Rush Cardiac News
                          The Rush Heart Institute Newsletter for Physicians
                          a...
Preventive Cardiology                                              NIH study seeks recruits
(continued from page 1)
      ...
Promising results seen                                            cations for placement
                                  ...
Rush pediatric CV                                             KEY STEPS TO SURGERY
  surgeon successfully                 ...
New mitral valve repair                                                 1A               Anterior leaflet
offered at Rush ...
This giant thromboembolism consisting of
                                                                             clot...
Beta-Radiation
(continued from page 1)

Cardiologists in the Rush Interventional Cardiology
Program were among the most ac...
Department News                                               Scientific Symposium recently. His presentation was
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Rush Cardiac News

  1. 1. Rush Cardiac News The Rush Heart Institute Newsletter for Physicians and Other Health Professionals Volume 7 · Number 1 · Winter-Spring 2001 Rush Heart Institute 1725 W. Harrison St. Rush is first in the area Chicago, IL 60612 (312) 563-2230 to offer beta-radiation Joseph E. Parrillo, MD, for in-stent restenosis Medical Director Verdi J. DiSesa, MD, A 75-year-old woman presented at Rush in late 1998 Surgical Director with a nine-year history of persistent, intractable chest Services: pain. A veteran of two CABG operations and 16 • General Cardiology PTCAs, the patient could not remember a time when • Interventional Cardiology she did not experience the debilitating pain. • Electrophysiology • Heart Failure and Her presentation and medical history indicated she Transplant • Echocardiography would be a good candidate for a trial under way at • Cardiovascular- Rush using targeted low-dose beta-radiation to treat Thoracic Surgery in-stent restenosis. She received the new treatment, Beta-radiation sources • Cardiovascular Pediatrics and now, more than two years post-treatment, she has at treatment site • CV Stress Testing had no recurrence of symptoms. • Cardiac Rehabilitation ment of in-stent restenosis. The FDA approval was in No single subject in the past year has received more • Preventive response to superior outcomes from the START (Stent Cardiology attention or caused more excitement in cardiovascular • Pulmonary Heart and Restenosis Therapy) trials, in which patients who care than intracoronary radiation for the treatment of Disease participated demonstrated a 66 percent reduction in the • EBT Coronary in-stent restenosis. Screening rate of in-stent restenosis when treated with targeted This interest was validated last November when the low-dose beta-radiation. FDA approved intracoronary radiation for the treat- (continued on page 7) New Rush preventive medicine residency and cardiology fellowship at Rush- Presbyterian-St. Luke’s Medical Center. cardiology director Board-certified in internal medicine and cardiovas- defines program goals cular medicine, he has more than 100 publications to In light of growing evidence supporting the impor- his credit. INSIDE tance of primary and secondary prevention in the care His article, “Effects of Continuous Estrogen and of all patients, the Rush Heart Institute recently Estrogen-Progestin Replacement Regimens on •Biventricular appointed one of the nation’s Cardiovascular Risk Markers in Postmenopausal pacing for leading preventive cardiology Women,” appeared in the November 2000 issue of the heart failure clinicians and researchers, Archives of Internal Medicine. It is one of his most Michael Davidson, MD, as recent and important published works. He has also •Pulmonary Medical Director of the Rush coordinated more than 500 clinical trials, and in thromboen- Preventive Cardiology addition to his Rush responsibilities, will continue as Program. President of the Chicago Center for Clinical Research darterectomy Dr. Davidson, a graduate of and Executive Director of Protocare Trials. •New mitral Ohio State University The clinical research focus that has dominated much valve repair School of Medicine, of Dr. Davidson’s work for the past decade underscores completed both his internal Dr. Davidson (continued on page 2) Rush-Presbyterian-St. Luke’s Medical Center Page 1
  2. 2. Preventive Cardiology NIH study seeks recruits (continued from page 1) Partners for Life, a four-year $2.4 million NIH study the goals he has set for the Rush Preventive Cardiology conducted by Rush Heart Institute cardiac psychologist Program. “The primary goals of an advanced preventive Albert Bellg, PhD, and Tamara Sher, PhD, of the cardiology program should be clinical practice, education Illinois Institute of Technology, will examine whether a and research,” says Dr. Davidson. “Within clinical practice, behavioral change program that includes spouses or life we are able to offer patient screening that is far beyond partners can help patients maintain long-term change. HDL, LDL and triglyceride levels.” Patients appropriate for this study include those who: The laboratory screening done through the program may include determination of the following components: • are recovering from an MI, CABG or PTCA within the past six months, • particle size of HDL, LDL and VLDL, • LDL particle concentration, • reside with a live-in spouse or partner, • homocysteine levels, • require dietary changes or weight loss, cardiac reha- • fibrinogen, bilitation and lipid-lowering medication. • blood viscosity, “Patients recovering from cardiac events often have a • lipoprotein(a), difficult time making and maintaining the behavioral • high-sensitivity C-reactive protein. changes recommended by their physicians,” Dr. Bellg However, Dr. Davidson cautions, the program’s goal should says. “In the Partners for Life study, patients and their not only be to diagnose and treat complex lipid disorders; partners will learn how to work together to improve rather, the goal is also to integrate the concepts of preven- their adherence to taking lipid-lowering medication tion into the care of all patients through risk-factor analysis and maintaining risk-reducing lifestyle changes, such as and risk modification. weight loss, diet and exercise.” The Preventive Cardiology Program provides a team Long-term adherence in this group will be compared approach that includes an exercise physiologist, a clinical with that of patients who receive heart-healthy educa- nutritionist, a cardiac psychologist (Albert Bellg, PhD) tion without including their partners. and a nurse practitioner (Lynne Braun, RN, PhD). Dr. For more information or to refer a patient, contact Braun directs clinic activities with Dr. Davidson, addressing Jennifer Tennant, RN, at (312) 942-2375. many risk-modification issues with patients. “Patients often need education, planning and support to address modifiable addition to plans for establishing a national cholesterol risks. We provide the tools needed,” she says. index, Dr. Davidson plans to implement at Rush a nation- wide quality assurance program developed by the Clinical research will be an important aspect of Dr. American Heart Association entitled “Get With the Davidson’s work at Rush. One of his recent endeavors is an Guidelines.” The program includes patient-discharge abstract that will be presented at the American College of guidelines, such as specific education requirements needed Cardiology Spring 2001 Scientific Meeting entitled to address risk-factor modification. Dr. Davidson has also “Rosuvastatin is Superior to Atorvastatin in Reducing LDL developed a Palm Pilot program that uses cardiac risk Cholesterol Levels to NCEP Guideline.” factors to compare the patient’s chronological age with his or her calculated heart age. The program will debut at the He also recently began enrolling patients in a clinical trial American College of Cardiology Scientific Meeting. that will evaluate the combined cholesterol-lowering effect of adding ezetimibe—an investigational drug that blocks “Dr. Davidson brings a wealth of clinical and research the absorption of cholesterol in the intestinal track—to a expertise to his new position at Rush,” says Joseph patient’s current statin regimen. In addition, a clinical trial Parrillo, MD, Medical Director of the Rush Heart will begin in June involving cholesterol-lowering and the Institute. “The commitment Drs. Davidson and Braun Rush Heart Scan. The study will evaluate the progression have to improving cardiovascular health is a tremendous of atherosclerosis in patients who have electron-beam CT benefit, not only to patients but to other clinicians as scores of 30 or higher and low lipid levels and who are well.” given cholesterol-lowering therapies. For more information about preventive cardiology clinical Providing education for clinicians and patients will also be and research programs at Rush or to speak with Dr. a priority for the Rush Preventive Cardiology Program. In Davidson, call (312) 563-2011. Page 2 Rush-Presbyterian-St. Luke’s Medical Center
  3. 3. Promising results seen cations for placement of an implantable A C for biventricular pacing cardiac defibrillator as in heart failure well. A 65-year-old patient presented at Rush with New York “Patients with Heart Association (NYHA) Class III heart failure, demon- advanced heart failure strating dyspnea even with mild exertion. Having have a high incidence exhausted medical management options in search of of sudden cardiac symptom relief, the patient agreed to participate in a biven- death,” Dr. Pinski says. tricular pacing study. B “This trial will evaluate the benefits of After being randomized to the pacing arm of the trial, the This illustration shows the combined therapy of patient experienced dramatic improvement, moving from the position of the catheters biventricular pacing of a biventricular pacing NYHA Class III to Class I, in less than six months. The with an ICD for this system in the heart. One patient can now ambulate several blocks without dyspnea. complex patient popu- catheter is placed in the right In a recent poll of cardiovascular experts, biventricular lation.” atrium (A), one in the right pacing for the treatment of heart failure was listed as one of ventricle (B) and one in a For more information coronary vein (C) to pace the the top-ten advances in cardiology in 2000, an opinion or to refer a patient to left ventricle. shared by the heart failure and arrhythmia experts of the the COMPANION or Rush Heart Institute. MIRACLE-ICD trials, contact Dr. Costanzo at (312) Two clinical trials based on the scientific theory that 563-2121 or Dr. Pinski at (312) 942-6858. ventricular resynchronization improves cardiac function in severe heart failure are now being conducted at the Rush Heart Institute to assess the benefits of biventricular pacing. Department News Rush Principal Investigators Maria Rosa Costanzo, MD, Salpy Pamboukian, MD, recently joined the Rush Medical Director of the Rush Heart Failure and Cardiac Heart Failure and Cardiac Transplant Program. She Transplant Program, and Sergio Pinski, MD, Director of was also appointed Medical Director of the new the Rush Arrhythmia Device Program, are currently Heart Failure Program at Cook County Hospital and recruiting patients to the COMPANION (Comparison of an Assistant Professor at Medical Therapy, Pacing, and Defibrillation in Heart Rush Medial College. Failure) trial and the MIRACLE–ICD (Multicenter Dr. Pamboukian InSync Randomized Clinical Evaluation with an completed both medical Implantable Cardiac Defibrillator) trial. Both trials require school and her internal that candidates have a left-ventricular ejection fraction medicine residency at (LVEF) of 35 percent and symptomatic heart failure for at the University of least six months. Toronto. She then The COMPANION trial randomizes patients to one of completed fellowships three arms: biventricular pacing, biventricular pacing plus in cardiology at the Dr. Pamboukian backup defibrillator or medical therapy alone. Dr. Costanzo University of British feels the initial patient results have been very promising. Columbia and in heart failure and cardiac transplant at Rush-Presbyterian-St. Luke’s Medical Center. She “Most of our patients randomized to biventricular pacing is board-certified in internal medicine and cardiovas- improved their functional class within six months,” she cular disease. says. “The hope is that we can reproduce that level of improvement in many of our patients coping with Heart failure is Dr. Pamboukian’s area of interest, advanced heart failure. We believe this therapy has incred- with a special emphasis on outcomes management ible therapeutic potential.” and racial and gender differences in heart failure. She recently published an article on “Transplant The MIRACLE-ICD trial is also designed to assess the Coronary Vasculopathy” in Current Treatment benefits of biventricular pacing for the treatment of heart (continued on page 4) failure, with one key difference. Candidates must have indi- Rush-Presbyterian-St. Luke’s Medical Center Page 3
  4. 4. Rush pediatric CV KEY STEPS TO SURGERY surgeon successfully According to Dr. Amato, surgical correction of treats rare defect ectopia cordis requires four key steps: 1. covering the naked heart with skin as soon Ectopia cordis is such a as possible, rare defect in newborns, representing less than 2. palliating or completely repairing major 0.1 percent of all intracardiac defects, congenital heart 3. placing the heart into the thoracic cavity, defects, that cardiac 4. reconstructing the sternum or chest wall to surgeons may only see cover the heart. one case in their entire professional lifetime. outside the chest externally, cervically or abdomi- nally, Dr. Amato explains. The resulting entity is Yet, Joseph J. Amato, called ectopia cordis. Dr. Amato MD, Chief of the Section of Pediatric “When the child is born with a heart deformed in Cardiothoracic Surgery in the Department of this way, there may be a condition within the Cardiothoracic Surgery at Rush, has seen four heart so major that it cannot be corrected, and the infants born with ectopia cordis and has treated child will die,” he says. “Surgeons have made many three of them, the last one within the past several attempts to repair this defect, but not too many months. In fact, Dr. Amato is believed to be the have been successful. There have been only seven only surgeon in the Chicago area currently survivors reported in the world literature since performing the complicated procedure necessary to surgical correction of ectopia cordis was first correct this condition. performed successfully 24 years ago.” “Ectopia cordis is a congenital defect defined as the Dr. Amato credits the recent patient’s survival placement of the heart outside the chest,” Dr. thus far to the team effort at Rush and to the Amato says. “A more formal definition is an extremely dedicated nurses in the pediatric inten- extrathoracic heart coming to lie upon the outer sive care unit who work along with the physicians surface of the body or within the abdominal and resident staff. “This type of care can only be cavity.” given in a tertiary hospital where there is coordi- nated interaction among all of the disciplines As early as the third week of intrauterine life, involved,” he says. when both the heart and the sternum are being formed in the primary germ layers, the For more information, or to speak with Dr. Amato mesenchymal tissue that comprises the sternum directly, call (312)-942-5448. may fail to fuse, allowing the fetal heart to develop Department News chairman for the 5th Annual American Society of (continued from page 3) Nuclear Cardiology Symposium and Scientific Session. Options in Cardiovascular Disease (2001;3:55-63). She will James Calvin, MD, Rush cardiologist and Chairman of the divide her clinical and research responsibilities between Division of Cardiology at Cook County Hospital, and Rush-Presbyterian-St. Luke’s Medical Center and Cook Lloyd Klein, MD, have published an article, “Validated County Hospital. Risk Stratification Model Accurately Predicts Low Risk in Patients with Unstable Angina,” in the Journal of the Lloyd Klein, MD, Director of Rush Interventional American College of Cardiology (2000;36:1803-8). Cardiology, was recently appointed to the Editorial Board of the Journal of the American College of Cardiology. Dr. Philip Liebson, MD, Rush cardiologist, has published Klein also was the course director for the fall 2000 9th “Optimal Antihypertensive Therapy for Prevention and Annual Cardiac Intervention in Chicagoland meeting. Treatment of Left Ventricular Hypertrophy” in Current Hypertension Reports 2000. Robert Hendel, MD, Rush Director of Nuclear Cardiology in the Section of Cardiology, was the program (continued on page 8) Page 4 Rush-Presbyterian-St. Luke’s Medical Center
  5. 5. New mitral valve repair 1A Anterior leaflet offered at Rush for Annulus ischemic cardiomyopathy 1B The complex changes in ventricular geometry that occur in patients with ischemic cardiomyopathy often make surgical repair of mitral valve insufficiency extremely diffi- cult. However, cardiovascular surgeons at Rush have Posterior leaflet begun using a new approach to mitral repair that has proven successful for these challenging patients. 2A Anterior leaflet Approximately 25 percent of patients with ischemic cardiomyopathy have mitral insufficiency. Many of these patients continue with significant shortness of breath and fatigue despite optimal medical treatment with after- loading drugs. These significant symptoms lead some 2B patients and physicians to consider surgical repair. Posterior leaflet There are several challenges to performing mitral valve surgery for patients with this disease. The changes that occur in ventricular geometry interact with mitral valve function in a complex way. As with most forms of cardiomyopathy, the failing ventricle dilates. This dilation causes expansion of the posterior mitral annulus. Figures 1A and 2A illustrate the left atrial and lateral When the annulus dilates, there is progressive failure of views of the incompetent mitral valve. Figures 1B and good coaptation (fitting together) between the anterior 2B illustrate the competent valve after annuloplasty and leaflet approximation. and posterior mitral leaflets. This failure causes mitral insufficiency, which exacerbates and retraction of the mitral leaflet. This distortion and the volume load on the heart and leads to further dilation restriction in leaflet movement can cause mitral insuffi- and more mitral insufficiency. The cycle progressively ciency. “When a surgeon repairs mitral insufficiency in this destroys normal myocardial and valve function. This situation, the alteration in leaflet motion should be familiar mitral insufficiency scenario can be treated effec- addressed, as well as the annular dilation that typically tively with ring annuloplasty alone. In ischemic accompanies heart failure of many etiologies,” says Verdi cardiomyopathy patients, however, the etiology and the DiSesa, MD, Rush Chairman of Cardiovascular Surgery. therapy are not so straightforward. The procedure involves suturing the mid-portion of the Coronary artery disease can cause changes in regional anterior leaflet to the corresponding mid-scallop of the wall motion and regional ventricular shape. Because posterior leaflet. This approach creates a double-orifice normal function of the mitral valve depends on the mitral valve. The technique was originally proposed by O. normal shape and function of the left ventricle, these Alfieri, MD, from Milan, and it is often used to correct regional wall changes mitral insufficiency as part of ventricular volume reduction. can affect mitral compe- Remarkably, the procedure does not produce significant tence. Specifically, mitral stenosis, although it does change the flow pattern infarction, akinesis and through the mitral valve as assessed by echocardiography. enlargement of the region of ventricular Cardiovascular surgeons at Rush are the only surgeons in myocardium near the the Midwest currently using this approach for this chal- base of a papillary lenging group of patients. Successful outcomes have been muscle can alter mitral demonstrated thus far, but Dr. DiSesa cautions that careful valve function. follow up will be necessary to demonstrate the durability and long-term efficacy of the procedure. These ventricular changes may cause For more information, or to refer a patient to Dr. DiSesa, Dr. DiSesa please call (312) 563-2762. traction on the chordae Rush-Presbyterian-St. Luke’s Medical Center Page 5
  6. 6. This giant thromboembolism consisting of clot and fibrosis was removed from branches of the right pulmonary artery. It measures 6 inches long on the right side. immediate postoperative period has passed, many of these patients can look to this procedure as being curative.” Medical advances in the treatment of pulmonary heart disease are also being pursued at Rush, says Vallerie McLaughlin, MD, Associate Director of the Rush Pulmonary Heart Disease Program. “Endothelin- receptor antagonists and prostacyclin analogues are the two most promising areas of Pulmonary thrombo- clinical study for pulmonary hypertension,” she says. endarterectomy added to “In addition to continuous intravenous prostacyclin medical therapies at Rush medication (Flolan), which is one of the most effec- Few centers exist nationwide that can address the tive therapies for the treatment of primary pulmonary advanced needs of patients with pulmonary heart hypertension, there is a new continuous prostacyclin disease. Even fewer offer surgical relief in the form of subcutaneous analogue, Remodulin. Also, an oral pulmonary thromboendarterectomy for patients with analogue, Beraprost, is being studied,” she added. thromboembolism. According to Dr. Rich, the message is clear. Under the direction of Stuart Rich, MD, Medical “Pulmonary heart disease continues to be an Director of the Pulmonary Heart Disease Center, and extremely complex foe,” he says. “However, there are William Piccione, MD, a Rush cardiovascular surgeon, more new drugs and therapies available in 2001 for the Pulmonary Heart Disease Program offers Rush the treatment of pulmonary heart disease than in the patients surgical removal of chronic pulmonary previous 10 years. And, Rush remains one of only a embolisms, a condition that affects 15 percent of handful of centers in the world that can offer proven pulmonary heart disease patients. medical and surgical therapies, as well as access to the latest clinical trials.” Patients commonly present with progressive shortness of breath. CT scans and pulmonary angiography are done For more information about medical management of to confirm the presence of thromboembolism. Surgical primary pulmonary hypertension, contact Drs. Rich removal is the treatment of choice for these patients, and McLaughlin at (312) 563-2169, and for surgical Dr. Piccione reports. options in the treatment of pulmonary thromboem- bolism, contact Dr. Piccione at (312) 563-2762. “It is a complex procedure not performed at many centers nationwide,” says Dr. Piccione, who has performed more than 20 of the procedures. “Fortunately, Rush Cardiac News® The Rush Heart Institute Newsletter for Physicians advances in instrumentation now allow us to reach and Other Health Professionals segmental arteries more efficiently, significantly Volume 7 · Number 1 decreasing the patient’s cardiopulmonary bypass time.” Rush Cardiac News® is published by the Rush Heart Institute, The need for exceptional surgical expertise is not the 1725 West Harrison Street, Chicago, IL 60612, 312-563-2230. All rights reserved. only issue for these patients, says Dr. Rich. “Pulmonary Joseph E. Parrillo, MD Verdi J. DiSesa, MD thromboendarterectomy patients are extremely labile Medical Director Surgical Director postoperatively. They require continuous, expert Valerie Larkin, RN, MA Robert Hughes medical management by staff trained to assess and react Marketing Director Administrator to patients whose hemodynamic status changes quickly Dennis Connaughton and dramatically,” he says. “Fortunately, once the Editor Page 6 Rush-Presbyterian-St. Luke’s Medical Center
  7. 7. Beta-Radiation (continued from page 1) Cardiologists in the Rush Interventional Cardiology Program were among the most active participants in the START trials and subsequent compassionate use of the device, having performed more than 200 cases in the last three years. Rush cardiologists also performed the first commercial beta-radiation proce- dure in the Chicago area using the Beta-Cath System from Novoste Corporation. Rush is one of only three Chicago area sites to offer beta-radiation therapy for patients with in-stent restenosis. The Rush investigators, Gary Schaer, MD, Director of Gary Schaer, MD, (left) and R. Jeffrey Snell, MD, the Rush Cardiac Catheterization Lab, and R. Jeffrey discuss beta-radiation protocols in the Rush Cardiac Snell, MD, Assistant Director of Interventional Catheterization Lab. Cardiology, agree that the patient results are unequiv- wall, automatically centering the radiation source. ocally positive. “This is the first effective tool we have This unique combination of shape and centering had to combat restenosis,” Dr. Snell says. maximizes both the amount and uniformity of the dose given to the target tissue. Beta vs. Gamma Radiation In addition to the beta-radiation trials, concurrent “The initial trials conducted by Radiance with the gamma-radiation trials were conducted at several U.S. catheter system yielded an unprecedented zero percent sites, demonstrating a similar reduction in restenosis. restenosis rate at six month follow-up for 27 patients, However, warns Dr. Schaer, there are several caveats the lowest rate reported for this therapy,” reports Dr. to the use of gamma therapy. Schaer. “Gamma is much more penetrating, with a significant The unique delivery system also allows a dose rate to be increase in radiation exposure,” says Dr. Schaer. “This delivered effectively to larger vessels, such as saphenous increase in radiation exposure necessitates medical vein grafts, overcoming a limitation of previous delivery personnel leaving the patient unattended during the systems. Patients who are appropriate candidates for 15- to 30-minute dwell time. With the beta-radiation these trials must have a left-ventricular ejection fraction used at Rush, these problems do not occur.” (LVEF) greater than 25 percent, must be suitable candi- dates for percutaneous intervention and must be able to Two new brachytherapy trials are now under way at tolerate an aspirin, ticlopidine or clopidogrel regimen. Rush: the BRITE II (Beta Radiation to Reduce In- stent Restenosis) trial and the BRITE-SVG On the Horizon (Saphenous Vein Bypass Grafts) clinical study. BRITE Several new applications of beta-radiation are being II is a prospective, randomized (3:1 active vs. placebo) evaluated, reports Dr. Snell. “I believe radiation to trial designed to determine the efficacy of the RDX prevent restenosis for peripheral vascular disease will coronary radiation delivery system from Radiance soon be available,” he says. “And using brachytherapy as Medical Systems Inc. an adjunct during an initial coronary angioplasty proce- dure is on the horizon. At advanced centers like Rush, BRITE-SVG is a non-randomized registry for patients we will continue to explore treatment options that with either restenosis or new lesions not previously would expand the utilization of this therapy.” treated. The trials, under the direction of Drs. Schaer and Snell, will evaluate the RDX system for treating Drs. Schaer and Snell report that in addition to in-stent restenosis in native coronary arteries and brachytherapy advances, new gene-therapy trials and saphenous vein grafts. The Rush Heart Institute is the several other acute-intervention studies are soon to only Chicago area site for these studies. begin at Rush. The BRITE II and BRITE-SVG trials use a radiation For more information on brachytherapy or to speak source housed within an angioplasty balloon. The directly with Drs. Schaer or Snell, call Dr. Schaer at flexible catheter conforms to the shape of the vessel (312) 942-4655 or Dr. Snell at (312) 942-6569. Rush-Presbyterian-St. Luke’s Medical Center Page 7
  8. 8. Department News Scientific Symposium recently. His presentation was entitled “Managing Abnormal Vessels and Damaged (continued from page 4) Heart Muscle in Circulatory Shock.” Dr. Parrillo also Kathleen Grady, PhD, RN, received the participated as a faculty member for the Society of Arteriosclerosis/Heart Failure 2000 Research Prize from the Critical Care Medicine’s Fifth Critical Care Refresher American Heart Association and the Council of Course, presenting “Arrhythmia Management”, “Acute Cardiovascular Nursing for her manuscript entitled Coronary Syndromes”, “The Development of a Clinical “Change of Life from Before to After Discharge Post Left Research Career” and “Cardiology—Year in Review.” Ventricular Assist Device Implantation.” Steven Feinstein, MD, Director of the Rush Steven Hollenberg, MD, Walter Kao, MD, and Sergio Echocardiography Laboratory, was course director for the Pinski, MD, Rush cardiologists, have recently been fall 2000 15th Annual Advances in Echocardiography: promoted to associate professors of medicine at Rush The Latest Research and Clinical Information in Medical College. Contrast Echocardiography and Perfusion Imaging meeting. In addition, Dr. Feinstein’s article entitled “A Two Rush Cardiology Fellows received clinical poster Retrospective Experience of Right Atrial and Superior awards at a recent meeting of the Illinois and Wisconsin Vena Cava Thrombi Diagnoses by Transesophageal Chapter of the American College of Cardiology. Francis Echocardiography” was recently accepted for publication Q. Alameda, MD, won 1st place for his case presentation, in the Journal of the American Society of Echocardiography. “A Unique and Unusual Case of Metastatic Tumor Infiltration of the Pericardium Masquerading as Pericardial Tamponade.” Barry S. Merrill, MD, took 2nd place for his Dr. Feinstein also reports that important new clinical research, “Comparative Value of Troponin I versus Health Care Financing Administration legislation Clinical Risk Assessment as Predictors for In-hospital has been approved that provides Medicare reim- Events in Acute Coronary Syndrome.” bursement for diagnostic contrast agents and contrast-enhanced echocardiographic diagnostic Joseph Parrillo, MD, Medical Director of the Rush Heart procedures. The effective date for this provision is Institute, was a plenary session speaker for the Society of July 2001. Critical Care Medicine’s 30th International Educational & Rush Cardiac News NON-PROFIT ORGANIZATION The Rush Heart Institute Newsletter for Physicians U.S. POSTAGE and Other Health Professionals PAID Rush-Presbyterian-St. Luke’s Medical Center PERMIT NO. 1207 1725 West Harrison Street CHICAGO, IL Chicago, IL 60612 ADDRESS CORRECTION REQUESTED

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