Chief’s message: Radical concept and the Arc of Democracy – July 4th 2026
Hope you all stayed cool and had a happy July 4th (250th Anniversary weekend). Want to thank the teams of clinicians and staff that helped care for our patients and starting residents and fellows. Starting our residents and fellows off in the best way is always an important part of our year.
Our family was lucky enough to get to Philadelphia for the weekend and spend the weekend seeing Independence Hall 
(where both the Declaration was finally drafted and signed and Constitutional Convention with the colonies was held), and the several museums and events. 
It was great to learn some of the history of the complexities the founding fathers faced in both crafting the declaration and setting up the constitution and the government of the United States. Most impressive was the amount of disruption, the radical thinking, and continuous commitment and courage it took to move our nation forward. Inspiring to see and to give us some thought as we continue to work to improve the health of our communities, some integral to all in our region, country, and world where cardiovascular disease remains the leading cause of death and disability.
Revolutionary Guard at Constitution Center, above is Independence hall and table where Jefferson with Virginia delegation.
This last week was a busy one with new trainees, organization for our clinical programs for the upcoming year, ASE echo meeting with great amounts of our echo lab represented, another Nature publication from researchers in the CVRC, and announcement of my work as Volunteer President of the AHA this upcoming year. We have included my post below describing my excitement from Linkedin and AHA announcement. Look forward to sharing what I learn this year and the impact we have this upcoming year. Also excited to have Svati Shah, MD announced as the President-Elect for the AHA, a testament to our cardiovascular group and to her amazing work in precision health.
Highlights of the week:
Manesh Patel Begins One-Year Term as AHA President
I’m honored and humbled to step into the role of volunteer president of the American Heart Association for 2026-27, and proud to be the first South Asian person to hold this role, a moment that reflects my family’s journey and the values they instilled in me. This opportunity also reflects something larger than any one person. It is a testament to the culture of science and teamwork I have been fortunate to be part of at Duke, from the Duke Clinical Research Institute to Duke Heart and Duke Cardiology, where I have spent nearly 30 years building on a legacy of cardiovascular discovery.
Science saves lives. My focus as president will be making sure the discoveries we make are proven, and that proven therapies reach everyone, everywhere. By 2050, nearly half the world’s population may face some form of cardiovascular disease or its risk factors. That is the scale of the opportunity in front of us. The American Heart Association’s mission and commitment to improving human health is energizing and I look forward to working with the thousands of volunteers, clinicians, and scientists to meet this moment.
I especially want to thank all of our faculty and fellows who have helped me learn and the patients who have allowed me to care for them. I also want to thank the Heart Center board members and leaders, including our Chair Bob Keegan. Many of you have invested and believed in our ability to make these types of differences and impact.
Finally, if you’ve been putting off seeing a physician, let this be your sign. Know your numbers. Understand your risk. Most cardiovascular disease is preventable, but you can’t feel it until it affects you.
The link to the AHA announcement is here. The AHA also produced this profile story as part of their announcement: New American Heart Association president aims to close the gap between discovery and care.
Duke Heart & Vascular Earns Multiple AHA Achievement Awards
Every day, our teams come together across Duke Heart & Vascular to deliver safe, evidence-based care for patients. That commitment has once again been recognized by the American Heart Association (AHA), which awarded Duke University Hospital and Duke Raleigh Hospital multiple 2026 Get With The Guidelines® achievement awards for excellence in heart failure, atrial fibrillation and coronary artery disease care.
The AHA’s Get With The Guidelines® program recognizes hospitals that consistently apply the latest evidence-based treatment guidelines to improve patient care and outcomes. This year’s recognitions reflect the commitment of our teams across DUHS to delivering high-quality, guideline-directed care across the cardiovascular continuum.
“These recognitions are a reflection of our team,” said Manesh Patel, MD, chief of the division of cardiology and vice president of Duke’s Heart and Vascular Service line. “They represent the dedication of each of you across Duke Heart & Vascular who work together every day to provide safe, evidence-based care for our patients. I’m grateful for your commitment to excellence and for the difference you make in the lives of the patients and families we serve.”
Duke University Hospital
- Get With The Guidelines®–Heart Failure Gold Plus with Target: Heart Failure Optimal and Target: Type 2 Diabetes Honor Roll
- Get With The Guidelines®–AFib Gold with Target: Ablation
- Get With The Guidelines®–Coronary Artery Disease STEMI Receiving Center Gold Plus with Target: Type 2 Diabetes Honor Roll
- Get With The Guidelines®–Coronary Artery Disease NSTEMI Gold with Target: Type 2 Diabetes Honor Roll
Duke Raleigh Hospital
- Get With The Guidelines®–Heart Failure Gold Plus with Target: Type 2 Diabetes Honor Roll
Together, these recognitions celebrate the entirety of Duke Heart & Vascular, because your dedication makes our exceptional cardiovascular care possible for every patient, every day.
Congratulations to all!
Study Reveals First Drug-like Molecules that Control Key Cellular Signaling Proteins
To function normally, nearly every cell in the human body relies on G-protein coupled receptors (GPCRs) to receive and send signals. That’s why GPCRs are targeted by roughly one-third of all FDA‑approved drugs.
But the signals from these receptors don’t act alone. Decades ago, Duke University biochemist and cardiologist Robert J. Lefkowitz, MD, and colleagues discovered β-arrestins — proteins that attach to activated GPCRs, dampen their signaling, and pull them inside the cell. In the early 2000s, the lab showed that β-arrestins also launch their own signaling pathways, expanding their role far beyond simply shutting receptors off.
Now, researchers in the Duke Cardiovascular Research Center’s Lefkowitz lab have identified three powerful, drug-like molecules that directly target β-arrestins. The findings, published June 24 in the journal Nature, provide the first clear way to control these proteins with pharmacological precision.
In multiple tests, the compounds blocked β-arrestins from interacting with GPCRs and carrying out their normal functions, without interfering with the receptors themselves. Instead of shutting down GPCR activity, the molecules effectively remove β-arrestin control, allowing signaling through G proteins to persist.
The discovery provides the first chemical tools for studying β-arrestins, opening the door for scientists to better understand how β-arrestins shape cellular responses. And it suggests a path toward more precise therapies for conditions involving metabolism, immune responses, cardiovascular function, and brain signaling.
The study is the result of more than a decade of work from co-first authors Alem W. Kahsai, PhD, assistant professor of medicine, and postdoctoral researcher Natalia Pakharukova, PhD.
“Alem could have published a creditable paper about these molecules 10 years ago,” said Lefkowitz, Duke Health Distinguished Professor of Medicine and senior author of the study. “But he’s a perfectionist. He wanted to figure out how they actually work.”
Kahsai “lived and breathed” these molecules 24 hours a day, drawing in collaborators from Duke and across the country to “describe an extraordinary amount of their biology,” Lefkowitz said.
The team began with a broad, unbiased search of the National Cancer Institute’s vast compound library to identify molecules that might bind β-arrestins. Then they narrowed the field using tests that showed which compounds physically interacted with the protein and stabilized it. The most promising candidates were studied in engineered human cell systems, where researchers could track real-time GPCR signaling, and later in physiologically relevant immune and heart muscle cells to determine whether their effects extended beyond simplified laboratory models.
Through this step-by-step process, the researchers identified three compounds that disrupted multiple aspects of β-arrestin function — blocking their recruitment to receptors, preventing receptor desensitization and internalization, and shutting down β-arrestin–specific signaling pathways — while leaving G protein signaling intact.
“We tested these compounds from every angle we could think of before we were convinced they were bona fide β-arrestin inhibitors,” Kahsai said.
A pivotal moment came when Pakharukova used Cryo-electron microscopy to visualize one of the compounds, called Cmpd-5, binding to a previously unknown “pocket” on β-arrestin. This visualization showed that the inhibitor works “allosterically” – when it binds to this pocket, it changes the shape of β-arrestin globally and prevents it from fully engaging with GPCRs.
The team tested the inhibitors with several GPCRs, including the GLP-1 receptor, which is the target of widely used weight-loss drugs Ozempic and Wegovy. Even when the receptor was being stimulated by these drugs, adding the new compounds inhibited β‑arrestin control and allowed G protein signaling to continue longer than usual.
Such an approach promises to allow researchers to dial specific pathways up or down, potentially improving treatment precision while reducing unwanted side effects.
Kahsai and Pakharukova’s Duke co-authors are: Henry Y. Kwon, Kunal S. Shah, Caroline T. del Real, Bowie N. Shreiber, Jason G. Liang-Lin, Paul J. Shim, Mason A. Lee, Allison M. Schwalb, Uyen Pham, Anand Chundi, Haoran Jiang, Samuel Liu, Preston C. Nibley, Dana K. Bassford, Cal A. Kunzle, Brittany N. Thomas, Jihee Kim, Jialu Wang, Xingdong Zhang, Jeffrey S. Smith, Lindsay A.M. Rein, Sudha K. Shenoy, Sudarshan Rajagopal, Seungkirl Ahn, Howard A. Rockman, Robert J. Lefkowitz, and Ali Masoudi.
Funding: Howard Hughes Medical Institute, the National Institutes of Health, the St. Jude Children’s Research Hospital Collaborative Research Consortium on GPCRs, and the Mandel Foundation.
Congratulations to Alem, Natalia, and their study coauthors!
Duke at ASE2026!
Duke was well represented at the American Society of Echocardiography’s 51st Scientific Sessions held June 26 – 28, 2026 at the Gaylord Rockies Resort in Aurora, CO.
Alicia Armour, Practice Administrator, served as co-chair for the meeting and was fortunate to have several Duke faculty members present across several tracks. Contributing to the success of the meeting were: Anita Kelsey, MD, Sreekanth Vemulapalli, MD, Pamela Douglas, MD, Ashlee Davis, Richie Palma, Carissa Bregadze, Melissa LeFevre, Alina Nicoara, MD, Piers Barker, MD, Tracy Ralston, and Anna Lise Brinson.
Award winners included: Emily Lynch (sonographer travel grant), Laura Miller and Chris Dube (Allan D. Waggoner Student Scholarship Award). A big round of thanks for their contribution to the sessions!
Congratulations, Emily, Laura, Chris, and Alicia! Excellent representation across our team!
NACE/Cardiology Grand Rounds on Dyslipidemia Guidelines Success
Our first Grand Rounds partnership with the National Association for Continuing Education (NACE) was a resounding success, with more than 1700 people registered as virtual attendees of the hybrid event.
The continuing education session, 2026 Dyslipidemia Guidelines: Practical Implementation, was led by presenter Nishant Shah, MD, and moderator Manesh Patel, MD. It was held on Monday, June 29, 2026, at the JB Duke Hotel in Durham.
Thank you to everyone who joined us in person and to all those who joined us online. It was an excellent presentation by Dr. Shah with lots of humor throughout, thanks to Dr. Patel. Many thanks to Christy Darnell for her work in making this a successful CME activity.
Congratulations, Nishant, Manesh, and Christy!
Shout-out to Thakkar!
We are excited to share that Aetna has updated its policy on lipoprotein A testing, and this comes in large part due to the persistence and dedication of Aarti Thakkar, MD. We received a note this week from Nishant Shah recognizing her work on behalf of the preventive cardiology team:
“I wanted to highlight some great work Aarti Thakkar has led to advocate for insurance coverage for Lp(a) testing. We received this note below from the PRMO showing the success of Aarti’s advocacy and letters she has drafted with Aetna. In addition to Aetna, we now have coverage from many payers in the state of North Carolina that serve Duke Health patients for an Lp(a) test once in a lifetime. Aarti played a big role in helping with the access in order to promote the guideline recommendation of getting an Lp(a) test.” – Nishant Shah, MD
Note from Jamie Ashmore, Duke PRMO:
“Drs. Pagidipati, Shah, and Thakkar, Good news! With the help and support of your advocacy, Aetna has finally updated their policy on lipoprotein A testing. They will now cover it once per lifetime for patients 19 and over. This would not have happened without your advocacy and the excellent letter you submitted nearly a year ago in support of this effort. Aetna was the last of our major commercial payers who declined to cover this testing, and because they now have the NC State Employees Health Plan, they are a much more significant part of our payer base than in previous years. Thank you so much for your willingness to lend your voices to this effort!”
Way to go, Aarti, Duke PRMO team, Neha, and Nishant! Your advocacy to get patients the care they need, when they need it, is outstanding!
Upcoming CME Events & Opportunities
Cardiology Grand Rounds
CGRs have concluded for the summer. We will return in the fall! Meanwhile, please enjoy past recordings.
All Duke CGR Recordings (except for those containing PHI) can be found on Duke Warpwire by year: 2026, 2025, 2024. Questions about recordings? Contact Tracey Koepke.
2026 Symposia
The dates for the following 2026 Duke Heart symposia have been set. We will announce others as they are added.
- September 26: Duke Case-Based Multimodality Imaging Symposium – Registration is now open. Course directors are Sreekanth Vemulapalli and Anita Kelsey. Location: Trent Semans Center, Great Hall.
- October 30: 18th Annual NC Research Triangle Pulmonary Vascular Symposium – Course directors are Terry Fortin, Sudar Rajagopal, and Jimmy Ford. Location: Durham Convention Center, Durham, NC.
Please save the dates!
Hitting with Heart Softball Tournament
The 10th Annual Hitting with Heart Softball tournament will be held on Saturday, August 22 at Valley Springs Park, 3805 Valley Springs Road, in Durham. The tournament raises funds that will, in part, support the American Heart Association’s 2026 Triangle Heart Walk.
Have news to share?
If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart & Vascular 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 team. Please call me with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.
