Chief’s message: The Future is Bright

As we move towards spring and the changing of our organization to an aligned practice, this episode of the Duke Heart Pulse notes lots of important milestones and achievements.  You will see how our academic mission continues to drive our practice – with several members of our faculty getting grants, awards and induction into honor societies.  Pictured below, congratulations to  Jennifer Rymer who was awarded the 2023 physician-scientist award from the American Society of Clinical Investigation (ASCI) and Gerald Bloomfield and Jonathan Piccini who will be inducted into the ASCI in the class of 2023.  They will join other members of Duke Cardiology who are members of ASCI.

Additionally, please find some of our faculty that were selected for leadership programs both at Duke (Larry Jackson and Titus Ngeno) and nationally – the American College of Cardiology emerging leadership academy (Nishant Shah).

There is also the story that ran on CBS evening news around a DCD heart transplant patient at Duke with interview of Jacob Schroder – full story farther down below with a link to the entire segment on the news.

In this week’s Pulse we will also recognize many of the Mandel awardees, the Mandel foundation and support of the Cardiovascular Research Investigator’s remains critical to our success.  You will see the amazing group of investigators supported by the program.  Finally, we welcome back Tom Ryan to the Duke Heart center – lucky to have him join us from Ohio State University.

Highlights of the week:

Welcome Back to Duke Heart, Tom Ryan, MD!

Former Duke cardiologist Dr. Thomas Ryan has returned to our team at Duke Heart as of Feb. 1, and we are glad to have him back! Ryan was most recently the executive director of the Richard M. Ross Heart Hospital and director of The Ohio State University Heart and Vascular Center in Columbus, OH.

Ryan will see general cardiology patients at our South Durham clinic and provide cardiology services through the Duke Health Signature Care Program at both the Center for Living Campus and the South Durham locations.

“Our plan was always to move back to the Research Triangle area — for family reasons, but also because we have a lot of friends in this area,” said Ryan. “We were at Duke for 12 years before we left for Ohio, so that was always the plan, but I was also planning to simply retire and then move back.

“But, I started talking to my Duke friends and one thing led to another, and the opportunity came up to work part-time at Duke. I jumped at it! I wasn’t quite ready to retire completely and the chance to be back at Duke was just too good to pass up,” he added.

He says he never anticipated leaving Duke. But Ohio State was about to build a new heart hospital and a new heart and lung research institute – and they needed someone to lead that endeavor.

“They were interested in creating a ‘heart center’ model, similar to what we had here at Duke. So, I was recruited there specifically for that, and frankly, I didn’t think I’d be there for 16 years but that’s how it worked out.

“It was a terrific opportunity to build something from scratch. We opened a beautiful facility and I worked with a terrific team to create a ‘heart center’ model. I’m proud of the work we did there — it was a great experience and I really enjoyed being there, but I am so happy to be back here at Duke.”

Ryan has fond memories of his 12 years in Durham. “I never would have had the opportunities in my academic career were it not for my first tenure here at Duke. So, I am grateful for all Duke has given me. I love the people here and still have wonderful friends throughout the Triangle — especially at Duke — and it’s a fantastic medical center from top to bottom.”

When reflecting on his career, Ryan says he knew pretty early on that he wanted to go into medicine.

“From an early point in my medical education, I decided I want to go into cardiology, and it turned out to be — for me — a very good decision,” Ryan said. “It has led to 35 years of very satisfying work. There is a lot of variety in what you can do within the field, so that is a part of why I chose this specialty. Beyond that, it has to do with the relationships you build with patients who have heart problems.

“Nobody has a heart problem that they consider to be a minor problem,” he adds. “When someone thinks they have a heart problem, or when they know they have a heart problem — for them, that’s a big deal. The bond that you develop with patients is important. They’re placing their life in your hands and that’s a very special responsibility. So, I’ve always liked that part of it — helping people when they perhaps felt most vulnerable or had the greatest need.”

Ryan says he has always tried to walk-the-walk while encouraging others to live a healthy lifestyle. He exercises regularly – running, riding his bike, staying active in general, and making the effort to take care of his health.

Ryan is keen on having an impact again at Duke and to providing great service both to our patients and his Duke Heart colleagues, including trainees and students.

“I want to give something back out of gratitude for what Duke has given to me,” he adds. “It’s just great to be back here in the Triangle and have the opportunity to stay active in a profession that I really truly love — and to have more time to enjoy life outside of work.”

Ryan earned his medical degree from Indiana University School of Medicine and holds an MBA from Duke University Fuqua School of Business.  He completed internship and residency in internal medicine, and a fellowship in cardiology, at Indiana University.

Please extend a warm welcome to Tom when you see him, or reach out to him via email.

Welcome back, Tom! We’re glad to have you back on the Duke Heart team!

 

ICYMI: Duke Heart Patient, Schroder, Featured in CBS Evening News Story

Jacob Schroder, MD, director of Duke’s Heart Transplantation Program, and one of our patients – a DCD heart transplant recipient — were featured in a story that aired last week during the CBS Evening News with Norah O’Donnell.

Also, a very special shout-out to our entire heart transplant team: they surpassed 100 DCD heart transplants last weekend, placing them among the highest volume and most experienced in DCD heart transplantation in the world. Congratulations!

This week! Lefkowitz Lecture Kicks-off Research Series 2023

The Duke University School of Medicine’s Dean’s Distinguished Research Series showcases groundbreaking research from the basic, clinical, and translational sciences. Formerly called “Research Week”, the reimagined series will be held in-person and livestreamed. All faculty, staff, trainees, and students are welcome to attend.

For the full schedule, please visit: https://medschool.duke.edu/research/deans-distinguished-research-series-2023.

The Robert J. Lefkowitz, MD, Distinguished Lecture is the kick-off event and is scheduled for Feb. 23 at 4 p.m. in the Great Hall of the Trent Semans Center for Health Education (it will also be livestreamed via Zoom).

Titia de Lange, PhD, Laboratory of Cell Biology and Genetics and Director, Anderson Center for Cancer Research at Rockefeller University is the invited presenter. Her topic is Telomeres and cancer: genome instability and tumor suppression. Reception to follow.

 

Duke Cardiac Ultrasound Students Named ASE Scholarship Award Winners

We are thrilled to announce that two of our Duke Cardiac Ultrasound Certificate Program students have won American Society of Echocardiography (ASE) Foundation student scholarships.

Ricky Damon has been selected as a recipient of a 2023 Alan D. Waggoner Student Scholarship Award and Forrest Zimmermann has been chosen as the 2023 recipient of the Katanick Scholarship Award.

The Katanick award is given to the highest-ranking student sonographer candidate nominated for ASEF scholarship awards. This award was established in 2016 and named to honor the legacy of Sandy Katanick, RN, RVT, CAE, who retired as CEO of the Intersocietal Accreditation Commission after more than 25 years of service to the field.

This is only the second year that Duke has been eligible to nominate students for these ASEF awards, and our second year with two awardees and back-to-back Katanick’s!

The awards will be presented to Damon and Zimmermann at ASE 2023 during the 34th annual meeting scheduled for June 23-26 at Gaylord National Resort & Convention Center in National Harbor, MD. They will each receive $1,000 and support for travel.

Congratulations to Ricky and Forrest, as well as to Richie Palma and Anita Kelsey, MD, for their incredible recruitment to and leadership of the Cardiac Ultrasound Certificate Program. We are so proud of this program!

 

CVRC 2023 Mandel Awards

The Duke Cardiovascular Research Center (CVRC) has recently awarded their annual Mandel Awards. This year, six awards totaling approximately $300K will fund a Mandel Fellow Award and five Mandel Seed Awards. The selected projects will advance scientific understanding in the areas of hypertension, atherosclerosis, and related cardiovascular diseases, thanks to the generosity of the Edna and Fred L. Mandel Jr. Foundation.

Mandel Fellow Award

Andrew Ressler, PhD, mentored by Doug Marchuk, PhD

Project: Elucidating Genetic Mechanisms in CCMs

Somatic variants in cells within the vasculature of the cerebral cortex lead to Cerebral

Cavernous Malformations (CCMs). CCMs are groups of abnormal small blood vessels that often result in slow-moving blood, clotting and/or leakiness. Symptoms vary depending on the size and location of the CCM. CCMs present heterogeneously, but common complications include hemorrhage and epilepsy. Currently, the only definitive treatment for problematic CCMs is surgical excision, with targeted radiation therapy as a potential alternative for surgically inaccessible lesions. Identifying alternative, less invasive therapies would be highly beneficial to patients and may require improved understanding of the genetic underpinnings of large lesions with particularly aggressive clinical presentation. To date, all genetic diagnoses of CCMs either include loss-of-function (LoF) variants of one of three CCM genes or a somatic activating variant in MAP3K3. Evidence from animal models and human genetics are suggestive of a two-hit mechanism for LoF variants in a CCM gene. However, current sequencing strategies have failed to identify bi-allelic loss of CCM in a majority of lesions without a MAP3K3 variant. One explanation for many of these ‘missing mutations’ is somatic structural variants that are difficult to identify. We aim to use single nucleus DNA-sequencing (snDNA-seq) to identify somatic loss-of-heterozygosity in surgically resected CCMs. We further aim to mine existing genetic data to see whether or not variants in neighboring genes are associated with clinical outcomes.  Critically, such an approach of using snDNA-seq to identify somatic chromosomal alterations as causative for disease may be utilized to investigate the array of cardiovascular disorders with evidence of large somatic variations.

 

Mandel Seed Awards

Sharon Gerecht, PhD and Neil Freedman, MD

Project: Synthetic Arterial Grafts Engineered to Resist Atherosclerosis

Atherosclerosis, with the consequent plaque buildup resulting in restriction (stenosis) or occlusion of blood flow, is a significant underlying cause of cardiovascular disease. In patients with serious vascular stenosis, arterial bypass surgery is used to re-establish blood flow in the coronary and peripheral arteries. Unfortunately, autografts require a second surgical site and have insufficient availability in patients with widespread atherosclerosis or previously harvested vessels. Thus, there is an urgent clinical need to develop synthetic grafts that provide long-term patency. Engineered bypass grafts could offer a robust and reliable solution, but a functional, engineered bypass graft has remained elusive mainly due to post-implantation thrombogenicity and intimal hyperplasia. We recently developed natural small-diameter vascular grafts (sdVGs), which are made of natural material with properties mimicry of blood vessels that enable immediate perfusion and formation of a confluent endothelium in vivo. Our compelling data show that these grafts retain patency for 24 weeks in mice and acquire structural and mechanical features that closely resemble the native abdominal aorta. The goal of this proposal is to investigate the regeneration capacity of the sdVGs in an atherosclerosis disease model and determine if conjugating anti-coagulant in the graft prevents thrombosis-induced graft failure. The Specific Aims are: (1) To determine the effect of atherosclerosis on sdVGs integration and function; (2) To determine if sustained local inhibition of thrombosis improves sdVG integration in the atherosclerosis disease model.  There is a critical need to understand how the atherosclerosis environment modulates arterial-engineered graft integration and function to be able to make significant inroads toward clinical translation. To our knowledge, no study has yet examined engineered arterial grafts in a cardiovascular disease animal model. The proposed work will generate a scientific understanding of how to prevent graft failure as a result of thrombosis in atherosclerosis and may ultimately have therapeutic implications for patients with atherosclerosis.

 

Robert W. McGarrah, MD and Christopher Holley, MD PhD

Project: New Regulatory Mechanisms of RNA Modification that Mediate Protein Translation in the Heart

Cardiac hypertrophy (thickening of the heart muscle) and heart failure (the inability of the heart to pump enough blood to supply the body’s needs) are the end result of many diseases, including

hypertension, obesity, diabetes and atherosclerosis. Better understanding of the early events that lead to cardiac hypertrophy and heart failure may form the foundation of new therapies to treat these common conditions. In the past 5 years, several research groups, including those from Duke, have found that as the heart begins to fail, there are changes in a biological pathway involved in the breakdown of certain amino acids (building blocks of proteins). These changes are thought to contribute to the development of cardiac hypertrophy by leading to a build-up of amino acids in the heart. We have recently discovered that if we specifically perturb an enzyme from this amino acid pathway in the heart, we do not change the concentrations of the amino acids in the heart, but we still see a change in protein synthesis, which can lead to cardiac hypertrophy. Based on preliminary experiments, we hypothesize that the changes in protein synthesis in the heart that we observe might be related to newly described functions of this enzyme on modifications of RNA, rather than any functions related to amino acid metabolism. This proposal will test this hypothesis in more depth, using newly generated genetically altered mice and cutting-edge approaches to measure RNA modifications. We expect that the findings will define new mechanisms underlying cardiac hypertrophy and will generate data that will be used to apply for larger collaborative grants for our laboratories.

 

Sudarshan Rajagopal, MD, PhD and Ravi Karra, MD

Project: Location-specific Signaling by Different GPCRs in Cardiomyocytes

There are nearly eight hundred G protein-coupled receptors (GPCRs) in our body that detect different hormones and neurotransmitters that regulate nearly every aspect of our body’s functions. It has been thought that these receptors act as gatekeepers by sensing signals from outside the cell and then activating signaling pathways inside the cell. However, we now realize that GPCRs can actually signal from different sites inside the cell, and that these signals result in different effects. However, the extent of this signaling in heart muscle cells (“cardio-myocytes”), where we know such signaling is very important, is currently unknown. Our long-term goal is to develop drugs that target this signaling to treat cardiovascular disease. However, to develop these therapies, we have to first characterize this location-specific signaling. Here we propose to monitor location-specific signaling by different GPCRs in cardiomyocytes. The Rajagopal Lab already developed a number of “biosensors” that can detect this signaling inside the cell, and used them to characterize signaling by other receptors in model cells. The Karra lab has developed an efficient system for expressing these proteins in cardiomyocytes from induced pluripotent stem cells (iCMs). Together, this will allow us to quantify location-specific signaling profiles of GPCRs in iCMs. We will then correlate these signaling patterns with changes in iCM shape and function. This project uses an innovative approach to study important GPCR signaling in the cardiovascular system by investigators with expertise in cardiomyocyte biology (Dr. Karra) and GPCR signaling (Dr. Rajagopal). Successful completion of these studies will inform future drug development of locations-specific drugs in the treatment of cardiovascular disease.

 

Senthil Selvaraj, MD, MS, MA, and Svati Shah, MD, MHS

Project: Metabolomic Profiling in Patients with Heart Failure with Preserved Ejection Fraction

Heart Failure with preserved ejection (HFpEF) is common, costly, and associated with a significant risk for hospitalization and death. Despite extensive studies to date, only very recently has the first and only

treatment option shown to alter the disease course (SGLT2 inhibitors) been identified. SGLT2 inhibitors were originally designed to treat diabetes, though studies quickly demonstrated their greater utility in heart failure. Yet, our understanding of why SGLT2 inhibitors are breakthrough drugs in HFpEF is quite limited. SGLT2i have many effects on the body, but changes in the type of fuel that the body utilizes are likely highly relevant. The goal of this study is to perform comprehensive laboratory analyses (metabolomics) on blood samples from a clinical trial of SGLT2 inhibitors in HFpEF to understand changes in “fuels” used to generate energy that may underpin these benefits. We have recently demonstrated the novelty and utility of this approach in another form of HF (HF with reduced ejection fraction), and will leverage our outstanding team and resources at Duke to improve understanding of these changes as a novel treatment in HFpEF. Identifying metabolic changes and pathways affected by SGLT2 inhibitors may highlight new targets for treating patients with HFpEF.

 

Jonathan A. Stiber, MD, Conrad Hodgkinson, PhD, and Neil J. Freedman, MD

Project: Atheroprotective Mechanisms of Zmynd8

Atherosclerosis leads to significant morbidity and mortality as the result of heart attacks, congestive heart failure, and stroke. Previous work supported by the Mandel Foundation showed that atherosclerosis and vascular inflammation are reduced in mice by the activity of Drebrin, a protein that is expressed in vascular smooth muscle cells (SMCs) and that increases its expression level in the context of human atherosclerosis. Drebrin inhibits a key event in the initiation of atherosclerosis known as SMC transdifferentiation: the conversion of smooth muscle cells into foam cells (cholesterol-laden cells that express macrophage markers and are pro-inflammatory), but the mechanisms by which genes involved in SMC transdifferentiation are regulated remain unclear. Drebrin binds Zmynd8, a protein that reads DNA modifications to promote or repress expression of certain genes and whose role in SMCs and atherosclerosis is unknown. We plan to test the hypothesis that Zmynd8 inhibits the development of atherosclerosis by directly regulating genes involved in SMC transdifferentiation.

Congratulations to our newest Mandel Fellow and Seed awardees – we look forward to seeing where your research takes you!

 

 

Future Relocation of DUH Unit 7100 for Renovations

As most of you know, Duke University Hospital’s bed tower 100 is in the process of being renovated. Unit 7100 will be relocated to Duke North 2200 (a 16-bed unit) and 3200 (also a 16-bed unit) in April.

These units were selected for their close proximity to one another and to other Heart units; the provision of 32 beds for Cardiology patients; and, for being move-in ready after recent renovations. 7201-7208 will close as the Hospital Surge Unit, and the eight Emergency Department admit hold patients will relocate from 2200 to this area.

The exact dates for closing 7201-7208 and relocating 7100 will be communicated once we have firm dates identified. There will be no change in the patient population we will care for on units 2200/3200.

 

Shout-out to Duran!

We received a nice note this week that was sent to Anna Lisa Chamis, MD regarding cardiology fellow Jessica Duran, MD, and we thought we’d share it with you. It’s from a grateful family member.

“I am writing to heap praise on one of your fellows: Jessica Duran. Jessica has been on call this weekend taking care of my dad who came in through the ER with unstable angina. Jessica’s depth of Cardiology expertise, passion for patient care, and dedication are inspiring.  Although she was only professionally tasked with seeing my dad in the ER yesterday, she paid him a social visit today only to find him in extremis with what turned out to be a SBP in the 50s. She took immediate action to stabilize him, called for help, and ultimately brought him back from the brink of what could have been a life-threatening disaster.

“My whole family and I are deeply grateful to Jessica for going above and beyond the call of duty multiple times just this weekend. She is a star!” — Yuriy

We agree – she’s a star! Well-done, Jessie!

 

Duke Heart Family Grows by One!

Congratulations to cardiology fellow Nathan Goodwin, MD and his wife Laura, on the birth of their baby boy, Luke Patrick on Feb. 11. Baby Luke helped cheer the Kansas City Chiefs to a Super Bowl victory at just one day old!

Congrats, Nate & Laura – we are excited for you and hope to meet Luke soon!

 

Duke Heart Network Update: Frye Regional

Frye Regional Medical Center, a Duke LifePoint hospital, is bringing emergency medical care to new heights. After several months of careful planning, construction and staff education, Frye Regional has a new rooftop helipad – technically two helipads – located on the top floor of the hospital’s parking garage on N. Center Street in Hickory, NC.

“This marks a tremendous step forward for the delivery of critical care at Frye Regional and further exemplifies our mission of making communities healthier,” said Philip Greene, MD, chief executive officer of Frye Regional Medical Center. “This investment in our facility has been years in the making and is a visible sign of the progress made in establishing Frye Regional as the region’s leader in cardiac and neurosurgical care.”

A ribbon cutting ceremony, attended by Duke Heart Network team members Melanie Watson, Trevor Krawchuk, and Lisa Kotyra, was held at Frye Regional for their “ceremonial first flight” on Feb. 3. Their new helipad is now fully operational!

To read more about this, please visit: https://duke.is/wwfrb.

 

Griffith Selected as an AHA/Go Red Women of Impact nominee

Barbara Griffith, MD, president of Duke Raleigh Hospital, has been selected as a Woman of Impact nominee by the Triangle American Heart Association.

Every year across the U.S., a select group of individuals are nominated to be a part of Women of Impact because of their passion and drive to make a difference. Women of Impact is a 9-week blind competition focused on women’s heart health. Launched earlier this month, Griffith has until 9 p.m. on April 6, 2023 to recruit her team members and raise vital funds for the AHA. All nominees work to build campaign plans, recruit Impact teams, and inspire their networks to support the American Heart Association’s lifesaving mission.

At the end of the campaign, this special group of nominees will be celebrated for the overall impact they have on our mission and community. The nominee who makes the greatest impact and raises the most funds locally will be named a local 2023 Woman of Impact Winner. Additionally, the nominee who makes the greatest impact nationwide will be named the American Heart Association 2023 National Woman of Impact Winner.

To read Dr. Griffith’s statement and to support her campaign, please visit: https://duke.is/rsew2. An overview of the campaign can be found here: https://duke.is/5eb9y.

Go, Barbara!

 

Link for Feb. 16 CGR

If you missed or would like to re-watch Haider Warraich, MD’s cardiology grand rounds presentation from Feb. 16, you can link to it here: https://duke.is/vrpms. Warraich is director of the Heart Failure Program at VA Boston Healthcare System. The title of his talk is State of the Heart: What the History of Heart Disease Teaches Us About Its Future.

Thanks to all who were able to join us live on Thursday morning!

 

DHIP update

We will have a grand rounds to review expected DHIP agreements this upcoming week. We know there are areas that need to be updated but want to get agreements to faculty. Distribution of Employment Agreements for transitioning members begins this week and will take place on a rolling basis by department. Employment documents for senior leaders, managers, APPs, and staff are expected to be distributed within the next two weeks.

The Duke Guarantee offers the minimum compensation each Member can expect to receive. Additional compensation opportunities which exist today will continue to be available to members within DHIP.

Benefits:

• Information regarding Duke Benefits is available on SharePoint.
• All benefits related questions can be sent to DHIPBenefits@Duke.edu.

All other questions can be sent to DHIP@duke.edu, and all DHIP updates can be found at https://dhip.org.

 

Upcoming Events & Opportunities

Cardiology Grand Rounds

Feb. 21: No CGR today.

Feb. 28: Topic TBD with Sandeep Nathan of Univ. of Chicago Medicine. 5 p.m., Zoom.

DCRI Research Forum: Feb. 28

The Duke Clinical Research Institute’s upcoming Research Forum will feature a fireside chat with Journal of the American Medical Association (JAMA) Editor-In-Chief Dr. Kirsten Bibbins-Domingo

What: A Fireside Chat with JAMA Editor-in-Chief Kirsten Bibbins-Domingo, PhD, MD, MAS

When: Tuesday, Feb. 28 from 12 p.m.-1 p.m.

(Required) Register:  https://duke.is/y45qv

Webinar details and link will be provided upon registration.

 

Save the Date: Spring Faculty Reception

All Duke SOM faculty members are invited to the 2023 School of Medicine Spring Faculty Celebration scheduled for Wednesday, May 17, 5:00-7:30 p.m. at the Doris Duke Center, Duke Gardens. This event is a wonderful opportunity to network, celebrate achievements, and recognize colleagues with faculty awards. Refreshments will be served. Link to RSVP is below.

Feel free to invite your SOM faculty colleagues to attend with you or to make plans to come as a group and celebrate the end of the academic year together.

Tentative Agenda:

5:00 – 6:00 p.m. — Networking reception with heavy hors d’oeuvres

6:00 – 6:15 p.m. — Opening Remarks

6:15 – 7:00 p.m. — School of Medicine Faculty Awards and Recognitions

7:00 – 7:30 p.m. — Reception and Dessert

The Office of Faculty is looking forward to seeing you there! If you have any questions about the event, please do not hesitate to contact their team: facdev@dm.duke.edu.

To RSVP: https://duke.is/cyp46

 

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. Submissions by Noon, Wednesdays, to be considered for weekend inclusion.

 

Duke Heart in the News:

February 10 — Stephen Greene

HCP Live

Don’t Miss a Beat: STRONG-HF with Alexandre Mebazaa, MD, PhD

https://duke.is/zkjun

February 15 — Jacob Schroder

CBS Evening News*

New method revolutionizes heart transplants

https://duke.is/rj2kh

*also carried by 50+ CBS News TV & radio affiliates including in Dallas-Fort Worth, New York & Philadelphia, and in Yahoo News

February 16 — Jacob Schroder

Sur Noticias

El revolucionario método de transplante de corazón

https://duke.is/ngcrw

February 16 — Jacob Schroder

Es Postsus

Nuevo método revoluciona los trasplantes de corazón

https://duke.is/b9eva