Yale: Cardiovascular Medicine:

Section of
Cardiovascular Medicine
Yale University
School of Medicine
333 Cedar Street
PO Box 208017
New Haven, CT 06510
USA
(203) 785-4114

Yale | Cardiovascular Medicine

Introduction
The Section of Cardiovascular Medicine first became an entity under the leadership of the late Alan Goodyer. Lawrence Cohen was recruited to Yale as Chief in 1969. In 1978 Barry Zaret became Chief of the Section. Over the past 25 years there has been enormous sectional growth. The current faculty is 43. There are currently 34 fellows in training. This includes those both in the core two year clinical training program as well as subspecialty and specific research trainees. This program is supported by a staff of 71 people. The annual operating budget for the section is approximately 26.5 million dollars

The Section is extraordinarily diverse with respect to both its research and clinical programs. The faculty include a spectrum involving MDs, MD-PhDs and PhDs whose phenotypes range from quintessential clinician-educators, to primary investigators devoting 80-90% of their time to research, and to clinician scholars. The research effort ranges from programs of excellence in vascular molecular and cell biology to outcomes research involving large populations of patients. The individual research and clinical programs will be discussed in more detail below. A basic priority over the past several decades has been to foster the sense that clinical and investigative excellence must coexist effectively in the same environment in order to develop an optimal academic effort. As such, substantial effort has been placed upon developing excellence in both spheres.

Clinical Programs
The Section of Cardiovascular Medicine represents the largest referral cardiology practice in the state. Faculty referrals result in 45-55% of inter-hospital referrals to Yale-New Haven Hospital. The Section leadership has taken the prime leadership role in developing the Yale-New Haven Heart Center. Last year resulted in a major one million dollar increase in clinical collections, resulting in gross collections of 10 million dollars. This represents well over half of the clinical revenues of the Department of Internal Medicine. The Section recently has taken responsibility for its front end billing process. This change has played a critical role in enhancing collections. The clinical revenues of the various programs within the section are outlined in Attachment 3.

The following clinical programs exist within the section. It is important to recognize that each program (with the exception of general cardiology and preventive cardiology) is led by a program chief who reports directly to the Section Chief and Associate Section Chief for Clinical Affairs. The specific subgroups are:

Interventional Cardiology
Electrophysiology
Echocardiography
Nuclear Cardiology
Congestive Heart Failure/Cardiac Transplantation
General Cardiology
Preventive Cardiology
West Haven VA Cardiology Program

It should be noted that the program at the West Haven VA has grown dramatically and now consists of 7 faculty members. The program has just received approval for a second cardiac catheterization laboratory.

The specific heads of the individual programs are:

Interventional Cardiology - Michael Cleman, M.D.
Electrophysiology - William Batsford, M.D.
Echocardiography - Robert McNamara, M.D.
Nuclear Cardiology/Exercise Testing - Frans Wackers, M.D.
Congestive Heart Failure/Cardiac Transplantation - Stuart Katz, M.D.
West Haven VA - Robert Soufer, M.D.

The clinical program has emphasized outreach to referral sources both in our primary and secondary cachement areas. We have established extensive referral lines for interventional procedures throughout the state, particularly in New London, Norwich, Danbury, Westerly Rhode Island, Greenwich, and Waterbury. Seamless procedures have been developed for immediate patient transfer.

We have several additional sites for outpatient cardiology besides the Dana 3 clinic. This includes an extremely active outpatient site in Branford, staffed by the interventional cardiology group as well as additional members of the Section. The Heart Failure/Transplantation group has its clinical and investigative offices and laboratories at 135 College Street. In addition, we have placed a faculty cardiologist in an internal medicine practice office in Hamden where he sees patients and does echocardiography 2 ½-3 days/week. We are constantly evaluating new clinical opportunities that will expand and solidify our referral base.

Research
The Cardiovascular Medicine Section research portfolio has dramatically increased in breadth and quantity over the last 10 years. Sectional extramural support includes 16 NIH R01s, R21s and projects in program project grants, 6 K08 and other NIH career development grants, 7 American Heart Association and other non-federal grants, 1 new NIH postdoctoral research training grant (see below), 2 other NIH awards (N01 instrumentation), and 9 clinical trial contracts.

The historical anchor of the section’s research program has been in nuclear cardiology. Dr. Zaret has been the originator and innovator of this field, developing exercise myocardial perfusion and equilibrium radionuclide angiography techniques. Dr. Frans Wackers, another pioneer in the field, has optimized the quantification of myocardial regional blood flow during physical and pharmacological stress. Dr, Zaret and Dr. Robert Soufer have described the role of mental stress and various psychological factors in acute coronary syndromes. Dr. Soufer has developed a strong cardiac PET program at the VAMC and he has used PET approaches to begin unraveling the basis for this neurocardiac interaction. Dr. Matthew Burg has collaborated and contributed great psychology expertise in these studies. He is also performing clinical trials in therapy for depression in the acute MI population. This psychological stress work has extended to cardiac electrophysiology research, in which Dr. Rachel Lampert studies the effect of mental stress on heart rate variability, ventricular tachycardia, and atrial fibrillation.

Most recently, Drs. Zaret, Sinusas and Sadeghi has been spearheading a new area of “molecular imaging” the union of nuclear imaging with basic principles of molecular and cell biology, largely of the vascular system. Dr. Mehran Sadeghi is screening for and developing novel ligands that bind to activated/altered endothelium, and addressing their utility in animal models of vascular pathology. Dr. Albert Sinusas is developing noninvasive nuclear imaging strategies to identify the hypoxic stimulus for angiogenesis, including the imaging of selected integrins in both large and small animal models. This is possible at Yale not only because of the strength in nuclear cardiology, but also because of the broad-based expertise in molecular and vascular biology.

The move to The Anlyan Center (TAC) has allowed the coalescence of the Section’s cellular and molecular research laboratories, into a cardiovascular medicine research program. Dr. Jeffrey Bender has studied leukocyte-endothelial cell interactions, recognized to be important in the rejection of vascularized allografts and atherosclerosis. His work on the immune, inflammatory and hormonal effects on the endothelium has laid the foundation for the Section’s vascular biology program development. His studies on endothelial estrogen receptors have led to new paradigms in hormonal effects on the vasculature. Dr. Frank Giordano has been studying myocardial angiogenesis, evaluating the consequences of deletion or over-expression of pro-angiogenic genes in animal models. He has been working on the development of new viral vectors for gene delivery, in ongoing assessments of cardiovascular gene therapy. Dr. Giordano is leading the efforts to develop a viral vector core at Yale. Dr. Kerry Russell studies signaling pathways induced by growth factors of the neuregulin family, and their erbB receptors, and the effect of activation on vascular form and function.

Studies on cardiomyocyte physiology and pathology complement the aforementioned vascular biology studies throughout the Section. Dr. Russell studies the effects of the noted signaling responses in cardiomyocytes and in animal heart failure models. Dr. Giordano uses gene delivery approaches to modulate cardiomyocyte phenotype and myocardial function in animal models. Furthermore, a primary effort in cardiomyocyte biology is directed by Dr. Lawrence Young, who has collaborated with Yale endocrinologists to develop a program in the cellular and molecular mechanisms of metabolic adaptation to ischemia, with a focus on glucose transport proteins. Dr. Raymond Russell also studies cardiac metabolism, in the setting of heart failure, and the control of myocardial glucose metabolism in animal models.

An additional component of the vascular biology program also lies at the interface of vascular and myocardial biology. Dr. Stuart Katz, the director of the Section’s Heart Failure and Transplant Program, has established a clinical vascular research laboratory to investigate pathophysiology and pharmacology in heart failure patients, and the role of the endothelium in the pathogenesis of heart failure. Dr. Daniel Goldstein, another member of the Heart Failure and Transplant Program, is using murine models to elucidate the role of innate immunity in the acute and chronic rejection of vascularized allografts, including dissecting the mechanisms of resultant vascular pathology.

The fourth additional component of the vascular biology program involves translational research performed by the Section’s Interventional Cardiology group which includes Drs. Michael Cleman, Henry Cabin, Michael Remetz, Joseph Brennan, John Setaro, Steven Pfau and Christopher Howes. The group has been exploring the role of vascular inflammation, specifically involving neutrophil and complement activation, in acute coronary syndromes, and hormonal influences on these inflammatory, vascular events in patients. Beyond Cardiovascular Medicine, there exists a strong vascular biology community that is highly interactive with the Section’s faculty. This strength, both within the Section and throughout the school, is the basis of the Section’s Vascular Research NIH Postdoctoral Training Grant (T32). There are currently 7 postdoctoral fellows funded by this mechanism.

A new program in human molecular cardiovascular genetics has recently been instituted with the recruitment of Dr. Arya Mani to the faculty. Dr. Mani trained in the laboratory of Rick Lifton M.D. Ph.D., Chair of Human Genetics and internationally recognized in the field. Dr. Mani's initial work focused on the genetics of familial patent ductus arteriosis. Currently he is studying families with premature coronary artery disease to approach the genetics of this condition.

Outcomes research in cardiovascular disease highlights the Section’s clinical research efforts. Dr. Harlan Krumholz directs this world class program. He is also the Director of the Robert Wood Johnson Clinical Scholars Program. Using methods of clinical epidemiology and health services research, Dr. Krumholz’s efforts have been directed at determining optimal clinical strategies and in identifying opportunities in the prevention, treatment and outcome of cardiovascular disease, with emphasis on older populations. The work has been facilitated by innovative collaborations with Yale-New Haven Hospital Center for Outcome Research and Evaluation, the Centers for Medicare and Medicaid Services, and the Department of Defense. Dr. Martha Radford, as the System Director for Clinical Quality for the Yale-New Haven Health System, works on understanding organization factors the impact on quality of care and outcomes. Dr. JoAnne Foody also uses epidemiologic methods to identify preventive, clinical strategies that will reduce cardiovascular events in patients with and without coronary artery disease, in particular in the elderly. This includes evaluating the impact of older patient’s preferences for preventive therapies on their care and outcomes.

The Section participates in several clinical trials at any one time. As a result, our interventional group has been the first in the region to use stents, monthly therapy and several other advances. Dr. Frans Wackers organized the ongoing DIAD trial, which is evaluating cardiovascular disease in asymptomatic patients with diabetes mellitus.

Last modified: Friday, 12-Dec-2003 08:34:35 EST (PL).