Annual Report


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Annual Report

  1. 1. Division of Cardiology Report to the Chair of Medicine Acting Chief: Abel E. Moreyra, MD  2003 – present “Help each other be right, not wrong. Look for ways to make new ideas work, not for reasons they won’t. Do everything with enthusiasm, it’s contagious.” – Ian Percy OVERVIEW The Division of Cardiology and Hypertension continues to provide excellent clinical care, teaching, and research in cardiovascular diseases. The Division has a long history of significant contribution in the field of cardiovascular diseases since it’s inception in 1972 under the leadership of Dr. Peter T. Kuo. Throughout the succeeding years, headed by Drs. Kostis, Lacy and Moreyra, the Division has provided leadership nationally and in the State of New Jersey in the fields of hyperlipidemia, hypertension, congestive heart failure, and interventional cardiology. Many prominent cardiologists who are now practicing across the country have trained in the Division. Presently the Division has fifteen faculty members; two full-time professors, eight associate professors, and four assistant professors Clinical Activities The major focus of the Division is to provide comprehensive treatment to patients with a variety of cardiovascular diseases. We have divided the delivery of clinical care to hospitalized patients into separate cardiology teaching and cardiology consultation services. This has enhanced the teaching of residents and students as well as the performance of our cardiology fellows. • During the academic year 2004-2005 there were 1,512 hospital admissions by the cardiology faculty totaling 5,757 hospital days. There were 8,815 outpatient visits (1,922 initial visits and 6,893 revisits). • The section of electrophysiology has maintained their activity with 278 pacemakers implanted (114 by faculty), 582 AICD implants (209 by faculty), 114 ablation procedures (64 by faculty), and 327 EPS studies (119 by faculty).
  2. 2. • The section of congestive heart failure continues to grow. Dr. Shinnar (an expert on MRI) has now joined this section. During the fiscal year 2004-2005 a total of 9 cardiac transplants were performed with excellent results (100% one-year survival), 135 myocardial biopsies were obtained, and the program has gained approval for Medicare reimbursement. • The invasive cardiology section continues to maintain an adequate volume for the performance of clinical trials and teaching. During the academic year a total of 5,467 left cardiac catheterizations were performed (703 by faculty) and 3,045 interventional procedures were performed (301 by faculty). A major new program for STE MI patients was launched in the third quarter of 2004, applying the concept of CODE_MI “Trauma Model” to improve the time from door-to-balloon for Time to PCI for STEMI Patients at RWJUH 100 Number of cases 91 90 90 minute compliance 88 120 minute compliance *JAN 2005 NEW 84 DATA COLLECTION 80 RULES 75 70 *67% 60 58 50 40 30 20 10 19 25 24 26 23 24 0 2003q4 2004q1 2004q2 2004q3 2004q4 2005q1 INCEPTION OF PRIMARY ANGIOPLASTY OCT 2003 INCEPTION OF CODE MI PROGRAM AUG 2004 patients undergoing primary angioplasty. The figure above illustrates the compliance with the 90- minute and 120-minute targets over the last 18 months. The new data collection rules (door-to- balloon instead of door-to-needle) apply to the 1st quarter of 2005 onwards. 2
  3. 3. • The section of non-invasive cardiology continues to be very busy. A total of 8,861 echocardiograms were performed (7,219 transthoracic and 1,642 TEE) and 513 cardiac MRI studies. A pulmonary hypertension evaluation program in patients with scleroderma is now well established. A unique database containing hemodynamic, ultrasound and MRI data on these patients has been developed. Presentations of analyses from these data have been very well received at national rheumatology and cardiology meetings. During the past year a total of 2,988 stress tests were performed. EKG volume was 60,122. There were a total of 8,200 outpatient visits and consultations. Educational The educational mission of the Division is to provide excellent teaching to our medical students, house staff, and fellows. The faculty has been involved in, and presented at, national and international conferences and symposia. The faculty of the Division teaches the second year medical students pathophysiology course, third and fourth year clerkships, and cardiology electives. Students from the physician’s assistant program also rotate through the Division. The Cardiology Teaching Service continues to be successful with excellent feedback from the internal medical residents. There are currently ten cardiology fellows in the Cardiovascular Disease Fellowship Program. The present rate of trainees passing the cardiology boards is 100%. The new Interventional Cardiology fellowship was approved for accreditation in early 2005 and the first trainee (one of the graduating cardiology fellows) started in July 2005. Research The Division currently has over three million dollars in research funds. We are currently participating in five NIH sponsored clinical trials and 35 industry supported studies. The past academic year 10 abstracts were presented and 19 papers were published in peer-reviewed journals. At the American Heart Association Scientific Sessions, Dr Moreyra presented the results of a study combining a statin with psyllium (Metamucil) for the treatment of hyperlipidemia. This presentation was featured on the front page of the Scientific Sessions news and gained much national attention. Irina Korinchneva, PhD joined the Division officially in April 1, 2005, she has NIH funding to study basic mechanisms in molecular cardiology. She has made contributions to the understanding of intracellular and intercellular communication, and regulation of cell growth and death, including stress-induced apoptosis. Undoubtedly, the addition of this research laboratory will make a valuable contribution to the Division. 3
  4. 4. Faculty Activities • Jai Agarwal, M.D., F.A.C.P., F.A.C.C., Director, Interventional Cardiology is noted for his research in balloon angioplasty, stents, laser myocardial revascularization, and coronary brachytherapy. • Rohit Arora, M.D., actively participated in the curriculum development of the Cardiology fellowship and in the mentoring of the trainees in their research projects. • Ronald Freudenberger, M.D. is the Director of the Heart Failure and Transplantation program. He is highly active in research on heart failure, and the medical and mechanical support of heart failure patients. • Irina Korichneva, Ph.D. is the Director of Myocardial Energetics Laboratory. An internationally recognized researcher in the area of redox mechanisms of protein kinase C mediated cardioprotection she is using fluorescent probes and microscopy (Zinc signals) for translational research into ischemia/reperfusion induced oxidative stress • John B. Kostis, M.D., F.A.C.P., F.A.C.C. is John G. Detwiler Professor of Cardiology, Professor of Medicine and Pharmacology and Chairman, Department of Medicine. A past chief of the Division his wide research activities encompass the breadth of cardiovascular disease and cardiovascular pharmacology. • Clifton Lacy, M.D. F.A.C.P., F.A.C.C. (a past Division Chief) is presently serving as CEO of the Robert Wood Johnson University Hospital. His research contributions are centered on disease management and clinical outcomes. • Abel Moreyra, M.D., F.A.C.P., F.A.C.C. is the Medical Director of The Heart Center of New Jersey, Director of the Cardiology Fellowship Program, and is also Director of the Cardiac Catheterization Laboratories. He is involved in many invasive cardiology research protocols aimed at interventions in patient s with acute coronary syndromes, and different forms of myocardial revascularization. • Sebastian T. Palmeri, M.D., F.A.C.P., F.A.C.C. is Medical Director of the Coronary Care Unit, and Medical Director of the Exercise Physiology Laboratories. He is recognized for his research in multi-center cholesterol management and acute coronary syndromes clinical trials. • Archana Patel, M.D. is Director, Cardiac Telemetry and is researching cardiac telemetry and arrhythmias. • Mark W. Preminger, M.D., F.A.C.C., Director of the Cardiac Electrophysiology and Arrhythmia Program and the Cardiac Electrophysiology Laboratories, is Associate Chair of Medicine for Clinical Services. He has been undertaking research in cardiac electrophysiology and pacing. • Daniel Shindler, M.D., F.A.C.C. is Director of the Echocardiography Laboratory and hosts the E-cho cardiography Journal Website ( An Electronic Journal of Cardiac Ultrasound. His research interest is in the area of Internet Cardiac Education. • Meir Shinnar, M.D., Ph.D., Director of the Cardiac MRI Laboratory is studying mathematical modeling in Cardiac MRI. 4
  5. 5. • Alan K. Tannenbaum, M.D. is Medical Director of the Cardiac Exercise and Rehabilitation Training (CERT) center and is interested in pericardial disease. • Tudor D. Vagaonescu, M.D., Ph.D. recently joined the Division as an interventional cardiologist and his activities will focus on new technologies and procedures in the field of interventional cardiology. • Alan C. Wilson, Ph.D., Scientific Director of the Lipid Disorder Center, is researching cardiovascular diseases and atherosclerosis/hyperlipidemia in clinical trials and uses biomedical statistics applications to study trends in NJ myocardial infarctions. • Nina Wokhlu, M.D., Director of the Digital Echo Laboratory is involved in the application of cardiac imaging to characterize the progression of heart failure. Future Directions The building of the new Cardiovascular Institute will be the next step in the development of the Division as envisioned by its leadership. From the inception of the CVI as an institute-without-walls when Dr Hadley L. Conn (a former Chair of Medicine) was the Director, to the ongoing search for a Director who will encompass the clinical and research activities of both the cardiac surgeons and cardiologists under the same roof, this endeavor is a proof of the careful guidance of the Division chiefs past and present. Division of Cardiology Faculty Roster Professor of Medicine Associate Professor of Medicine (continued) John B. Kostis, M.D., F.A.C.P., F.A.C.C. Meir Shinnar, M.D., Ph.D. Abel Moreyra, M.D., F.A.C.P., F.A.C.C. Alan C. Wilson, Ph.D. Associate Professor of Medicine Assistant Professor of Medicine Jai Agarwal, M.D., F.A.C.P., F.A.C.C. Irina Korinchneva, Ph.D.* Ronald Freudenberger, M.D. Archana Patel, M.D. Clifton Lacy, M.D., F.A.C.P., F.A.C.C. Alan K. Tannenbaum, M.D. Sebastian T. Palmeri, M.D., F.A.C.P., F.A.C.C. Tudor D. Vagaonescu, M.D., Ph.D.* Mark W. Preminger, M.D., F.A.C.C. Nina Wokhlu, M.D. Daniel Shindler, M.D., F.A.C.C. *New faculty since July 2004 5
  6. 6. Papers, Reviews and Letters Published (July 2004-June 2005) (faculty and fellows names are in bold font) 1. Vasseur BG. Anderson MB. Freudenberger RS. Anomalous coronary artery in a transplanted heart: a technical modification. Journal of Heart & Lung Transplantation. 23(8):1008-9, 2004 Aug. 2. Guglin ME. Wilson A. Kostis JB. Parrillo JE. White MC. Gessman LJ. Immediate and 1-year survival of out-of-hospital cardiac arrest victims in southern New Jersey: 1995-2000. Pacing & Clinical Electrophysiology. 27(8):1072-6, 2004 Aug. 3. Weinstein MP, Mirrett S, Kannangara S, Monahan J, Harrell LJ, Wilson AC, and Reller LB. Multicenter Evaluation Of The Use Of Penicillin And Ampicillin As Surrogates For In Vitro Susceptibility Testing Of Imipenem Versus Enterococci. J Clinical Microbiology 42 (8);3747-3751, 2004 August. 4. Kostis JB. Ahmad B. International medical graduates and the cardiology workforce. [Review] Journal of the American College of Cardiology. 44(6):1172-4, 2004 Sep. 5. Shindler D. Post-it apexcardiography. [Letter] New England Journal of Medicine. 351(13):1364, 2004 Sep 6. White HD. Palmeri ST. Sleeper LA. French JK. Wong CK. Lowe AM. Crapo JW. Koller PT. Baran KW. Boland JL. Hochman JS. Wagner GS. SHOCK Trial Investigators. Electrocardiographic findings in cardiogenic shock, risk prediction, and the effects of emergency revascularization: results from the SHOCK trial. American Heart Journal. 148(5):810-7, 2004 Nov. 7. Lacy CR. Commissioner of the Department of Health and Senior Services Clifton R. Lacy, MD, recounts achievements. Interview by Leah Z. Ziskin and Clark Martin. [Interview] New Jersey Medicine. 101(11):13-5, 2004 Nov. 8. Lacy CR. Health emergency and disaster preparedness initiatives of the New Jersey Department of Health and Senior Services. New Jersey Medicine. 101(11):17-9, 2004 Nov. 9. Volpe M. Alderman MH. Furberg CD. Jackson R. Kostis JB. Laragh JH. Psaty BM. Ruilope LM. Beyond hypertension toward guidelines for cardiovascular risk reduction. American Journal of Hypertension. 17(11 Pt 1):1068-74, 2004 Nov. 10. Freudenberger R. Cahn SC. Skotzko C. Influence of age, gender, and race on depression in heart failure patients. Journal of the American College of Cardiology. 44(11):2254-5; author reply 2255-6, 2004 Dec. 11. Kostis JB. Wilson AC. Freudenberger RS. Cosgrove NM. Pressel SL. Davis BR. SHEP Collaborative Research Group. Long-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes.[see comment]. American Journal of Cardiology. 95(1):29-35, 2005 Jan. 12. Olshansky B. Sami M. Rubin A. Kostis J. Shorofsky S. Slee A. Greene HL. NHLBI AFFIRM Investigators. Use of amiodarone for atrial fibrillation in patients with preexisting pulmonary disease in the AFFIRM study. American Journal of Cardiology. 95(3):404-5, 2005 Feb. 13. Kim HJ. Arora R. Emerging role of direct thrombin inhibitors in nonvalvular atrial fibrillation: potential and peril. [Review] [44 refs] [Journal Article. Review. Review, Tutorial] Journal of Cardiovascular Pharmacology & Therapeutics. 10(1):11-21, 2005 Mar. 14. Freudenberger RS. Wilson AC. Lawrence-Nelson J. Hare JM. Kostis JB. Myocardial Infarction Data Acquisition System Study Group (MIDAS 9). Permanent pacing is a risk factor for the development of heart failure. American Journal of Cardiology. 95(5):671-4, 2005 Mar. 15. Kostis WJ, Wilson AC. In search of true value. (letter to the editor) J Clin Hypertension 7(3):194 2005 March. 16. Moreyra AE. Wilson AC. Koraym A. Effect of combining psyllium fiber with simvastatin in lowering cholesterol. Archives of Internal Medicine. 165(10):1161-6, 2005 May. 17. Whelton PK, Barzilay J, Cushman WC, Davis BR, Ilamathi E, Kostis JB, Leenen FHH, Louis GT, Margolis K, Mathis DE, Moloo J, Nawachuku C, Panebianco D, Parish DC, Pressel S, Simmons DL, 6
  7. 7. Thadani U. Clinical outcomes in antihypertensive treatment of Type 2 diabetes, impaired fasting gluclose concentration, and normoglycemia. Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med. 165:1401-1409, 2005 June. 18. Blood Pressure Lowering Treatment Trialists' Collaboration (JB Kostis, Member). Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus. Results of prospectively designed overviews of randomized trials. Arch Intern Med 165:1410-1419, 2005 June. 19. The Impact of Hyperglycemia on Cardiac Outcomes in Hospitalized Patients. Strategies to Reduce Morbidity and Mortality. Reviewed for relevance, accuracy of content, balance of presentation and time required for participation by John B. Kostis, M.D.; Harold Kim, M.D., Apurva Shah, M.D.; and Chirag Shah, D.O. Medical Crossfire 6(11); 2005 June. Abstracts of Presentations (July 2004-June 2005) (faculty and fellows names are in bold font) 1. Kulkarni G, Guerard C, Wilson A, Wimalawansa SJ. Prevalence of Vitamin D Insufficiency in Post Menopausal Women and its relevance to I-PTH in Central Jersey. American Society for Bone and Mineral Research (ASBMR) 26th Annual Meeting in Seattle, WA on October 3, 2004 2. Vivien M Hsu, Meir Shinnar, Abel Moreyra, Daniel Shindler, Alan Wilson, Julianne Wilson, Ami Desai, James R Seibold. Assessment of Pulmonary Hypertension (PH) in Systemic Sclerosis (SSc): A Comparison of Doppler Echocardiography, Cardiac MRI and Right Heart Catheterization. American College of Rheumatology meeting in San Antonio, TX on October 16-21, 2004 3. John B. Kostis, Alan C. Wilson, Ronald S. Freudenberger, Nora M. Cosgrove, Sara L. Pressel, Barry R. Davis. Long-Term Effect of Diuretic Based Therapy in Subjects with Isolated Systolic Hypertension With and Without Diabetes: Fourteen-Year Follow-up of the Systolic Hypertension in the Elderly Program (SHEP). AHA Scentific Sessions, Nov 7-10, 2004, New Orleans. Circulation 110(17) Supp III, III-434, November 2004. 4. Paula T. Einhorn, Barry R. Davis, Linda B. Piller, Lara M. Simpson, John B. Kostis, Daniel Levy, Barry M. Massie, Chuke E Nwachuku, Henry R. Black, William C. Cushman. The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Heart Failure (HF) Validation Study: Clinical presentation of hospitalized HF events and subsequent mortality rates. AHA Scentific Sessions, Nov 7-10, 2004, New Orleans. Circulation 110(17) Supp III, III-731, November 2004. 5. Robert D. Langer, Judith Hsia, Mary Pettinger, Pat Caralis, Sybil Crawford, Charles B. Eaton, Nancy Greep, Susan B. Heckbert, Susan L. Hendrix, John B. Kostis, Lewis H. Kuller, Karen C. Johnson, JoAn e. Manson. Conjugated Equine Estrogens-Alone and the Risk of coroanry Heart Disease: Results of the Women’s Health Initiative (WHI) Clinical Trial. AHA Scentific Sessions, Nov 7-10, 2004, New Orleans. Circulation 110(17) Supp III, III-791, November 2004. 6. Abel E. Moreyra, Ashraf Koraym, Alan C. Wilson, Celeste Cardona, Krystof Kopec, Soluble Fiber Supplementation With Psyllium is as Effective as Doubling the Dose of Simvastatin in Lowering ApoB and LDL Cholesterol. AHA Scentific Sessions, Nov 7-10, 2004, New Orleans. Circulation 110(17) Supp III, III-830, November 2004. 7. Berger, Jeffrey S; Brown, David L; Burke, Gregory L; Langer, Robert D; Kostis, John B; Oberman, Albert; Wong, Nathan; Wassertheil-Smoller, Sylvia Underuse of Aspirin in Postmenopausal Women with Cardiovascular Disease: The Women's Health Initiative Observational Study: Circulation. 111(4):E49, February 1, 2005. 7
  8. 8. 8. Abel E. Moreyra, Vivien H. Hsu, Alan C. Wilson, Meir Shinnar, Daniel M. Shindler, Julianne E. Wilson, Ami Desai, James R. Seibold Comparison of Noninvasive Cardiac Methods to Evaluate Pulmonary Hypertension in Patients with Scleroderma. ACC Annual Scientific Session 2005, March 6-9, Orlando, FL. JACC 45(3 Supp A): 370A, February 2005. 9. John B. Kostis, Harold J. Kim, James Rusnak, Elliott Levy. ACE Inhibition and Angioedema: A Prospective Controlled Study in 12,557 Patients. ACC Annual Scientific Session 2005, March 6-9, Orlando, FL. JACC 45(3 Supp A): 485A, February 2005. 10. Julia Grimes, Nora Cosgrove, Alan Wilson, Sunil Wimalawansa, Gayathri Kulkarni. "Risk Factors Associated with Low Vitamin D Levels in Postmenopausal Women", poster at the National Osteoporosis Foundation 6th International Symposium on Osteoporosis: Current Status and Future Directions, April 6-10, Washington, DC, April 2005. 8