2009 Faculty Presentations

Below is the list of faculty presentations for ACC Lake Louise 2009. For faculty info, abstract(s), supplemental slides and/or podcasts, please click on the physician’s name.

Paul W. Armstrong, MD FRCPC

• Do ACS Guidelines Change Clinical Practice?
  Podcast available.

Heidi Maria Connolly, MD FACC

• Update on Infectious Endocarditis Prophylaxis
• Evaluation of Cardiac Masses
  Presentation notes and podcasts available.

Ralph Damiano, Jr., MD FACC

• Surgical Treatment of Atrial Fibrillation
• CABG vs. PCI for Left Main and Three-Vessel Coronary Artery Disease: The Great Debate
  Presentation notes and podcasts available.

Justin Ezekowitz, MBBCh MSc FRCPC

• Canadian Cardiovascular Society Workshop:
  The Many Different Faces of Heart Failure
  Presentation notes and podcasts available.

Paul W. M. Fedak, MD PhD FRCSC

• Bigger Is Not Better: How to Shrink a Failing Heart
  Podcast available.

Matthias G. Friedrich, MD FESC

• New Approaches to Imaging in Acute Infarction: The Role of CT and MRI
  Podcast and notes available.

Bernard J. Gersh, MB ChB DPhil FRCP FACC

• From Darwin to Tilt Table Testing: Pathophysiology and Management of Vasovagal Syncope
• The Natural History of Atrial Fibrillation: Is It a Vascular Disease?
  Presentation notes and podcasts available.

Chris Granger, MD FACC

• Reorganizing Acute MI Care: What Next in Canada and the United States
• Clinical Trials: Why They Fail to Meet Expectations
  Presentation notes and podcasts available.

Jonathan Howlett, MD FRCPC

• Canadian Cardiovascular Society Workshop
  The Many Different Faces of Heart Failure
  Presentation notes and podcasts available.

Debra Lynn Isaac, BN MD FRCPC

• Canadian Cardiovascular Society Workshop
  The Many Different Faces of Heart Failure
  Presentation notes and podcasts available.

Peter Liu, MD FRCPC FACC

• Ronnie Campbell Memorial Lecture Heart Failure Lost and Found - Discoveries over 25 Years
• Looking Forward: Are We Ready for Cardiovascular Vaccines?
  Presentation notes and podcasts available.

Allan M. Ross, MD FACC FAHA

• The Treatment of AMI: What Have We Learned in 50 Years?
  Presentation notes and podcasts available.

Erik Schampaert, MD FRCPC

• CABG vs. PCI for Left Main and Three-Vessel Coronary Artery Disease: The Great Debate
• Antithrombotics in Post-PCI Care
  Presentation notes and podcasts available.

Reginald E. Smith, PharmD ACPR

• Knowledge Translation Workshops
  Case-Based Interactive Exercises with Faculty

• Canadian Cardiovascular Pharmacists Network (CCPN) Pharmacotherapy Workshop

Mario Talajic, MD FRCPC

• Pulmonary Vein Ablation for Atrial Fibrillation
• Management of Atrial Fibrillation in Heart Failure
  Presentation notes and podcasts available.

Alexander Turpie, MD FRCPC

• Venous Thromboembolic Disease: Diagnosis and Treatment
• Novel Anticoagulants: Goodbye, Warfarin!
  Presentation notes and podcasts available.

David D. Waters, MD FACC

• Newer Indications and Limitations of Statin Therapy
• The Metabolic Syndrome: What Every Cardiologist Should Know
  Presentation notes and podcasts available.

Paul W. Armstrong, MD FRCPC

Paul Armstrong is University Professor of Medicine (Cardiology) and Director of the Canadian VIGOUR Centre (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research).

Dr. Armstrong’s investigative career has developed around congestive heart failure and acute coronary syndromes. He frequently serves as visiting professor and is the author or co-author of over 400 peer reviewed publications. He is also a member of a number of international editorial boards, advisory groups and consults widely on health science matters.

Dr. Armstrong has received several awards, including the: Research Achievement Award of the Canadian Cardiovascular Society, Heart and Stroke Foundation Award of Merit, Robert Beamish Leadership Award, Prix Galien
Canada Research Award, and University of Alberta Kaplan Award for Excellence in Research.

Do ACS Guidelines Change Clinical Practice?

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Heidi Maria Connolly, MD FACC

Heidi Connolly is a Professor of Medicine and a Consultant in Cardiovascular Diseases at Mayo Clinic.

She received her medical degree from the Royal College of Surgeons in Dublin Ireland. She completed an Internal Medicine residency, Cardiology fellowship at Mayo Clinic. Subsequently she completed special training in Echocardiography and Adult Congenital Heart Disease and is Board Certified in both Internal Medicine and Cardiovascular Diseases.

Dr. Connolly is Director of the Congenital Heart Center and Co-Director of the Marfan and Thoracic Aortic Clinic at Mayo Clinic. She is an active member of the Echocardiography Laboratory with special interests in congenital and intraoperative echo.

Additional clinical and research interests include valvular heart disease, carcinoid heart disease, and cardiac disorders in pregnancy. Among other awards, Dr. Connolly has been recognized by the Mayo Cardiovascular Division Fellows for her teaching programs. She also received the United States Department of Health and Human Services FDA Commissioner’s Special Citation for her work on drug related valve disease.

Update on Infectious Endocarditis Prophylaxis

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Evaluation of Cardiac Masses

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Ralph Damiano, Jr., MD FACC

Ralph J. Damiano, Jr., M.D., earned a B.S. in biology and graduated summa cum laude from Dartmouth College. He was awarded an M. D. degree from Duke University and went on to complete both his General Surgery and Cardiothoracic Surgery training at Duke University Medical Center. From 1996 until 2000, Dr. Damiano was Professor and Chief of the Division of Cardiothoracic Surgery at Hershey Medical Center, Penn State University. He joined the faculty of Washington University School of Medicine as the John M. Shoenberg Professor of Surgery and Chief of Cardiac Surgery in April, 2000. In 2005, he was appointed Vice-Chairman of the Department of Surgery.

His clinical interests include all aspects of adult cardiothoracic surgery, with particular emphasis on coronary artery revascularization, atrial fibrillation surgery, valve repair and minimally invasive surgery. He was one of the pioneers of robotically assisted cardiac surgery and performed the first robotically-assisted surgery in North America in 1998. His group has also been the world leader in the research and development of surgery for atrial fibrillation.

Dr. Damiano has over 250 publications and has given over 300 invited lectureships around the world. He was Associate Editor of the Journal of Thoracic and Cardiovascular Surgery from December 1998 through January 2008 and is presently Editor of the journal Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. He has been President of the Cardiac Surgery Biology Club, is President-elect of the Society of Clinical Surgery, and also President-elect of the International Society for Minimally Invasive Cardiothoracic Surgery. In 2006, he was the recipient of the Clinical Teacher of the Year Award at Washington University School of Medicine. He was named the 2008 Physician Health Care Hero of the Year by the St. Louis Business Journal.

Surgical Treatment of Atrial Fibrillation

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CABG vs. PCI for Left Main and Three-Vessel Coronary Artery Disease: The Great Debate

View presentation (PDF)

Justin Ezekowitz, MBBCh MSc FRCPC

Dr. Justin Ezekowitz obtained his undergraduate medical training at the Royal College of Surgeons in Ireland, achieving an honors degree. He completed his medical residency at the University of Texas Southwestern Medical Centre in Dallas, Texas, a Masters of Science in Clinical Epidemiology at the University of Alberta Public Health Sciences (as well as participating in the CIHR TORCH program), and his Cardiology fellowship at the University of Alberta.

His clinical interests are focused on heart failure. He is the Director of the Heart Function Clinic at the University of Alberta Hospital, the oldest and one of the largest heart function clinics in Canada. He is also involved in the setting up of the chronic disease management programs in heart failure across Alberta. He is also on the 2008 and 2009 CCS HF guideline committee.

His research focus is heart failure. He is involved in numerous clinical trials in heart failure both at a local investigator-initiated level as well as multicenter international trials. Primary interests include clinical research into heart failure with a preserved systolic function, population health of heart failure, devices in heart failure, and acute heart failure. He has published numerous manuscripts related to the outcomes of heart failure patients in Circulation, JACC, CMAJ, JAMA and Annals of Internal Medicine amongst others.

Canadian Cardiovascular Society Workshop
The Many Different Faces of Heart Failure

Download presentation (PDF)

• Vignette 2: I wish I had taken my anti-hypertension medications. Now what do I do? “Treat me like it’s 1974.”
• Vignette 3: What do you mean I have heart failure?

Paul W. M. Fedak, MD PhD FRCSC

Paul W. M. Fedak graduated with honours from the University of Toronto medical school and completed further training in cardiac surgery (F.R.C.S.C.) and biomedical science (Ph.D.) in Toronto. He was awarded a Detweiler Fellowship from the Royal College of Physicians and Surgeons of Canada which supported advanced training in surgery for end-stage heart disease at Northwestern Dr. Fedak is currently an active clinical cardiac surgeon and independent research investigator at the University of Calgary. He is a “Clinical Investigator” of the Alberta Heritage Foundation for Medical research (AHFMR). Dr. Fedak aims to develop novel approaches to treat heart failure, through mechanical device, stem cell and tissue engineering platforms. He has published over 60 peer-reviewed original manuscripts and five book chapters in this field.

Dr. Fedak serves as an Invited Reviewer and/or Editorial Board Member for 12 leading biomedical publications. He is a “Distinguished Reviewer” of the Journal of Thoracic and Cardiovascular Surgery. He is the recipient of numerous international and national research awards. Some of these include the C. Walton Lillehei Award (American Association for Thoracic Surgery), Vivien Thomas Young Investigator Award (American Heart Association), Paul Cartier Award (Canadian Society of Cardiac Surgeons), and Wilfred Bigelow Award (University of Toronto). He actively serves on Committees for the American Heart Association and Canadian Cardiovascular Society.

Bigger Is Not Better: How to Shrink a Failing Heart

Matthias G. Friedrich, MD FESC

Matthias Friedrich earned his MD in 1990 in Erlangen, Germany. He completed his cardiology training in Berlin, Germany with cardiac intensive care, invasive and non-invasive imaging as his main areas of interest. Among other responsibilities, he served as the Deputy Director of the Cardiology Department (Franz-Volhard-Klinik) at the Charité University Hospital in Berlin.

Since his time as a graduate student he has been active in research using Cardiovascular Magnetic Resonance (CMR). In 1991, he published his first paper on CMR spectroscopy. His main scientific interest, though, has been tissue characterization in acute and chronic heart disease. In 1995, he founded the CMR working group at the Humboldt University in Berlin and published several seminal papers on the clinical use of CMR in cardiomyopathies and myocarditis in the subsequent years.

In 2004, he assumed the position of the Director of the Stephenson Cardiovascular MR Centre Libin Cardiovascular Institute of Alberta in Calgary. He holds an appointment as Associate Professor for Medicine with the Departments of Cardiac Sciences and Radiology at the University of Calgary.

Dr. Friedrich has published more than 80 papers and book chapters on CMR, is a reviewer for several grant agencies, numerous specialty journals, and a member of several editorial boards. For 2007 and 2008, he was the Chair of the Program Committee of the Society for Cardiovascular Magnetic Resonance (SCMR). In 2005, Dr. Friedrich founded the Canadian Society for Cardiovascular MR and is its elected President.

New Approaches to Imaging in Acute Infarction: The Role of CT and MRI

Electrocardiograms, biomarkers, and ventricular function studies are diagnostic tools that are currently used to assess patients with acute myocardial disease. These tools are limited in their diagnostic accuracy and scope. Thus, for informed therapeutic decision making, tissue characterization may serve as a very important source of information in these initially regional diseases. Cardiac magnetic resonance (CMR) is becoming an important tool for phenotyping cardiac patients in vivo. Recent advances of CMR hardware and software as well as protocols have allowed for accurately visualizing tissue changes in patients with acute myocardial diseases. This is of special interest for acute myocardial infarction and acute myocarditis, because these entities may have a very similar clinical presentation and require immediate therapeutic decision making. Several CMR approaches can be combined in a comprehensive CMR examination, which provides information not only on ventricular size, morphology, and function, but also on the stage, degree, and extent of reversible and irreversible myocardial injury.

Streamlined protocols allow such a CMR examination to be a time- and cost-efficient diagnostic tool, even in patients with acute disease. Current CMR approaches for visualizing tissue pathology in vivo are reviewed, examples are presented, and the potential role of CMR tissue characterization in patients with acute myocardial disease is discussed. The specific role of imaging the extent and regional distribution of myocardial edema and necrosis is discussed. (J AmColl Cardiol Img 2008;1:652-62)©2008 by the American College of Cardiology Foundation.

Bernard J. Gersh, MB ChB DPhil FRCP FACC

Dr. Bernard Gersh is Professor of Medicine at Mayo Clinic College of Medicine, Consultant in Cardiovascular Diseases and Internal Medicine and Associate Chair of Academic Affairs and Faculty Development in the Division of Cardiovascular Diseases at Mayo Clinic.

His past positions include The W. Proctor Harvey Teaching Professor of Cardiology and Chief of the Division of Cardiology at Georgetown University Medical Center. Dr. Gersh received his MB, ChB, from the University of Cape Town in South Africa. He received his Doctor of Philosophy Degree from Oxford University where he was a Rhodes Scholar. Dr. Gersh is a Fellow of the South African College of Physicians and Royal College of Physicians in the United Kingdom as well as a Fellow of the American College of Cardiology, and the American Heart Association.

Dr. Gersh’s interests include the natural history and therapy of acute and chronic coronary artery disease, clinical electrophysiology, adult congenital heart disease, the cardiomyopathies and the clinical implications of molecular genetics. He has written 620 articles and 124 book chapters. Dr. Gersh is the editor of 11 books and is on the editorial board of 25 journals including Circulation, Journal of the American College of Cardiology (Senior Consulting Editor), Nature Cardiovascular Medicine, and The European Heart Journal (Deputy Editor). He is a member of the Advisory Board of the Reynolds Foundation, a Past Chairman of the Council of Clinical Cardiology of the American Heart Association, and a former Member of the Board of Trustees of the American College of Cardiology. He has served on the Steering Committees and Data Safety Monitoring Boards of multiple clinical trials, sponsored by the National Lung and Blood Institute and other organizations.

Dr. Gersh’s honors include Teacher of the Year Award from the Division of Cardiovascular Diseases, Mayo Clinic, and numerous Visiting Professorships and Invited Lectures both nationally and internationally. He is an Honorary Member of the South African Cardiac Society and The South African Heart Association, and he is an Honorary Fellow of the Sociedad Chilena de Cardiología y Cirugía Cardiovascular. He is an Honorary Professor of Medicine at the University of Cape Town, South Africa.

Dr. Gersh was the 2004 recipient of the Distinguished Achievement Award of the AHA Council of Clinical Cardiology and the 2007 recipient of the ACC Distinguished Service Award.

Ph.D. (honoris causa) from The University of Coimbra, Portugal in 2005. He summited Mount Kilimanjaro in 2002.

From Darwin to Tilt Table Testing: Pathophysiology and Management of Vasovagal Syncope

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The Natural History of Atrial Fibrillation: Is It a Vascular Disease?

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Chris Granger, MD FACC

Dr. Christopher Granger is a Professor of Medicine in the Division of Cardiology at Duke University. He is Director of the Cardiac Care Unit and co-director of cardiovascular clinical trials at the Duke Clinical Research Institute. He is a Fellow of the American College of Cardiology and of the European Society of Cardiology. He is Associate Editor of the American Heart Journal and serves on the editorial boards of the Journal of the American College of Cardiology and the European Heart Journal. He is on the Board of External Experts of the National Heart, Lung and Blood Institute (NHLBI) and on the clinical trials review committee for CIHR. He is on various committees for the American Heart Association and American College of Cardiology.

His primary research interest is in conduct and methodology of large randomized clinical trials in heart disease. He has co-authored over 250 peer-reviewed manuscripts. He has recently coordinated the Duke Clinical Research Institutes’ activities in the ASSENT-4 PCI, OASIS-5 and -6, and APEX-AMI trials that evaluated acute MI reperfusion and antithrombotic strategies; and the CHARM trial that evaluated angiotensin receptor blockers for heart failure. He is co-chairman of the Steering Committee of the ARISTOTLE trial assessing an oral factor Xa inhibitor for stroke prevention in atrial fibrillation. He is co-director of the Reperfusion of Acute MI in Carolina Emergency Departments (RACE) project that is a North Carolina state-wide program to improve reperfusion care for acute myocardial infarction.

Reorganizing Acute MI Care: What Next in Canada and the United States

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Clinical Trials: Why They Fail to Meet Expectations

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Jonathan Howlett, MD FRCPC

Dr. Howlett graduated from Medical School, University of Toronto in 1989. He completed Internal Medicine and Cardiology Fellowship training at Dalhousie University in 1994, and continued at the Toronto Congenital Cardiac Centre for Adults, University of Toronto.

Dr. Howlett was on active staff at the Queen Elizabeth II Health Sciences Centre from September 1995 to August 2008, where he became Clinical Professor of Medicine at University of Calgary, at the Foothills Medical Centre. Current activities also include acute chronic heart failure, and evaluation of health care delivery and outcomes and Knowledge Translation.

He is currently Principal Investigator for A Strategy of Telehomecare for the Treatment of Heart Failure (STARTEL), a multicentre Canadian study evaluating the impact of telehomecare treatment for heart failure patients with issues of difficult access to care. He serves on several Steering and Executive Committees for international clinical trials. He is Chair of the Canadian Cardiovascular Society Consensus Conference Primary Panel for the Diagnosis and Management of Heart Failure, co-Chair of the CCS Heart Failure Workshop Initiative and a member of the recent Canadian Heart Health Strategy initiative.

Dr. Howlett has over 60 peer reviewed articles published or in press in addition to over 80 abstract presentations.

Canadian Cardiovascular Society Workshop
The Many Different Faces of Heart Failure

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Debra Lynn Isaac, BN MD FRCPC

Dr. Debra Isaac started her career in Health Care as a registered nurse, working as a staff nurse and nurse educator in Intensive Care and Cardiac Intensive Care Units in Winnipeg and Calgary. She obtained her MD degree and completed residency training in Internal Medicine at the University of Calgary. She then completed a fellowship in Cardiology at Northwestern University in Chicago, and has done further clinical and research fellowships in Echocardiography, Heart Failure, and Cardiac Transplantation.

She is currently an Associate Clinical Professor of Medicine at University of Calgary, Director of Cardiac Transplant at the Foothills Medical Centre, and Medical Director of the Echocardiography Lab at the Rockyview Hospital. She runs a clinical heart failure research program at the Heritage Medical Research Clinic, University of Calgary.

Canadian Cardiovascular Society Workshop
The Many Different Faces of Heart Failure

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• Vignette 1: Third Lead or Third Wheel? Should we ‘Synchronize’ my ICD?
  Dr. Debra Isaac

• Vignette 4: I only had the flu… what is the big deal?
  Dr. Debra Isaac

Peter Liu, MD FRCPC FACC

Dr. Peter Liu is the Scientific Director of the Institute of Circulatory and Respiratory Health at the Canadian Institutes of Health Research. He is also the Heart & Stroke/Polo Chair Professor of Medicine and Physiology at the Toronto General Hospital, University Health Network, and till recently, the Director of the Heart & Stroke Richard/Lewar Centre of Excellence for Cardiovascular Research at the University of Toronto.

He completed his MD degree at the University of Toronto, and did his postgraduate training at Harvard University. Dr. Liu has focused his research on the causes of heart failure from bench to bedside, and the condition afflicts one in five Canadians. His team has identified the role of inflammation in changing heart structure and function, and identified potential new biomarkers through system biology approaches and novel treatment targets. His laboratory has also identified how viruses and bacteria can accelerate heart failure and coronary artery disease, and is developing novel vaccines to prevent these complications.

He has published over 250 peer reviewed articles in high impact journals, including Nature, Nature Medicine, and the New England Journal of Medicine. He has received numerous awards in recognition of his accomplishments, including the Rick Gallop Research Award from the Heart & Stroke Foundation (2003), the Research Achievement Award from the Canadian Cardiovascular Society (2003), the Extramural Award of Merit from the American College of Cardiology (2005), Postgraduate Mentorship Award from the University of Toronto (2006), and Award of Merit from the Federation of Chinese Canadian Professionals (2006). He has been the scientific program chair of the Canadian Cardiovascular Society, Heart Failure Society of America and International Society of Heart Research Scientific Sessions. He is the President-Elect of the International Society of Cardiomyopathy and Heart Failure of the World Heart Federation. He co-chaired a series of Canadian Cardiovascular Society Consensus Guideline Recommendations for heart failure care. He also chaired several CIHR and NIH scientific review panels. He is also the co-chair the 6th International Initiative on Global Cardiovascular Proteomics for HUPO (Human Proteome Organization), and will be co-hosting the 2009 International HUPO Meeting in Canada.

At the Canadian Institute of Health Research (CIHR), he coordinates research in heart, lung, blood and critical care and establishes strategic directions for the Canadian research community, and liaises with national and international partners. He is also the champion of the CIHR’s Clinical Research Initiative, promoting excellence and building capacity to maximize the opportunity in translating fundamental discoveries to the bedside, and fostering excellence in evidence based health care delivery to Canadians.

Ronnie Campbell Memorial Lecture Heart Failure Lost and Found - Discoveries over 25 Years

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Looking Forward: Are We Ready for Cardiovascular Vaccines?

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Allan M. Ross, MD FACC FAHA

Allan M. Ross was born in New York City. He graduated from Northwestern University (BA) and Chicago Med (MD). His internal medicine and cardiology training was at George Washington University, University of Colorado and Yale University.

His faculty positions have been at Yale and George Washington University. At the latter he served as Director of the Cardiology Division from 1978 to 1994. His present position is Professor of Medicine Emeritus (cardiology).

Dr. Ross’ investigative career has focused on acute coronary syndromes. Amongst trials he designed, managed or served on executive committees are TIMI 1 and 2, GUSTO 1 (designed and managed the angiographic substudy) and PACT. Presently he is Co-Chairman and US Principal Investigator for ASSENT 4-PCI.

The Treatment of AMI: What Have We Learned in 50 Years?

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Erik Schampaert, MD FRCPC

Dr. Schampaert completed his M.D. in 1989, and a residency in Cardiology in 1994, University of Montreal, and a fellowship in interventional Cardiology in 1996, University of Toronto.

He is a clinical associate professor of Medicine at the University of Montreal since 2005 and works as an interventional cardiologist at Hopital du Sacré-Coeur de Montreal since 1997, serving as director of the cardiac catheterization laboratories and the clinical cardiovascular research unit since 2001 and head of the Division of Cardiology since 2006.

His research interests are stents (BMS and DES), coronary physiology (FFR) and imaging (IVUS), ACS, and more recently platelet function studies with clopidogrel and aspirin under the leadership of Drs. Pharand and Diodati. Since 2001, he is the principal investigator of C-SIRIUS and a steering committee member for E-SIRIUS. His current research interest is focused on the mechanisms of stent thrombosis, ULM PCI and new generation DES, acting as the Canadian P.I. and angiographic sub-study P.I. for the new biodegradable polymer Sirolimus-eluting stent (RESOLUTION, Cordis J&J) research program (RES-II and RES-III), currently underway.

He has authored or co-authored of more than 30 manuscripts in peer-reviewed journals such as NEJM, Lancet, Circulation, JACC and EHJ. He has been the local PI for more than 40 clinical trials since 1997. He is co-director for the Annual Canadian IVUS and Coronary Physiology workshop with Dr. Fort since 1998, for the Tremblant Interventional Cardiology (TCI) since 2009, a faculty to the Montreal Interventional Cardiology Course since 1999 and an invited international faculty to the TCT since 2003.

Finally, he serves as the president of the Canadian Association of Interventional cardiologists (CAIC) since 2007.

CABG vs. PCI for Left Main and Three-Vessel Coronary Artery Disease: The Great Debate
Dr. Ralph Damiano, Jr., and Dr. Erick Schampaert

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Antithrombotics in Post-PCI Care

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Reginald E. Smith, PharmD ACPR

Reg Smith is a Clinical Pharmacy Specialist in Cardiology at the Royal Jubilee Hospital (RJH) in Victoria, BC, and a Clinical Researcher at the Victoria Heart Institute. He operates the Venous and Arterial Thromboembolism Clinic for the Vancouver Island Health Authority. He is also a Clinical Instructor in the Island Medical Program, University of Victoria, and the Faculty of Pharmaceutical Science at the University of British Columbia.

Dr. Smith’s area of research interest is in anticoagulation and antithrombotic therapies. He has been either a principle or co-investigator in more than 50 clinical trials, including many in the treatment and prevention of venous or arterial thromboembolism. A large portion of Dr. Smith’s clinical practice is in the perioperative/periprocedural management of anticoagulation.

Dr. Smith was the recipient of a Pfizer Cardiovascular Research Grant Award for 2007 on behalf of the Canadian Cardiovascular Pharmacists Network.

Knowledge Translation Workshops
Case-Based Interactive Exercises with Faculty

Canadian Cardiovascular Pharmacists Network (CCPN) Pharmacotherapy Workshop

Mario Talajic, MD FRCPC

Dr. Talajic is a cardiac electrophysiologist at the Montreal Heart Institute and is currently the JC Edwards professor of medicine at the University of Montreal. He is also the director of specialty training programs for the department of medicine of the university of Montreal and is the director of the cardiac genetics center of the Montreal Heart Institute.

He completed his medical training at the University of Ottawa in 1980. He completed internal medicine and cardiology training at McGill University in 1985. He subsequently completed fellowship training in cardiac electrophysiology at McGill University with Dr Stanley Nattel and at the University of Limburg under the guidance of Professor Hein Wellens. He has been a cardiac electrophysiologist at the Montreal Heart Institute since 1987. He was chief of the electrophysiology service from 1991 until 1998 and was the chief of medicine and cardiology of the Montreal Heart Institute from 1998 until 2006. He became the first Marvin and Philippa Carsley chair in cardiology in 2005. He has served in the past as a Royal College examiner in cardiology and has won teaching and career achievement awards from the University of Montreal. He has also served on multiple peer-reviewed research committees in Canada and chaired a provincial committee on electrophysiology services in Quebec. He currently serves onthe council of the Canadian Cardiovascular Society where he chairs the Canadian Journal of Cardiology committee.

His research interests include the pharmacologic treatment of cardiac arrhythmias, the treatment of patients with atrial fibrillation and the stratification of patients at risk for sudden death. He has authored more than 180 peer-reviewed articles and book chapters and over 270 abstracts.

Pulmonary Vein Ablation for Atrial Fibrillation

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Management of Atrial Fibrillation in Heart Failure

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Alexander Turpie, MD FRCPC

Dr. Alexander Turpie received his medical degree from the University of Glasgow, Scotland , and is now Professor of Medicine at McMaster University, and Internist at Hamilton Health Sciences Corporation. He is a member of the Institutional Review Board of the Hamilton Health Sciences Corporation.

Dr. Turpie serves as an External Examiner in Medicine at the Chinese University of Hong Kong and the University of the West Indies. Dr. Turpie’s interests are reflected in his membership of numerous organizations active in education and research in thromboembolic disease, including the Thrombosis Interest Group (Canada), the Thrombosis Forum (North America), the Anticoagulation Forum (United States) and the International Cardiology Forum (International). He is a member of the Steering Committee of the International Studies on Infarct Survival (ISIS) and of several societies including the Medical Research Society and the International Society on Thrombosis and Haemostasis.

Dr. Turpie has published papers and abstracts in numerous medical journals, and regularly serves as a reviewer for journals such as The Annals of Internal Medicine, Circulation, Thrombosis Research, New England Journal of Medicine and Thrombosis and Haemostasis. He is also a member of the Editorial Board of the Journal Vascular Medicine Review.

Venous Thromboembolic Disease: Diagnosis and Treatment

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Novel Anticoagulants: Goodbye, Warfarin!

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David D. Waters, MD FACC

Dr. David D. Waters was Chief of Cardiology at San Francisco General Hospital and the Maurice Eliaser Jr. Distinguished Professor of Medicine at University of California, San Francisco from 1999 to 2007, and is now Emeritus Professor in the Department of Medicine. He completed medical school at the University of Western Ontario and did his Internal Medicine training at McGill University. After completing his cardiology fellowship training at Emory University, he was a Canadian Heart Foundation Research Fellow at Cedars-Sinai Medical Center in Los Angeles. From 1976 to 1992 he worked at the Montreal Heart Institute, where he was Director of the Research Center from 1988 to 1992.

Dr. Waters has published more than 300 manuscripts, mainly related to coronary artery disease, has written more than 60 book chapters, and has lectured in 40 countries. He is a member of the editorial boards of several major cardiology journals and was for several years an associate editor of the Journal of the American College of Cardiology. His early research involved vasospastic angina, risk stratification in acute coronary syndromes and trials of antiplatelet and antithrombotic therapy for unstable angina. For most of his career he has been involved in clinical trials assessing the effect of different interventions, including hormone replacement therapy and cholesterol lowering therapy, upon the progression of coronary disease or upon clinical endpoints.

Newer Indications and Limitations of Statin Therapy

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The Metabolic Syndrome: What Every Cardiologist Should Know

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Dr. Peter Liu to present 2009 Ronnie Campbell Memorial Lecture at ACCLL

Dr. Peter Liu is the Scientific Director of the Institute of Circulatory and Respiratory Health at the Canadian Institutes of Health Research.

He is also the Heart & Stroke/Polo Chair Professor of Medicine and Physiology at the Toronto General Hospital, University Health Network, and till recently, the Director of the Heart & Stroke Richard/Lewar Centre of Excellence for Cardiovascular Research at the University of Toronto.

He completed his MD degree at the University of Toronto, and did his postgraduate training at Harvard University.

Dr. Liu has focused his research on the causes of heart failure from bench to bedside, and the condition afflicts one in five Canadians. His team has identified the role of inflammation in changing heart structure and function, and identified potential new biomarkers through system biology approaches and novel treatment targets. His laboratory has also identified how viruses and bacteria can accelerate heart failure and coronary artery disease, and is developing novel vaccines to prevent these complications.

He has published over 250 peer reviewed articles in high impact journals, including Nature, Nature Medicine, and the New England Journal of Medicine. He has received numerous awards in recognition of his accomplishments, including the

• Rick Gallop Research Award from the Heart & Stroke Foundation (2003)
• Research Achievement Award from the Canadian Cardiovascular Society (2003)
• Extramural Award of Merit from the American College of Cardiology (2005)
• Postgraduate Mentorship Award from the University of Toronto (2006)
• Award of Merit from the Federation of Chinese Canadian Professionals (2006).

He has been the scientific program chair of the Canadian Cardiovascular Society, Heart Failure Society of America and International Society of Heart Research Scientific Sessions. He is the President-Elect of the International Society of Cardiomyopathy and Heart Failure of the World Heart Federation. He co-chaired a series of Canadian Cardiovascular Society Consensus Guideline Recommendations for heart failure care. He also chaired several CIHR and NIH scientific review panels. He is also the co-chair the 6th International Initiative on Global Cardiovascular Proteomics for HUPO (Human Proteome Organization), and will be co-hosting the 2009 International HUPO Meeting in Canada.

At the Canadian Institute of Health Research (CIHR), he coordinates research in heart, lung, blood and critical care and establishes strategic directions for the Canadian research community, and liaises with national and international partners. He is also the champion of the CIHR’s Clinical Research Initiative, promoting excellence and building capacity to maximize the opportunity in translating fundamental discoveries to the bedside and fostering excellence in evidence-based health care delivery to Canadians.

Ronnie Campbell Memorial Lecture: Heart Failure Lost and Found — Discoveries over 25 Years

Sunday, March 1, 2009
6:00 PM

Download Dr. Liu’s slide set [PDF].

Retrospectives on Heart Failure Research on the ACC Lake Louise 25^th Year Anniversary – Many Hits, More Misses
On this auspicious occasion of the 200^th birthday of Charles Darwin, the 25^th anniversary of the ACC Lake Louise conferences, and the 10^th anniversary of the passing of Professor Ronald W.F. Campbell, it is inspirational for us to look back how the understanding and treatment of heart failure has been completely transformed. We are reminded that through evolution, the shape and function of the heart have not changed. Heart failure, on the other hand, is a modern human disease, a consequence of ageing and acute and chronic injury to the heart. Keep in mind that the original textbook of medicine by Sir William Osler, heart failure occupied only couple pages in the end of the section on valvular disease, and digitalis with bed rest were the only treatments. In the current Braunwald’s textbook, heart failure occupies multiple sections of the book, and we are now spoiled for choices of therapy for systolic heart failure.

1984 - Vasodilators to Rattle Snake Venoms - Orwellian Prophecy?
Back in 1984, the patients with heart failure were treated with digoxin, diuretics and bedrest. Beta blockers were contraindicated. An innovative discovery at the time was the use of vasodilators in the acute heart failure setting. This started a new trend in the use of vasodilators such as nitrates or hydralazine in patients with heart failure, lowering peripheral vascular resistance, and improving peripheral muscle blood flow, with the first indication of improvement in outcomes¹. The focus of heart failure shifted away from the heart to the peripheral musculature. Much controversy ensued as to whether the heart or the periphery is more important in heart failure². The support for the role of the periphery is only evident 2 decades later with the A-HeFT and HF-ACTION trials, where combination of nitrates and hydralazine was able to reduce mortality and hospitalization in patients who are unresponsive to ACE inhibitors³, and exercise training was beneficial in reducing heart failure hospitalization.

CONSENSUS on ACE inhibitors - But how do they really work?
The most dramatic turnaround point for thinking about heart failure occurred in 1987 on the release of the CONSENSUS trial results, in which only 253 patients with severe heart failure were randomized to the ACE inhibitor enalapril or placebo⁴. The patients receiving enalapril showed a 31% reduction in one year mortality, and had smaller hearts and less heart failure progression. This was confirmed by the SOLVD trials, and ushered in the era of renin-angiotensin blockade in the setting of heart failure^5,6. This protection was subsequently expanded to the post-myocardial infarction (MI) patients^7,8. This also began an era in which neurohormones are regarded as culprits in heart failure, and that the more we blocked the neurohormones the better should be the outcome.

But, how did the ACE inhibitors really work in the setting of heart failure? Was it a vasodilator, or blocker of a harmful chemical that was regarded as “toxic” in heart failure? Much of this was elucidated by the team of Marc and Janet Pfeffer, in whose laboratory discovered that ACE inhibitors were potent inhibitors of cardiac dilation and functional deterioration, a process called “cardiac remodeling”^9,10. The focus of heart failure research has finally returned to the heart.

PROMISE no more Inotropes in Chronic Heart Failure
Short term observations in basic laboratory and coronary care unit have continued to identify the lack of contractile reserve as the fundamental flaw in heart failure, and investigators extolled the virtues of increasing inotropy. However, intrope after inotrope have failed to prolong survival or even improve quality of life. This included the classic digoxin in the DIG trial, where no survival benefit was observed despite 200 years of experience since William Wuthering¹¹. Worse, trials such as PROMISE evaluating the potential efficacy of milrinone, a phosphodiesterase inhibitor that putatively did not raise intracellular calcium, increased mortality and complications, despite the fact that patient may temporarily feel better¹². With the limited efficacy seen with levosimendan ten years later, the future of inotropic agents will need to change an entirely different paradigm for approach¹³.

Constellation of Rediscovered Beta and Aldosterone Blockers, with the Birth of Molecular Cardiology
Again due to the extrapolation of acute heart failure experience to chronic heart failure, beta blockers were long contraindicated in the textbooks of medicine for heart failure. Fortunately, the treatment of heart failure has taken a major forward leap after a cluster of clinical trials evaluated beta blockade in the 1990s in a more formal setting than Fenn Waggstein’s original momentous experiment in which he showed the efficacy of beta blockade in patients with heart failure for which he was reprimanded¹⁴. The “modern” beta blocker trials were all conducted on the background of ACE inhibition, yet the trials were all terminated early because of overwhelming efficacy of beta blockade in reducing mortality and hospitalization^{15, 16}. This included the COPERNICUS trial, in which patients with class III-IV heart failure benefited surprisingly and dramatically to graduated doses of carvedilol¹⁷. This has transformed the treatment of heart failure, and the challenge for the next 5 years is to undo the teachings of the last 2 decades on the role of beta blockers in heart failure. The subsequent negative results of more potential neurohormonal blockers such as moxonidine and omapatrilat suggested that it is not neurohormonal blockade per se, but more likely the biology of these specific agents on reverse remodeling of the damaged heart cells that made the difference.

A parallel set of studies uncovered the surprising efficacy of aldosterone antagonist such as spironolactone in the RALES trial¹⁸, more recently eplerenone in the EPHESUS trial in heart failure post-myocardial infarction¹⁹. The efficacy is as great if not greater than ACE inhibitors or beta blockers. The EPHESUS study is the only major trial in modern era of reperfusion post myocardial infarction (MI) to show such a dramatic reduction in all cause mortality, sudden deaths and prevention of heart failure. Fast forward to the present, we anticipate the potential approval of eplerenone for patients with cardiac dysfunction post MI in Canada later this year.

Better CARE with Devices rather than Antiarrhythmics
The triumph with pharmacological therapy was matched only by the innovations in electrical devices that appear to also reverse remodel the heart. The concept of multi-sited pacing in diseased hearts really took a firm step forward in patients with heart failure and conduction abnormalities. The initial results of cardiac resynchronization therapy (CRT) improved quality of life and exercise tolerance, but CARE trial with its impact on survival and reduction in heart size and mitral regurgitation suggested reverse remodeling using electrical signals became a reality²⁰. This together with ICDs have secured the electrical devices as part of the treatment repertoire in the appropriate patients with heart failure.

Lessons Learned and Challenges Ahead for the Next 25 Years
It is indeed gratifying to look back at the major advances in heart failure research over the last 25 years. Now patients with heart failure in Canada are enjoying improved survival and less hospital stay. For decades, we have seen the inexorable rise of the heart failure epidemic in our population²¹. But in the past year for the first time, we are witnessing a plateau in the incidence of heart failure, a direct results of innovations in research.

This is changing the epidemiology of cardiovascular disease, and transformed the lives of many of these patients. However, while one type of heart failure has been tamed, the rising tide in heart failure now turns to diastolic heart failure or heart failure with preserved systolic function²². The failure of the recent I-PRESERVE trial underscores the plight and the absence of any evidence based therapy for this rising population. Equally challenging are the patients with acute heart failure, where the table has been turned around - chronic therapy does not work for acute decompensated heart failure. The failure of recent tirals such as EVEREST and SURVIVE put the focus back on understanding the underlying pathophysiology of these “new conditions”. The agenda promises that the next 25 years of heart failure will be just as challenging, paradigm shifting and I am sure as fruitful.

Selected References

1. Cohn J, Archibald DG, Ziesche S, Franciosa JA, Harston WE, Tristani FE, Dunkman WB, Jacobs W, Francis GS, Flohr KH, Goldman S, Cobb FR, Shah PM, Saunders R, Fletcher RD, Loeb HS, Hughes VC, Baker B. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. New England Journal of Medicine. 1986;314:1547-1552.
2. Cohn JN. Nitrates are effective in the treatment of chronic congestive heart failure: The protagonist’s view. American Journal of Cardiology. 1990;66:444-446.
3. Taylor AL, Ziesche S, Yancy C, Carson P, D’Agostino R, Jr., Ferdinand K, Taylor M, Adams K, Sabolinski M, Worcel M, Cohn JN. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med. 2004;351:2049-57.
4. CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. New England Journal of Medicine. 1987;316:1429-1435.
5. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. New England Journal of Medicine. 1991;325:293-302.
6. The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fraction. New England Journal of Medicine. 1992;327:685-691.
7. The AIRE Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet. 1993;342:821-828.
8. Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Kober L, Maggioni AP, Solomon SD, Swedberg K, Van de Werf F, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM, Valsartan in Acute Myocardial Infarction Trial Investigators. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. New England Journal of Medicine. 2003;349:1893-906.
9. Pfeffer MA, Braunwald E. Ventricular remodeling after myocardial infarction: experimental observations and clinical implications. Circulation. 1990;81:1161-1172.
10. Pfeffer MA, Lamas GA, Vaughan DE, Parisi AF, Braunwald E. Effect of captopril on progressive ventricular dilation after anterior myocardial infarction. New England Journal of Medicine. 1988;319:80-86.
11. The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. New England Journal of Medicine. 1997;336:525-533.
12. Packer M, Carver JR, Rodeheffer RJ, Ivanhoe RJ, DiBianco R, Zeldis SM, Hendrix GH, Bommer WJ, Elkayam U, Kukin ML, Mallis GE, Sollano JA, Shannon J, Tandon PK, DeMets DL, Group PSR. Effect of oral milrinone on mortality in severe chronic heart failure. New England Journal of Medicine. 1991;325:1468-1475.
13. Mebazaa A, Nieminen MS, Packer M, Cohen-Solal A, Kleber FX, Pocock SJ, Thakkar R, Padley RJ, Poder P, Kivikko M. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. Jama. 2007;297:1883-91.
14. Waagstein F, Hjalmarson A, Varnauskas E, Wallentin I. Effect of chronic beta-adrenergic blockade in congestive cardiomyopathy. British Heart Journal. 1975;37:1022-1036.
15. MERIT-HF Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999;353:2001-7.
16. The CIBIS-II Group. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999;353:9-13.
17. Packer M, Coats AJ, Fowler MB, Katus HA, Krum H, Mohacsi P, Rouleau JL, Tendera M, Castaigne A, Roecker EB, Schultz MK, DeMets DL, Group. CPRCSS. Effect of carvedilol on survival in severe chronic heart failure. New England Journal of Medicine. 2001;344:1651-8.
18. Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J, Investigators. R. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. New England Journal of Medicine. 1999;341:709-17.
19. Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, Bittman R, Hurley S, Kleiman J, Gatlin M. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309-21.
20. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L. The effect of cardiac resynchronization on morbidity and mortality in heart failure. New England Journal of Medicine. 2005;352:1539-49.
21. Johansen H, Strauss B, Walsh P, Moe G, Liu PP. Congestive Heart Failure: the Coming Epidemic. Canadian Journal of Cardiology. 2003;19:430-435.
22. Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, Gong Y, Liu PP. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006;355:260-9.

Looking Forward: Are We Ready for Cardiovascular Vaccines?

Monday, March 2, 2009
9:00 AM

Protecting the Population against Environmental Challenges to Health - the Efficacy of Vaccines

The British Medical Journal conducted a poll in 2007 for its readers to rank the most important medical milestones that impacted on health since 1840. Amongst the top 10 milestones was the discovery of vaccines that was ranked #4¹. Certainly, as effective preventive measures for major public health problems, very few discoveries rival vaccines in their ability to transform the nature of health burden, and even eliminate diseases from human populations altogether.

The vaccines we have today are grounded in the innovation that Louis Pasteur introduced with his rabies vaccine. Pasteur’s breakthrough in 1885 represented the medical solution of an otherwise untreatable disease. In the 21st century we have witnessed the elimination of diseases such as smallpox from all countries in the world. The most recent awarding of the Nobel Prize to Professor Harald zur Hausen for discoveries that led up to the development of the HPV vaccine is another example². The influenza and pneumococcal vaccines annually save many lives in the vulnerable populations³. One of the major goals of global funding agencies such as the Gates Foundation in improving the global health challenge is the development of effective vaccines. As the focus of chronic diseases such as cardiovascular disease move towards prevention in the new millennium, an intriguing concept is the possibility of cardiovascular preventive vaccines.

The Concept of a Cardiovascular Vaccine
The development of cardiovascular vaccines is however much more challenging, as the most successful vaccines to date are against infectious agents. In chronic conditions that constitute risk factors for cardiovascular disease, such as atherosclerosis, hypertension, and diabetes, there are not always infectious triggers that could be readily identified as antigens for vaccination. However, it is well known that the progression of cardiovascular disease, whether atherosclerosis, diabetes, hypertension and cardiovascular remodelling all involve the activation of inflammatory systems. The recent identification of high sensitivity C-reactive protein (hsCRP), a biomarker indicative of inflammation, as a potential new risk factor for atherosclerotic complications underscores this concept.

Work from our and other laboratories suggest that modifying the immune system can significantly change the outcomes of chronic diseases such as atherosclerosis and cardiac hypertrophy⁴. Vaccination thus may be a strategy to modify our immune system such that the excessive inflammatory reaction towards the environmental insult could be attenuated to protect the host. In this case, the pro-inflammatory cytokines, macrophages or T-cells against oxidized lipoprotein, shared vascular antigen, angiotensin receptor or other targets could be modulated to avoid the complications.

Developing Potential Candidates for Cardiovascular Vaccines
How do we approach the concept of the cardiovascular vaccine? The current approach is to take conditions where some of the immunogenic triggers may be identifiable. This included atherosclerosis where oxidized lipoproteins have been used as a vaccine candidate. Other candidates included the potential chlamydial outer wall antigen, which crosses react with the vessel wall components to promote inflammatory response, underscoring the association of chlamydial infections with atherosclerosis^5,6. Similarly, the utilization of angiotensin and its receptor as potential immunogens help to block the function of angiotensin with its receptor. This can be applied also to aldosterone, and beta adrenergic receptors as targets for blockade. Finally, for myocarditis and diabetes, the shared trigger of enteroviruses such as coxsackievirus made the viral coat antigen another ideal target⁷.

Preclinical studies for infectious agents such as coxsackievirus in myocarditis has indicated that combinatorial approaches using coxsackieviral receptor engaging viral coat protein is effective in protecting the host against exposure to the virus. A combination of molecularly generated DNA vaccine together with protein based vaccine appears to be most efficacious. Similarly, the utilization of chlamydial based antigen in a LDL-receptor knockout animal fed with high fat western diet was able to reduce the burden of atherosclerosis, particularly if the animals also were exposed the infectious agents. Other strategies include the use of heat shock protein (HSP-60) which is shared between chlamydia and vascular atherosclerotic lesions appear to be also efficacious⁸. The various combinations of these type of strategies will likely result in several clinical vaccine candidates.

Secondary Prevention of Cardiovascular Complications with Influenza Vaccines
Evidence from cohort studies and a randomized clinical trial indicates that annual vaccination against seasonal influenza prevents cardiovascular morbidity and all-cause mortality in patients with identified cardiovascular conditions. The American Heart Association and American College of Cardiology recommended influenza immunization with inactivated vaccine as part of comprehensive secondary prevention in persons with coronary and other atherosclerotic vascular disease (Class I, Level B)⁹. The Canadian Cardiovascular Society Heart Failure guidelines also recommend influenza and pneumococcal vaccination in patients with heart failure or post-myocardial infarction¹⁰. The efficacy likely arise from at least 2 different mechanisms of action: (1) patients with cardiovascular conditions are prone to infections such as influenza, and the consequences are more severe including deaths; and (2) infection with influenza virus induces an overall inflammatory response in the host that can trigger cardiovascular events such as myocardial infarction or heart failure. Therefore, vaccination with the influenza vaccine has already been shown to be effective in preventing cardiovascular complications.

Clinical Trial of a Potential Anti-Hypertensive Vaccine
Most recently, the development of clinical vaccines targeted towards angiotensin II/receptor interaction in a hypertensive population has reached phase II trial¹¹. The result was encouraging in that the patients with mild to moderate hypertension had a magnitude of blood pressure reduction similar to that of standard antihypertensive medication. The patient showed an average of 9/4 mmHg reduction at week 14 following immunization. There were only minor side effects related to local immunization injection site similar to other vaccines. This is an important proof of concept that gave hypertension treatment a “new shot in the arm”.

The Future of CV Vaccines - Promises and Challenges
The shift of focus from treating complications to prevention in chronic diseases such as cardiovascular disease demands innovations in prevention. While pharmacological therapies are currently most efficacious in achieving broad patient protection, the challenges of compliance and side effects make it relatively ineffective over the long run. Vaccination while still in its infancy, does offer some attractive alternatives to the traditional lifestyle modifications and pharmacological treatments. Further research will shed light on better antigenic targets, better immunological interventions, and better means of delivering vaccines and combinations with other preventive strategies. There may come one day all children get a combination vaccine together with their DPTP to prevent heart disease, Alzheimer’s disease and other health problems before they ever occur.

Selected References

1. Worboys M. Vaccines: conquering untreatable diseases. Bmj. 2007;334 Suppl 1:s19.
2. Weiss RA. On viruses, discovery, and recognition. Cell. 2008;135:983-6.
3. Nichol KL, Nordin JD, Nelson DB, Mullooly JP, Hak E. Effectiveness of influenza vaccine in the community-dwelling elderly. N Engl J Med. 2007;357:1373-81.
4. Nian M, Lee P, Khaper N, Liu P. Inflammation and cytokines in post-myocardial infarction remodeling. Circulation Research. 2004;94:1543-53.
5. Bachmaier K, Neu N, de la Maza L, Pal S, Hessel A, Penninger J. Chlamydia infections and heart disease linked through antigenic mimicry. Science. 1999;283:1335-39.
6. Saren A, Pascolo S, Stevanovic S, Dumrese T, Puolakkainen M, Sarvas M, Rammensee HG, Vuola JM. Identification of Chlamydia pneumoniae-derived mouse CD8 epitopes. Infections and Immunity. 2002;70:3336-43.
7. Scheerlinck. Genetic adjuvants for DNA vaccines. Vaccine. 2001;19:2647-2656.
8. Benagiano M, D’Elios MM, Amedei A, Azzurri A, van der Zee R, Ciervo A, Rombola G, Romagnani S, Cassone A, Del Prete G. Human 60-kDa heat shock protein is a target autoantigen of T cells derived from atherosclerotic plaques. J Immunol. 2005;174:6509-17.
9. Davis MM, Taubert K, Benin AL, Brown DW, Mensah GA, Baddour LM, Dunbar S, Krumholz HM. Influenza vaccination as secondary prevention for cardiovascular disease: a science advisory from the American Heart Association/American College of Cardiology. Circulation. 2006;114:1549-53.
10. Liu P, Arnold M, Belenkie I, Howlett J, Huckell V, Ignazewski A, al. e. The 2003 Update of the Canadian Cardiovascular Society Heart Failure Practice Guidelines. Canadian Journal of Cardiology. 2003;19:347-356.
11. Tissot AC, Maurer P, Nussberger J, Sabat R, Pfister T, Ignatenko S, Volk HD, Stocker H, Muller P, Jennings GT, Wagner F, Bachmann MF. Effect of immunisation against angiotensin II with CYT006-AngQb on ambulatory blood pressure: a double-blind, randomised, placebo-controlled phase IIa study. Lancet. 2008;371:821-7.

Finalists Announced in 2009 Residents’ Research Competition

The 14th Annual Residents’ Research Competition at Lake Louise is slated for:

Sunday, March 1, 2009
2:30 PM
Main Lecture Hall

Thanks to Novartis for sponsoring this year’s competition!

Congratulations to the 2009 Finalists

• Dr. Osama Alhadramy, University of Alberta (Edmonton, Alberta)
  “Is Visual Interpretation of Coronary Angiography Reliable in ST-Elevation Myocardial Infarction Patients Undergoing Primary Angioplasty? Insights from APEX-AMI”
  

• Dr. Benoit Daneault, Centre Hospitalier Universitaire de Sherbrooke (Sherbrooke, Québec)
  “Reduction of Delays in Primary PCI”

• Dr. Mark Kotowycz, McGill University (Montréal, Québec)
  “Is it feasible to discharge low-risk patients with STEMI after only 2-3 days of observation?”

• Dr. Katia Dyrda Langelaan, Montréal Heart Institute (Montréal, Québec)
  “Therapeutic Hypothermia: The Montreal Heart Institute Experience”

All conference attendees are invited to attend the competition, which takes place immediately prior to the conference’s opening scientific session. There will be an opportunity after presentations for attendees to submit questions and comments to the residents about their work.

Judges for this year’s competition include Drs. Matthias Freidrich, Peter Liu and David Waters. Dr. J. Wayne Warnica is the Director of the Annual Residents’ Research Competition at Lake Louise.

The winner will also present his or her research on Wednesday during scientific sessions.

Competitions in previous years have been exciting — and regularly involve residents who have gone on to play to an active role in academic and clinical cardiology in Canada.

Previous Winners
2008 – Dr. Jonathan Afilalo, McGill University
2007 – Dr. Francois-Pierre Mongeon, CHU Montreal
2006 – Dr. E. Marc Jolicoeur, Montreal
2005 – Dr. Jean-Francois Sarrazin, Quebec City
2004 – Dr. Justin Ezekowitz, U of Alberta
2003 – Dr. Subodh Verma, U of Calgary, U of Toronto
2000 – Dr. P. J. Devereaux, Dalhousie
1998 – Dr. Satish Raj, Queen’s U, Ontario
1997 – Dr. Chris Simpson, Queen’s U, Ontario
1996 – Dr. Derek Exner, U of Calgary