NEW YORK (June 1, 2017) – Dr. Ralf Holzer, a pediatric cardiologist and expert in minimally invasive techniques to treat children and adults with congenital heart disease, has been named chief of the Division of Pediatric Cardiology at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine, and director of Pediatric Cardiac Catheterization at The Komansky Children’s Hospital, effective June 1.

Dr. Holzer joined Weill Cornell Medicine as a professor of clinical pediatrics in 2016, following his appointment two years earlier as the medical director of cardiac catheterization and interventional therapy at the Sidra Medical and Research Center in Doha, Qatar. There, he also served as the interim director of the Division of Pediatric Cardiology. Dr. Holzer is internationally recognized for performing complex pediatric cardiology cases at the highest level of care.

“Dr. Holzer is a renowned expert who is committed to innovative interventional techniques and approaches to pediatric cardiology care. He is adept at even the most challenging pediatric cardiology cases, and brings a tremendous amount of proven skill, experience and talent that will enhance the already exceptional care we are known for,” said Dr. Gerald Loughlin, the Nancy C. Paduano Professor and chairman of the Department of Pediatrics at Weill Cornell Medicine, and pediatrician-in-chief of The Komansky Children’s Hospital. “Patients with congenital heart disease and cardiac conditions are in the best possible hands under Dr. Holzer’s leadership.”

Dr. Holzer will maintain and enhance excellence in pediatric cardiology at The Komansky Children’s Hospital and further cement the division’s role as a leader in cardiac care. He is committed to quality-driven care, whether it be in interventional cardiology, cardiac intensive care, non-invasive cardiology, electrophysiology or other cardiology treatments and investigations, to ensure the best outcomes.

“Quality of care, patient satisfaction and helping our patients achieve positive outcomes is at the core of our clinical work,” said Dr. Holzer, who was recruited to Weill Cornell Medicine as the David Wallace-Starr Foundation Professor of Clinical Pediatric Cardiology. “I look forward to working with this team, which has already received national recognition for its treatment of congenital heart disease, to deliver the highest quality care to patients and their families.”

Dr. Holzer plans on closely collaborating with the pediatric cardiology programs at NewYork-Presbyterian’s affiliated centers across its Regional Hospital Network to continue to improve quality and efficiency. His own clinical focus will be on providing cardiac catheterization services for patients with congenital heart disease that cover the full spectrum of interventional procedures. Those include treating birth defects that cause a hole in the wall between the heart’s chambers, treating narrowed blood vessels through implantation of endovascular stents, as well as using a minimally invasive procedure to replace damaged valves. In addition, he is at the forefront of establishing and evaluating new and innovative procedures for patients with congenital heart disease, including procedures that are based on a close collaboration between interventional cardiologists and cardiothoracic surgeons. He has a strong academic focus on outcomes research, quality improvement and risk adjustment.

Dr. Holzer received his medical degree from the Johannes Gutenberg University of Mainz in Germany. He completed his residency training in Germany and the United Kingdom, and his cardiology fellowship training at the Royal Liverpool Children’s Hospital in the United Kingdom. He also completed an advanced fellowship in transcatheter interventions at the University of Chicago Children’s Hospital. Following his training, Dr. Holzer worked as a consultant in pediatric cardiology and led interventional services at the Royal Liverpool Children’s Hospital. He subsequently served for nine years as an attending physician and co-director of the cardiac catheterization laboratory at Nationwide’s Children’s Hospital in Columbus, Ohio, before moving to the Sidra Medical and Research Center in Qatar in 2014.

Dr. Holzer has published more than 80 articles in peer-reviewed journals such as Pediatrics, Circulation, JACC, Catheterization and Cardiovascular Intervention, Pediatric Cardiology and Cardiology in the Young. He is the author of more than 20 book chapters and numerous scientific abstracts and is committed to medical education. Dr. Holzer also holds a Master of Science in Information Technology, with distinction, from the University of Liverpool.

NewYork-Presbyterian

NewYork-Presbyterian is one of the nation’s most comprehensive, integrated academic healthcare delivery systems, whose organizations are dedicated to providing the highest quality, most compassionate care and service to patients in the New York metropolitan area, nationally, and throughout the globe. In collaboration with two renowned medical schools, Weill Cornell Medicine and Columbia University Medical Center, NewYork-Presbyterian is consistently recognized as a leader in medical education, groundbreaking research and innovative, patient-centered clinical care.

NewYork-Presbyterian has four major divisions:

• NewYork-Presbyterian Hospital is ranked #1 in the New York metropolitan area by U.S. News and World Report and repeatedly named to the Honor Roll of “America’s Best Hospitals.”
• NewYork-Presbyterian Regional Hospital Network comprises hospitals and other facilities in the New York metropolitan region.
• NewYork-Presbyterian Physician Services, which connects medical experts with patients in their communities.
• NewYork-Presbyterian Community and Population Health, encompassing ambulatory care network sites and community healthcare initiatives, including NewYork Quality Care, the Accountable Care Organization jointly established by NewYork-Presbyterian Hospital, Weill Cornell Medicine and Columbia.

For more information, visit www.nyp.org and find us on Facebook, Twitter and YouTube.

Weill Cornell Medicine

Weill Cornell Medicine is committed to excellence in patient care, scientific discovery and the education of future physicians in New York City and around the world. The doctors and scientists of Weill Cornell Medicine — faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and Weill Cornell Physician Organization—are engaged in world-class clinical care and cutting-edge research that connect patients to the latest treatment innovations and prevention strategies. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where Weill Cornell Medicine-Qatar offers a Cornell University medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey. Weill Cornell Medicine faculty provide comprehensive patient care at NewYork-Presbyterian/Weill Cornell Medical Center, NewYork-Presbyterian Lower Manhattan Hospital and NewYork-Presbyterian Queens. Weill Cornell Medicine is also affiliated with Houston Methodist. For more information, visit weill.cornell.edu.

NEW YORK (June 1, 2017) – A technique to treat an irregular heartbeat that limits or eliminates patients’ exposure to radiation should be more widely adopted by physicians, NewYork-Presbyterian and Weill Cornell Medicine cardiologists argue in a new review article in Heart Rhythm, published in the June print issue and previously published online. They posit that the primary obstacle to the procedure’s widespread use – physicians’ discomfort with a different visual tool – can be overcome with training and experience.

Atrial fibrillation (AF) is a condition that affects as many as 6.1 million Americans and is characterized by an irregular, often rapid heart rate caused by a misfiring of electrical impulses. Physicians commonly treat the condition using a minimally invasive procedure called catheter ablation, in which doctors insert thin, flexible wires into veins, snaking them up into the heart. Once there, physicians apply radiofrequency energy or freezing temperatures to eliminate the abnormal electrical pathways, restoring the heart’s regular rhythm.

To guide this procedure, many cardiologists rely on an imaging technique called fluoroscopy that uses a continuous X-ray beam to visualize the heart. While effective, the technique exposes both the care team and patient to high doses of radiation.

“The amount of fluoroscopy received by a patient during a routine AF ablation procedure is estimated to be the equivalent of the dose of radiation a patient would receive with 830 X-rays,” said lead author Dr. Bruce Lerman, chief of the Division of Cardiology and director of the Cardiac Electrophysiology Laboratory at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine, where he is also the H. Altschul Master Professor of Medicine. “In our hands, the vast majority of AF patients do not require fluoroscopy, resulting in no radiation exposure to the patient or the electrophysiologist performing the procedure.”

To accomplish fluoroless catheter ablation, the NewYork-Presbyterian and Weill Cornell Medicine team use technology that emits high-frequency sound waves, known as intracardiac echocardiography (ICE), to create a complete and precise image of the heart. In addition, the use of computerized three-dimensional mapping systems and pre-procedural cardiac imaging can further guide the procedure. Weill Cornell Medicine electrophysiologists believe that physicians around the country can embrace fluoroless ablation of atrial fibrillation by challenging entrenched practices.

“Although the concept of fluoroless catheter ablation was introduced several years ago, it has yet to gain wide adoption, mostly because many electrophysiologists were trained to rely on X-ray imaging and are reluctant to trust ICE,” said co-author Dr. Jim Cheung, director of clinical electrophysiology research and cardiac electrophysiology fellowship training at NewYork-Presbyterian/Weill Cornell Medical Center and associate professor of medicine at Weill Cornell Medicine. Dr. Cheung is a consultant for and has received fellowship grant support from Biosense Webster, a manufacturer of electrophysiology devices. “This concern can be remedied with experience. For some, the learning curve can be steep, but generally, the skill set can be readily acquired. By thoughtfully modifying the way the procedure is performed, we can significantly reduce the radiation risk in the process.”

“We are currently training our fellows to utilize this technique in an effort to guide the next generation of cardiologists to become well-versed in fluoroless ablation,” Dr. Cheung said.

“The most critical requisite for performing fluoroless catheter ablation of AF is a willingness to relinquish an old habit,” said Dr. Lerman, who is also a consultant for Biosense Webster. “Doing so will have a tremendous advantage for both patients and healthcare professionals.”  

NewYork-Presbyterian

NewYork-Presbyterian is one of the nation’s most comprehensive, integrated academic healthcare delivery systems, whose organizations are dedicated to providing the highest quality, most compassionate care and service to patients in the New York metropolitan area, nationally, and throughout the globe. In collaboration with two renowned medical schools, Weill Cornell Medicine and Columbia University Medical Center, NewYork-Presbyterian is consistently recognized as a leader in medical education, groundbreaking research and innovative, patient-centered clinical care.

NewYork-Presbyterian has four major divisions:

• NewYork-Presbyterian Hospital is ranked #1 in the New York metropolitan area by U.S. News and World Report and repeatedly named to the Honor Roll of “America’s Best Hospitals.”
• NewYork-Presbyterian Regional Hospital Network comprises hospitals and other facilities in the New York metropolitan region.
• NewYork-Presbyterian Physician Services, which connects medical experts with patients in their communities.
• NewYork-Presbyterian Community and Population Health, encompassing ambulatory care network sites and community healthcare initiatives, including NewYork Quality Care, the Accountable Care Organization jointly established by NewYork-Presbyterian Hospital, Weill Cornell Medicine and Columbia.

For more information, visit www.nyp.org and find us on Facebook, Twitter and YouTube.

Weill Cornell Medicine

Weill Cornell Medicine is committed to excellence in patient care, scientific discovery and the education of future physicians in New York City and around the world. The doctors and scientists of Weill Cornell Medicine—faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and Weill Cornell Physician Organization—are engaged in world-class clinical care and cutting-edge research that connect patients to the latest treatment innovations and prevention strategies. Located in the heart of the Upper East Side’s scientific corridor, Weill Cornell Medicine’s powerful network of collaborators extends to its parent university Cornell University; to Qatar, where Weill Cornell Medicine-Qatar offers a Cornell University medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey. Weill Cornell Medicine faculty provide comprehensive patient care at NewYork-Presbyterian/Weill Cornell Medical Center, NewYork-Presbyterian Lower Manhattan Hospital and NewYork-Presbyterian Queens. Weill Cornell Medicine is also affiliated with Houston Methodist. For more information, visit weill.cornell.edu.

Two Weill Cornell Medicine faculty members whose research focuses on tuberculosis and heart disease — both among the most lethal conditions globally — were elected to the American Academy of Arts and Sciences.

Dr. Carl Nathan, chair of Weill Cornell Medicine's Department of Microbiology and Immunology, and Dr. David Hajjar, dean emeritus of the Weill Cornell Graduate School of Medical Sciences and former executive vice provost of Weill Cornell Medicine, are among 211 other scholars, scientists and worldwide leaders — including two others from Cornell University — across a variety disciplines who received the honor.

Dr. David Hajjar

Founded in 1780 by James Bowdoin and John Adams, who went on to become the second president of the United States, the American Academy of Arts and Sciences is one of the oldest policy research centers and learned societies in the country. Its 4,600 fellows and 600 foreign honorary members are joined this year by a class that includes Temple Grandin, a prominent spokesperson for people with autism, novelist Colm Toibin, and former Botswanan President Festus Mogae. All members are asked to contribute to academy publications and help guide the academy when it's deciding how to respond to far-reaching, worldwide challenges.

For Dr. Nathan, who is the R.A. Rees Pritchett Professor of Microbiology at Weill Cornell Medicine, that likely means weighing in on discussions about how we can better combat tuberculosis and why we must develop new antibiotics — both areas of specialty for him.

"I'm honored to be included among this diverse and talented group of people, and to get the opportunity to contribute to the American Academy of Arts and Sciences' important causes," said Dr. Nathan, a member of the National Academy of Sciences and the National Academy of Medicine whose contributions to the fields of immunology and microbiology were celebrated in a special symposium hosted April 19 in the Belfer Research Building. "I consider it a mission to educate people — including doctors, medical students, policymakers and other leaders — on the pressing threat of antibiotic-resistant bacteria. I hope that this designation helps me to do that."

Dr. Hajjar, who is also a professor of pathology and biochemistry, is recognized as an international expert in cardiovascular disease. Dr. Hajjar studies a form of heart disease called atherosclerosis, which is an inflammatory condition characterized by the accumulation of cholesterol-laden plaques on the arterial wall.

"It's a privilege to be recognized by the American Academy of Arts and Sciences, and I'm eager to contribute my broad knowledge of heart disease and its root causes to help lessen the global impact of this condition," said Dr. Hajjar, who has also been honored for his work by the American Heart Association, the Andrew Mellon Foundation, and the American Chemical Society. "As we look into the future, the number of deaths associated with cardiovascular disease is expected to grow exponentially. If we can develop better diagnostic tools, treatments and public health policies for this condition, it could make a huge and positive impact on global healthcare and finances. In this regard, I hope to continue working with the Brookings Institute as a senior fellow on science policy issues as they relate to human health and disease."

The academy will induct this year's honorees during a ceremony on Oct. 8 in Cambridge, Mass.

Cardiologist Dr. Geoffrey Pitt to Lead Institute Designed to Translate Research Discoveries in Cardiovascular Disease from Bench to Bedside

NEW YORK (April 29, 2016) — With the goal of improving heart health for patients worldwide, Weill Cornell Medicine has established the Cardiovascular Research Institute to expand and enhance the institution's basic and translational research activities. Dr. Geoffrey Pitt, a leading cardiologist and scientist, will direct the institute, which will be dedicated to understanding the molecular, cellular and genetic underpinnings of the disease.

Headquartered in the Belfer Research Building, the interdisciplinary Cardiovascular Research Institute will build upon the successes of Weill Cornell Medicine's already robust cardiovascular research activities while unifying them under one research entity. Dr. Pitt will recruit a team of leading scientists to the institute to pursue innovative research that improves treatments and therapies for conditions including coronary artery disease, heart failure, cardiac arrhythmias, and hypertension. Basic and translational investigators in the institute will complement and collaborate closely with the exceptional clinical cardiology and cardiovascular surgery teams at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center, ensuring that laboratory breakthroughs are rapidly applied to the clinic.

Dr. Pitt was recruited to Weill Cornell Medicine from Duke University, where he is currently the director of the Ion Channel Research Unit and a professor of medicine, neurobiology, and pharmacology and cancer biology. He is also an attending cardiologist at Duke University Hospital, caring for patients in its Adult Cardiovascular Genetics Clinic. A distinguished physician-scientist, Dr. Pitt investigates the structure, function and regulation of proteins located on the surface of cells that enable the transmission of electrical signals, called ion channels. His laboratory uses electrophysiology, biochemistry and structural biology approaches to discern how abnormal ion channel function causes diseases such as cardiac arrhythmias, epilepsy and ataxias, which are characterized by a loss of muscle control during voluntary movements.

"Physician-scientists have made critical advances in cardiovascular clinical care that have produced a difference in patients' lives, but we have not yet found a cure for heart disease," said Dr. Augustine M.K. Choi, the Weill Chairman of the Weill Department of Medicine at Weill Cornell Medicine and physician-in-chief at NewYork-Presbyterian/Weill Cornell. "It is vital that we discover and develop better diagnostic and treatment strategies, and there is no one better than Dr. Pitt to direct these efforts at Weill Cornell Medicine. A proven leader, I have no doubt that he will take us to the next level of excellence in cardiovascular research and care."

"It's a truly exciting opportunity to lead the Cardiovascular Research Institute at Weill Cornell Medicine," said Dr. Pitt, who was recruited as the Ida and Theo Rossi Distinguished Professor of Medicine and will have a clinical appointment at NewYork-Presbyterian/Weill Cornell. "Weill Cornell Medicine is uniquely positioned at the forefront of basic and translational research, which is critically important to support and improve patient care. The high-impact science our esteemed investigators will perform at the institute dovetails perfectly with the outstanding care our clinical cardiologists provide to our patients — with the goal of making that care even better."

While research advances achieved in recent decades have transformed the way doctors treat patients with cardiovascular disease, the condition remains the leading cause of death worldwide, accounting for 17.3 million deaths each year — a number that the American Heart Association expects to swell to more than 23.6 million by 2030.

At the Cardiovascular Research Institute, investigators will use cutting-edge scientific approaches — including precision medicine and stem cell research — to explore the fundamental biology of heart and blood vessel development and function. Researchers will also seek to understand how the structure and function of proteins and the way small molecules interact with larger biological systems are involved in cardiovascular disease. The insights physicians glean from these studies will enable them to develop effective diagnostic strategies and clinical interventions when these systems fail. They will also collaborate with investigators at the Cornell Tech campus on Roosevelt Island to mine and analyze data generated from genome sequencing and from patient medical devices to develop more effective treatments.

About Dr. Geoffrey Pitt

Dr. Pitt, a board-certified internist and cardiologist, is a member of the American Heart Association, Biophysical Society, Society for Neuroscience, Cardiac Electrophysiology Society, and the Heart Rhythm Society. He is also an elected member of the American Society for Clinical Investigation and the Association of American Physicians. He currently serves as associate editor of the Journal of Clinical Investigation; and is on the Journal of General Physiology's Editorial Advisory Board. Dr. Pitt previously served on the editorial boards of the Journal of Cardiovascular Pharmacology, the American Journal of Physiology-Heart and Circulatory Physiology, and the Journal of Clinical Investigation, and was an associate editor of Cardiovascular Drugs and Therapy and editor for its Education in Cardiovascular Therapy section. He has authored more than 70 peer-reviewed articles and is an ad hoc reviewer for 33 top-tier journals, including the Cell Metabolism, Circulation, the Journal of the American College of Cardiology, Nature, PNAS, and Science - STKE. He has also reviewed for or served on several national and international study sections, including those of the National Institutes of Health, the National Science Foundation, and the American Heart Association.

Dr. Pitt has received numerous awards, including the Harrington Discovery Institute Scholar-Innovator Award (2015), the American Heart Association's Established Investigator Award (2007), the Lewis Katz Cardiovascular Research Prize for a Young Investigator (2006), the Harold and Golden Lamport Award for Excellence in Basic Science Research (2006), and the Irma T. Hirschl Monique Weill-Caulier Trust Research Career Award (2004).

Dr. Pitt received his bachelor's degree in 1984 from Yale University and his medical degree and doctorate in 1993 from the Johns Hopkins University School of Medicine. He also earned a Master of Science degree in 1987 from the Johns Hopkins Bloomberg School of Public Health. Dr. Pitt completed a residency in internal medicine and cardiology fellowship training at Stanford University Hospital in 1995 and 1999, respectively, and a postdoctoral fellowship in 1999 at the Stanford University School of Medicine. After spending two years at Stanford as a research associate in molecular and cellular physiology, Dr. Pitt joined Columbia University College of Physicians and Surgeons as the Esther Aboodi Assistant Professor of Medicine and as an assistant professor of pharmacology. Dr. Pitt earned a position on Duke's faculty in 2007.

He will begin his appointment at Weill Cornell Medicine on July 1.

Weill Cornell Medicine

Weill Cornell Medicine is committed to excellence in patient care, scientific discovery and the education of future physicians in New York City and around the world. The doctors and scientists of Weill Cornell Medicine — faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and Weill Cornell Physician Organization — are engaged in world-class clinical care and cutting-edge research that connect patients to the latest treatment innovations and prevention strategies. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where Weill Cornell Medicine-Qatar offers a Cornell University medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey. Weill Cornell Medicine faculty provide comprehensive patient care at NewYork-Presbyterian/Weill Cornell Medical Center, NewYork-Presbyterian/Lower Manhattan Hospital and NewYork-Presbyterian/Queens. Weill Cornell Medicine is also affiliated with Houston Methodist. For more information, visit weill.cornell.edu.

The Dalio Institute of Cardiovascular Imaging and its clinical program, HeartHealth, aim to revolutionize cardiac disease prevention and treatment

By Beth Saulnier

Photographs by John Abbott

Alain Baume is 59, the same age his father was when he died of heart failure in their native Italy. Because of that family history, Baume has long been concerned about his cardiac health; when he'd get out of breath from hurrying up a flight of stairs, for example, he'd worry that it was a harbinger of incipient disease rather than simply a sign of being a bit out of shape.

His wife, 67-year-old Marialuisa Baume, on the other hand, has no family history of heart disease. Although she does smoke cigarettes on occasion, she exercises regularly — "more than him," she says with a laugh, in her lyrical Venetian accent — and has no worrisome symptoms. But during a routine visit to the family internist, Dr. Serena Mulhern, an assistant professor of medicine, the physician detected a moderate heart murmur and referred her to a colleague, cardiologist Dr. Erica Jones.

Dr. Jones, an associate professor of clinical medicine and of medicine in clinical radiology, doesn't run a typical cardiology practice. She has a special emphasis on prevention — and when the Baumes came to see her, she was gearing up an ambitious new program that aims to curb heart disease long before symptoms appear. "Right now we're in our infancy, but we have a lot of vision," Dr. Jones says of the program, dubbed HeartHealth. "We're going to be able to take patients who are at risk and show them significant change." Formally launched this winter, HeartHealth combines tried-and-true strategies — promoting a nutritious diet and regular exercise; prescribing medications like statins — with state-of-the-art imaging technologies that promise to revolutionize how medicine approaches heart disease. "What's the problem in cardiac care?" Dr. Jones muses. "More than half the time, it's that we find people in the end stage of disease. They have a positive stress test, they're having angina, they've had a heart attack. Most cardiologists are very interested in prevention — it's just that by the time we see our patients, it's often too late. They tend to be referred to us after they've had an event."

Where the heart is: Dr. James Min (center) and colleagues at the Dalio Institute of Cardiovascular Imaging in the Belfer Research Building

The Baumes, who live in Manhattan and run a high-end shoe company with offices on Fifth Avenue, routinely attend their medical appointments as a couple, and both signed on as Dr. Jones's patients. They each had a comprehensive exam, plus CT scanning that sought to identify calcium in the arteries that could lead to heart attack. The results were surprising. "He, with the bad risk, ended up having a completely beautiful, clean scan, but hers actually showed a lot of calcium," says Dr. Jones, who spoke about the Baumes' cases with their permission. "It showed he was at less risk than he thought he would be, and she was at more."

Based on those results, Alain is continuing on the cholesterol-lowering statin drug Lipitor at the same level as before; Marialuisa has had her dose doubled and is working to quit smoking. Dr. Jones is monitoring the murmur, and Marialuisa is heartened by the fact that even if a valve replacement becomes necessary down the road, it can be done non-invasively. "I didn't know what to expect, so when I went there I was a bit nervous, but the people there are so nice they make you feel relaxed," Marialuisa says of her experience at the practice, located on the eighth floor of the Weill Greenberg Center. "I feel like I'm in good hands. I would recommend it to everyone."

HeartHealth's special focus stems from its affiliation with the program that oversees it: it's the clinical arm of the Dalio Institute of Cardiovascular Imaging, a joint venture between NewYork-Presbyterian Hospital and Weill Cornell that was established in fall 2013 with the aim of better understanding heart disease through the use of such tools as MRI, CT, PET, and novel technologies such as 3D printing and computer modeling of blood flow dynamics. Funded by a $20 million gift from NewYork-Presbyterian life trustee Raymond Dalio through his Dalio Foundation, the institute has set an ambitious goal. "Our hope," says director Dr. James Min, a professor of radiology and of medicine who is board certified in cardiology, "is to imagine a world without heart disease."

Headquartered on the first floor of the Belfer Research Building, the Dalio Institute is involved in some two dozen multicenter trials, with ongoing investigations into a wide variety of topics — from the efficacy of absorbable stents to the role that endothelial wall shear stress (pressure that runs perpendicular to the artery) plays in heart disease. Dalio researchers are casting their net wide, partnering with experts in engineering, fluid dynamics, genetics, metabolomics, molecular imaging, and a host of other specialties.

They're studying data from healthy patients — one project, for instance, is examining the coronary calcium scores of members of an Amazonian tribe that never gets heart disease — as well as from people who have died of heart attack, and from those in between. In an effort to develop more accurate guidelines for diagnosis, for example, Dalio researcher Dr. Quynh Truong, an assistant professor of radiology and of medicine and co-director of cardiac CT, is leading a clinical imaging program for patients who come into the ED with chest pain. "In more than 50 percent of patients who have coronary heart disease, their first symptom is either a heart attack or death," Dr. Min notes. "That accounts for more than 500,000 sudden cardiac deaths per year. It's a true public health epidemic, and it occurs in people who are healthy and asymptomatic. So if we have early detection and good treatments, we can cut into that."

The essential takeaway, says Dr. Jones, is that not all plaques are created equal — and while medicine has become much better at assessing cardiac risk in recent decades, it still has a long way to go. "There are many people at risk who do great until their '90s and '100s — and many who are at ‘no risk' and have their first heart attack at 40," Dr. Jones says. "Who are these people? We're not good at understanding that yet."

For researchers and clinicians working in the field today, the canonical example of a patient that the current system failed is Tim Russert. In 2008, the journalist died suddenly of a heart attack due to an arterial blockage at age 58, just weeks after having passed a stress test. "They told him, ‘You're OK,' " Dr. Min says. "But we didn't use the proper tools to assess his risk, and I think we can do more for patients like that." The key — and the Dalio Institute's holy grail — is to identify what's known as "vulnerable plaque," the kind that actually causes heart disease and leads to ill health and death. "Dalio is challenging the existing paradigm with new ways to see the coronary arteries — and not just seeing them broadly, but looking at aspects that can't be easily seen on noninvasive or even invasive tests," says Dr. Joshua Schulman-Marcus, a fellow in clinical cardiology at NewYork-Presbyterian/Weill Cornell Medical Center. "Does the way they look affect how they're going to behave or respond to medication? That kind of research is only being done in a few places in the country. And while not all of it is ready for clinical prime time, it's a game-changing, paradigm-challenging research that will advance the field as a whole, and may advance prevention in a way that we just can't anticipate right now."

Dr. Schulman-Marcus — whom Dr. Jones lauds as "the future of prevention" — is working with Dr. Min on a project analyzing cardiac CT data with the aim of ascertaining which medications have the best results in patients with arterial blockages; he's also collaborating with Dr. Truong on the study of cardiac CT in the emergency department. In July, he began a one-year fellowship in cardiovascular disease prevention at HeartHealth, which ultimately aims to offer patients such risk-reduction resources as behavioral psychology, nutrition counseling, and exercise physiology. "Clinically, the most interesting aspect to me, and the part that I want to spend more of my career focusing on, is how to change behavior," Dr. Schulman-Marcus says. "It's easy and nice to talk about risk factors, but it's hard to change people's behavior from a lifestyle standpoint."

In addition to altering patient behavior, the clinicians note, change is needed in the healthcare funding system to promote early detection. Dr. Jones points out that while technologies like CT angiogram — which illustrates blood flow through the heart — can help cardiologists better assess risk, they're new enough that insurance companies often have to be convinced that they're necessary. Sometimes, she says, her patients opt to pay $100 to $150 out of pocket for a blood test to assess calcium score, which is increasingly seen as a predictor of a potential heart attack, or even foot the $650 to $800 bill for a CT angiogram. "I have to tell some of my patients, ‘The insurance company will pay for x, y or z, but it isn't the study that I want,'" Dr. Jones says. "For whatever reason, insurers have not jumped on board — which to me is quite shocking, because they're willing to pay for a nuclear stress test that costs more than $2,000 and gives the patient more than 10 times the radiation."

As an example, Dr. Jones cites a hypothetical patient who's 45, the same age his father was when he died of a heart attack — but who's so fit that he runs marathons. "I don't need a stress test on that gentleman," she says. "He's not symptomatic; his EKG is normal. I want to know if he's got asymptomatic disease." Ultimately, she says, the right testing doesn't just save lives — it can offer a solid return on investment. "What we need to do as clinicians and researchers is to keep at it, to prove that this is changing care," she says. "We need to work with these large insurance companies and HMOs to say, ‘Look, if I show you that this 45-year-old with a terrible family history has no calcium, then you don't have to pay for his statin for 10 years, because he's safe. If I end up telling you that he does have significant calcium, fine; you end up paying for generic statin, which is very inexpensive, but I've possibly just saved you from a hospitalization for a heart attack.'"

Dr. Michael Wolk, a clinical professor of medicine, is a past president of the American College of Cardiology and the chief contracting officer of the Weill Cornell Physician Organization. He places the new technologies that Dalio and HeartHealth are spearheading in a long line of advances he has seen in his four decades of practice — lifesaving breakthroughs that include bypass surgery, angioplasty, percutaneous valve replacement, and the development of statins. "I love the concept that Dr. Min has brought forward," Dr. Wolk says, "which is, ‘How early can we diagnose coronary artery disease before there are clinical symptoms, decreasing cardiovascular events and therefore minimizing the need to do expensive interventions?'" While heart disease remains the leading cause of mortality in the United States, he notes that thanks to such advances, the incidence of vascular-related death has been cut by half in the past 35 years — and that the World Health Organization has set an ambitious goal of continuing that trend by reducing mortality from noncommunicable disease by 25 percent by 2025. Says Dr. Wolk: "It's only through people like Dr. James Min — who are getting innovative and thinking of how to diagnose people before events occur — that we'll be able to achieve such progress."

With the aim of getting patients at elevated risk into the HeartHealth program, Dr. Jones has been spreading the word about the practice to her colleagues. She's been speaking to high-risk obstetricians, for example, because women who had preeclampsia or diabetes during pregnancy are at higher risk of cardiac events later in life. Similarly, she led grand rounds at Hospital for Special Surgery — speaking to rheumatologists about patients with inflammatory disorders, also at increased risk — and at Memorial Sloan Kettering Cancer Center, since cancer survivors can have arterial calcification due to the higher doses of radiation that were administered in years past. "The purpose of HeartHealth is not to see the patients who've already had a heart attack, but to serve the population who isn't sick enough to have a cardiologist but has risk factors like family history or inflammatory diseases that predispose them to heart disease," says Dr. Truong, who is also a cardiologist and will be seeing patients through the new clinical program. "HeartHealth is unique in that it integrates the latest technology to help patients understand their risk. It's really important for us to have this armamentarium of imaging modalities and incorporate it into how we treat patients. Even something like a calcium score, which is very inexpensive, will be able to guide us in terms of, ‘Do you need to take that statin for the rest of your life, and how low do we need to bring that LDL cholesterol level?' These are all beneficial tools to help us decide how aggressively to manage patients in their lifestyle and risk factor modifications."

For Alain and Marialuisa Baume, Dr. Jones's combination of individual attention and appropriate testing is the perfect fit. They also praise the practice's patient-friendly logistics. "When we call, we get immediate responses," says Alain, speaking in the midst of a busy week last February, when the couple was working on their shoe company's winter 2015–16 collection and Marialuisa was preparing for a trip to India. "You never feel like you're ‘just another patient.' It's so personal, and we feel so well taken care of."

This story first appeared in Weill Cornell Medicine,Vol. 14, No. 1.

A non-invasive scan used to determine the extent of plaque buildup in the heart accurately predicts the likelihood of heart attack or death over a 15-year period, a research team led by Weill Cornell Medical College investigators reported July 6 in the Annals of Internal Medicine. Doctors can use this information to intervene if a patient is shown to be at risk for heart disease but not yet showing any symptoms.

"All high-risk individuals — irrespective of their symptom status — should be considered for this study. It is like a mammogram for the heart," said Dr. James K. Min, director of the Dalio Institute of Cardiovascular Imaging at NewYork-Presbyterian Hospital and Weill Cornell Medical College, and a professor of radiology and of medicine at Weill Cornell. "If physicians can accurately predict who is at risk, they can intervene earlier and more aggressively and hopefully prevent patients from ever having a heart attack."

Heart disease is the number one cause of death in the United States, killing 40 percent more people than all types of cancer combined. But while there are routine screens for many types of cancer — like breast and prostate — there isn't a universally adopted test used to check for heart attack risk in people not exhibiting any symptoms associated with heart disease. The investigators say their findings demonstrate that the coronary artery calcification test, a five minute-long procedure that examines the total amount of calcified plaque buildup in the heart arteries, should fill that void.

"This test predicts the risk of heart attacks better than any other diagnostic heart test that we have, especially in asymptomatic patients," Dr. Min said. "It embodies the goal of precision medicine, namely, to precisely identify and exclude the patients who have or do not have disease that places them at heightened risk of heart attacks."

While previous studies have connected coronary artery calcification test results and long-term patient prognosis, this study is significant for its size and scope: It looked at the largest patient population over the longest period of time.

Investigators, who also came from Emory University School of Medicine in Atlanta and Cedars-Sinai Medical Center in Los Angeles, reviewed the medical records of 9,715 patients in the area surrounding Nashville, Tenn., who were referred by their primary care physician to a single outpatient clinic from 1996 to 1999. Physicians at the clinic gathered basic demographic information along with patients' cardiac risk factors, including history of diabetes, elevated cholesterol levels, documented high blood pressure or family history of coronary heart disease.

All patients then underwent a coronary artery calcification test. The Calcium — or Agatston — Score goes from zero, representing a normal scan with no calcium at all, up to more than 1,000. Within the study, the participants were grouped by their resulting number in the following configuration: zero, one-10, 11-99, 100-399, 400-999 and more than 1,000.

"More than 1,000 is considered the worst case scenario, with imminent risk," Dr. Min said. "But over 400 is severely elevated. It's all very linear and predictable."

After collecting this de-identified data, the investigators tracked the status of all participants through the National Death Index, a central computerized index from the National Center for Health Statistics. The investigators followed the patients for a mean of 14.6 years.

With the Calcium Score and cardiac risk factor variables, investigators calculated the risk that participants would die for any reason, not just because of a heart attack, called all-cause mortality. They then compared this long-term prognosis against what actually happened, and found that the Calcium Score was highly predictive of all-cause mortality. During the 15 years, 936 study participants died at the rate of 3, 6, 9, 14, 21 and 28 percent, respectively, compared to the increasing Calcium Scores.

So what does the data mean? "In all asymptomatic patients, someone with a score of zero has a minimal risk that they will die from any disease in the next 15 years," Dr. Min said. "It's a very long-term warranty period.

"On the other hand, if a patient has any calcium in his heart, he or she is at risk. We must intervene quickly and aggressively for patients' future health because that risk never goes away," he continued. "We have medicine that saves lives; we just need to identify earlier the right patients so that we can get them the right treatments."

Using basic information like age, gender and clinical history, Weill Cornell Medical College researchers have developed a simple method to more accurately predict whether a stable patient is likely to suffer from coronary artery disease or die of a heart attack in the next three years.

Cardiologists often use algorithms to determine whether or not patients should undergo invasive testing. With this easy-to-use, accurate method to determine risk, they can intervene when patients need it, skip invasive testing if they don't, and ultimately save time and money.

"We do 10 million stress tests a year in the United States, and so many people don't need them and don't have the disease," said lead author Dr. James K. Min, the director of the Dalio Institute of Cardiovascular Imaging at NewYork-Presbyterian Hospital and Weill Cornell Medical College and a professor of radiology at Weill Cornell. "We're wasting a lot of money, and wasting it on the wrong people. This method will allow us to better define who we need to evaluate."

While other algorithms to predict risk are already in use, Dr. Min said that the status quo "severely overestimates the probability of disease by almost three-fold." In a study published April 10 in the American Journal of Medicine, Dr. Min's team set out to create an updated, contemporary method to reach a risk score that quantifies the probability of disease, and also the likelihood that a patient will die of a heart attack, a figure that previously didn't exist.

To reach these figures, Dr. Min and his team followed 14,004 adults who were symptomatically stable but had suspected coronary artery disease for periods of 1.6 to five years between 2004 and 2011. They collected patient data, and with it, used advanced statistical methods to develop the algorithm, in which doctors input simple digits correlated to clinical information. For example: If a patient is 60 years old they get a six; if they're 50 years old they get a five; if they have diabetes they get a one; if they don't have diabetes they get a zero. When all of the data is entered, the algorithm computes an integer-based score, which corresponds to a percent likelihood of having disease and a percent likelihood of having a heart attack in the next three years. If a patient's likelihood for either is greater than 30 percent, their clinician will likely send them in for more testing.

"Our intention was to create something really, really easy to use," Dr. Min said. "In the clinic when doctors are seeing a patient, it's not hard to apply this score because it's just so foolproof."

Dr. William Zoghbi, Weill Cornell Medical College professor of medicine and cardiologist at the Methodist DeBakey Heart & Vascular Center, recently took the helm of the world's largest society of cardiologists with a goal of creating and expanding programs that directly help patients.

Dr. William Zoghbi

"As our information–based society evolves, and more and more people around the world have access to information, we feel it makes sense to put a new emphasis on patients," said Dr. Zoghbi, the William L. Winters Chair in Cardiac Imaging at the Methodist DeBakey Heart & Vascular Center in Houston, Texas. "We want to make patients part of the decision making, and give them tools to educate themselves."

Dr. Zoghbi, the chief of cardiac imaging and the director of the Cardiovascular Imaging Center at The Methodist Hospital, became President of the American College of Cardiology on March 26.

Among the new information–based American College of Cardiology (ACC) initiatives are expansions of CardioSmart.org, an ACC website that serves patients and their caregivers, and CardioSource.org, a portal for doctors, nurses, and other health care providers. The ACC will also provide new mobile tools for smart phones and tablets that help users find crucial information — wherever they may be.

Dr. Zoghbi has formally identified his priorities as:

• Patient–Centered Care — In addition to creating new and improving existing information technology tools, Dr. Zoghbi said the ACC will develop "robust news and editorial features" that are patient–friendly. The ACC will also continue to support community–based programs and events (such as the U.S. Dept. of Health & Human Services' Million Hearts™ Campaign), and seek out patient perspectives more actively to improve the delivery of information and health care assistance.
• Education — Lifelong learning tools will be more easily accessible to members, as well as tools that help doctors and other health care providers meet competency requirements at their hospitals and clinics. The ACC will launch its first–ever annual curriculum planning guides for educators, and a broader array of Internet–based education tools, including events that can be live–streamed on the Web from the point of lecture or procedure.
• Science and Quality — The ACC supports outcomes–focused studies to reduce inpatient hospital stays and increase patients' well being. The College will provide a knowledge base that will allow cardiologists and health care administrators to compare their own outcomes to the National Cardiovascular Registry Data — and also upload their own research data.
• Advocacy — The ACC will continue to support efforts to eliminate Medicare's "sustainable growth rate" formula that most physicians, including those representing the American Medical Association and most state medical associations say is hurting the timely and efficient delivery of health care services to older Americans. The ACC will also continue to work with government agencies to propose new payment models that reward quality and outcome over the traditional volume of care.
• International — About 13 percent of American College of Cardiology members do not live in the United States. These non–U.S. residents are the fastest–growing contingent within the organization, and are expected to outnumber American members within the next few decades. Dr. Zoghbi said that the American College of Cardiology will continue to work with sister entities in other countries to improve heart and vascular health, and look at new ways to engage its international members.

"This year, the College will have 20 international chapters — the most we've ever had," Dr. Zoghbi said. "This coming year, we aim to enhance educational engagements between American and international chapters, both through national and international meetings and through our CardioSource and CardioSmart online communities."

 Looking back on her choice to become a cardiologist, Dr. Holly Andersen is refreshingly frank about her motivations.

"I was always interested in how the body worked, and when I became a medical student, the heart was clearly the most interesting," she said. "People come in here dying and we make them better. And anything you do for the heart that's good for you is good for the rest of you."

Dr. Andersen is an associate professor of clinical medicine at Weill Cornell Medical College and the director of education and outreach at the Ronald O. Perelman Heart Institute at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. She came to Weill Cornell as an intern in 1989, and in those years of emergency interventions and nursing ailing hearts back from the brink of failure, Dr. Andersen had to adjust her philosophy on cardiac care.

"Physicians are really good at taking care of heart attacks — great at it, actually, but we aren't as good at preventing them," she said. "After putting out all those fires, we now have to think about keeping the fires from starting in the first place. What I love about cardiology is that heart disease is largely preventable."

February is American Heart Month, and in her role as director of education and outreach at the Perelman Heart Institute, Dr. Andersen is working overtime to increase cardiac health awareness, and not just to those who come to her office for an appointment. The Perelman Heart Institute opened in 2009, as a center dedicated to treatment and research, as well as focusing on becoming the national voice in prevention and awareness.

For Heart Month, the Institute has planned a month-long series of events and lectures, most of which will be held at the Ronald O. Perelman Heart Institute Education Center, on topics ranging from stroke prevention to heart attack signs and symptoms in women.

As part of its ongoing commitment to fighting heart disease before it even has a chance to strike, The Perelman Heart Institute employs a full-time nurse educator who teaches prevention and lifestyle choices to patients, and to the family and friends that visit them in the Hospital.

"We have a very captive audience, and what we are teaching them is how to not end up here," Dr. Andersen said.

The Institute also started the Perelman Mile for Hospital employees, an initiative to get staff to walk one mile every day on their lunch breaks.

In recent years, as heart disease has become the leading cause of death for women worldwide, Dr. Andersen has seen her role shift somewhat to educating women about the risks associated with heart disease.

A 2010 American Heart Association survey showed that only 53 percent of women who believe they are having a heart attack will call 911 for help.

"That means 47 percent of women actually believed they were having a heart attack but didn't call 911," Dr. Andersen said. "Heart disease is still viewed as a disease for men or old people."

The good news is that awareness is going up, through community outreach initiatives as well as doctors doing a better job of educating their patients. And awareness is what leads to better practices, which leads to lives saved.

"When you educate a woman, you educate a family," Dr. Andersen said. "Educating women may be our best tool toward improving society's health."

For more information on heart health, click here.