Children’s will be held on Dec. 15-16. Tune in to MIX 101.5 FM during the Radiothon to hear incredible and moving stories from our Duke Children’s patient families and pledge your support. Together, we can continue to advance care and give hope to the children and families who need it most. Donate today at bit.ly/DukeRadiothon2020.

Have news to share?

Duke Heart in the News:

December 4 — Joseph Rogers, Cameron Wolfe (ID) & Rita Oakes (Nursing)

WRAL

With scores of infected workers, Duke Health preps to vaccinate staff

https://bit.ly/3gty98e

December 4 — Joseph Rogers, Cameron Wolfe (ID) & Rita Oakes (Nursing)

WRAL

Challenges with COVID vaccine distribution

https://bit.ly/3n6jmTE

December 6 – Duke, Eugene Stead

MedpageToday

Remembering the Past to Inspire the Future for Advanced Practice Professionals

https://bit.ly/3nlN3QM

December 8 — Manesh Patel

docwirenews

Manesh Patel, MD Talks Atherosclerotic Disease Updates

https://bit.ly/37fVZBr

Duke Heart Week Ending December 6th 2020

December 6, 2020 / Leave a comment

Chief’s Message: Moments of Brightness

Being on call for the cath lab this weekend highlighted for me the continued dedication and strain our teams are facing in the Winter of 2020 as we struggle with the Pandemic for hopefully the last time. All of our health systems and communities have been strained, but perhaps not as much as they are now. Although the health system entry points, the routine of masking and PPE, visitation, clinical care, and communication and distancing procedures have now been going on for many months – there is still a sense of new found struggle. I see the calm and resolve that our faculty, staff, fellows, and teams exhibit hourly to help care for our patients and each other. And it is the hope and now the expectation with vaccines and improved treatments that there will be a light at the end of a long tunnel. It is in this journey that I ask for all of your in this upcoming Holiday time to take a moment to get any rest possible, appreciate those in our lives, and recognize the moments of brightness that are happening.

This weekend was the last weekend of call with Lavetta Staton “LV” (a long standing Duke Cath lab nurse – over 22 years in the cath lab and 30 years at Duke). If you have been in the Duke lab, you have heard the LV sayings – “Teamwork makes the Dreamwork”, “If you stay ready, you don’t have to get ready,” and many more. Generations of patients, fellows, faculty, and staff have been touched by LV. We will be holding a proper retirement when we can – but until then it was an honor to take care of the last Acute MI patient with her as another class of diagnostic and interventional fellows will have there own personal sayings and lessons from LV. Perhaps the most important lesson from a long career in the Duke Cath Lab that LV imparted was the sense of vigilance, readiness that we continually strive for to ensure our patient care is as good as it can be. The fun, the interaction, all of it came after ensuring we could get patients the care they needed in times of acute and sometimes unexpected need. Therefore, as we near a hopeful end to a long winter, we should all appreciate the moments of joy/brightness this holiday season while we strive to stay ready and safe as we care for our patients and each other.

Highlights of the week

Duke Cardiology Fellowship Program Announces 2021 Class

The newest fellows to the Duke Cardiology fellowship program were announced earlier this week. They’ll join us in July, 2021. Please join us in celebrating with:

Willard Applefeld, Osler Medicine Training Program, The Johns Hopkins Hospital
Sara Coles, Duke University Health System
Ijeoma Eleazu, Massachusetts General Hospital
Mohammad Shahzeb Khan, Cook County Health & Hospital System
Veraprapas Mark Kittipibul, Jackson Memorial Hospital/University of Miami
Nkiru “Kiki” Osude, Loyola University Medical Center
Balimkiz Senman, Brigham & Women’s Hospital
Ilya Shadrin, Mayo Clinic
Lonnie Sullivan, Duke University Health System
Manasi Tannu, Emory University School of Medicine

Congratulations to all! Hat tip to Anna Lisa Crowley, Arlene Martin and all the fellows and faculty who helped during this recruitment season. Great job!

Barnes named Clinical Director, Advanced HF Services, Effective Jan. 1

Duke Heart is pleased to announce that effective January 1, 2021, Stephanie Barnes, MSN, AGPCNP-C, PCCN will assume the role of Clinical Director for Advanced Heart Failure Services at Duke University Hospital. As the Clinical Director, she will be responsible for programmatic oversight of services providing care to the advanced heart failure patients, including the medical heart failure patients and durable mechanical circulatory support population. In this role, Stephanie will partner with the focus on programmatic development, regulatory compliance, evidence based care, and overall quality outcomes and improvement for the heart failure population in partnership with the Heart Failure and Ventricular Assist Device Medical and Duke Heart Center leadership teams.

Stephanie completed her BSN at the University of South Carolina and MSN with Adult Gerontology Primary Care Nurse Practitioner focus at the University of North Carolina. Stephanie has experience as a heart failure and LVAD nurse and Nurse Practitioner at both Duke University Hospital and Tufts Medical Center. Most recently, she has served as a Nurse Practitioner and Team Leader on the Duke Cardiology inpatient Advanced Practice Provider team.

“Steph has been a brilliant and dedicated team member and team leader for the Cardiology APPs for over 3 years,” her team of cardiology APPs said. “She is an outstanding provider and will be greatly missed. We are excited about this new opportunity for her and look forward to seeing her in her new role.”

Stephanie has presented and published on heart failure and LVAD topics and serves as a clinical preceptor for NP students. Please help us congratulate Stephanie in her new role in Duke Heart.

Blumer Recognized by Patient Family

Anna Lisa Crowley shared an email she received this week from the family member of a patient cared for by Vanessa Blumer. We wanted to share it with all of you:

Dr. Crowley,

I’m writing this email to commend a trainee from your cardiovascular disease program. I saw your name listed as director on the Duke webpage, but if I should be directing this email to another person, please accept my apologies.

Often times, I feel we fail to recognize the efforts of those who go out of their way for others’ wellness. In our case, we didn’t want to miss out on the opportunity to openly highlight the kindness, aptitude, and extraordinary work ethic of Dr. Vanessa Blumer. She cared for my mother while she was in the intensive care and never have we encountered someone so caring. You could easily tell her high level of competency and in-depth knowledge but, more importantly, she had humanity. Like my mom said: “there’s an angel in her”. Sometimes physicians forget what it’s like to be a patient or a family member; in this regard and all others, Dr. Blumer was exemplary.

Thank you for your leadership and for allowing my family the opportunity to be cared by world-class physicians.

Grateful,

Megan*

Way to go, Vanessa! We are blessed to have you on our amazing team of care providers. (*Shared with permission of the family.)

Kudos to Coles, Narcisse & Durham VAMC Cath Lab Staff

In a note from Raj Swaminathan to Anna Lisa Crowley this week, we heard about a great save at the Durham VAMC this week:

“Just wanted to give some praise to our fellow, Dennis Narcisse, and our incoming fellow, Sara Coles, for a great save late in the day yesterday at the VA. A veteran in the MICU with a history of advanced heart failure quickly went into shock with rising lactate and Cr, and reduced urine output. [The patient] was ice cold and not mentating well. Sara and Dennis quickly notified the cath lab team, performed a bedside ECHO confirming poor ejection and volume overload, obtained telephone consent from family, and triaged [the patient] to the lab. Dennis then performed the RHC confirming severe cardiogenic shock and placed an IABP. Overnight, [the patient] turned the corner with improving labs, brisk urine output, and is now off pressors.

[The patient] would not have made it overnight had it not been for our amazing house staff expediting care. I also want to recognize our VA cath lab staff who stayed late to get this case done. Strong work all around!”

In a follow-up note to Raj’s from Sunil Rao, we got a second round of accolades for Narcisse and Coles for the same patient case:

“Dennis and Sara are awesome! An additional word about Dennis – he was in the MICU to see an entirely different patient but noticed that this particular patient wasn’t doing well. So he took the initiative and, with Sara, diagnosed [the patient] appropriately with severe cardiogenic shock.”

Great job, everyone!

Yankey Receives High-5

Congrats to Sipa Yankey for receiving a High-5 this week! He was nominated by Michel Khouri who said, “Dr. Yankey spent a lot of time providing comfort to a patient and their family. He helped ease the patient’s transition to another treatment course after a complex hospitalization.”

Nicely done, Sipa!

DUHS Well-being Survey: Dec. 7

A short survey will be sent to all Duke Health team members starting Dec. 7 to better understand how everyone is holding up during this challenging year. DUHS leadership wants to hear the organization’s voice on two things that have changed our world dramatically – the COVID-19 pandemic and racial injustice. DUHS nursing and house staff will each have a unique, short set of additional questions.

The survey is being administered by a 3rd party survey partner (SMD) in order to maintain confidentiality. The survey will ask specific questions to understand how DUHS can improve things that may increase our resilience and well-being. The effort will also check how we’re doing with our effort to increase our diversity, inclusion and belonging. We will use your thoughts to guide these efforts going forward. Please participate.

Duke Voice Mail upgrade, Dec. 10

On the evening of Thursday, December 10, the Office of Information Technology (OIT) will upgrade Duke’s voice mail system and move it to new servers. Users will not lose access to voice mail during the cutover. After the cutover:

New messages will be available immediately and can be accessed as usual from 919-613-MAIL (6245).
Messages up to 12 months old will be migrated to the new servers. These may not be available for up to 48 hours, while they are imported. Users may access messages on the old servers by calling 919-385-0090 and following the standard procedure for listening to messages (see https://oit.duke.edu/help/articles/kb0025163).
Messages older than 12 months will not be migrated. These messages may be recovered upon request by contacting the Service Desk (see below).

OIT expects the import will be complete by 6:00am on Monday, December 14.

If users experience any issues with voice mail, they should contact their Service Desk:

Duke Health Service Desk, 919-684-2243 or http://dhts.duke.edu
OIT Service Desk, 919-684-2200 or https://oit.duke.edu/help

COVID-19 Updates:

All the latest official DUHS information regarding coronavirus/COVID-19 response at the following locations:

NOTE: A reminder that Pulse will not be published on Dec. 27 or Jan. 3 so that we may enjoy some time off.

Upcoming Opportunities/Save the Date:

Cardiology Grand Rounds

Dec. 8: Duke Faculty/Fellow grand rounds — COVID plans updates

Dec. 10: Cardio-Pulmonary Joint Grand Rounds: Ryan Tedford of MUSC, Assessment of Right Ventricular Function: The Role of RV-PA Coupling and RV Reserve. 12 pm, Webex.

Dec. 22: No Cardiology GR. Happy Holidays!

Dec. 29: No Cardiology GR. Happy Holidays!

Moments to Movement Virtual Town Hall, Dec. 7

Join us for our next Moments to Movement (M2M) virtual town hall on Monday, Dec. 7 from 4:30 to 5:30 p.m. During this town hall, leaders will discuss the Duke University School of Medicine’s work to dismantle racism and create a just, diverse and equitable school and community. Submit questions in advance to M2M@duke.edu.