PH GME Subspecialty Programs - Cardiovascular Disease Research

General Description
Participation in research is required of all trainees. It is expected that each cardiovascular fellow will prepare a research project for presentation at a regional or national meeting and will submit at least one project for publication in a peer review journal. The Department of Research at Providence Hospital is in a position to offer technical facilities and monetary assistance (through research grants to staff members) to residents and trainees participating in clinical research. The Research Department acts as a complement to the medical teaching program and fulfills requirements for the unique individual research studies required in specialized medical fields. Elective rotations in research are offered during the 3rd year of training. This rotation is under Dr. Shukri David’s supervision.  

Through research, practicing physicians are kept alert to problems outside of routine patient care and are stimulated to search for new medical knowledge and techniques.

The Research Department is under the direction of David Svinarich, Ph.D., Director of Patient Care Research. A newly constructed 10,000 sq ft facility was opened in June of 2001. The Research Department consists of the following divisions: Clinical Trials Unit, Research Laboratory, Teaching Laboratories.

Clinical Trials Unit
The Clinical Trials Unit has three experienced Research Nurses with expertise in conducting Phase I-IV clinical research studies.  Services offered include assistance with regulatory documents, study coordination and data management.  The Clinical Trials Unit has clinical research experience with the following sponsors and clinical research organizations:

• AFFIRM (NIH, NHLBI)
• PEACE (NIH, NHLBI)
• MOST (NIH, NHLBI)
• SCD-HeFT (NIH, NHLBI)
• VALIANT (NIH, NHLBI)
• RAMPART (Parke Davis)
• A double-blind comparison of the incidence of hypotension with two formulations of intravenous amiodarone:  Cordarone IV vs amiodarone aqueous IV injection (Wyeth Ayerst)
• Acute evaluation of autocapture in Bachmann’s Bundle vs right atrial appendage using Affinity DR Device (St Jude Medical)
• PEACE:  Prevention of events with angiotensin converting enzyme inhibitor therapy – Ancillary study (NIH, NHLBI)
• Evaulation of atrial arrhythmias utilizing the onset of electrogram capability of Discovery II and Ventak Prizm AICD  (Guidant)
• Omapatrilat cardiovascular treatment assessment vs enalapril (OCTAVE) protocol CV-137-120 (Bristol-Myers Squibb Company)
• CONSERVE: Comparison on new stents for equivalency of reduction in vascular events (IVT)
• PainFree Rx II:  Does pacing fast VT Reduce Shock Rx?  (Medtronic)
• TACT: Tachos Atrial Conversion Therapy (Biotronik)
• The open evaluation comparing stent thrombosis rate of the BX Velocity Heparin Coated Stent and the BX Velocity Stent (Cordis)
• TENAX XR registry investigational plan (Biotronik)
• TherOx Aqueous Oxygen System -Acute Myocardial Infarction with Hyperoxemic Therapy (AMIHOT) Phase II Clinical Trial:  A randomized, controlled, multicenter trial of aqueous oxygen infusion for 90-minutes post-primary PTCA/Stent Intervention in Acute MI (TherOx, Inc.)
• Evaluating the value of fluoroscopy in screening for coronary artery disease (Providence Hospital and Medical Centers)
• OAT: The occluded artery trial (NIH)
• Evaluation of the role of non-invasive hemodynamic monitoring in treatment of congestive heart failure (Providence Hospital and Medical Centers)
• Is cardiac monitoring post pacemaker placement necessary?  A retrospective evaluation of trends in admitting post pacemaker placement patients to monitored unit versus non-monitored unit. (Providence Hospital and Medical Centers)
• Early ambulation following diagnostic coronary angiography using perclose closure of femoral arteriotomy (Providence Hospital and Medical Centers)
• Evaluation of doppler echocardiographic velocities in intra-aortic balloon pumping (DEVIAB) doppler correlates of left ventricular performance and prognostic implications of weaning (Providence Hospital and Medical Centers)
• Synergistic effects of risk factors for sudden cardiac death (SERF) study (Guidant)
• Does low androgen state correlate with more major adverse clinical events after coronary stenting? (Providence Hospital and Medical Centers)
• Feasibility of percutaneous suture closure for diagnostic electrophysiologic studies (SCEPS):  Efficacy, safety and length of stay evaluation (Providence Hospital and Medical Centers)
• Pain FREE Rx II Expansion Study with GEM III AT ICD (Medtronic)
• The pacing energy margin verification via intracardiac electrogram study (Guidant)
• Optimal atrial lead placement for AF suppression (St Jude Medical)
• Optimization of atrial mode of pacing and AV interval in cardiac resynchronization therapy (CRT) using impedance cardiography and myocardial performance index (TEI index)   (Providence Hospital and Medical Centers)
• The Clinical Trials Unit has an examination room and storage room for case report forms, records and investigational drug/device storage.
  

Research Laboratory
The Research Laboratory has a staff of two medical technologists with research experience.  Two cell culture rooms are available for development of cell lines from tissue and the expansion of cell numbers for use in wound repair studies and/or bioengineering studies. A microbiology laboratory is available for specimen handling and set-up for cultures and other bioassays.  It is equipped with a biosafety cabinet (Class II), incubator with CO2, and a microscope.  This area also houses a general laboratory for specimen processing of blood and body fluids, extraction of nucleic acids (DNA and RNA), protein chemistries (protein quantitation, western blot), and immunohistochemistry.  This area is equipped with a teaching microscope.    There is a PCR and post PCR room for DNA and RNA detection and quantitation and a dark room for x-ray film processing.

Teaching Laboratories
The Teaching Laboratories consist of a Microvascular and Gross Anatomy Laboratory and a skull based surgery laboratory, which is still under construction.     The Research Department holds an Annual Resident Research Day where residents from various specialties present their research projects in a competition.  All cardiovascular fellows are encouraged to participate. The award recipients from this competition then compete in the OHEP Research Forum.  This Forum is also an annual event and the participants are from local area hospitals that are members of OHEP.

The resident who has a paper or poster presentation accepted at a national or international meeting is provided funds to attend those meetings. Research publications and presentations are listed below:

1.       Burgess B, Farah A, David S.  Homocysteine and restenosis after coronary angioplasty.  American College of Physicians, Michigan Chapter 2000 (Abstract).

2.       Burgess B, Farah A, David S.  Comparison of abciximab and eptifibatide in a community hospital setting.  Am Coll Cardiology 2000 (Abstract).

3.       Saba S, Nimri M, Shamaileh Q, Al-Hakim F, Krayyem M, Abu-Ata I, Harbi N, Hiari A, Turi Z, David S. Balloon coarctation angioplasty:  Follow-up of 103 patients.  J of Invas Cardiol 2000, 12(8): 402-406.

4.       David S, Spears R, Grinberg I.  Global and regional left ventricular function after intracoronary hyperoxemic perfusion with the aqueous oxygen system in acute myocardial infarction:  TherOx Study.  Abstracts from Scientific Session 2000, Journal of American Heart Association. 2000 (Abstract).

5.       David S.  Trial of abciximab with and without low-dose reteplase for acute myocardial infarction.  Circulation 10 2000 (Abstract).

6       Farah A, Khan F, Machado C. Thrombus formation at the site of radiofrequency catheter ablation.  PACE 2000 (23).

7.       Machado C.  Prospective evaluation of efficacy of antitachycardia pacing for spontaneous rapid monomorphic ventricular tachycardia.  Abstracts from Scientific Session 2000, Journal of the American Heart Association 2000 (Abstract).

8       Machado C, Zarghami J, Cunningham D, Liddon V.  Intravenous procainamide:  A facilitator for transthoracic cardioversion in recalcitrant atrial fibrillation.  PACE 2000;23.

9.       Ramasamy K, Khan F, David S.  Acute myocardial infarction in pregnancy:  A case report.  American College of Physicians Michigan Meeting 2000 (Abstract).

10.   McCullough P, O’Neill W, Graham M, Stomel R, Rogers F, David S, Farhat A, Kazlauskaite R, Al-Zagoum M, Grines C.  Impaired culprit vessel flow in acute coronary syndromes ineligible for thrombolysis.  Journal of Thrombosis and Thrombolysis 2000;10:247-253.

11.   Trial of abciximab with and without low-dose reteplase of acute myocardial infarction:  Strategies for Patency Enhancement in the Emergency Department (SPEED) Group.    Circulation June 2000:2788-2793.

12.   McCullough P, O’Neill W, Graham M, Stomel R, Rogers F, David S, Farhat A, Kazlauskaite R, Al-Zagoum M, Grines C. A time-to-treatment analysis in the medicine versus angiography in thrombolytic exclusion (MATE) trial.  Journal of Interventional Cardiology 2001;14(4): 415-421.

13.   Hanna-Moussa S, Haddad A, Freih M, Machado C.  Gender differences in QTC response after IV amiodarone infusion.  American College of Cardiology Michigan Meeting 2001.

14.   Zarghami J.  Loop recording, a new approach to syncope.  American College of Cardiology Michigan Meeting 2001 (Case Presentation).  Ron J. Vanden Belt Memorial Award Recipient.

15.   Saba S, Nimri M, Shamaileh Q, Al-Hakim F, Krayyem M, Abu-Ata I, Saket A, Harbi N, Hiari A, Turi Z, David S, Goussous Y.  Balloon coarctation angioplasty:  Follow-up of 103 patients.  J Invas Cardiology 2000;12(8) 402-406.

16.   McCullough P, O’Neill W, Graham M, Stomel R, Rogers F, David S, Farhat A, Kazlauskaite R, Al-Zagoum M, Grines C.  Impaired culprit vessel flow in acute coronary syndromes ineligible for thrombolysis.  Journal of Thrombosis and Thrombolysis 2000; 10, 247-253.

17.   Wathen MS, Sweeney MO, DeGroot PJ, Stark AJ, Koehler JL, Chisner MB, Machado C, Adkisson WO, PainFREE Investigators.  Shock reduction using antitachycardia pacing for spontaneous rapid ventricular tachycardia in patients with coronary artery disease.  Circulation 2001, Aug 14;104(7):796-801.

18.   Hanna-Moussa S, Johnson V, Raina A, Machado C. Implantation of a dual-chamber pacemaker in a patient with persistent left superior vena cava using a steerable stylet. J Invas Cardiol 2002;14:192-193.

19.   Roy D, Liddon V, Machado C.  Radiofrequency catheter ablation of fast pathway via unconventional right subclavian venous access for atrioventricular nodal reentrant tachycardia.  (Accepted to Journal of Interventional Cardiology.  To be published in July).

20.   Burgess BC, Hanna-Moussa S, Ramasamy K, Sigler D, David S.  Abciximab or eptifibatide in percutaneous conronary intervention:  In-hospital outcomes and costs and six-month results.  (Accepted to International Journal of Angiology).

21.   David S, Dixon SR, Bartorelli AL, Marcovitz PA, Spears R, Grinberg I, Qureshi M, Pepi M, Trabattoni D, Fabbiocchi F, Montorsi P, O’Neill W.  Initial experience with hyperoxemic reperfusion after primary angioplasty for acute myocardial infarction.  Journal of the American College of Cardiology 2002;39(3).

22.   Bui C, Ficaro EP, Hanna-Moussa S, Kritzman JN, Shreve P, Corbett JR. Enhanced integrated report generation:  Efficient system for reporting myocardial perfusion SPECT in normal and abnormal patients. American College of Nuclear Medicine 2002 (Abstract).

Awards

- Roy D. Hameed A, Alper A, Williams F, Liddon V, Machado C.  A comparative assessment of safety and cost for deep sedation in electrical cardioversion by anesthesiologist versus electrophysiologist.  Presented by D. Roy at the 66th Annual Resident Research Day, April 25, 2002.  Awarded 2nd Place Fellow Category. 

- Z arghami J.  Recurrent syncope (Clinical Vignette).  Michigan Cardiology Fellows American College of Cardiology Society’s Clinical Vignette Competition, Henry Ford Hospital, August 25, 2001. Ron J. Vanden Belt Memorial Award Recipient.

- Zarghami J, Toukan K, Freih M, Al-Azzeh H, Machado C. Ou tpatient cardiac pacemaker implantation:  No difference in outcome between postoperative admission to cardiac monitored bed versus non-monitored bed.  Presented by J. Zarghami at the 67th Annual Resident Research Day, April 17, 2002.  Awarded 2nd Place in the Fellows Category.

Specialized Courses and Meetings
Second and third year residents are given the opportunity to attend one of the major cardiology meetings, such as the annual meeting of the American Heart Association or the American College of Cardiology.  In addition, senior residents are encouraged to attend the Michigan Chapter meeting of the American College of Cardiology and provide presentations for this meeting. Provisions are made for the attendance of specialized courses in order to obtain certification in specialized techniques or to add a qualification, such as echocardiography or electrocardiography.