HEART RESEARCH AT EMORY


July 28, 1997


Media Contacts: Sarah Goodwin, 404/727-3366 - sgoodwi@emory.edu
Kathi Ovnic, 404/727-9371 - covnic@emory.edu
http://www.emory.edu/WHSC/





PREVENTIVE CARDIOLOGY
DETECTION
RESEARCH
RANKINGS
OTHER HEART-RELATED WORK at EMORY UNIVERSITY
TREATMENT
HEART TERMS & STATS






PREVENTIVE CARDIOLOGY



REVERSING CORONARY ARTERY DISEASE



The bad news: heart disease is the No. 1 killer of Americans; the good news: unlike many other diseases, a great deal can be done to prevent and even reverse it. R. Wayne Alexander, M.D., Ph.D., chairman of Cardiology, Department of Medicine, Emory University School of Medicine, and his colleagues at The Emory Heart Center, are leaders in the current push toward prevention and reversal. Emory heart researchers are leading numerous large, national studies of new drugs to lower high blood pressure and lower cholesterol, hormones to delay disease onset, clot dissolvers to nip heart attacks or stroke in the bud and are contributing to the body of medical knowledge about the powerful benefits of eating a low-fat diet, exercising and quitting smoking.

THE ABC'S OF CHOLESTEROL



Past president of the American Heart Association (1991), Virgil Brown, M.D., is an internationally recognized authority on cholesterol. His research focuses on the "C" proteins he himself isolated and characterized while at the National Institutes of Health, but he is called upon by doctors, scientists and media worldwide to comment on many aspects of the role of cholesterol in heart disease.



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DETECTION



ULTRAFAST CT SCANNING



A pioneer in the use of new cardiac imaging technology, Emory Heart Center has been asked to provide the medical direction for the state's first Ultrafast CT Scanning Center. The electron beam tomography heart scans let Atlanta doctors detect coronary artery disease more than a decade before symptoms appear.

2D AND 3D IMAGING, SPECT AND EMORY BULL'S-EYE MAPS



The goal of Emory University's Ernest V. Gracia, Ph.D., a leading innovator in cardiac diagnosis, has been to improve imaging technology so that physicians may evaluate the heart muscle more precisely. Most notably, Dr. Garcia and his colleagues have developed, refined and marketed advanced two-dimensional heart imaging technology. The advantage of the computer software is that it provides valuable quantitative information to enhance the visual, qualitative, information provided by conventional cardiac scans.



PET SCANNING FOR WOMEN



Emory cardiologist Randolph E. Patterson,November 1993 showed for the first time that percutaneous transluminal coronary angioplasty (PTCA) is just as safe and effective as coronary bypass surgery, a proven therapy for advanced atherosclerotic heart disease. Many patients with multiple-vessel coronary artery disease whose arteries require revascularization (to unclog or partially replace arteries) are equally eligible for either PTCA or coronary artery bypass surgery (CABG), a therapy with proven clinical benefit.

FIRST TRIPLE 'KEYHOLE' BYPASS USING MINI-CABG TOOLS



The first minimally invasive triple "keyhole" coronary artery bypass surgery on a beating heart using Mini-CABG instrumentation was performed in spring 1997 at Crawford Long Hospital of Emory University by cardiothoracic surgeon John Puskas, M.D. United States Surgical Corporation instruments allowed the doctors to complete the procedure on the beating heart of a 54-year-old man without using a heart-lung machine and eliminating the costs and potential complications associated with current heart-lung bypass technology.

HOSPITAL STAYS REDUCED AFTER OPEN HEART SURGERY



Are shorter hospital stays best for the patient? Emory Heart Center is a leader in asking, and answering, that question. Patients under 65 whose open heart surgery goes smoothly and who have no other chronic illnesses may often leave the hospital within four or even three days after surgery, reported Emory Heart Center cardiothoracic surgeon Joseph M. Craver, M.D., at the 1996 American Association for Thoracic Surgery meeting. According to Dr. Craver, more than one half of all 1,050 open heart surgery patients treated at Emory University Hospital during 1995 were discharged within five days after surgery. Ninety-eight heart patients were discharged within three days, 252 were discharged after four days and 205 were discharged after five days. In the past, patients usually have stayed in the hospital six to eight days after open heart procedures such as coronary artery bypass surgery.

IMPROVED HEART VALVE



Emory heart surgeon John Gott, M.D., pioneered a solution to a troubling problem with heart valve replacements. He and his Emory Heart Center colleagues specially treat porcine value replacements with an agent that slows the calcifications process and delays the need for replacements. Thus far, about 2,000 patients worldwide have received AOA-treated porcine valves.

AORTIC ANEURYSM SURGERY



A retired civil servant and a retired neurologist were the first Georgians and among the first patients in the world to undergo a new surgery at Emory University Hospital to repair aortic aneurysms. Rather than making a large abdominal incision to access each man's abdominal aortic aneurysm, Emory vascular surgeon Elliot L. Chaikof, M.D., Ph.D., led a team in delivering a graft to the aneurysm via a catheter fed through an artery. The procedure carries the promise of being safer, minimally invasive, requires less time in surgery and for recovery, and is less costly.

RE-WIRING THE HEART



Electrophysiologist Paul Walter, M.D., has built Emory's reputation as a center for treating electrical malfunctions in the heart. By feeding a special catheter through a vein to the site on the heart muscle that is "short circuiting," Dr. Walter and his colleagues can permanently cure a number of heart rhythm abnormalities -- and keep many persons young and old from having to take medications every day of their lives. The team now is implanting small, innovative pacemakers in certain patients with other types of rhythm disturbances.

WOMEN & HEART DISEASE



In love, so the saying goes, women fall more often, but men fall harder. In heart disease, the opposite may be true. In her newly published book Women & Heart Disease (D. Julian and N. Wenger, Eds., Martin Dunitz, London, 1997) and in her 1993 New England Journal of Medicine paper, Emory cardiologist Nanette Wenger, M.D., lists point after point in which women are more devastated by heart disease than men. Dr. Wenger was one of the first physician-scientists to speak out about the great underrepresentation of women subjects in medical research. She currently heads the Emory component of the Heart and Estrogen-Progestin Replacement Study (HERS), a national study evaluating whether hormone replacement therapy can prevent or stall heart disease in women after menopause. Dr. Wenger was named "One of the 10 Most Important Women in Medicine" by Ladies Home Journal in 1995, was recognized by McCall's magazine in 1994 for her research into causes and treatments for heart disease in women, has been recognized as Atlanta Woman of the Year in Medicine and cited in Time magazine's Woman of the Year issue.

PATCHING TINY HEARTS



Robert Guyton, M.D., director of Cardiothoracic Surgery and recognized as one of the nation's top surgeons, developed a revolutionary procedure to repair babies' hearts which incorporates a patch that grows along with the heart -- and which negates the need for additional surgery.



FIRSTS



1962 -- First "blue baby" operation in Georgia performed by Emory cardiothoracic surgeon Charles R. Hatcher Jr., M.D. The open heart procedure corrects tetralogy of Fallot.
1963 -- First aortic valve replacement in Georgia performed by Emory cardiothoracic surgeon Charles R. Hatcher Jr., M.D.
1970 -- First coronary artery bypass in Georgia performed by Emory cardiothoracic surgeon Charles R. Hatcher Jr., M.D.
1985 -- First heart transplant in Atlanta; since then more than 260 adult heart transplants and five adult heart-kidney transplants have been performed by Emory Heart Center specialists at Emory University Hospital. Emory is one of few centers worldwide to perform the rare heterotopic or "piggyback" transplant during which the donor heart is attached to the patient's own heart.
1988 -- First pediatric heart transplant in the state performed by Emory Heart Center surgeons at Egleston Children's Hospital; more than 64 children's heart transplants have been performed since.
1988 -- First "domino" heart transplant performed in the state, during which the healthy heart of a patient -- who, because of failing lungs, received a heart-lung transplant from a cadaveric donor -- was transplanted into another patient.



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RESEARCH



RADIATION FOR RESTENOSIS



Emory researchers are international pioneers in applying low levels of radiation to coronary arteries after angioplasty to prevent reclogging. A research team led by interventional cardiologist Spencer B. King III, M.D., was the first to receive Food and Drug Administration approval to test whether beta radiation applied to the site of clogged coronary arteries dilated by balloon angioplasty helped prevent restenosis in human subjects. The Emory team also convened in 1996 the first international conference on this promising new therapy.

RENOWNED CARDIAC DATA BANK



The Cardiac Data Bank maintained by Emory Heart Center is one of the oldest, largest and most well-regarded in the world. For nearly two decades, researchers there have carefully tracked information on thousands of heart patients seen at Emory University Hospital, The Emory Clinic and Crawford Long Hospital of Emory University. The data has provided physician-statisticians like cardiologist William Weintraub, M.D., with a wealth of information for predicting trends in heart disease and for conducting long-term analyses of treatment outcomes.

A PILL TO ALTER CELLS -- AND STOP HEART DISEASE



The "v-protectant" technology developed by Emory cardiologists R. Wayne Alexander, M.D., Ph.D., and Russell Medford, M.D., Ph.D., has the possibility not only of inhibiting heart disease but also of reversing it. They are working to find the right drug compound to switch off a common group of genes that controls heart disease. They believe it will be possible to permanently alter -- and fortify -- blood vessel cells against damage caused by arterial blockage. The two doctors formed the company AtheroGenics in 1994 to commercialize this possible discovery. They also are working to develop blood tests to diagnose heart disease and monitor treatments.

LASERS FOR SEVERE CHEST PAIN



Emory Heart Center is one of 14 centers nationwide chosen to evaluate whether "punching" holes in the heart via laser may prove the best treatment yet for patients with untreatable angina. The treatment, called transmyocardial revascularization, or TMR, creates new channels in the heart to facilitate bloodflow. Emory cardiothoracic surgeon Dr. W. Morris Brown III is leading the Emory study. Brown says the Phase II trial is designed to evaluate the effectiveness of the treatment. TMR offers an alternative for patients who otherwise would have to live with constant debilitating.

PORTABLE HEART PUMP



Emory Heart Center is among the few centers nationwide testing a new heart pumping device that makes waiting for a new heart a little more bearable for heart transplant candidates. The pump allows patients to get out of their hospital bed and exercise, thereby improving strength and chances for a successful transplantation. The new device is designed to keep blood pumping throughout the body until a donor heart becomes available for transplantation. While the conventional models are big, noisy and keep the patient tethered to a hospital bed, the new model is worn as a backpack uses batteries, and allows patients to walk up and down halls, exercise on a stationary bicycle and even do physical therapy.

CHAOS



A group of Emory Heart Center and Georgia Tech researchers are testing a technique that may help control irregular cardiac rhythms by altering chaotic patterns in the electrical signals controlling the heart. If successful, the technique could lead to development of a new type of implantable device that would be smaller and apply less electrical energy than the defibrillators now used to correct the erratic heartbeat of atrial fibrillation. The chaos control technique developed by Emory cardiologist Jonathan J. Langberg, M.D., and Georgia Tech physicists, is based on the application of small electrical signals to the heart at carefully chosen points in the heartbeat cycle. The researchers believe the small signals will encourage the heart itself to correct the irregularities.

ORGANOIDS FOR TISSUE REGENERATION



Vascular surgeon Elliot Chaikof, M.D., Ph.D., is conducting groundbreaking research in tissue engineering to develop an arterial replacement or "organoid," which combines both artificial and natural biological elements. The highly specialized, biomolecular material that is at the heart of his research, is an outcome of a process which mimics the way nature designs complex biological structures from microcapillaries to major arteries.

NITRIC OXIDE ENZYME CLONED



The enzyme responsible for making nitric oxide was cloned by Emory Heart Center clinician and researcher David Harrison, M.D., professor of Medicine (Cardiology). Since nitric oxide is produced as a relaxant by endothelial cells lining blood vessels when they become stressed, the Emory team is gaining a better understanding of how nitric oxide is regulated (for instance, its production is stimulated by nitroglycerin and inhibited by dangerous oxidative free radicals).



DISCOVERY OF HYPERTENSION HORMONE RECEPTOR



Emory Heart Center investigator R. Wayne Alexander, M.D., Ph.D., chief of Cardiology at Emory, was a leader of the team that isolated the gene for the major hormone receptor controlling blood pressure.

CHOLESTEROL DRUG HEALS VESSELS



Emory University cardiology researchers reported in New England Journal of Medicine in 1995 results of the first randomized, placebo-controlled study demonstrating that cholesterol-lowering drugs have a healing effect on damaged blood vessels and can eliminate vasospasm, the dangerous tendency for diseased arteries to constrict rather than dilate. "Aggressive lipid (fat) lowering may become part of our armamentarium for the treatment of ischemic coronary syndromes," reports Charles B. Treasure, M.D., assistant professor of medicine (cardiology) at the Emory University School of Medicine. "In addition, clinical assessment of endothelial tone regulation may become a starting point for directing preventive approaches and an endpoint for evaluation of therapeutic efficacy in coronary atherosclerosis."

A 'STICKY' DISCOVERY



In 1993, cardiologists Russell M. Medford, M.D., Ph.D., and R. Wayne Alexander, M.D., Ph.D., became the first to identify a protein that regulates the activity of endothelial cells -- the cells that line the inside of blood vessels and are integral to the development of deadly atherosclerotic plaque. The protein regulator tells endothelial cells modified or damaged by oxidation to express vascular cell adhesion molecule-1 (VCAM-1). VCAMs are "sticky" adhesion molecules that are supposed to attract circulating white blood cells to help heal the site of the blood vessel's injured lining. Unfortunately, the glut of white blood cells attracted is actually the precursor to plaque formation and lethal atherosclerosis. Most significantly, Dr. Medford has learned that one can quiet the expression of this regulatory protein with certain antioxidants, preventing it from urging white blood cells to attach to endothelial cells and initiate the events which ultimately result in atherosclerotic plaque formation.

HOW BLOOD PRESSURE DAMAGES ARTERIES



For a long time, scientists haven't known exactly how high blood pressure, a risk factor for "hardening of the arteries," or atherosclerosis, injures blood vessels. But a 1995 review conducted by Cardiology chief R. Wayne Alexander, M.D., Ph.D., of recent research presents a clearer picture, and it's a familiar one: high blood pressure (hypertension) and high blood fats (hyperlipidemia) share common mechanisms that can damage cells that form the inner lining of blood vessels. "The endothelium is a likely central focus for the effect of both diseases," Dr. Alexander wrote in the American Heart Association journal Hypertension. Both diseases can cause endothelial injury that initiates an inflammatory response leading to cell proliferation, artery wall thickening and tissue-damaging oxygen free-radicals a condition called "oxidative stress," says Dr. Alexander. Elevated blood pressure appears to accelerate atherosclerosis, he says, through "synergy" with other disease-stimulating factors that combine to induce oxidative stress on the arterial wall.

NIH VASCULAR RESEARCH CENTER



The National Institutes of Health awarded vascular biologists at Emory Heart Center $4.8 million to establish one of the nation's six vascular medicine research centers.

WOMEN'S HEALTH INITIATIVE



Emory Heart Center investigators are actively involved in the largest women's health study ever undertaken in the United States: the $625 million Women's Health Initiative (WHI). The $10.9 million research grant supports one of the most ambitious clinical research efforts ever undertaken in Georgia certainly the largest involving women. Better understanding of how we may prevent three of the leading causes of death and disability among women -- heart disease, cancer and osteoporosis -- is the aim of the Emory component of the study, says Principal Investigator W. Dallas Hall, M.D., chief of the Division of Hypertension (high blood pressure) in Emory medical school's Department of Medicine.

HERS



Heart disease not cancer is the leading cause of death in women. The largest study ever of hormone replacement therapy for reducing heart disease risk in postmenopausal women is under way at 15 medical centers across the country, including Emory. Cardiologist Nanette Wenger, M.D., is principal investigator of the Emory component.



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RANKINGS



U.S. NEWS & WORLD REPORT



-- America's Best Hospitals, 1996: Emory Cardiology ranked 6th
-- America's Best Hospitals, 1995: Emory Cardiology ranked 8th
-- America's Best Medical Schools, 1997: Emory ranked 19th out of 125
-- America's Best Medical Schools, 1996: Emory ranked 24th
-- America's Best Medical Schools, 1995: Emory ranked 23rd



GOOD HOUSEKEEPING



Emory Heart Center specialists were among the doctors most frequently cited by 260 department chairs and section chiefs at major medical centers when asked by Good Housekeeping magazine staff to name their top peers. From more than 1,000 heart and stroke specialists named, the magazine published in the March 1996 issue only the 357 most cited for its list of "The Country's Best Heart Doctors." Emory University School of Medicine faculty entries on the list include the following:
-- Daniel Barrow, M.D., chairman and professor, Department of Neurosurgery;
-- Marc Chimowitz, M.D., director, Emory Stroke Center; associate professor, Department of Neurology;
-- Joseph M. Craver M.D., professor, Division of Cardiothoracic Surgery, Department of Surgery;
-- Robert A. Guyton, M.D., director and professor, Division of Cardiothoracic Surgery, Department of Surgery;
-- Ellis Jones, M.D., professor, Division of Cardiothoracic Surgery, Department of Surgery;
-- Spencer B. King III, M.D., director, Andreas Gruentzig Cardiovascular Center; professor, Division of Cardiology, Department of Medicine;
-- Robert C. Schlant, M.D., professor, Division of Cardiology, Department of Medicine;
-- Willis H. Williams, M.D., professor, Division of Cardiothoracic Surgery, Department of Surgery.



AMERICAN HEALTH -- Best Doctors



Among the Emory physicians named to the Best Doctors in America list published in the March 1996 issue of American Health magazine are the following three physicians from The Emory Heart Center. The 1,019 physicians named in the list were chosen by 3,200 of their peers at 350 leading academic medical centers across the country. According to the magazine, about 660,000 physicians currently practice in the United States.
-- Spencer B. King III, M.D., director, Andreas Gruentzig Cardiovascular Center; professor, Department of Medicine, Division of Cardiology;
-- Joseph I. Miller, M.D., professor, Department of Surgery, Division of Cardiothoracic Surgery;
-- Robert B. Smith III, M.D., director, Division of Vascular Surgery; professor of Surgery.

AMERICAN HEALTH -- Best Hospitals



Emory University Hospital was listed among the nation's Best Hospitals in the September 1996 issue of American Health in the categories of Cardiology and Cardiothoracic Surgery.

THE BEST DOCTORS IN AMERICA



A number of Emory Heart Center specialists were among the Emory doctors listed in the book The Best Doctors in America: Southeast Region, 1996-1997 (Woodward/White Inc., Aiken, S.C., 1995). Researchers asked 1,100 top doctors who practice in the Southeast to identify outstanding caregivers; the 4,000 doctors cited were themselves asked to name top physicians. The following names were among 130 excerpted from the book and published in the September 1995 issue of Atlanta magazine featuring Top Doctors in Atlanta who treat life-threatening diseases.


Cardiovascular disease:
-- R. Wayne Alexander, M.D., Ph.D., director, Division of Cardiology, Department of Medicine;
-- B. Woodfin Cobbs, M.D., professor of Cardiology, Department of Medicine;
-- John S. Douglas Jr., M.D., associate professor of Cardiology, Department of Medicine;
-- Spencer B. King III, M.D., director, Andreas Gruentzig Cardiovascular Center; professor of Cardiology,



Department of Medicine;
-- Randolph P. Martin, M.D., director, Echocardiography, professor of Cardiology, Department of Medicine;
-- Douglas C. Morris, M.D., director, Emory Heart Center; associate professor of Cardiology, Department of Medicine;
-- Robert C. Schlant, M.D., professor of Cardiology, Department of Medicine;
-- Andrew Lee Smith, M.D., director, Center for Heart Failure and Transplantation; assistant professor of Cardiology, Department of Medicine;
-- Paul F. Walter, M.D., director, Electrophysiology; professor of Cardiology, Department of Medicine;
-- Nanette K. Wenger, M.D., director, Cardiac Clinics, Grady Memorial Hospital; professor of Cardiology, Department of Medicine;
-- Byron R. Williams Jr., M.D., assistant professor of Cardiology, Department of Medicine;



Thoracic Surgery:
-- Joseph M. Craver M.D., professor of Cardiothoracic Surgery, Department of Surgery;
-- Robert A. Guyton, M.D., director and professor of Cardiothoracic Surgery, Department of Surgery
-- Ellis Jones, M.D., professor, Division of Cardiothoracic Surgery, Department of Surgery;
-- Joseph I. Miller, M.D., professor of Cardiothoracic Surgery, Department of Surgery.



The following names were among those excerpted from the book and published in the September 1996 issue of Atlanta magazine. In contrast to Atlanta magazine's previous list of acute care experts, the following features Top Doctors in Atlanta who treat chronic diseases:



High Blood Pressure:
-- R. Wayne Alexander, M.D., Ph.D., director, Division of Cardiology, Department of Medicine;
-- B. Woodfin Cobbs, M.D., professor of Cardiology, Department of Medicine;
-- Douglas C. Morris, M.D., director, Emory Heart Center; associate professor of Cardiology, Department of Medicine;
-- Robert C. Schlant, M.D., professor of Cardiology, Department of Medicine;
-- Andrew Lee Smith, M.D., director, Center for Heart Failure and Transplantation; assistant professor of Cardiology, Department of Medicine;
-- Byron R. Williams Jr., M.D., assistant professor of Cardiology, Department of Medicine;



Cardiovascular disease:
-- R. Wayne Alexander, M.D., Ph.D., director, Division of Cardiology, Department of Medicine;
-- B. Woodfin Cobbs, M.D., professor of Cardiology, Department of Medicine;
-- John S. Douglas Jr., M.D., associate professor of Cardiology, Department of Medicine;
-- Spencer B. King III, M.D., director, Andreas Gruentzig Cardiovascular Center; professor of Cardiology,



Department of Medicine;
-- Randolph P. Martin, M.D., director, Echocardiography, professor of Cardiology, Department of Medicine;
-- Douglas C. Morris, M.D., director, Emory Heart Center; associate professor of Cardiology, Department of Medicine;
-- Robert C. Schlant, M.D., professor of Cardiology, Department of Medicine;
-- Andrew Lee Smith, M.D., director, Center for Heart Failure and Transplantation; assistant professor of



Cardiology, Department of Medicine;
-- Paul F. Walter, M.D., director, Electrophysiology; professor of Cardiology, Department of Medicine;
-- Byron R. Williams Jr., M.D., assistant professor of Cardiology, Department of Medicine;



Thoracic surgery:
-- Joseph M. Craver M.D., professor of Cardiothoracic Surgery, Department of Surgery;
-- Robert A. Guyton, M.D., director and professor of Cardiothoracic Surgery, Department of Surgery
-- Ellis Jones, M.D., professor, Division of Cardiothoracic Surgery, Department of Surgery;
-- Joseph I. Miller, M.D., professor of Cardiothoracic Surgery, Department of Surgery.



TOWN & COUNTRY



In its February 1995 issue, Town & Country magazine published doctors named in the book The Best Doctors in America (Woodward/White Inc., Aiken, S.C., 1995). Emory heart doctors include the following:
-- Joseph M. Craver M.D., professor, Division of Cardiothoracic Surgery, Department of Surgery;
-- Robert A. Guyton, M.D., director and professor, Division of Cardiothoracic Surgery, Department of Surgery;
-- Ellis Jones, M.D., professor, Division of Cardiothoracic Surgery, Department of Surgery.

LADIES' HOME JOURNAL



In 1994, Ladies' Home Journal listed Nanette K. Wenger, M.D., among The Ten Most Important Women in Medicine, for her extensive research, treatment and education involving the manifestations of heart disease in women. Dr. Wenger is director, Cardiac Clinics, Grady Memorial Hospital; professor of Cardiology, Department of Medicine. Magazine staff asked more than 100 agencies and institutions across the country to name "...the most powerful women in medicine today."

McCALL'S



Emory University Hospital was named in the June 1994 issue of McCall's magazine one of the Ten Top Hospitals for Women. The magazine chose Emory as top pick for the category of heart disease and women. Magazine staff consulted doctors across the country in compiling the list.



OF NOTE



-- J. Willis Hurst, M.D., professor emeritus, Division of Cardiology, Department of Medicine, has edited seven editions of The Heart, the definitive cardiology text. He chronicles his experience as cardiologist to the 36th U.S. president in his most recent work: LBJ: To Know Him Better. Dr. Hurst has several times been listed among the nation's best doctors by Good Housekeeping and Town & Country magazines.
-- R. Bruce Logue, M.D., professor emeritus, Division of Cardiology, Department of Medicine, was Founding President of Georgia Affiliate of the American Heart Association.
-- John Stone, M.D., professor of Cardiology, Department of Medicine; director of Admissions, Emory University School of Medicine, is also an accomplished author, poet and lecturer. For three summers he has taught courses in Literature & Medicine at Oxford University, England. His writing has appeared frequently in The New York Times Magazine, Journal of the American Medical Association, in his own books and in many other publications.

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OTHER HEART-RELATED WORK at EMORY UNIVERSITY



BLOOD VESSEL LINING IS FOCUS OF SKIN DISEASE CENTER



The cells that line blood vessels are the major focus of research at the Emory Skin Disease Research Core Center, established with a $3.1 million grant from the National Institutes of Health. "The human endothelial cell, which has been dubbed the 'Cell of the Decade,' is of primary interest to center researchers," says S. Wright Caughman, M.D., center director and acting chairman of dermatology at the Emory University School of Medicine.

WORLD AUTHORITY ON CHOLESTEROL



Virgil Brown, M.D., past president of American Heart Association and director of the Division of Lipid Metabolism, Department of Medicine, is considered one of the leading authorities on cholesterol and lipid metabolism. His Emory lab has accumulated data from all over the world and has developed a computer model to characterize what happens to fat once it has been ingested. The team is using the model to develop a "fat challenge" test analogous to glucose tolerance tests used to detect diabetes to identify and characterize abnormalities in the way that fats are metabolized in individual patients. Dr. Brown also continues to study the "C" proteins he himself isolated and characterized while at the National Institutes of Health. "C" apolipoproteins are important regulators of cholesterol and triglyceride levels in the blood.

WORLD AUTHORITY ON ANTIOXIDANTS



Sampath Parthasarathy, Ph.D., professor of Medicine (Cardiology) as well as director of research for Gynecology and Obstetrics, is one of the world's foremost authorities on the antioxidant theory of atherosclerosis. He was the first scientist to identify the potent antioxidant potential of the cholesterol-lowering drug probucol and the postcoital pill RU-486.

SOME OF THE WORLD'S FIRST 4-D IMAGES OF THE HEART



Employing the extraordinary computer graphics techniques coined by George Lucas in Star Wars, radiologist Roderic Pettigrew, M.D., Ph.D., is giving pediatric heart surgeons the ability to do something impossible in the operating room: pick up a child's heart and turn it upside down and all around while it is pumping. Dr. Pettigrew, who also is a physicist, is using magnetic resonance imaging (MRI) to create some of the world's first four-dimensional images of the heart in motion.

CONTROLLING CLOTS



A well-known investigator on the subject of thrombosis -- the formation of blood clots -- and ways to control the process, Hematology-Oncology Division Chief Laurence Harker, M.D., is now applying his knowledge to vessel wall injury. He is particularly interested an enzyme called thrombin, a primary perpetrator of injury to the inner wall of arteries. Thrombin not only encourages blood to clot, but promotes inflammatory response, causes growth in smooth muscle cells and triggers vessels to constrict.



IMPROVING BLOOD COAGULATION



Hematologist John Lollar, M.D., is using molecular biology to make improved clotting proteins for improving the treatment of coagulation disorders. His team is also investigating key enzymes involved in bleeding and clotting disorders.

HYPERTENSION IN BLACKS



The International Society for Hypertension in Blacks was founded by hypertension experts at Emory and Morehouse School of Medicine. The group provides forums in which ethnicity and disease research. The group is M.D., is an expert in using Positron Emission Tomography (PET) to evaluate heart disease in women. PET and electron beam tomography are the only "equal opportunity" imaging modalities for diagnosing heart disease in women, he says.



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TREATMENT



ANGIOPLASTY PIONEERED AT EMORY



Emory Heart Center is known the world over for pioneering angioplasty -- the less-invasive alternative to cardiac bypass surgery. The late Andreas Gruentzig, M.D., renowned for developing coronary angioplasty and for performing the first human procedure in 1977, directed the angioplasty program at the Emory University School of Medicine from 1981 until his death in 1985. The Andreas Gruentzig Cardiovascular Center is now a major component of The Emory Heart Center. A world authority on angioplasty, Spencer B. King III, M.D., professor of medicine (cardiology), directs the center's clinical and research activities.

EMORY ANGIOPLASTY VS. SURGERY TRIAL (EAST)



Completion of the landmark EAST trial, led by Spencer B. King III, M.D., in committed to determining why African-Americans have significantly higher rates of high blood pressure and kidney failure than whites. Emory researcher Josiah Wilcox is studying heart disease in blacks at the basic science level.

FLUID FLOW BLOOD FLOW



Is the tissue that lines blood vessel walls along curves under greater stress than tissues that lines the "straight-aways?" Are the endothelial cells lining the inside of branching arteries at higher risk for developing athersclerosis? Emory heart researchers are collaborating with engineers from the Georgia Institute of Technology to apply these questions to fluid flow mechanics.



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HEART TERMS & STATS



CORONARY ARTERY BYPASS SURGERY: One means of treating obstructed coronary arteries is to create new circulation pathways to bypass them. In coronary bypass surgery a surgeon connects a vein from the leg or an artery from the chest beyond the occlusion to bring unimpeded blood flow to the heart. Open heart surgery requires the opening of the entire chest cavity for surgical access. The procedure takes about four to six hours under general anesthesia, requires about five to seven days of in-patient hospitalization and up to 36 days out of work. Coronary bypass is the most common major surgery performed in America. According to the National Center for Health Statistics, 407,000 bypass surgeries were performed in 1991, the most recent year for which statistics are available.

ANGIOPLASTY: Occluded coronary arteries may also be cleared by percutaneous transluminal coronary angioplasty (PTCA). A cardiologist initiates the procedure by introducing a small tube (catheter) into a vein or artery, usually in the groin, and guides it to the occluded coronary artery. A tiny balloon at the tip of the catheter is inflated to flatten plaque against the arterial wall and improve circulation. Patients require only local anesthesia and may watch the catheter's journey via a special video screen. They spend one or two nights in the hospital and may return to work in about four days. Although initially less expensive, about 30 to 40 percent of the cleared arteries renarrow within a year and additional angioplasties or surgery are frequently required. The National Center for Health Statistics reports that 331,000 angioplasties were performed in the United States in 1991.

HEART STATS: Heart disease is by far the leading killer of Americans -- and far more lethal than AIDS and all cancers combined. The American Heart Association estimates about 1.5 million Americans will experience a heart attack this year and about one third will not survive. That translates to a heart attack every 20 seconds with every third one being fatal. For example, coronary artery disease kills six times the number of women who die of breast cancer.




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