A Heart That Beats for Others from Weill Cornell Medicine on Vimeo.

Dr. Evelyn Horn

For a former Marine and New York City firefighter, fear was never an option. But when John Martinelli began experiencing shortness of breath, chest pains and exhaustion, he became concerned for his heart.

With the help of Dr. Evelyn Horn, director of heart failure and pulmonary hypertension at the Perkin Heart Failure Center and a professor of clinical medicine in the Division of Cardiology at Weill Cornell Medicine, Martinelli successfully had open-heart surgery to replace both his aortic and mitral valves, along with the re-implantation of his coronary arteries around his newly modeled aorta. A husband, father and grandfather, Martinelli is now able to live life to his fullest — thanks to the groundbreaking research and skilled physicians at Weill Cornell Medicine.

In a video — coming amid American Heart Month — Weill Cornell Medicine shares Martinelli's story and showcases the cutting-edge research that its scientists and those at Cornell University are conducting to improve cardiac surgery and care. For one such project, Cornell engineers Drs. Jonathan Butcher and Robert Shepherd, collaborate with the Dalio Institute of Cardiovascular Imaging at NewYork-Presbyterian and Weill Cornell Medicine to develop an innovative procedure that involves printing 3D replacement tissue precisely modeled after the patient's imaging results.

Visit the websites for the Division of Cardiology and the Department of Cardiothoracic Surgery for more information about Weill Cornell Medicine's cardiac care, surgery and research programs.

Weill Cornell physician-scientists and Cornell University engineers collaborate — and patients benefit

By Beth Saulnier
Illustration by Heidi Schmidt

The triple-negative form of breast cancer is one of the disease's most challenging types, with lower survival rates and a more aggressive course. Pioneering cancer researcher Dr. Lewis Cantley '75, has been studying it from various angles for decades — and now, thanks to Ithaca-based engineers, he has a powerful new way to explore it from New York. "Increasingly, biological science is relying on high levels of technology to improve our ability to visualize what's going on in a tumor, and to be able to physically manipulate events within it and follow in real time what happens," says Dr. Cantley, a professor of cancer biology in medicine and the Meyer Director of the Sandra and Edward Meyer Cancer Center, who has been working with an Upstate colleague, Dr. Claudia Fischbach-Teschl, an associate professor of bio-medical engineering. "The technologies that have been developed in Ithaca are cutting-edge techniques in growing cells and even tumors in a controlled environment, where you can monitor and physically affect a tumor and look at its response. We're able to understand what's going on at a level that has never been possible in the past. It's a very exciting time."

The joint effort between Dr. Cantley — himself a doctoral alumnus of the Ithaca campus — and Dr. Fischbach-Teschl is just one of the many ongoing collaborations between Weill Cornell Medicine researchers and Cornell engineering faculty. Research teams are working together on topics from Alzheimer's to epilepsy, reconstructive surgery to heart disease. "From my perspective, it's absolutely crucial to have collaborations with engineers," says Dr. Jason Spector, a Weill Cornell Medicine professor of surgery. "Even though I have a background in some other disciplines, at heart I'm a clinical physician and my expertise is in taking care of patients. I may have a clinical insight but no way to pursue it because I don't have the technical knowledge in that particular field. The engineers have incredible expertise in diverse areas ranging from polymer chemistry to tissue engineering to the use of lasers and optical imagery, so their insights and perspectives are perfectly complementary to mine."

Over the past decade, the university has strengthened its commitment to fostering collaborations between the two campuses, including logistical support like the Cornell bus that runs between Ithaca and New York City several times a day, providing reliable Wi-Fi, snacks and a comfortable place to work during the 200-mile journey. Occasional retreats between engineers and their counterparts in Weill Cornell Medicine departments like surgery, neurological surgery, and radiology allow faculty to make matches with colleagues who have complementary research interests. The university has also offered several rounds of seed grant funding to help intercampus projects get off the ground — and according to one initial analysis, the investment has more than paid off.

In 2010, Dr. Lawrence Bonassar, a professor of biomedical engineering and of mechanical and aerospace engineering, studied the outside funding generated by roughly a dozen awards given in the previous five years, finding that the seed support had facilitated substantive results that impressed outside granting agencies. "It had about an eight-fold return on investment," reports Dr. Bonassar, whose collaborative projects with Weill Cornell Medicine surgeons include two types of implants made of living tissue: ears for children born without them, and replacements for degenerated spinal discs that cushion the vertebrae. "About $400,000 in grants had been given out — and they had returned, at that time, more than $3 million from other organizations including the National Institutes of Health, private foundations, and the National Science Foundation. So these tend to be productive collaborations that are well received by the outside world."

In the field of oncology research, intercampus collaborations got a particularly strong boost in 2009 with the awarding of a five-year, $13 million grant from the National Cancer Institute that created the Center on the Microenvironment and Metastasis. Established under the NCI's Physical Sciences-Oncology Centers initiative, it has fostered numerous projects including the ongoing effort by Weill Cornell Medicine's Dr. David Nanus, the Mark W. Pasmantier Professor of Hematology and Oncology in Medicine, and Dr. Evi Giannakakou, an associate professor of pharmacology, to develop a method to detect prostate cancer cells in the blood. They're working with Dr. Brian Kirby, an associate professor of mechanical and aerospace engineering who is based in Ithaca but holds a joint appointment in Weill Cornell Medicine's Division of Hematology and Medical Oncology. Says Dr. Kirby: "There's basically no way for me to impact human health directly unless I'm working with clinicians, looking at real samples, and trying to influence actual clinical practice."

Last summer's establishment of the Meinig School of Biomedical Engineering also strengthened intercampus research — elevating an existing department that had been founded in 2004. The school was created with a $50 million gift from undergraduate alumni Nancy and Peter Meinig and their children; as Weill Cornell Medicine Dean Dr. Laurie Glimcher, said at the time, their generosity "will enable us to expand our collaborations and advance our critical work translating new discoveries into the best patient care."

Weill Cornell Medicine researchers are also working with Cornell engineers who are based in Manhattan. Not only does the new Cornell Tech campus (temporarily located in Chelsea, but with three buildings currently under construction on Roosevelt Island) have a program devoted to health-related topics, but about 10 percent of students earning doctorates in biomedical engineering at the university are doing their thesis research at Weill Cornell Medicine. "When you look around the country, you'll see that there are no biomedical engineering programs in the top 10 or 20 that aren't strongly tied to a top medical school — and interestingly, there aren't many top medical schools that aren't strongly tied to a bio-medical engineering program," says Dr. Chris Schaffer, an Ithaca-based associate professor and director of graduate studies in biomedical engineering, noting that all of his department's first-year doctoral candidates spend about two months at Weill Cornell Medicine for an immersion program in clinical medicine. "Much of the future of biomedical research, and of improving healthcare, will involve increased reliance on quantitative and engineering approaches to drugs and diagnostics. We do that best when we do it together."

Ears for Kids

Of every 10,000 babies born worldwide, between one and four have a congenital birth defect called microtia, in which one or both outer ears is missing or deformed. Unfortunately for these kids and their families, the options for surgical reconstruction have long been limited and imperfect — consisting of either an artificial implant or one crafted from the patient's rib cartilage. But professor of surgery Dr. Jason Spector, and biomedical engineer Dr. Lawrence Bonassar, hope they'll soon be able to offer an alternative: a natural implant created from a patient's own cells that would grow along with the child and never require replacement. For several years, the two have been working together on the ears, which could either be formed through 3D printing or shaped in a mold. Since most cases of microtia occur on only one side of the head, computer imaging can be used to scan a patient's normal ear, so the implants can be custom-made for a perfect fit. While the work began using bovine tissue, it has evolved to comprise human cartilage; microtia patients usually have a small amount of vestigial ear tissue, which can be nurtured with stem cells until there is enough material to form an implant. The results have been highly promising: the growth system is working well, and the resulting ears are durable and have the proper anatomical form. The researchers hope to move into clinical trials in the next two to three years. "As a result of our collaborative efforts, we are poised to revolutionize the treatment of children who have microtia — and as we further develop these cutting-edge tissue engineering strategies, to make much needed 'replacement parts' in many other areas of the body," Dr. Spector says. "It's all very exciting."

Tumor-Cell Detector

It's known as a "liquid biopsy": taking a sample of blood from a patient and analyzing it for cancer cells. Potential uses for such technology include allowing oncologists to refine a diagnosis, detecting the spread of cancer from a tumor to elsewhere in the body, and predicting the efficacy of a certain drug — all without an invasive procedure. According to Dr. David Nanus, associate director of clinical services at the Meyer Cancer Center, "it's something that a lot of medical centers and cancer centers are working on that will have utility in the future." Dr. Nanus has been working with pharmacologist Dr. Evi Giannakakou, and engineer Dr. Brian Kirby, on employing liquid biopsies for a particular purpose: they're doing a proof-of-concept study using a microfluidic device to detect prostate cancer circulating tumor cells. An expert in microfluidics, Dr. Kirby devised a silicon chip known as GEDI; pronounced like the Star Wars heroes, it stands for Geometrically Enhanced Differential Immunocapture. "We coat the surface of the microdevice with a substance that will specifically stick to cancer cells and not to blood cells," Dr. Kirby explains. "We designed it to be sort of a maze that tricks the cancer cells into colliding with the surfaces many times over." The multi-institution study, involving about five dozen patients with late-stage prostate cancer, is looking for biomarkers that may predict sensitivity or resistance to a class of chemotherapy drugs known as taxanes. "A major goal is to figure out the mechanism of chemotherapy resistance," Dr. Nanus says. "If a patient progresses, can we look at their circulating tumor cells and — from an analysis of their DNA or RNA expression — determine the molecular reason why they have become resistant to treatment?"

Battling Breast Cancer

The "seed and soil" concept of cancer metastasis holds that tumors require fertile ground in which to grow — which means that making the body inhospitable to them is key to battling the disease. Dr. Andrew Dannenberg, the Henry R. Erle, M.D.- Roberts Family Professor of Medicine, and breast cancer specialist Dr. Linda Vahdat, have ongoing collaborations with biomedical engineer Dr. Claudia Fischbach-Teschl, whose Ithaca lab is devoted to studying the environment in which a tumor exists, including its surrounding blood vessels and other non-tumorous host cells. They have worked together to explore diagnosis, treatment and prevention from two major angles: the effect of obesity on patient outcomes and — a major focus of Dr. Vahdat's work — the promise of copper-depleting drugs in treating triple-negative breast cancer. For the obesity work, for example, Dr. Vahdat provided specimens from lean and obese breast cancer patients; Dr. Fischbach-Teschl was able to show that obese women have increased levels of proteins typically associated with wound-healing, which makes for a "soil" more hospitable to cancer, thus raising the likelihood of its spread. "Claudia's expertise is in physical factors that promote metastasis — getting down to the practical aspects of, 'How does a tumor cell get from point A to point B?' says Dr. Vahdat, a professor of medicine. "It's a totally different way to look at things, but it's highly complementary to what someone like myself does, which is on a very macro level, taking care of patients."

Back Pain Relief

Among the projects sparked during a retreat between Ithaca engineers and Weill Cornell Medicine surgeons is one that could someday provide relief to the millions of Americans suffering from chronic back or neck pain. Spinal surgeon Dr. Roger Härtl, is working with Dr. Bonassar to develop a bioengineered intervertebral disc to replace those lost to degeneration or herniation — be it from natural aging, playing contact sports, or other factors like obesity or years of manual labor. Currently, most patients are treated with pain medication or physical therapy — but 5 to 10 percent require more invasive methods such as injections or surgery. In the latter case, the most common procedure is spinal fusion, in which a damaged disc is removed and bone is fused into the gap; while artificial discs made of metal and plastic are available, they can damage adjacent tissue, and their longevity is unclear. So Dr. Härtl, a professor of neurological surgery and director of spinal surgery and neurotrauma at Weill Cornell Medicine's Brain and Spine Center, teamed up with Dr. Bonassar to design 3D-printed implants made of living tissue. The technology was successfully demonstrated in rats; in collaboration with the College of Veterinary Medicine, it's currently being tested in animals, who can suffer from disk degeneration just as humans do. Ultimately, the implants could be created based on MRI imaging of a patient's spine and comprise cells either taken from a cadaver or — a greater challenge — grown using a person's own tissue. Another project, which Dr. Härtl reports is much closer to clinical implementation, is a technique to repair injured discs using tissue-engineered biological "glues."

A 'Laser Scalpel' for Epilepsy

Of the two main kinds of epilepsy — general and focal — the latter is much harder to treat. While general epilepsy — in which the entire brain spasms with neural activity — can be well controlled with medication, focal epilepsy is more challenging. Often caused by brain trauma or congenital malformation, it involves too much neural activity in specific regions; to control it with drugs, says biomedical engineer Dr. Chris Schaffer, "you end up almost anesthetizing the brain." Instead, the condition is treated with resective brain surgery — an imprecise option that can lead to cognitive and motor deficits. But Dr. Schaffer, an expert in advanced optical techniques, is working with Dr. Theodore Schwartz, the David and Ursel Barnes Professor of Minimally Invasive Neurosurgery, to offer a much better surgical solution. They're collaborating to develop a "laser scalpel" that can cut with precision on the scale of a micron — one-millionth of a meter. They're writing up a paper reporting promising results in a rodent model, in which a targeted cut decreased seizures by 50 percent; they're currently studying whether the improvement is long-lasting. Dr. Schaffer is also working with Dr. Frank Wise '88, the Samuel B. Eckert Professor of Engineering in Ithaca's Department of Applied and Engineering Physics, to design the device, which pulses at a rate of 100 femtoseconds. "The ratio of 100 femtoseconds to a minute is about the same as the ratio of a minute to the known age of the universe [about 13.8 billion years]," Dr. Schaffer notes. "So it's a really, really short burst of light."

Heart of the Matter

At the Dalio Institute of Cardiovascular Imaging, director Dr. James Min, and colleagues aim to better understand heart disease, in the hope that it will lead to improved treatments and preventive measures. To that end, they use not only familiar tools like MRI, CT and PET — but also novel technologies like 3D printing and computer modeling of blood flow dynamics, drawing on the expertise of Ithaca-based engineers. Dr. Min, a professor of radiology and of medicine who is board certified in cardiology, has been working with Dr. Jonathan Butcher, associate professor of biomedical engineering and associate director of undergraduate studies in biomedical engineering, to study how the particulars of various surgical procedures — say, the shape and placement of a vascular graft — affect patient outcomes. Ultimately, grafts that have been designed for optimum performance in an individual person's heart could be fabricated through tissue engineering, obviating the need to obtain them from elsewhere in a patient's body. The grafts — or even entire heart valves — would be made of a patient's own cardiac cells, harvested by surgeons and grown on a scaffold of water-soluble polymers. In the best-case scenario, Dr. Butcher says, "we could do all of those procedures in the operating room, in one sitting." On the clinical side, the collaboration also involves veteran heart surgeon Dr. Leonard Girardi '89, chair of the Department of Cardiothoracic Surgery and cardiothoracic surgeon-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center.

This story first appeared in Weill Cornell Medicine, Vol. 15, No.1.

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.

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."

Funded by a $20 million gift from the Dalio Foundation, the institute will combine research, clinical care, and education to uncover new answers about preventing heart disease

NEW YORK (November 12, 2013) — To help reduce the burden of cardiovascular disease, the nation's leading killer, NewYork-Presbyterian Hospital and Weill Cornell Medical College have created the Dalio Institute of Cardiovascular Imaging. Raymond T. Dalio, a life trustee of NewYork-Presbyterian Hospital, has made a gift of $20 million through his Dalio Foundation in support of the institute.

The Dalio Institute of Cardiovascular Imaging will employ a multidisciplinary, multimodality approach to the detection and treatment of heart disease, with a focus on finding new answers about prevention of heart disease in at-risk individuals and ultimately save lives. Its mission is to innovate, integrate, and educate, goals that will be achieved through cutting-edge research, transformations of current clinical paradigms, and dissemination of knowledge.

Dr. James K. Min, an expert in cardiovascular imaging and a physician-scientist who has led several large-scale multicenter clinical trials, has been appointed director of the Dalio Institute of Cardiovascular Imaging. Dr. Min is an attending physician at NewYork-Presbyterian Hospital and a full-time faculty member in the Department of Radiology at Weill Cornell Medical College. He joins NewYork-Presbyterian/Weill Cornell from the Cedars-Sinai Medical Center, where he was director of cardiac imaging research and co-director of cardiac imaging.

Rooted in the central role of imaging techniques to better diagnose cardiovascular disease, the institute will not only use state-of-the-art tools such as MRI, CT, and PET scanners, but will also focus on the development of novel next-generation technologies and diagnostic tests. Applying a team-based approach that draws on the expertise of physicians and scientists in radiology, cardiology, genetics, proteomics, and computational biology, the institute's primary research initiative is to identify the "vulnerable plaque," or the specific coronary artery lesion that is responsible for a future heart attack or sudden cardiac death.

"The vulnerable plaque is the holy grail in the diagnostic work-up of individuals with suspected coronary artery disease, and its elusive nature has precluded the timely treatment of millions of high-risk individuals," says Dr. Min. "We will apply an array of innovative hardware and software imaging technologies to improve identification of the vulnerable plaque, and then seek to apply these findings in large-scale multicenter clinical trials and registries to encourage full integration of our research findings into clinical practice."

To develop the world-class clinical program to diagnose early cardiovascular disease, the Dalio Institute of Cardiovascular Imaging will use state-of-the-art imaging technologies in conjunction with other cutting-edge diagnostic tests, including blood markers of inflammation, protein expression, and metabolism. The clinical program will serve patients in the outpatient and inpatient setting, as well as in the emergency department. Three specific initiatives within the clinical program will emphasize early identification of heart disease in women, ethnic minorities, and young patients with a family history of premature heart disease.

The institute's educational mission will focus on disseminating knowledge of the latest advances in cardiovascular imaging through the education of physicians, physician trainees, and allied health professionals through formal didactic curricula and symposia.

"More than half of people who die from sudden heart attacks never knew they were at risk because their underlying heart conditions had never been diagnosed," says Dr. Min. "Many heart attacks can be prevented if people know of the extent and severity of their asymptomatic heart disease and are properly treated. By bringing together a multidisciplinary group of experts, the Dalio Institute of Cardiovascular Imaging will not just offer the latest imaging techniques for early detection, but will also develop disruptive technologies to fight the battle against heart disease. Ultimately, these pioneering methods aim to challenge current clinical paradigms in order to reduce the morbidity and mortality associated with cardiovascular disease."

"Establishing the Dalio Institute of Cardiovascular Imaging is an incredibly significant milestone in our fight against heart disease," says Dr. Steven J. Corwin, CEO of NewYork-Presbyterian Hospital and a cardiologist by training. "While modern medicine offers highly sophisticated tools for treating heart disease, we still have a long way to go in terms of identifying high-risk individuals with early-stage disease so that we can prevent catastrophic outcomes and save lives. Dr. Min's unique background, expertise, and clinical research experience make him ideally suited to lead the institute and its groundbreaking initiatives. We are thrilled that Dr. Min has joined us, and we are extraordinarily grateful to Ray Dalio for his vision and generous support."

"The interdisciplinary nature of the new Dalio Institute of Cardiovascular Imaging exemplifies the best in translational research — investigations that can make lifesaving impact on our patients," says Dr. Laurie H. Glimcher, the Stephen and Suzanne Weiss Dean of Weill Cornell Medical College. "Dr. Min has a proven track record of effectively testing novel theories, and we enthusiastically support what we know will be innovative research at the institute."

NewYork-Presbyterian/Weill Cornell Medical Center

NewYork-Presbyterian/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and Weill Cornell Medical College, the medical school of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, education, research and community service. Weill Cornell physician-scientists have been responsible for many medical advances -- including the development of the Pap test for cervical cancer; the synthesis of penicillin; the first successful embryo-biopsy pregnancy and birth in the U.S.; the first clinical trial for gene therapy for Parkinson's disease; the first indication of bone marrow's critical role in tumor growth; and, most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, NewYork-Presbyterian/Westchester Division, NewYork-Presbyterian/The Allen Hospital, and NewYork-Presbyterian/Lower Manhattan Hospital. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. In its commitment to global health and education, Weill Cornell has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, Cornell University is the first in the U.S. to offer a M.D. degree overseas. For more information, visit www.nyp.org and weill.cornell.edu.