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A Glimpse at the Future of Heart Care

Cardiac Recovery Experts Collide at ÈËÆÞÖгöÊÓƵ of Utah Symposium

Could cardiac recovery therapies for restoring damaged heart tissue, one day make heart pumps and heart transplants obsolete?

This exciting and complex area of study was what drew 450 leading scientists and clinicians from around the globe to the ÈËÆÞÖгöÊÓƵ of Utah for the 3rd Annual International (U-CARS), on January 17, 2015.

Heart failure, like cancer, is a complex disease, requiring an interdisciplinary team of specialists––cardiologists, surgeons, radiologists, transplant coordinators, nurses, social workers and pharmacists––to diagnose, treat and manage. But the prognosis for heart disease is worse than most cancers.

"It's going to take a collaborative research approach to realize the promise of recovery therapies", said Craig Selzman, cardiothoracic surgeon at ÈËÆÞÖгöÊÓƵ of Utah ÈËÆÞÖгöÊÓƵ Care (UUHC). "That's why we created this symposium. It's all about collaboration and getting rid of ego. This field can only move forward if we network and share."

U-CARS was organized by heart failure experts at ÈËÆÞÖгöÊÓƵ of Utah School of Medicine: Stavros Drakos, M.D., Ph.D., associate professor of cardiology, medical director of the Cardiac Mechanical Support Program at UUHC; Abdallah Kfoury, M.D., associate professor of cardiology, medical director of the Heart Transplant Program at Intermountain ÈËÆÞÖгöÊÓƵ Care; Craig Selzman, M.D. associate professor of cardiothoracic surgery, surgical director of the Heart Transplant and Mechanical Support Program at UUHC; and Josef Stehlik, M.D., M.P.H., associate professor of cardiology, medical director of the Heart Transplant Program at UUHC.

"The objective of this conference is to bring thought leaders together to exchange ideas, debate paradigms, and share information directly focused on issues related to myocardial recovery and regeneration," said Drakos.

"It was great to see that topics discussed during the symposium expanded across the basic, translational, and clinical sciences to provide a unique forum to push the field of heart recovery forward," said Stehlik.

Attendance at U-CARS, the only event of its kind worldwide, has nearly doubled since its inception three years ago.

"Meetings like this are important because they function like a think tank," said George M. Wieselthaler, M.D., surgical chief of Cardiac Transplantation and Mechanical Circulatory Support at ÈËÆÞÖгöÊÓƵ of California, San Francisco. Big meetings organized by large societies have their place, but tend to cover too much ground to be of much relevance to specialists with narrower interests, he said. "Here I can meet with people in the same field who maybe have a different approach, which I can bring back to my lab and incorporate in a new way."

The keynote speaker was none other than the "father of modern cardiology," Eugene Braunwald, M.D. of Harvard Medical School and Brigham and Women's Hospital.

James Fang, M.D., chief of the Division of Cardiovascular Medicine at the ÈËÆÞÖгöÊÓƵ of Utah, noted that the keynotes of past U-CARS events were also delivered by "living legends" of cardiovascular medicine­­: Sir Magdi Yacoub, M.D., Imperial College London, UK; and Karl Swedberg, M.D., Ph.D., Gothenburg, Sweden.

Also among this year's presenters:

• David Kass, M.D., Johns Hopkins ÈËÆÞÖгöÊÓƵ
• Donna Mancini, MD, Columbia ÈËÆÞÖгöÊÓƵ
• Joseph Wu, M.D., Ph.D., Stanford ÈËÆÞÖгöÊÓƵ
• Ken Margulies, M.D., ÈËÆÞÖгöÊÓƵ of Pennsylvania
• Leslie Cooper, M.D., Mayo Clinic, Rochester
• Todd Rosengart, M.D., Baylor College of Medicine

Heart failure is a global problem affecting an estimated 38 million people worldwide. It's the most common reason that the Medicare population is admitted to the hospital, and in many ways, the price we pay for success, Braunwald said, referring to a decline in heart attack mortality rates, which has spared lives but left survivors with very sick hearts. It's time, said Braunwald, for an all-fronts war on heart failure.

Dean Li, M.D., Ph.D., vice dean of research at ÈËÆÞÖгöÊÓƵ of Utah School of Medicine and chief scientific officer at the ÈËÆÞÖгöÊÓƵ of Utah Heath Care, stated that U-CARS fits with ÈËÆÞÖгöÊÓƵ of Utah ÈËÆÞÖгöÊÓƵ Sciences' strategic vision of organizing care and scientific resources around patients.

"At the typical academic medical center, there's a surgery department and departments of medicine and orthopedics and so on. But patients don't know that. They just know they have a problem and they want to fix the problem without having to make 10 separate trips to 10 different specialists," Selzman said. "The explosion of knowledge and tightening of funding have made collaboration in the exam room and the lab non-negotiable", Selzman said. "The [National Institutes of ÈËÆÞÖгöÊÓƵ] has caught onto this. That's why they're funding collaborative networks in an attempt to break down institutional barriers."

ÈËÆÞÖгöÊÓƵ of Utah ÈËÆÞÖгöÊÓƵ Care is among an NIH-funded network of health centers exploring new regenerative therapies in tandem with heart pumps. The U. has a pioneering history in treating advanced heart failure, dating back to the Jarvik 7 artificial heart first implanted in retired dentist, Barney Clark in 1982. That groundbreaking advance set the stage for the development of ‘another Jarvik pump', the , which helps the left side of the heart pump blood through the body.

LVADs of different varieties have traditionally been used as a bridge to sustain patients and ready them for heart transplantation. Increasingly, they're being put to more long-term use, as a destination therapy. "Some of our longest patients have been on a device for 10 years," said David Farrar, Ph.D., Vice President for Research and Scientific Affairs for a California-based world-leading LVAD maker, Thoratec Corporation.

There has been a lot of hype surrounding regenerative therapies because they offer hope of reversing heart disease, whereas heart pumps are designed more as supportive therapies. But despite progress, and more than a decade of studying stem cell therapy techniques, nothing has worked well enough to be adopted as mainstream treatment.

If, or when, that day dawns, heart pumps will likely still play a role. "You need to get the heart to the point where regeneration therapy can help," explained Nir Uriel, M.D., medical director of Advanced Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support at ÈËÆÞÖгöÊÓƵ of Chicago Medicine. In patients with advanced heart failure, the heart enlarges, changes shape and becomes less efficient. LVAD's assist the heart, allowing it to rest, and as a result, the organ shrinks and recovers some of its function, said Uriel, who studies physiological changes tied to the linkage of heart and pump, body and device.

But pumps can also strip some of the clotting and healing properties from blood and cause arterio-venous malformations and internal bleeding, Uriel said. "We need to better understand [how this happens] so we can adjust and improve the technology."

If the future is uncertain, it's also full of possibility, provided that the right specialists and sub-specialists convene around the right ideas. "Fifty to 100 years from now," said Wieselthaler, "cardiologists will look back at us and think of us as operating in the Stone Age."