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Innovations in Care and Research

Innovations in Care and Research

Read more about the latest clinical and research advances at Ohio State's Heart and Vascular Center

CMR Research Advances Detection of Myocardial Inflammation

Cardiovascular Magnetic Resonance (CMR) Pinpoints Inflammation Related to Sarcoidosis and Sepsis

Results of the Ohio State-based studies recently were published in the American Journal of Respiratory and Critical Care Medicine. Two cardiovascular imaging research studies recently completed at Ohio State are helping physicians more accurately diagnose and treat myocardial inflammation in patients with sepsis and sarcoidosis.

Co-principal investigators of the Ohio State-based studies Subha Raman, MD, Ohio State's cardiovascular magnetic resonance medical director, and Elliott Crouser, MD, one of the directors of critical care and the director of the sarcoidosis program at Ohio State, are confident their findings can improve patient outcomes by helping with individual risk stratification and guiding larger studies targeting myocardial inflammation in at-risk patients.

Nonischemic Myocardial Changes Detected by Cardiac Magnetic Resonance in Critical Care Patients with Sepsis

Troponin, a nonspecific serum biomarker for cardiac injury, often is elevated in patients with sepsis, raising suspicion for acute coronary syndrome. For many years, physicians have noted that patients with sepsis have a higher mortality rate if troponin is elevated, as compared with septic patients who don't have an elevated level. Muscle damage was often ascribed to ischemia, prompting treatment with blood thinners and cholesterol-lowering medications, or consideration of heart catheterizations to look for damage-causing coronary artery disease.

Through use of non-contrast cardiac magnetic resonance imaging (CMR), investigators at Ohio State have found that elevated troponin levels in patients with sepsis correspond to an inflammatory pattern of heart muscle injury, with preferential involvement of the subepicardium, rather than myocardial infarction that injures the subendocardium.

With an accurate diagnosis of myocardial inflammation, physicians can consider more tailored treatment options, including avoidance of unnecessary and potentially harmful treatments.

CMR may be helpful in patients with sepsis and elevated troponin level where the cause is uncertain.

Ohio State investigators predict that this study will prompt larger-scale clinical trials to target inflammatory myocardial injury in patients with sepsis and troponin elevation.

Improved Detection of Cardiac Sarcoidosis Using Magnetic Resonance with Myocardial T2 Mapping

Sarcoidosis is a multi-system, granulomatous disease of unknown cause that most commonly affects young adults, particularly black females. Recent studies indicate that sarcoidosis-related mortality is on the rise, perhaps relating to improved disease detection. Cardiac complications are the second leading cause of sarcoidosis-related death, and young adults particularly are at risk.

Cardiac sarcoidosis (CS) is commonly missed during routine clinical screening, including history, exam and electrocardiography (ECG). Most cases are detected for the first time during autopsy.

Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) is emerging as the preferred diagnostic modality. This may be insufficient, however, as LGE does not detect active and potentially reversible disease.

Through a retrospective study of 50 patients with histologically-proven sarcoidosis, Ohio State investigators have shown that more refined CMR-based myocardial characterization improves the detection of active myocarditis compared with LGE alone.

Given that active CS is an inflammatory condition, Ohio State researchers hypothesized that this approach demonstrates quantitative abnormalities in the myocardium of patients with sarcoidosis compared with controls, and myocardial T2 provides complementary myocardial characterization relative to LGE; these together likely form the myocardial substrate for conduction system disease and cardiac arrhythmias.

Ohio State researchers recommend CMR for patients with sarcoidosis who also have ECG abnormalities, palpitations, unexplained shortness of breath or chest pain.

CMR detection of cardiac sarcoidosis holds promise in preventing deadly – and largely under-recognized – complications of the heart by enabling earlier treatment with drugs such as immunosuppressives and steroids.

Dr. Crouser has received funding to expand sarcoidosis research to multiple centers. The investigators hope further implementation of their findings around the country and the world will reduce morbidity and mortality in cardiac disease.

Fenestrated Stent Graft Offers Solution for Para-Renal Aortic Aneurysms

Endovascular approach reduces complications, recovery time

Endovascular repair of para-renal aortic aneurysms using a fenestrated stent graft is one of the latest ways the Aortic Center at The Ohio State University Wexner Medical Center is improving patients’ lives.

“We are one of the few medical centers in Ohio with the specialized training to offer this endovascular procedure,” says Patrick Vaccaro, MD, director of the Division of Vascular Surgery at Ohio State.

Up to 4 percent of Americans experience abdominal aortic aneurysms, most commonly affecting men, people over age 65 and smokers. A smaller percentage of the population will have an aneurysm in the aorta near the renal arteries. Dr. Vaccaro says surgeons at Ohio State will likely insert the highly specialized endovascular stent graft in 10 to 15 patients this year.

“We see a potential for growth with this procedure and want to be at the leading edge,” he notes. He adds that the procedure is an excellent option for patients who aren’t good candidates for open surgery.

Advantages Over Open Surgery

Smaller incisions, less blood loss, less discomfort, fewer complications, a shorter hospital stay and faster recovery all are advantages of the endovascular approach as compared to open surgery. The graft is placed in the abdominal aorta in a sheath that is threaded through the femoral arteries.

By contrast, an open surgical procedure requires a much larger incision in the side or abdomen.

Aortic Center Expertise

“Several years ago, we started the Aortic Center to combine the skills and expertise of nearly a dozen vascular and cardiothoracic surgeons. Our excellent results and ongoing research draw patients from throughout Ohio, and beyond,” Dr. Vaccaro says. “We perform a high volume of vascular procedures, and our excellent results have been documented through independent organizations such as Leapfrog.”

Make a Referral

For a referral or more information, call 1-888-293-7677 [ROSS]


World’s Smallest Pacemaker Being Tested at Ohio State

Wireless Micra device recently implanted in Columbus woman

A tiny pacemaker about the size of a large vitamin pill is being tested in people with bradycardia at The Ohio State University Wexner Medical Center.

The Micra Transcatheter Pacing System is the smallest pacemaker available. Unlike conventional pacemakers that require implantation through a chest incision, this wireless device is threaded to the heart via a catheter through the femoral artery then attached directly to the heart muscle. It turns on only when the heart stops and can last up to 14 years.

Doctors at Ohio State’s Richard M. Ross Heart Hospital recently implanted the mini pacemaker in a Columbus woman as part of a global clinical trial to test its safety and effectiveness.  

“With this investigational device, the battery, the pacing electrodes, everything is in a little piece of metal sitting inside the heart. We believe that will eliminate a lot of risk for infection and complications,” says John Hummel, MD, a cardiologist and principal investigator of the trial at Ohio State.

Ralph Augostini, MD, also a cardiologist at Ohio State, says, “I think this could be a significant development in pacing procedures. This could cut our procedure time by more than half.”

For now, the tiny pacemaker is being tested in people with bradycardia who need single chamber ventricular pacing.

A former librarian, 77-year-old Mary Lou Trejo of Columbus had been suffering from atrial fibrillation for years. Her heart had slowed, despite medication and other treatments to restore rhythm, so she was eager to be among the first in the United States to participate in this clinical trial.

“The new pacemaker sounded so simple, and I have always thought research is important, so I thought this is a way I could contribute,” Trejo says.

The trial will enroll 780 patients in 50 centers worldwide. Investigators are expected to report initial results later this year, once the first 60 patients have been followed for three months.

The Micra Transcatheter Pacing System is made by Medtronic, which is funding the clinical trial. Dr. Hummel is a consultant for Medtronic. Dr. Augostini serves on a Medtronic advisory board. 

About Ohio State’s Electrophysiology Services

Ohio State’s integrated electrophysiology laboratory facility has six procedure rooms and 25 recovery rooms. We have central Ohio’s largest electrophysiology staff, with subspecialty electrophysiologists who provide focused care for a better patient experience and significantly improved outcomes.

For arrhythmia management, we have a dedicated 30-bed inpatient unit in the Richard M. Ross Heart Hospital.

Make a Referral

For a referral or more information, call 1-877-293-7677 (ROSS).  


New Director, New Studies Propel Ventricular Assist Device Program

New director, new studies propel Ventricular Assist Device Program forward

With one of the country’s largest ventricular assist device (VAD) programs, The Ohio State University Wexner Medical Center is offering people with advanced heart failure fresh hope for a better quality of life. Ahmet Kilic, MD, newly appointed medical director of Ohio State’s Ventricular Assist Device Program, leads both clinical and research efforts.

Ohio State’s Ventricular Assist Capabilities

Ohio State is recognized worldwide for its leadership in cardiac mechanical support. We have three cardiac surgeons who specialize in mechanical assist devices. Together, they implant long-term and temporary devices in more than 50 patients a year.

“We have the largest heart failure program in central Ohio, and most of our patients have advanced heart failure. Our goal is to recommend the best option for each person and provide excellent, patient-focused care,” says Ayesha Hasan, MD, a cardiothoracic surgeon and associate professor of Cardiovascular Medicine. “We want to see people as early as possible in the disease process to provide optimal outcomes. In the majority of cases, we can help improve the quality of life,” she continues.

Dr. Kilic adds, “Our expertise in providing a continuum of care for heart failure patients through a dedicated Heart Failure Disease Clinic allows us to care for some of the most complex patients.”

Primary reasons to implant long-term devices are as a bridge to heart transplantation or as destination therapy — a permanent solution for patients with advanced heart failure.

Devices include:

  • Heartmate, a VAD implanted in the chest to promote continuous blood flow from the left side of the heart into the aorta. The VAD is run by a small external computer, which is connected to the pump via a small cable that passes through the upper abdomen.
  • HeartWare, a more recently developed VAD approved as bridge to transplantation. It is implanted entirely within the heart sac and can be implanted in a wide range of people, including those of smaller stature. 
  • C-Pulse counterpulsation technology, available only through clinical trials. See below.

In addition, our surgeons can help patients in cardiogenic shock with temporary devices that sit outside the body to provide immediate circulatory support. “We have access to every available ventricular assist device, and our short-term and long-term survival rates exceed the national average. Quality in care is something we are very proud of and we will continue to hold ourselves to the highest expectations for our patients,” Dr. Kilic says.

VAD Research

“We have a very robust research program,” Dr. Kilic explains. “Taking part in national and international trials translates into better care for our patients.”

VAD studies currently under way at Ohio State include:

  • HeartWare clinical trial to evaluate the pump’s effectiveness as a destination therapy in addition to continuation of its Food and Drug Administration-approved use as a bridge to transplant 
  • HeartMate II® Prevent trial to reduce the rate of and prevent  pump thrombosis
  • HeartMate II® Roadmap trial to evaluate and compare the effectiveness of this VAD versus optimal medical management in ambulatory heart failure patients
  • C-Pulse trial to evaluate counterpulsation technology that acts like a balloon pump to increase coronary blood flow and cardiac output and reduce the heart’s pumping workload among patients with Class III and ambulatory Class IV heart failure

Ohio State enrolls its patients in INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support), a national registry with more than 6,000 patients from 145 hospitals that helps classify the severity of a patient’s illness and predict mortality of patients receiving a VAD implant.

Comprehensive Care Model for Heart Failure

Our surgeons collaborate with heart failure specialists, nurse practitioners, VAD coordinators, pharmacists, social workers and dietitians — all working in our Heart Failure Disease Clinic — to provide ongoing care for more than 90 patients with long-term VADs.

Looking Forward

VAD procedure numbers continue to increase at Ohio State, as a long-standing tradition of excellent care continues. “We’re on the forefront with new technology, including clinical trials in 2015 for the next generation of devices,” Dr. Kilic says. “My hope is to continue to build on the VAD Program’s strengths and engage the various physicians involved in the care of these complex patients. With continuous communication and early referral, we can continue to care for the ever-increasing number of heart failure patients. 

“The goal is to not only improve their survival, but perhaps more importantly, the quality of life for all of those suffering from advanced heart failure,” Dr. Kilic concludes.

About Our Medical Director

Ahmet Kilic, MD, joined The Ohio State University Wexner Medical Center in 2011 as a cardiothoracic surgeon, assistant professor of Surgery in the Division of Cardiac Surgery and clinical investigator for the Dorothy M. Davis Heart and Lung Research Institute.

In addition to serving as medical director for the Ventricular Assist Device Program, he helps lead Ohio State’s Level 1 Heart and Vascular Emergency Program and is the director of Education for the Cardiothoracic Surgery Training Program.

Dr. Kilic earned his medical degree from the Medical College of Virginia – Virginia Commonwealth University. He completed his surgical training at the University of Maryland and his cardiothoracic surgery residency at the University of Virginia.

You can reach Dr. Kilic at ahmet.kilic@osumc.edu or at 410-302-1396.

Make a Referral to Ohio State’s Mechanical Assist Device Program

Heart Failure Disease Clinic

614-293-6038

888-293-7677

VAD and Heart Transplant

614-293-3787

800-538-1886

URGENT REFERRAL

If a patient’s condition warrants an urgent outpatient evaluation or inpatient transfer, please notify us so we can expedite the patient’s care. To arrange a same-day physician consult or patient transfer, call our 24-hour referral and transfer service at 614-293-4444 or 800-824-8236.


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