Cardiac Catheterization Laboratory
Fellows are encouraged to participate in the ongoing research activities of the catheterization laboratory. Major research efforts are focused on the pathophysiology and therapy of unstable coronary syndromes. Some of these research endeavors are concerned with interventional procedures, including the determinants of thrombosis during angioplasty; intravascular ultrasound during percutaneous interventions; mechanisms of the early change in luminal diameter following interventional procedures; comparisons of angioplasty to atherectomy; trials of new stents; and IVUS guided stenting. In addition, myocardial regeneration is an area of ongoing research activity. Mount Sinai is the coordinating center of the international, multicenter, NIH-sponsored FREEDOM trial of coronary revascularization (percutaneous or surgical) in diabetic patients.
Research in the Echocardiography Laboratory covers a broad range of subjects including new, emerging technologies (three-dimensional echocardiography, Doppler tissue imaging, high frequency imaging of coronary arteries and atherosclerotic lesions), transesophageal echocardiographic evaluation of left atrial appendage dysfunction, and cardio-embolic risk and newer contrast agents. A number of studies (completed and underway) have looked at the utility and impact of portable handheld echocardiographs in locales as such as the Coronary Care Unit and Emergency Room while using a range of imagers (from medical students to medical residents to cardiology fellows). There has been collaboration with Dr. Juan Badimon's laboratory in the serial in vivo assessment of human plaque under treatment with lipid lowering drugs. Several studies of left ventricular dyssynchrony are underway (many using real-time, three-dimensional echocardiography) in a collaboration between the echocardiography and electrophysiology groups.
Research interests in this area include atrial flutter-fibrillation mapping and ablation, risk assessment of post-myocardial infarction patients, signal-averaged electrocardiography (both for atria and ventricles) and clinical trials related to investigational antiarrhythmic drugs. In a collaborative effort with the Heart Failure Program and the Echocardiography Laboratory, the optimization of biventricular pacemakers is under intense study.
Heart Failure and Cardiac Transplantation Program
Research in the Heart Failure and Transplant Program encompasses both the basic science laboratories and clinical research. Current clinical research involves neurohormonal, exercise and hemodynamic evaluation in heart failure patients. In addition, ongoing studies of alterations in immunosuppressive regimens have borne fruit, with excellent graft survival and few side effects.
Current basic science research includes regulation of calcium channels in heart failure, the development of animal models to study gene regulation during heart failure and the use of antiproliferative drugs to prevent accelerated atherosclerosis and rejection after transplant. Clinical research now involves markers for rejection, protocols for myocarditis, immunosuppressive protocols, and prevention of allograft arteriopathy.