Heart programs align for real-time translations

Heart failure. Heart rhythm disorders. Research shows when a patient suffers one, they're more likely to also suffer the other. And yet, most medical centers still silo these clinical programs into two disparate research organizations, delaying the translation of research into treatment.

At The Ohio State University College of Medicine, we believe our cardiac patients – as well as our students, faculty, researchers and physicians – deserve better.

Earlier this year, the two heart clinical and research groups aligned under the new Bob and Corrine Frick Center for Heart Failure and Arrhythmia at the Ohio State Richard M. Ross Heart Hospital through gifts totaling $18 million. The result? Real-time translation from research to patient care.

“Because Ohio State is invited to contribute to unsolved heart failure and arrhythmia cases internationally, research and clinician teams are able to discover new genetic mechanisms for heart diseases across the globe.” Click to tweet this story

Enhancing Science and Treatment, Together

Heart disease is personal for the Frick family. Bob Frick's parents, as well as an aunt, three uncles and two brothers, have dealt with heart problems. Bob Frick suffered a heart attack when he was 40 years old and had triple bypass surgery 11 years later — the same year his brother, Bernie, died of arrhythmia and heart failure. He was 60.

Funded by the family's generous gifts, the Frick Center supports life-changing research and education focused on integrating clinical and basic research on heart failure and arrhythmia. The donation also funded three endowed research chairs: a chair in heart failure, a professorship and a fellowship for the College of Medicine.

Beyond research, a second benefit of the Frick Center is realized in patient care. The unique approach provides a seamless integrated clinical experience in which a patient can easily see both heart failure and arrhythmia teams in one location.

Treatment decisions are coordinated and streamlined, and research and learning are bridged with patient care.

  • Heart failure occurs when the heart muscle doesn't pump blood as well as it should, or stops entirely. According to the Centers for Disease Control and Prevention (CDC), it's the leading cause of death for both men and women in the United States.
  • Heart arrhythmia is a chronic condition that occurs when electrical impulses which coordinate heartbeats don't work properly, causing the heart to beat too fast, too slow or irregularly. It can lead to stroke, heart failure and cardiac arrest.

More than 6 million Americans live with heart failure and about 8 million have irregular heartbeats, according to the CDC. Understanding how the two conditions are related, researchers and clinicians at Ohio State work side by side to facilitate rapid translation of discovery into patient care.

Research translations that previously took years to get to patients can now happen in a matter of days – and, in some cases, hours.

"You can see translation in real time," says Peter Mohler, PhD, vice dean for Research, director of the Dorothy M. Davis Heart and Lung Research Institute, and professor and chair of the Department of Physiology and Cell Biology. "You don't have to wait 15 years. We see it every day at Ohio State."

"When we get out of our silos, we get a better real-time approach seeing patients," says Sakima Smith, MD, a heart failure transplant cardiologist. "What we're doing from a basic science standpoint is not only applicable but readily translatable every day."

Dr. Mohler discusses the incredible heart and vascular research that is happening at the Ohio State Wexner Medical Center’s Dorothy M. Davis Heart and Lung Institute.

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Enhancing Science and Treatment, Together

If you want to make breakthroughs in human heart research, one thing is certain – you need the real thing. One key benefit of keeping researchers and clinicians in close quarters is the ability to use actual human hearts for scientific study. While lab mice offer significant insight into basic science, human hearts respond differently to treatment and add significant value to translation and treatment.

Research teams at Ohio State understand that the privilege of working with a human heart comes with great responsibility. When a new heart becomes available, time is of the essence – teams must mobilize immediately, before cell deterioration begins. Recently, Vadim Fedorov, PhD, associate professor of Physiology and Cell Biology, was participating in a triathlon with his research team when they received the call that not one but two new hearts had become available. "We had to finish the race by relay as a team," he explains with a smile. "We arrived at the lab one by one – as we finished the race – and got right to work."

3D Imaging Identifies "Tornadoes" on the Heart

Dr. Fedorov's laboratory research is focused on developing new targeted antiarrhythmic treatments. They do so by using state-of-the-art 3D imaging techniques to uncover functional, structural and molecular mechanisms of malignant cardiac arrhythmias.

"Trying to identify electric function can be very difficult with atrial fibrillation patients, as the electrical function isn't straight as it should be. It swirls, like a tornado," he explains. When arrhythmia micro-scars are present on the heart, they create anchors for these spiraling waves of electricity, keeping them from flowing as intended. With help from 3D infrared camera imaging and a fluorescent dye, Dr. Fedorov and his team are able to not only identify the inhibiting micro-scars, but also precisely deliver treatment to the tissue and connection pathways for local healing of the heart. "Using this technology, we can make the heart beat properly again," he says.

Dr. Fedorov's team is also using this technology to improve or restore the impaired portions of the sinoatrial node (SAN), the heart's main natural pacemaker, which normally consists of three intranodal pacemakers and five conduction pathways. "Patients are at high risk of cardiac arrest if the SAN gets down to one pacemaker, or one conduction pathway," Dr. Fedorov says. "Knowing this, our next quest is to work with electrophysiologists to more precisely identify who needs a pacemaker implant, and who still has backups and can get along without one." Clinicians are excited by this discovery. Their hope is that, someday, pacemaker implants will be obsolete – and the heart's natural electrical and mechanical capabilities can be restored.

Diagnostics Display Fingerprints of Disease

When it comes to heart health, sometimes patients need cardiac diagnostic tests to identify issues properly and get their motor running again. "The heart is mechanical – it contracts and circulates blood like a machine," explains Tom Hund, PhD, professor of Biomedical Engineering. "At Ohio State, we fix electrical and mechanical problems together, not in isolation."

As a biomedical engineer, Dr. Hund is part of Ohio State's College of Engineering. Yet, his state-of-the-art, cross-functional lab resides in the heart of the College of Medicine, where he's been studying arrhythmia mechanisms for nearly a decade. "There are no centers that combine research and clinical in the heart failure and arrhythmia space like this," he says.

Ohio State's diverse, holistically built teams allow Dr. Hund and his colleagues to stay highly specialized with depth of expertise, while synergistically complementing the cross-functional collaborators next door. "You'd be pressed to find a similar environment," he says. "Not only in the United States, but in the world."

Dr. Hund's team is currently studying the human heart's cytoskeletal response to stress and exercise, for better or worse. "We know an elite athlete's heart gets bigger as they train in a way that supports increased cardiac output," Dr. Hund explains. "A heart failure patient also has an enlarged heart – but for very different reasons, with deadly outcomes."

Uncovering the reasons for the growth at a molecular level allows for the identification of biomarkers to benefit both research findings and patient therapies. This unique approach allows for precision therapies, rather than typical trial-and-error treatments.

Genetic Pathways Overcome Cultural "Curses"

Discovering new genetic pathways for heart disease and testing varying treatments happens off-campus, too. "We get calls from groups around the world asking to collaborate," Dr. Mohler says.

Because Ohio State is invited to contribute to unsolved heart failure and arrhythmia cases internationally, research and clinician teams are able to discover new genetic mechanisms for heart diseases across the globe.

Whether we're fighting heart disease and arrhythmia in children in Saudi Arabia or elite athletes in Southern California, Ohio State's College of Medicine is restoring hearts and expanding minds internationally. "It's changing the way we do medicine," Dr. Mohler says.

"It takes a top-down commitment from leadership to build an organization like ours," Dr. Hund says. "And we have that here at Ohio State. I love the innovation that comes with being a Buckeye."

And breaking down physical and administrative barriers between once-thought unrelated heart conditions is how Ohio State will continue to lead the way, now and into the future.

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