Chief’s message: Heart walk and impactful science – ongoing story of White Blood Cell Count and Acute MI
Please see the notes below about the AHA Heart Walk. We will be setting up teams and sending a note to the broader community tomorrow. We are really looking forward to a tremendous local Duke Turnout at the Heart walk this year and have some fun competitions and videos coming to engage everyone.
In the science of CV this week – I was interested by a continuing story around immune cell interactions around Acute Myocardial Infarction.
Worth a read this week: A paper worth your attention is the STEMI neutrophil progenitor work out of the Richter group, published in Nature Cardiovascular Research with a News & Views from Thurston and Mills on August 3rd. The core finding: emergency granulopoiesis after STEMI pushes genuinely immature preneutrophils — not just the usual left-shift neutrophilia we already track — into peripheral blood, and the degree of that mobilization outperforms our established biomarkers for predicting 30-day mortality. Detectable on a standard automated blood counter, this isn’t a research-only assay sitting years from the bedside.
Worth noting: this is really the third act of a story our own institution helped write. Our DCRI teams and colleagues (Barron, Cannon, and later Chris Granger, Paul Armstrong and others via CARDINAL and APEX-AMI – a trial I was a DCRI Fellow on) established over 20 years ago that elevated WBC count on admission independently predicts in-hospital and 30-day mortality after AMI, and later tied that signal mechanistically to reduced epicardial flow and larger infarct size. That descriptive WBC-mortality association is what motivated our complement-inhibition push with pexelizumab — the hypothesis that blocking C5 activation upstream would blunt the leukocyte-driven reperfusion injury we were seeing in the WBC data. APEX-AMI (we were fortunate to also have the MRI substudy with biomarkers) ultimately didn’t move the needle on clinical outcomes, and Martel/Granger’s substudy gave us the mechanistic postmortem: pexelizumab suppressed C5a but failed to inhibit terminal complement complex (sC5b-9) assembly, which likely explains why downstream leukocyte activation, and mortality, weren’t meaningfully affected. In hindsight, we were looking at the right signal (leukocyte burden as a marker of injury severity) but intervening at the wrong node, and with a drug that didn’t fully hit its target.
The Richter paper essentially picks up where we left off — swapping a crude WBC count for a maturation-stage-resolved readout (preneutrophils specifically) that’s mechanistically closer to the bone marrow stress response itself, which may be why it’s outperforming legacy markers. Given our own history here, I think there’s a natural translational angle for Duke Heart, Precision Health, and DCRI to revisit: could preneutrophil fraction identify the subgroup of STEMI patients who would benefit from a complement- or neutrophil-targeted therapy, in a way unselected enrollment in APEX-AMI couldn’t?
The clinically relevant core finding: emergency granulopoiesis after STEMI pushes genuinely immature preneutrophils — not just the usual left-shift neutrophilia we already track — into peripheral blood, and the degree of that mobilization outperforms our established biomarkers for predicting 30-day mortality – is something that we could both follow, test, and target therapies for today. I write this with the knowledge that this last week also saw a study in patients with chronic Kidney disease not get benefit from IL-6 inhibiiton (the Zeus) trial. Lots of reasons for that – that we can discuss. All of this is for our teams to think about with ESC coming up at the end of the month.
Highlights of the week:
Davis Leads New ASE Guideline on Sonographer Safety
Congratulations to Ashlee Davis, chief technologist for the Cardiac Diagnostic Unit at Duke University Hospital, who served as chair of a new American Society of Echocardiography (ASE) guideline focused on protecting the long-term health of cardiac sonographers.
Guidelines for the Prevention of Work-Related Musculoskeletal Disorders for Cardiac Sonographers: Recommendations from the American Society of Echocardiography provides evidence-based recommendations for addressing a significant occupational health concern: work-related musculoskeletal disorders (WRMSDs) affect up to 90% of cardiovascular sonographers.
The guideline addresses ergonomic equipment and workplace design, safe scanning practices, scheduling strategies, early recognition of symptoms, and emerging technologies that may help reduce injury risk. Importantly, it emphasizes that preventing these injuries is a shared responsibility among sonographers, healthcare organizations and administrators, educators, and equipment manufacturers.
“For too long, musculoskeletal injury has been viewed as an expected part of being a cardiac sonographer,” Davis said. “This guideline challenges that mindset by demonstrating that many of these injuries are preventable through thoughtful design, education and organizational commitment.”
Congratulations to Ashlee on her national leadership in this important work to support the health, safety and longevity of the cardiac sonography workforce. Excellent work!
Heart Ma’am Brings Heart Walk Spirit to Duke Heart
Heart Walk season is underway, and a familiar red friend helped spread the word across Duke University Hospital this week!
Heart Ma’am joined Duke Heart team members for visits to 7100, 7200, 7300 and 6300, bringing plenty of Heart Walk spirit — along with opportunities for photos and selfies with teams across the units.
The visits are part of Duke Heart’s efforts to build excitement and participation ahead of the 2026 Triangle Heart Walk, set for Saturday, Oct. 3.
Missed her this time? Heart Ma’am will return to DUH on Tuesday, Aug. 18, for another round of visits with Duke Heart & Vascular units.
Ready to join us? Register for the Triangle Heart Walk by Aug. 19 to be guaranteed a Duke Heart Walk T-shirt!
Let’s go, team!!!
DUHS & SOM Updates:
Brandon to Retire as DUHS Chief People Officer
Rhonda Brandon, senior vice president and chief people officer for Duke University Health System, has announced plans to retire at the end of June 2027 after more than a decade of leadership at Duke Health.
Since joining Duke Health in 2016, Brandon has led the transformation of the DUHS Human Resources function, including the development of systemwide approaches to recruitment, performance coaching, employee engagement and HR business partnerships. She also championed affinity groups, Duke Health’s Culture Commitment work and efforts to foster an inclusive workplace centered on the belief that “we are people taking care of people.”
DUHS will launch a national search for its next senior vice president and chief people officer. Additional opportunities to celebrate Brandon and her contributions to Duke Health will be shared in the months ahead.
Paulson to Step Down as Chair of Radiology
Erik K. Paulson, MD, Robert J. Reeves Distinguished Professor of Radiology, will step down as chair of the Duke Department of Radiology on March 31, 2027, after 13 years of leadership. He will remain at Duke as a faculty member, continuing to contribute to the School of Medicine’s academic, research and clinical missions.
During Paulson’s tenure, the department experienced significant growth, with the number of clinical faculty more than doubling and imaging services expanding across Duke Health. The department also strengthened its education and research programs and is recognized as an international leader in laboratory and clinical investigation.
A national search for the next chair will be led by Ben Alman, MD, chair of the Department of Orthopaedic Surgery.
Meet Our Newest Colleagues: Flobot, R2-DU and Wall-D
This fall, three new team members join Duke University Hospital — though you won’t find them on the schedule. Flobot, R2-DU and Wall-D are autonomous delivery robots, introduced through the Duke Care Innovation Collaborative, that will carry medications and supplies throughout the hospital.
Tasks like these can take up to 30% of nurses’ time each shift. By taking them on, the robots are designed to give frontline teams more time for what matters most: caring for patients.
“Every minute a nurse spends walking across the hospital for supplies is a minute not spent with a patient,” said Chantal Howard, chief nursing and patient care services officer. “Flobot, R2-DU, and Wall-D are here to give that time back, so our teams can focus on what they do best.”
Thank you to everyone who helped name our new colleagues and to the teams preparing to pilot them across DUH.
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.
- January 9: Duke EP Symposium. Course director is Jon Piccini. Location: JB Duke Hotel.
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.
Triangle Heart Walk
The American Heart Association’s 2026 Triangle Heart Walk will take place on Saturday, October 3, 2026, at Coastal Credit Union Music Park at Walnut Creek, 3801 Rock Quarry Road, Raleigh.
The Walk is expected to start around 9:30 a.m., but that may change. Stay tuned for a more formal announcement from the AHA. Meanwhile, registration for team captains and walkers is open!
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.
