James McCarthy, M.D.

Cardiologists are quick to point to statistics showing that the “door-to-balloon” treatment time for heart attack patients has dropped significantly in the past few years. But a retrospective study reveals that those who call 911 are most likely to have suffered a severe heart attack and despite receiving treatment quickly, they are still dying at unacceptable rates, say UT Physicians researchers.

Results from the large retrospective study were presented at the American Heart Association’s Scientific Sessions 2011 by lead author James McCarthy, M.D., UT Physicians emergency medicine specialist and director of the Emergency Center at Memorial Hermann-Texas Medical Center.

Door-to-balloon refers to the period of time from a patient’s arrival at the hospital to when a guidewire reaches the blockage and opens the artery with the inflation of a tiny balloon.

The results of the study showed that patients who call 911 instead of transporting themselves to the emergency room arrive 30 minutes faster and have shorter door-to-balloon times (56 minutes versus 70). Unfortunately, in spite of this they are more likely to be in shock (10.7 percent versus 3.5), suffer heart failure (9.9 percent versus 6.3) by the time they get to the hospital, and more likely to die during their hospitalization (7.2 percent versus 2.4).

“Those who call an ambulance are three times more likely to die because their disease is worse. They are much sicker,” Dr. McCarthy says. “We suspect that it means they have a larger infarct (area of damage). It’s a vulnerable population that despite rapid emergency medical services (EMS) and hospital care still has higher mortality.”

Previous research has shown that if the artery is unblocked in the first hour after a heart attack, there is minimal damage. After three hours, most of the damage has been done so UT Physician researchers have been concentrating on how to shorten that time to two hours or less.

The only way to lower the current time from symptoms to opening the artery is to treat the patient in the ambulance, Dr. McCarthy says. A year ago he presented results of a clinical trial called Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization (PATCAR). That trial showed that the mortality rate of patients arriving via EMS could be lowered to 2.9 percent by giving them a low dose of a clot-busting drug intravenously before they arrived at the hospital. The research was a collaboration of UTHealth, Memorial Hermann Heart & Vascular Institute-Texas Medical Center (HVI), and the Houston Fire Department.

“We know we’ve optimized the hospital system and integrated that with EMS, but for the cohort that calls 911, that’s still not enough,” he says. “We need to figure out something else.”

The researchers looked at 37,715 patients in the American College of Cardiology’s National Cardiovascular Data Registry. The presentation title is “EMS Transport of STEMI Patients Shortens Ischemic Times and is Associated with a Higher Risk Population: Results from the ACTION Registry.”

— Deborah Mann Lake, Office of Advancement, Media Relations

The medical group practice of The University of Texas Medical School at Houston, UT Physicians offers the most advanced technologies with a personalized touch from its flagship location in the Texas Medical Center and at a growing number of clinics throughout the greater Houston area.

Colin Barker, M.D.

Cardiologists and cardiovascular surgeons at the Medical School and Memorial Hermann Heart & Vascular Institute (HVI) are the first in Houston to implant the artificial heart valve recently approved by the Food and Drug Administration (FDA), as well as a newer, smaller version that is part of a clinical trial.

The Sapien heart valve made by Edwards Lifesciences is implanted through a catheter as an alternative to open heart surgery for patients with inoperable aortic valve stenosis disease. George Cumberledge, 86, of Livingston, received the FDA-approved Sapien + Retroflex3, the first ever transcatheter aortic valve, on Nov. 17.

“Mr. Cumberledge had prior open-heart surgery and suffered from congestive heart disease for the past two years, so he was not a candidate for open surgery,” says Colin Barker, M.D., UT Physicians cardiologist. “We were able to offer him the approved device, and he’s ready to go home 36 hours later.”

That same day, Houstonian Martha Frazier, 88, received the Sapien XT + NovaFlex, the next-generation valve that is currently part of a multi-site trial comparing this newer, smaller valve to the current one.

“In the case of Mrs. Frazier, we took someone with severe disease who was a nonsurgical patient, and now we’ve cured her,” Dr. Barker says. “We are the only site in Houston with the option of using an alternative smaller device, and it was necessary in this procedure. Otherwise, it would not have been successful.”

UTHealth Medical School/HVI is one of just two sites in the state to test the FDA-approved valve against the newer version. The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves will recruit 600 patients, who will be followed for at least five years. Principal investigator of the Houston site of the Phase III study is Richard Smalling, M.D., Ph.D., UT Physicians cardiologist and director of interventional cardiovascular medicine in the Division of Cardiovascular Medicine.

Aortic valve stenosis is an age-related disease caused by calcium deposits in the valve that cause it to narrow and stiffen. As it becomes harder to pump the blood out to the rest of the body, the heart weakens. Patients experience fainting, chest pain, heart failure, irregular heart rhythms, and cardiac arrest. Without treatment, patients usually die within two years. It affects approximately 300,000 Americans.

“With the aging population, the potential impact of this procedure is enormous,” Dr. Barker says. “The quality of life metrics are incredible. People can go from dependence to independence. I estimate about 20 percent of my patients will be candidates for this valve replacement.”

The Sapien valve, made of bovine tissue and stainless steel, is about the width of a pencil when it is deployed through a catheter in the femoral artery in the groin. The newer version is smaller and therefore easier to deploy in smaller arteries. Once it arrives at the correct spot, the new valve is released, replacing the diseased one. Patients generally stay in the hospital for an average of three days, compared to seven days with open heart surgery, Dr. Barker says.

“Surgeons and cardiologists are part of a whole team unified for this one disease process,” Dr. Barker says. “There is very little sedation, and in experienced hands, it takes about 45 minutes.”

For the procedures, Drs. Barker and Smalling team with UTHealth/HVI surgeons including Hazim Safi, M.D., UT Physicians cardiothoracic surgeon; and Anthony Estrera, M.D., UT Physicians cardiothoracic surgeon and chief of cardiac surgery at Memorial Hermann-Texas Medical Center.

The UTHealth/HVI Heart Valve Team also includes a cardiac anesthesiologist, echocardiologist, critical care experts, and research nurses.

“This could add years to the life of patients,” Dr. Estrera says. “By the time they get out of the hospital, they are already feeling better.”

For more information, call 713.704.8287.

— Deborah Mann Lake, Office of Advancement, Media Relations

The medical group practice of The University of Texas Medical School at Houston, UT Physicians offers the most advanced technologies with a personalized touch from its flagship location in the Texas Medical Center and at a growing number of clinics throughout the greater Houston area.

Erik Wilson, M.D.

UT Physicians are recruiting adults with chronic reflux for a clinical trial on an innovative procedure designed to provide long-lasting relief.

Reflux is the abnormal regurgitation of stomach and intestinal contents into the esophagus, which is the muscular tube connecting the mouth and stomach.

An estimated 60 million Americans experience acid reflux each month, which creates a burning sensation when a valve designed to contain stomach acid does not work properly and the acid backs up into the esophagus.

“We are one of a select group of sites in the United States chosen to participate in the study,” says Erik Wilson, M.D., a study principal investigator at the Houston site and director of Minimally Invasive Surgeons of Texas at UT Physicians. “The fundamentals of the procedure have been studied in animals and humans. We’re gathering additional data on outcomes.”

Nationwide, 120 people are being recruited for a multi-center, randomized trial for the treatment of gastroesophogeal reflux disease (GERD). Two out of three participants will receive the incisionless procedure and a placebo medication. The remainder will get a control procedure and a medication called omeprazole, says Dr. Wilson, who is on the medical staff of Memorial Hermann-Texas Medical Center.

Afterward, researchers will compare data to better understand the relative merits, safety, and effectiveness of the procedure known as an advanced Transoral Incisionless Fundoplication (TIF), which is approved by the Food and Drug Administration.

Locally, Dr. Wilson hopes to recruit at least 15 people. Eligible participants will receive multiple follow-up checkups over the course of 12 months. Once the study is over, the procedure will be offered to those who originally received the control procedure. There is no charge for the procedure.

Wilson’s team is looking for people 18 to 80 years of age who have chronic symptoms and have been taking a medication to control symptoms.

With the aid of a tiny television camera and slender instruments inserted through the patient’s mouth, doctors can fortify the valve designed to keep stomach acid and bile from reaching the esophagus. The procedure is done while the patient is under a general anesthetic.

Those interested in enrolling in the study should call Anna Cecilia Tenorio at 713.486.1350 to determine eligibility. Participants may be asked to complete screening tests that may be covered by insurance.

— Robert Cahill, Office of Advancement, Media Relations

The medical group practice of The University of Texas Medical School at Houston, UT Physicians offers the most advanced technologies with a personalized touch from its flagship location in the Texas Medical Center and at a growing number of clinics throughout the greater Houston area.

“Somewhere between 10 and 20 percent of babies have colic. The condition has a terrible impact on the parents and may be one factor linked to a doubling of the number of infanticides over the past three decades,” says Marc Rhoads, M.D., UT Physicians pediatric gastroenterologist and director of the Endoscopy Laboratory at Children’s Memorial Hermann Hospital. “While reflux, which causes irritability, might be helped with a liquid acid blocker, a placebo-controlled study showed that crying time in babies with colic does not improve with acid blocker treatment.”

Colic is defined as inconsolable crying for more than three hours a day for more than three days a week for more than three weeks. It is associated with parental depression.

Dr. Rhoads is researching whether a supplement could be helpful while Christopher Greeley, M.D., UT Physicians pediatrician, is studying a behavioral approach.
Rhoads’ randomized, double-blinded trial examines a probiotic, a health-promoting bacteria called Lactobacillus rhamnosus GG (LGG), which may help relieve colic when added to formula. Dr. Rhoads and his colleagues previously satisfied Federal Drug Administration requirements for a safety and tolerability study for a similar Lactobacillus in adult volunteers before launching the pediatric trial.

“The gastrointestinal tract of infants, particularly preterm infants, is highly vulnerable because they haven’t completely developed their protective mechanisms,” Dr. Rhoads says. “Babies with colic have higher levels of breath hydrogen and abnormal fecal bacteria. We theorize that LGG can restore a healthy balance of bacteria in the gut and decrease the inflammation and excess hydrogen gas that are causing pain.”

Dr. Rhoads’ study will enroll 60 formula-fed infants at the colic clinic who are between 3 weeks and 3 months of age. They can be partially breast-fed.

In Dr. Greeley’s randomized trial, all parents of children with excessive crying will receive standard parental counseling. Half of the infants’ parents will also be taught an infant soothing technique. The study, funded by the National Institutes of Health, will enroll 180 infants.

“Compared to mothers of infants without colic, mothers of infants with colic have lower parental confidence and higher rates of depression,” Dr. Greeley says. “Despite its impact on families, few interventions for families with a colicky infant have been studied in well-designed randomized trials. We feel this study is a very important step in trying to identify ways to help parents and caregivers.”

For information on either trial, call 713.500.5669. To make an appointment at the Colic Clinic, located in the UT Professional Building, 6410 Fannin, call 832.525.2617.

- Deborah Mann Lake, Media Relations

The medical group practice of The University of Texas Medical School at Houston, UT Physicians offers the most advanced technologies with a personalized touch from its flagship location in the Texas Medical Center and at a growing number of clinics throughout the greater Houston area.

Seven experts in the field of preventive cardiology and neurology from UT Physicians will present “Cardiovascular Disease Prevention and the ‘Million Hearts’ Initiative” during the free event, which is aimed at healthcare professionals.

The “Million Hearts” initiative was launched in September by the U.S. Department of Health and Human Services with partners such as the American Heart Association. Its message is centered on the “ABCS” of Aspirin for people at risk, Blood pressure control, Cholesterol management and Smoking cessation in an effort to prevent 1 million heart attacks and strokes over the next five years.

Francisco Fuentes, M.D., program director and UT Physicians cardiologist, will lead two panel discussions. Other speakers from UTHealth, Memorial Hermann-Texas Medical Center, and Baylor College of Medicine will speak on the pathological basis to reduce heart attack and stroke; early cardiovascular disease prevention in children; clinical aspects of the disease; the MyPlate initiative for heart health; exercise in children and adults; and overcoming the challenges of stroke prevention.

In addition to UTHealth, the forum will be webcast to The University of Texas Medical Branch at Galveston, Memorial Health System of East Texas in Lufkin, and The University of Texas School of Public Health Brownsville Regional Campus, which is part of UTHealth.

The event is sponsored by the Theodore and Maureen O’Driscoll-Levy Professorship. To register, visit www.UTcme.net, or email ms.pcfreg@uth.tmc.edu. For more details, call 713.500.6576.

- Deborah Mann Lake, Media Relations

The medical group practice of The University of Texas Medical School at Houston, UT Physicians offers the most advanced technologies with a personalized touch from its flagship location in the Texas Medical Center and at a growing number of clinics throughout the greater Houston area.

UT Physicians leadership breaks ground at a new Cinco Ranch location.

UT Physicians officially broke ground on new construction with a groundbreaking ceremony for its newest health center Dec. 8 at 23923 Cinco Ranch Blvd.

Slated to open in the late spring of 2012, UT Physicians at Cinco Ranch will offer primary and specialty care for children, adolescents, and adults.

“UT Physicians at Cinco Ranch will bring world-renowned health care to Cinco Ranch and the surrounding communities,” says Andrew Casas, vice president and chief operating officer of UT Physicians. “Our primary and specialty care doctors will provide unparalleled care for patients of all ages in Cinco Ranch and surrounding areas in a convenient location right in their neighborhood.”

The two-story, 11,000-square-foot clinic represents UT Physicians’ continued commitment to provide the most comprehensive, high-quality, and personalized medical care in the community.

“We are very pleased to announce this expansion to serve our neighbors in the Cinco Ranch/Katy area,” says Giuseppe Colasurdo, M.D., dean of The University of Texas Medical School at Houston. “This growth of UT Physicians follows our latest location in Bayshore to serve the regions of Clear Lake and Pasadena. Our goals are to bring the medical expertise of the UTHealth Medical School to our neighboring Houston communities and to work closely with the local physicians to provide continuity of the best patient care.”

UT Physicians, one of Houston’s largest physician practices, also offers community-based medical care at its flagship location in the Texas Medical Center and at health centers throughout the Houston area, including Bellaire and in Missouri City at Sienna Plantation. The team of internationally recognized medical experts includes more than 1,000 doctors certified in 80 medical specialties.

UT Physicians at Cinco Ranch will manage health care needs for people of all ages—from infants to the elderly. The health care team will provide a range of services from routine wellness exams and care for common illnesses to highly-specialized treatments for complex medical conditions. The clinic will be connected with the entire UT Physicians practice to offer patients a quick turnaround when referred by their primary care doctor to a specialist. The health center also will utilize a secure Electronic Medical Records (EMR) system to ensure that each doctor has access to a patient’s complete history, increasing patient safety and preventing duplication of diagnostic tests.

“We look forward to becoming part of the Cinco Ranch community, and when we open our doors next year, we hope many area residents will decide to make UT Physicians at Cinco Ranch their health care home,” Casas says.

— Meredith Raine, Office of Advancement, Media Relations

The medical group practice of The University of Texas Medical School at Houston, UT Physicians offers the most advanced technologies with a personalized touch from its flagship location in the Texas Medical Center and at a growing number of clinics throughout the greater Houston area.

Kate Wilson

Kate Wilson, UT Physicians genetic counselor, received the 2011 National Society of Genetic Counselors New Leader Award at the NSGC 2011 Annual Education Conference in October in San Diego.

Nominated by her genetic counseling colleagues and awarded by the NSGC awards committee, Wilson was one of two winners of the national award, which recognizes a new genetic counselor who has shown “significant initiative in contributions to NSGC and the profession.”

“I was very honored to receive this award. The National Society of Genetic Counselors is a great organization, and it’s been wonderful to be a part of NSGC,” said Wilson, who has been a genetic counselor for nearly five years.

“We are very proud of all of her work on the national level,” said Jennifer Hoskovec, UT Physicians genetic counselor.

Wilson received her master’s degree in science in genetic counseling at the University of South Carolina and joined the Medical School in 2007.

“I enjoy working with patients and helping them understand genetics and genetic testing,” Wilson says. “It’s also very rewarding to work with the UT Genetic Counseling Program and their students. I love being a part of their training and education.

“I just want to thank the other UT genetic counselors and the department of Ob/Gyn. They have been a source of constant support, and I am fortunate to work with them!”

— Darla Brown, Office of Communications, Medical School

The medical group practice of The University of Texas Medical School at Houston, UT Physicians offers the most advanced technologies with a personalized touch from its flagship location in the Texas Medical Center and at a growing number of clinics throughout the greater Houston area.

Heinrich Taegtmeyer, M.D.

UTHealth researchers have discovered that heart muscle cells eat their own proteins in order to stay alive.

The original research paper by Kedryn Baskin, a student in the Program of Integrative and Regulatory Biology of the Graduate School of Biomedical Sciences, and Heinrich Taegtmeyer, M.D., UT Physicians cardiologist, was recently published in Circulation Research, a publication of the American Heart Association.

In animal models, the investigators found that a stressed heart activates a signal, which takes down unneeded proteins. This process, in turn, makes it possible for the cell to survive and rebuild itself.

“We believe we are beginning to understand a whole new chapter in the biology of the heart—self-renewal of the cardiomyocytes. It’s like the heart muscle selling its family silver to stay alive,” Dr. Taegtmeyer says.

His lab is now working on other mechanisms by which the heart takes down old and useless proteins and replaces them with new and functional ones. If successful, the work will lead to new ways to treat heart failure, a disease that claims the lives of 500,000 Americans each year.

The medical group practice of The University of Texas Medical School at Houston, UT Physicians offers the most advanced technologies with a personalized touch from its flagship location in the Texas Medical Center and at a growing number of clinics throughout the greater Houston area.

Dr. O. Clark West looks at X-rays on the last multiviewer at Memorial Hermann-Texas Medical Center.

The Department of Diagnostic and Interventional Imaging ended the era of radiological film as the last of the multiviewers was retired from Memorial Hermann-Texas Medical Center Oct. 24.

Standing over six-feet tall, the newest and sole remaining member of a fleet of 25 multiviewers was purchased in 1997. The machine held 50 back-lit film panels, which the radiologist operated by foot pedal in order to rotate them via a conveyor belt much like a black-and-white Ferris wheel—and almost as noisy as the carnival ride. Before the conversion to digital imaging, the emergency radiology reading areas had three multiviewers. Such large viewers were especially useful for trauma patients, who might have 50 pieces of film.

“This is the sign that imaging has made the transition completely to digital,” said O. Clark West, M.D., UT Physicians radiologist and chief of emergency and trauma imaging at Memorial Hermann–Texas Medical Center.

As the rest of the hospital, and the entire Houston area, gradually switched to electronic systems, it was decided to remove the last manual film viewer to make room for computers to provide digital image viewing. Emergency radiology’s darkroom was shut down in 2005 and later converted into an office.

“This is a very large machine, and we needed the space. Plus, we do not even have the capability to make film images anymore,” Dr. West explains.

“A modern trauma CT scan has about 400 images, which would require 20 separate pieces of film spread over five film panels. A complete trauma imaging evaluation on a severely injured patient could fill half of the multiviewer. So the computer systems really are much more efficient,” Dr. West says. “Although, we still use film for teaching, hanging film on one of these old viewers is a lost art.”

— Darla Brown, Office of Communications, Medical School

The medical group practice of The University of Texas Medical School at Houston, UT Physicians offers the most advanced technologies with a personalized touch from its flagship location in the Texas Medical Center and at a growing number of clinics throughout the greater Houston area.

Colin Barker, M.D.

Patients who are not candidates for traditional surgery for severe carotid artery disease lesions could be treated with carotid artery stenting, according to results of a small feasibility study by UT Physicians cardiologists.

The results were presented Nov. 9 by lead investigator Colin Barker, M.D., UT Physicians cardiologist, at the Cardiovascular Research Foundation’s annual scientific symposium, Transcatheter Cardiovascular Therapeutics (TCT) 2011 in San Francisco.

“These were high-risk patients who had no alternatives because they were not candidates for surgery,” says Dr. Barker, attending physician at Memorial Hermann Heart & Vascular Institute (HVI). “We performed interventional stenting on these 10 patients with no complications or deaths.”

The patients, who had symptoms of stroke related to their carotid artery disease, had been evaluated by James Grotta, M.D., UT Physicians neurologist. Dr. Grotta, co-director of the Mischer Neuroscience Institute, then approached the UTHealth cardiology interventional team to see if stenting was a possibility.

“Dr. Grotta wanted to offer them something,” Dr. Barker says. “These were frail and elderly patients with 99 percent blockage and co-morbidities including kidney, heart, and lung disease. It’s been something that no one wanted to try, but we were willing to break that barrier.”

The procedure, done through the groin artery, takes approximately one hour and is done while the patients are awake with mild sedation. One-year follow-up with six of the patients revealed no obstructive disease in the artery.

Other UTHealth/Memorial Hermann HVI presenters at the conference were Richard Smalling, M.D., Ph.D., UT Physicians cardiologist; and Ali Denktas, M.D., UT Physicians cardiologist.

— Deborah Mann Lake, Office of Advancement, Media Relations

The medical group practice of The University of Texas Medical School at Houston, UT Physicians offers the most advanced technologies with a personalized touch from its flagship location in the Texas Medical Center and at a growing number of clinics throughout the greater Houston area.