Women's heart health

Direct Injection

In Tampa, Dr. Charles Lambert is leading the way for the first FDAapproved clinical trial in the United States using regenerative cells, derived from fatty tissue, in chronic heart failure patients.

In the ATHENA clinical trial, doctors first collect fat from the patient’s body by liposuction. They then flter the fat sample through a machine that extracts the stem cells. Finally, the stem cells are injected into the damaged part of the patient’s heart in 15 places. The trial is a controlled study, and participants either have their own cells or a placebo injected back into their damaged heart tissue.

“There are people that definitely respond, and some that don’t,” says Lambert, director of Florida Hospital Pepin Heart Institute and the Dr. Kiran C. Patel Research Institute. “There is still a lot we don’t know, and it’s certainly not one size fits all.” 

Lambert says research shows many variables make a difference, including the type of stem cells administered, the stage of heart disease and when and how the stem cells are given.

Doctors at Florida Hospital also have tested the use of stem cells on heart attack patients by administering stem cells from the patient’s own bone marrow into the heart within five days after a heart attack. Studies done in Europe had varying results. 

“Our trials are high caliber in the level of evidence provided, and they are placebo controlled,” Lambert explained. Some of the patients at Florida Hospital’s research center who participated in the trials saw improvement. A big variable, he says, was how long after a heart attack someone was treated with stem cells. “It seems as if you do it too early or too late it won’t work.” 

Gene-Based Therapies

In one Tampa trial using genebased therapies, doctors directly injected plasmid DNA into the heart. The therapy attempted to promote regeneration of heart tissue by encouraging the body to deploy more stem cells to the injury site in patients who had suffered heart failure. “This trial is unique in that it uses gene therapy to turn on a process leading to cell regeneration rather than simply administering stem cells directly,” Dr. Charles Lambert says. The preliminary results were positive. A second trial is under way in which doctors will administer the plasmids through a catheter. “If it works, it’s an easier mode of therapy for different trials,” Lambert says

Stem Cells in Space

At the University of Miami’s Miller School of Medicine, Dr. Joshua Hare has been a pioneer in research that has shown stem cell therapies can repair damaged hearts and restore their function. In October, Hare, founding director of the Interdisciplinary Stem Cell Institute and the Louis Lemberg Professor of Medicine, was among seven stem cell researchers across the nation who were awarded up to $300,000 each to use the space station’s unique environment to explore “the impact of microgravity on fundamental stem cell properties.” Says Hare, “We believe that microgravity could play an important role in generating new heart muscle.”

Regeneration

Dr. Claudia Martinez-Bermudez led a team at UM that participated in an international clinical trial to assess whether gene therapy can reduce the frequency of hospitalizations for advanced heart failure patients. The therapy could increase the time a person experiencing heart failure would be able to wait for a transplant or possibly even eliminate the need for a transplant, Martinez- Bermudez says. The yearlong trial is over. Researchers are awaiting results. “We know based on small studies that this regenerative approach works,” she says. “Now we are trying to prove that on a large scale.”

Leg Pain

In Gainesville, Dr. Carl Pepine at the University of Florida College of Medicine also is conducting stem cell research, with one study focused on helping people with chronic leg pain from heart disease. The trial, the fourth using patients’ bone marrow stem cells, examines whether injecting a concentration of cells directly into the affected leg muscles will result in the formation of new blood vessels and improved blood fow. A better blood supply would reduce the pain caused by peripheral arterial disease and allow patients to walk longer distances.

Studying Heart Disease

Baptist Health has begun work on its Miami heart study, which will span several years and include 4,000 participants who are 40 to 60 years old (2,000 from the community and 2,000 Baptist Health employees). Doctors will assess risk factors using advanced blood tests and imaging studies and gathering extensive genetic information to understand how cardiovascular disease begins and progresses and how to prevent it.

Aspirin and Cardiovascular Disease

UF researchers have discovered that a daily low dose of aspirin can offer important protection against heart disease, but people who could receive the most benefit from the medication may not be taking it. The study found only 40% of people who were at high risk of cardiovascular disease said that doctors had recommended aspirin therapy, while one-quarter of people at low risk reported their doctors told them to take the drug. The results appear in July in the Journal of the American Heart Association.

Better Monitoring

Doctors at Florida Hospital Orlando are treating arrhythmia in patients with a new heart monitor called a loop recorder. The implantable recorder is designed to help doctors diagnose rhythm problems while people do their day-to-day activities. Traditionally, patients had to wear a cumbersome halter monitor made up of electrodes attached to the chest and a battery pack to record heartbeats so doctors could diagnose rhythmic heart issues. The patient had to bring the device back into the doctor’s office to analyze the data that was recorded. With the new implantable loop recorder, data can be transmitted via cell phone to the doctor’s office.

Blood Pressure Monitoring

Alejandro Arrieta, assistant professor in the Department of Health Policy and Management at Florida International University in Miami, has documented the usefulness of home blood pressuremonitoring kits in early detection of medical emergencies related to hypertension. Arrieta’s study, published in the American Heart Association’s journal Hypertension, found that insurance firms realized a return of 85 cents to $3.75 for each dollar invested in home monitoring kits within the first year. The return increases over 10 years to $7.50 to $19.34 for every dollar invested.

Holistic Approach

Mona Shah, a cardiologist with Baptist Heart Specialists in Jacksonville, has become board certified in holistic medicine through the American Board of Integrative Holistic Medicine. She is one of only two cardiologists in the state with the certification. Shah says she will do a traditional cardiac visit that will address all the patient’s cardiac concerns and order appropriate testing and medications, but she will also address stress management, diet, nutrition, exercise and lifestyle. “Many patients Don’t want to use traditional medications when being treated, and in those cases I suggest alternative methods, including herbs and supplements,” Shah says. “I also review vitamins and supplements and confirm there are no interactions with their medications.”

Women’s Care

Florida Hospital Orlando broke ground in February on a comprehensive women’s hospital. The complex, north of downtown Orlando, is scheduled for completion next year. The 12-story, 322-bed tower will offer comprehensive health care and includes cardiac care among other areas of specialty services.

Robotic Surgery

Da Vinci robots are now a well-established tool in surgical suites throughout Florida. Baptist Medical Center in Jacksonville has purchased its sixth da Vinci robotic system. Its latest one is dedicated for cardiac use. Dr. Robert Still, a cardiothoracic surgeon, heads a team that will use the robot for complex procedures like coronary bypass or repairs to valves or holes in the heart. Still says the da Vinci allows more mobility “to cut, sew, dissect, pull and push and do whatever you need to do and get where you want to go.” With robotic surgery, patients typically have less pain, fewer infections and faster recovery, he says. Still and his team, which has trained with a group in Alabama that has been using the machines for heart surgery for about eight years, plan to offer robotic surgery in Jacksonville for heart care by year’s end. The use of robotic surgery of all types has increased more than 400% in the U.S. between 2007 and 2011. 

Teaming Up

Baptist Cardiac & Vascular Institute and South Miami Heart Center have created the Miami Cardiac & Vascular Institute. The rebranding effort reflects Baptist’s combined resources of experienced physicians, treatments and technology to bring the most advanced heart and vascular care to south Florida. A $100-million expansion under way on the Baptist Hospital campus will transform the institute and include unique programs for aneurysms and structural heart disease.

Stem Cell Therapies

Can a patient’s heart disease be cured by injecting his own fat cells into damaged parts of his heart?

Across the state, doctors and medical researchers in Miami, Tampa and Gainesville are conducting leading-edge cardiovascular stem cell research to answer that question and explore other possible ways to use stem cells to treat coronary heart disease.

Tags: Healthcare, Executive Health