Libin Life Fall 2017

Libin Life RESEARCH

EDUCATION

CARE DELIVERY

FALL 2017

The Libin Cardiovascular Institute of Alberta Magazine

IS THIS THE GATEWAY TO THE HEART? LIBIN CARDIOvASCULAR INSTITUTE RESEARCHERS SUCCESSFULLY MAP THE CALCIUM GATEWAY OF THE HEART FOR THE FIRST TIME. SEE STORY PAGE 21.

CRITICAL CARE: LIBIN CLINICIANS IMPLEMENT CUTTING-EDGE POST CARDIAC SURGERY PROCEDURE

GETTING PRECISE: LIBIN RESEARCHER TACKLES COMMON CONGENITAL HEART DEFECT WITH PRECISION TACTICS

IN TRAINING: LIBIN INSTITUTE TRAINEES SHINE AT TINE HAWORTH RESEARCH DAY

MESSAGE FROM THE DIRECTOR

W

ith the finalization of our Strategic Plan 2017-2022 this spring, the Libin Cardiovascular Institute of Alberta has embarked on an exciting journey.

Over the next five years, the Libin Institute will embrace the bold research vision of reducing the burden of suffering and premature death due to cardiovascular disease through transformative research by focusing on two key areas in which we have the strength to be world leaders.

Vascular health and disease is our first priority, and our goal in this area is to reduce the risk factors that cause kidney disease, heart attacks, stroke and diseases of the aorta.

The second priority is arrhythmias and autonomic dysfunction. We are seeking to reduce common heart arrhythmias, fainting and sudden cardiac death, which remains the leading cause of premature deaths in North Americans older than 65. The Libin Institute will take a precision-medicine, patient-centred approach to meeting these goals.

We will also continue to leverage our key research infrastructure platforms, including the Stephenson Cardiac Imaging Centre, the Mozell Family Analysis Core Lab, the APPROACH database and Libin’s Core Pathology facilities. Most importantly, we will rely on the amazing teams of world-class researchers the Libin Institute has assembled.

Our kidney researchers have had numerous successes over the past few months, including Braden Manns and Brenda Hemmelgarn winning the Kidney Foundation of Canada’s Medal of Excellence. In the area of syncope, our team is arguably one of the best in the world, thanks to the arrival of Dr. Carlos Morillo, the section chief of cardiology and a renowned syncope expert, who joined world-class expertise in doctors Robert Sheldon and Satish Raj. (See story page 13).

We will continue to grow in these and other areas by recruiting new talent and by supporting the nearly 200 clinicians and researchers whose work has made the Institute what it is today. While promoting this work, we won’t forget that our patients come first: we will continue to conduct numerous clinicial trials and to monitor patient outcomes with a quality assurance focus.

Our new initiative P2 Cardiovascular Health: Person to Population Research Collaborative, is one of the key areas in which we will incorporate the patient perspective and consider social determinants of health in optimizing cardiovascular health (see story page 13).

Over the next five years, we will continue to pass on our knowledge to our trainees through our commitment to education. It truly is an exciting time for cardiovascular research. We at the Libin Institute are ready to embrace the challenges.

DR. TODD ANDERSON Director

Libin Cardiovascular Institute Of Alberta

ABOUT THE LIBIN INSTITUTE

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The Libin Cardiovascular Institute of Alberta is an entity of both Alberta Health Services and the University of Calgary. It is the only Canadian health institute to offer a single cardiovascular program, which promotes a standard of quality across the city of Calgary and the region.

It is made up of 1,500 members, staff, students, and clinical trainees that coordinate cardiovascular research and education, along with delivering world-class cardiac care to a population of more than two million people in Southern Alberta, Saskatchewan and Eastern British Columbia. The Libin Cardiovascular Institute of Alberta is committed to reducing the burden of suffering and premature death due to cardiovascular disease through transformative research.

Libin Life

Libin Life is published semi-annually by the Libin Cardiovascular Institute of Alberta, an entity of the University of Calgary and Alberta Health Services (Calgary Zone). Libin Life’s mission is to share news and information about the Institute’s impact in research, education, and patient care.

Institute Director Dr. Todd Anderson @LibinDirector Institute Deputy Director Dr. Anne Gillis Institute Research Training & Mentorship Director Dr. Sofia Ahmed Institute Associate Director Al-Karim Walli @aswalli Editor Dawn Smith Editorial Committee Leslie Campbell, Barb Jones, Myrna Linder, Judy Siu, Dawn Smith, Al-Karim Walli, Melanie Yar Khan Contributors Dr. Todd Anderson, Dawn Smith, Kelly Johnston, Aisling Gamble, Dr. Robert Miller Design and Layout Steven Tov @madebysteventov Printer McAra Printing @mcaraprinting

Libin Cardiovascular Institute of Alberta University of Calgary HSC G242, 3330 Hospital Drive NW Calgary, Alberta T2N 4N1 P 403.210.6271 E libin@ucalgary.ca W libininstitute.org Twitter @LibinInstitute Facebook @LibinInstituteAB Editorial Inquiries Dawn Smith Communications Coordinator dawn.smith@ucalgary.ca

Send comments, requests for magazine copies, digital magazine issue subscriptions or change of mailing address notifications to libin@ucalgary.ca. Please request permission to reproduce any part of this publication. All rights reserved. © 2017 Libin Cardiovascular Institute of Alberta to share news and information about the Institute’s impact in research, education and patient care.

CONTENTS

DEPARTMENTS 2 Message from the director 4 Upcoming events 6 Awards & accolades 8 Community engagement 10 News & highlights

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24 New recruits 27 Philanthropy profile

FEATURES 12 GETTING STRATEGIC

The Libin Cardiovascular Institute sets its priorities for the next five years of research.

13 FIGHTING FAINTING

16

World-class syncope group assembled at Libin Institute.

13 PERSON TO POPULATION

Collaborative group committed to improving cardiovascular health

CARE DELIVERY 16 Cardiovascular Intensive Care Unit implements cutting-edge post-surgery protocol

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16 Adult Congenital Clinic program to ease transition into adulthood for young patients 17 Project aims to improve efficiency of Electrical Device Clinic 17 Device to reduce the risk of stroke in atrial fibrillation patients

EDUCATION 18 Annual Tine Haworth Research Day shines light on work of trainees 19 Libin Institute trainees net big awards

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RESEARCH 21 Libin researcher successfully maps the microscopic calcium gateway of the heart 22 Three million dollar grant to bring precision medicine to heart patients 23 Secrets of a mentor: Dr. Robert Miller speaks with longtime Libin researcher Henk ter Keurs

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Photo courtesy of the Canadian Cardiovascular Society

UPCOMING EVENTS

CANADIAN CARDIOVASCULAR CONFERENCE OCTOBER 21-24, 2017 The Libin Institute is once again a gold sponsor of the 2017 Canadian Cardiovascular Conference (CCC). This year’s event will be held at the Vancouver Convention Centre in Vancouver, British Columbia and will bring together cardiologists, cardiovascular surgeons, researchers, nurses and other cardiovascular specialists from across Canada and around the globe. Please visit booth number 418 to see what the Libin Institute has been up to.

ENABLING CARDIOVASCULAR HEALTH THROUGH TRANSFORMATIVE RESEARCH NOVEMBER 14, 2017 Come learn about the Libin Institute’s new research priorities. Discussion will focus on the two priorities: vascular health and disease and arrhythmias and autonomic dysfunction. Attendees will learn about how transformative research is tackling the problems of reducing kidney disease, heart attacks, stroke, diabetes, diseases of the aorta, sudden cardiac death, common abnormalities of the heartbeat and fainting. The public event will take place at the University of Calgary’s Foothills campus on Nov. 14 at 7 p.m.

SCIENCE IN THE CINEMA YYC FEBRUARY 2018 Hosted by the University of Calgary’s Cumming School of Medicine and the Libin Cardiovascular Institute of Alberta, Science in the Cinema brings together science and popular culture in a fun and engaging way. Come watch a film and listen to an expert explain the science.

An interactive question-and-answer period will follow the movie. Admission is free.

To find out more or to register for any event, visit libin.ucalgary.ca

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ABOUT THE COVER Libin discovery scientist S.R. Wayne Chen, PhD, successfully mapped, in three dimensions, the microscopic calcium gateway of the heart: the type 2 ryanodine receptor. Ryanodine receptors are intracellular proteins found within cardiac cells that mediate the release of calcium ions, and as such are critical in muscle contraction of the heart. Chen’s work was published in one of the top sceintific journals in the world, Science, in October 2016.

Engaging community on heart health, research and innovation.

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Libin 101 is a monthly educational series on cardiovascular health promotion, disease prevention and the latest research in cardiovascular care. It brings together doctors, researchers and medical students with members of the general public to spark discussion about the human heart and innovative research currently underway in Calgary.

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Visit www.libin101.ca for more information on monthly topics and to register for a free Libin 101 event

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aWards & accolades

Kidney researchers receive national honour

By Aisling Gamble, Cumming School of Medicine Libin Cardiovascular Institute doctors Brenda Hemmelgarn and Braden Manns were co-recipients of the Kidney Foundation of Canada’s (KFOC) 2017 Medal for Research Excellence.

It’s the first time in the Foundation’s history that the award was presented to two individuals.

“The Medal for Research Excellence from the Kidney Foundation attests to the international scope of the research done by an impressive team of kidney researchers at the University of Calgary,” said Dr. Todd Anderson, director of the Libin Cardiovascular Institute of Alberta.

“Their work has enabled important changes in the delivery of care and reduction in cardiovascular events in patients with chronic kidney disease.”

Hemmelgarn is a nephrologist and professor in the department of medicine and head of the department of community health sciences at the University of Calgary’s Cumming School of Medicine (CSM).

Her research interests include chronic kidney disease, end-stage renal disease,

doctors Brenda hemmelgarn and Braden manns (pictured right) are the first-ever co-recipients of the annual Kidney Foundation of Canada’s Medal of Excelllence.

and using computerized data sources, including the Alberta Kidney Disease Network repository of laboratory data and Alberta Health administrative data. She is renowned as a considerate teacher and mentor.

Hemmelgarn is humbled by the

recognition from the KFOC and receiving it jointly with Manns makes it more special.

“It reaffirms why we do research: to improve care and outcomes for those who mean the most—our patients,” she says.

Manns, a professor of health economics and a nephrologist in the CSM’s departments of medicine and community health sciences, echoes her sentiments, saying being awarded the medal with Hemmelgarn, who is a friend and a close collaborator, is an honour.

While much of Manns’ research focuses on health care and outcomes in chronic disease and assessing the adequacy of care for Albertans with diabetes, he has also been instrumental in founding numerous kidney networks and interdisciplinary collaborations.

The duo’s collaboration has had a major impact on the translation of health care for patients with chronic kidney disease.

Hemmelgarn and Manns have also been involved in different administrative roles related to the optimal delivery of renal services in Alberta and are the principle organizers and innovators of a major renal epidemiologic centre, noted not only in Canada, but also around the globe.

Fainting experts help pen First north american guidelines The Libin Cardiovascular Institute had great impact on the committee that penned the first syncope (fainting) guidelines published in North America.

Two Libin members, including Robert Sheldon, MD, PhD, and Dr. Satish Raj were part of the committee.

In fact, Sheldon, a clinical researcher, professor at the University of Calgary’s Cumming School of Medicine and cardiologist, was vice-chair.

The guidelines are entitled “2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society.”

They were published in Circulation on March 9, 2017.

The guidelines were funded by the American College of Cardiology, the American Heart Association and the Heart 6 LIBIN LIFE

Rhythm Society and cover how to assess and manage patients with syncope, a common clinical problem that can affect a wide range of patients.

According to Sheldon, because syncope is a symptom with many possible causes, it can be complicated to treat.

The condition can be debilitating for patients, who don’t know when they will faint.

The guidelines writing committee was chaired by Dr. Win-Kuang Shen of the Mayo Clinic in Arizona and included 16 members.

According to Sheldon, this is the first time such guidelines have been published in North America, although syncope guidelines have existed in Europe for several years.

Sheldon said the guidelines are meant to give doctors practical recommendations, using the latest treatment methods, to improve patients’ quality of care.—DS

Photos by Dawn Smith

WORLD-RENOWNED CLINICIAN-SCIENTIST delivers 10th annual lecture oF a liFetime

By Dawn Smith George Wyse, MD, PhD, professor emeritus at the Cumming School of Medicine, delivered the 10th annual University of Calgary Lecture of a Lifetime (LOAL) at MacEwan Hall on May 16.

The world-renowned clinician-scientist with the Libin Cardiovascular Institute spoke to a sold-out crowd of about 500 people, sharing highlights from his youth, career and research, which included studies that changed clinical practice in the area of cardiac arrhythmias.

Wyse, who retired from clinical practice in December 2016, also shared his twelve-step program for a successful career in research telling students and young researchers to embrace change, take risks and think of science as a team sport.

“Find those who are good mentors—people you can connect with in ways that go beyond just knowledge,” he said during the question-and-answer session following his formal presentation.

Wyse’s medical career was motivated by the death of his mother, who died from a stroke when she was just 42.

Determined to make a difference in the health-care field, Wyse enrolled in the University of British Columbia’s pharmacy program.

During his last year at the institution, he took on a project that piqued his life-long interest in research.

Wyse eventually completed his PhD in pharmacology at McGill University and conducted postdoctoral research at the University of New Mexico, where he honed his skills in vascular biology.

Wyse enrolled in medical school at the University of Calgary in 1971 and was part of the second class to graduate from the faculty.

He completed his residency training in Calgary and Portland, Oregon, where he specialized in cardiology.

He came back to the UCalgary in 1978 as a faculty member, beginning his more than 35-year tenure, receiving full professorship in 1985.

Dr. Wyse’s achievements continued: he was Chief of Cardiology for the Calgary region from 1986 to 1993 and Associate Dean (Clinical Affairs) in the University of Calgary’s faculty of medicine from 1993 to 1999.

During his LOAL presentation, Wyse detailed two cardiac-arrhythmia research projects he had major leadership roles in—the Cardiac Arrhythmia Suppression Trial (CAST) and the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM)—both had global impact on the way patients were treated.

CAST took place in the mid-1980s and resulted in the understanding that some of the agents being used to treat cardiac arrhythmia patients at the time were actually increasing mortality in patients, rather than achieving their intended purpose of preventing sudden cardiac death.

AFFIRM, which took place in the 1990s when many cardiologists used drugs to keep people with atrial fibrillation in normal rhythm, showed no significant benefit with respect to death or stroke from using the drugs.

These studies, along with Dr. Wyse’s other work, resulted in more than 300 publications and more than 18,000 citations, as well as international renown for the cardiologist, who was a member of the original electrophysiology group at the University of Calgary.

Wyse has received numerous awards during his career including the 2007 Distinguished Scientist Award from the Heart Rhythm Society, an Annual Achievement Award from the Canadian Cardiovascular Society in 2008, and the Top 40 Alumni Award (2007) and Distinguished Alumni Award (2005) from the University of Calgary. He has also held such roles as president of the Heart and Stroke Foundation of Alberta, Northwest Territories and Nunavut.

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COMMUNITY ENGAGEMENT

LIBIN 101 Robert Rose, PhD, (pictured left) was the March 29, 2017 Libin 101 speaker, telling a sold-out crowd at Crowfoot Library about his research on the sinoatrial node, the heart’s natural pacemaker. Libin 101 is a free public educational series on cardiovascular health promotion, disease prevention and the latest research in cardiovascular care. It brings together doctors, researchers and students with members of the general public to spark discussion about the human heart and research underway in Calgary. Find out more at libin101.ca.

Photos by Melanie Yar Khan

Photos by Lauren Thorne

ZOO DAY About 500 Libin staff, members, trainees and their families took part in Wild at Heart, the Libin Family Barbecue. The event is held at the Calgary Zoo on and includes a barbecue buffet, family-friendly games and activities and a photo booth. (Photos pictured were taken at 2016 event).

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PROJECT PULSE

Photo by Project Pulse

Dr. Katherine Kavanaugh speaks to a group of high school students during the Project Pulse Conference, which seeks to enlighten students on the possibilities of a career in health sciences through exposure to top researchers.

The event, which was sponsored by the Libin Institute, was organized by students and held at the University of Calgary’s Foothills Campus on April 8, 2017.

Photos by Melanie Yar Khan

Photos by Niket Sura

HEART & STROKE TOUR The Libin Institute’s Dr. Henry Duff speaks to visitors to his lab during this year’s annual Research to Life Tour at the University of Calgary on April 27, 2017. The event brought together Heart & Stroke Foundation supporters and donors, giving them an inside look at some of the research underway at the University of Calgary.

PIPELINE INTELLIGENCE: EXPLORING THE NETWORK OF OUR CIRCULATION This special edition of Libin 101, Pipeline intelligence: exploring the network of our circulation, took place at Calgary’s Central Library during Heart Month on Feb. 23, 2017. The free event featured Libin Institute members doctors Merril Knudtson, Jennifer MacRae, Todd Anderson and James White who spoke on innovative discoveries in the area of vascular science at the Libin Institute. About 80 people attended. Next year’s event is scheduled for Feb. 22, 2018 at Central Library.

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NEWS & HIGHLIGHTS

INTERNATIONAL RESEARCHER EARNS LIBIN/AHFMR PRIZE Professor Eric N. Olson, PhD, was the sixth recipient of the Libin/ AHFMR Prize for Excellence in Cardiovascular Research at the University of Calgary, which is given to an outstanding international researcher whose work is deemed to have had a major impact on the understanding, prevention, recognition or treatment of cardiovascular disease.

Olson, the founding chair of the department of Molecular Biology at the University of Texas’s Southwestern Medical Center, delivered a lecture, “Correction of Muscle Disease by Genomic Editing,” on Jan. 23, 2017 at the University of Calgary’s Foothills Campus.

Olson’s research focuses on studying muscle cells as a model for understanding how stem cells adopt specific fates and how programs of cell differentiation and morphogenesis are controlled during development.

During his lecture, he detailed how he and his team of researchers are working towards correcting the genes responsible for certain forms of muscular dystrophy, including Duchenne muscular dystrophy (DMD), a severe type that affects about one in 5,000 males.

Olson believes gene editing will change the future of precision

Eric Olson, PhD, delivers a lecture at the University of Calgary earlier this year.

Olson was the recipient of the sixth Libin/AHFMR Prize for Excellence in Cardiovascular Research.

medicine and genetic disorders in general, noting permanent correction of disease-causing mutations is possible.

In principle, this can be achieved in just one treatment with the potential to correct up to 80 per cent of DMD mutations.—DS

MEMBER PLAYS KEY ROLE IN WRITING HYPERTENSION GUIDELINES May was an exciting month for the Libin She added before new treatments are Cardiovascular Institute’s Dr. Doreen Rabi. included in the guidelines, there must be Rabi, a clinical endocrinologist and strong evidence they save lives and prevent associate professor in the University of heart attacks and strokes.

Calgary’s Cumming School of Medicine, had She noted Canada leads the world in a large presence in the Canadian Journal of patient outcomes when it comes to Cardiology’s May 2017 issue, which focused on hypertension, explaining the number of precision medicine in hypertension. people that are treated and controlled for Rabi was a guest editor, penned two high blood pressure in Canada has risen editorials and was the last author listed on from 13.2 per cent in 1992 to 63.9 per cent Hypertension Canada’s 2017 Guidelines, in 2011. due to her position as chair of the Rabi attributes the success to a greater Hypertension Canada Guidelines Committee awareness for the condition, better (HCGC), which consists of about 80 prevention and treatment and more clinicians and publishes guidelines annually. individualized care.

She is proud of Canada’s record when it Rabi said chairing the HCGC was a comes to treating hypertension, which is the wonderful, collaborative experience. She leading cause of premature death globally. noted numerous colleagues from across “Globally, Canada is the leader in Canada were involved in the process, Dr. Doreen Rabi was instrumental in hypertension control,” said Rabi, noting each including several from the Libin penning Hypertension Canada’s 2017 Guidelines. year the HCGC undertakes a comprehensive Cardiovascular Institute. and systematic review of new literature and The project’s lead was Dr. Alexander Leung, innovations in hypertension treatment and updates the guidelines as an assistant professor in the department of medicine at the required.

University of Calgary. Other Libin members who took part “Internationally, our annual updates set the Hypertension Canada include Dr. Kara Nerenberg, Dr. Kerry McBrien, Dr. Sonia Guidelines apart,” added Rabi.

Butalia, Dr. Norman Campbell and Dr. Michael Hill.—DS 10 LIBIN LIFE

RESEARCH GRANTS AWARDED

By Dawn Smith

DR. ED O’BRIEN Dr. Ed O’Brien’s lab received $100,000 in bridge funding from the Canadian Institutes of Health Research (CIHR) to study several groups of female patients to determine whether levels of HSP27, a naturally occurring protein, decrease in women after menopause.

This information may be used to predict coronary artery disease in post-menopausal women.

The study will also explore how the interrelated concepts of sex and gender influence the risk perception and management of coronary artery disease in males and females.

A related study, funded equally by CIHR and the Libin Institute, with both entities giving $25,000, will engage patients on how to better understand how gender influences cardiovascular disease.

DR. JAMES WHITE Dr. James White, director of the Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute, is co-lead on a project that was recently awarded a $300,000 grant from Alberta Innovates and Genome Alberta.

The Alberta Precision Health Initiative (APHI) Development Grant will help a team of researchers study heart damage in patients undergoing cancer-related treatments.

The Cardiotoxicity Prevention Research Initiative (CAPRI) is a collaborative project with the University of Calgary, University of Alberta and Alberta Health Services.

With several planned phases, CAPRI’s goals are to help standardize care pathways for breast cancer patients at elevated risk of heart damage and to allow for improved data capture and monitoring across Alberta.

This is a critical first step in the team’s ultimate goal of predicting, detecting and treating damage to the cardiovascular system related to cancer therapies—which can cause permanent decreases in heart function and sometimes death.

DR. STEPHEN WILTON Stephen Wilton, MD, PhD, is part of a multi-site team that received a CANet grant of $342,549 with matching funds of $385,500.

The funding will be used to study how heart attack patients who are at risk of sudden cardiac death are identified and treated across the country with the goal of designing interventions to address care gaps.

Wilton’s project sets out to establish a nationwide interactive registry designed to assess variability in current practice for post-myocardial infarction (MI) sudden cardiac death (SCD) risk stratification; optimize post-MI follow up, facilitate the implementation of guideline-based therapies, and provide a platform to evaluate novel interventions aimed at reducing SCD events.

Wilton is an cardiologist with a specialty in electrophysiology.

DR. SATISH RAJ Dr. Satish Raj led the team that earned a $1.4 million Strategic Research Grant from the Cardiac Arrhythmia Network of Canada (CANet) for Community Alternatives for Syncope Management in the Emergency Room (CASMER).

With CASMER, Raj and his team aim to provide a better and seamless alternative to emergency department assessments for patients with syncope (fainting) who are at low risk of adverse outcomes.

The project has numerous components such as the creation of reliable, accurate digital resources for patients; risk-assessment tools and training for emergency medical services staff on how to assess syncope patients to potentially provide alternatives to the emergency room; and creation of an outpatient “syncope haven.”

The results of the interventions will then be studied to assess their impact on patients and the health-care system.

The goal of CASMER is to reduce the burden of recurrent vasovagal syncope, restore quality of life in patients and lessen the burden on the health-care system. The program activities will also build national networked capacity in research; training and career development; and patient engagement in research.

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FEATURE

REDUCING THE BURDEN OF HEART DISEASE

Libin Cardiovascular Institute sets five-year research priorities

By Dawn Smith

T

he Libin Institute, an entity of the University of Calgary and Alberta Health Services that includes membership of more than 175 physicians and researchers, has a new Strategic Plan 2017-2022, which sets the Institute’s research and research-training priorities over the next five years.

Institute Director, Dr. Todd Anderson, said the plan is a framework that addresses goals and strategies for research and research training/mentoring at the Libin Institute, which is responsible for the delivery and coordination of all cardiovascular research, education and care in Calgary and includes a referral base of Southern Alberta as well as parts of British Columbia and Western Saskatchewan.

“This Strategic Plan… is meant to provide focus for our vision and mission: to prevent suffering and premature death from cardiovascular disease and provide better patient care,” said Anderson, noting Libin Institute Deputy Director Dr. Anne Gillis led the development of the plan after numerous consultation sessions with stakeholders that began in December, 2015.

The plan’s research priorities are vascular health and disease and heart rhythm disorders (arrhythmias), including autonomic dysfunction such as fainting.

The plan embraces the idea that no treatment plan fits all and places emphasis on patient-centred precision medicine.

Vascular health not only encompasses heart problems like coronary artery disease and diseases of the aorta, but also conditions that may lead to heart disease, such as obesity, diabetes, chronic kidney disease and high blood pressure.

According to Anderson, vascular disease

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remains the leading cause of death in Canada and contributes to problems such as heart failure, which is one of the top reasons for hospital admissions.

The Libin Institute is also focusing on arrhythmias and autonomic dysfunction— including atrial fibrillation, sudden cardiac death and fainting disorders.

Anderson said the Libin Institute has assembled an outstanding team of basic science, clinical and outcomes researchers in both priority areas. He sees this plan as a way of taking advantage of the institute’s strengths and providing opportunities to grow in these important areas.

Dr. Gillis is also excited about the new strategic plan, noting several new researchers have already been recruited to the Institute as a result of the new priorities.

“Bringing in established and new young research investigators re-energizes the Libin,” she said. “But we also want to build on the strengths and successes of our established investigators.”

The plan focuses on discovery of new therapies, early detection of risk/disease

and delivery of enhanced patient care.

Dr. Sofia Ahmed, the Libin Institute’s Director of Research, Training and Mentorship, said the Libin’s mandate of mentoring the next generation of researchers and clinicians will continue under the new plan.

“You can’t grow or even maintain [excellence and innovation] if you don’t train people and launch them in their careers. Education and mentorship is the only way the Institute will continue to grow,” she said.

Gillis added faculty renewal, retention and research training, as well as the core enabling platforms of the Libin, will continue to be keys to the institute’s success.

These platforms include the Mozell Family Analysis Core Laboratory; the Stephenson Cardiac Imaging Centre; numerous clinical research groups; and APPROACH, which is one of the largest cardiac databases in the world.

Gillis said although the Libin Institute focused the strategic plan on research, the ultimate motivation is patients.

“At the end of the day, all of these research priorities come back to the patient, and our success depends on expanding our relationships with the community at large,” she said.

“This Strategic Plan… is meant to provide focus for our vision and mission: to prevent suffering and premature death from cardiovascular disease and provide better patient care,” —Libin Cardiovascular Institute Director Dr. Todd Anderson.

COLLABORATIVE GROUP COMMITTED TO IMPROVING CARDIOVASCULAR HEALTH

By Alyssa Lam P2 Cardiovascular Health: Person to Population Research Collaborative is the Libin Institute’s newest research group.

P2 consists of researchers with a variety of expertise and backgrounds, including clinical research, health services research, statistics, health economics and implementation sciences. P2 members are committed to improving heart and blood vessel health in Alberta for both individuals and the Alberta population as a whole.

The group will conduct innovative research in diverse areas, including collaborating with patients in order to include the patient perspective, monitoring and reporting on risk factors and cardiovascular disease and developing interventions to prevent cardiovascular disease. Members of the group will also build high quality ‘big data’ sources to better research, monitor and report on cardiovascular disease throughout the province.

P2 members will leverage their position within the Libin Cardiovascular Institute to collaborate with local experts and take advantage of the vast network that extends the sectors of academia, health care and government.

This will ensure well-rounded and valuable work in the context of Alberta health care.

The team’s thematic areas include: Population Level Risk; Risk Prediction Modelling for Precision Medicine and Health System Projection and Forecasting; Social Determinants of Health, Vulnerable Populations and Social Disparities; Patient Care Process and Outcomes; and Community Photo by Al-Karim Walli Engagement and Patient-Centred Care.

Executive committee member, Dr. Maria Santana, is leading the Community Engagement and Patient-Centred Care area.

She says, “The strength of P2 is the multidisciplinary team which includes patients, families, clinicians and health researchers, all working together to address relevant issues to improve patient outcomes in cardiovascular health.”

WorLd-CLass faIntIng experts unIte With the arrival of Dr. Satish Raj in 2014 and Dr. Carlos Morillo in the fall of 2016, the Libin Institute ranks as one of the top syncope centres in the world.

Morillo and Raj joined world-renowned syncope expert Robert Sheldon, MD, PhD, a University of Calgary professor, clinical researcher and cardiac arrhythmia specialist who has practiced in Calgary since 1982.

“Most people in Canada would agree that we probably have the best syncope centre in the country and one of the best in the world,” said Raj. Syncope, commonly known as fainting, is a condition that affects a wide variety of people and can downgrade quality of life for sufferers.

It is often associated with low blood pressure, but is a symptom that has many possible causes—including pain, dehydration and emotional stress as well as several heart, neurologic, psychiatric, and metabolic and lung disorders—and is thus difficult to treat.

Sheldon’s interest in syncope began in 1989, and he has spent the last 30 years researching the condition.

His expertise in the area is well known.

In fact, Sheldon was selected as vice-chair

of the writing committee that penned the first North American syncope guidelines— developed by the American College of Cardiology, American Heart Association and the Heart Rhythm Society—and published in March 2017 in Circulation.

Sheldon’s outstanding work in the area of arrhythmias and syncope also earned him an Annual Achievement Award at the Canadian Cardiovascular Congress (CCC) in October 2016.

Morillo, a cardiologist, electrophysiologist and professor of medicine, was recruited to join the Libin Institute in October 2016 as the chief of cardiology and to conduct research alongside other Institute experts.

He brings expertise in the areas of syncope and Postural Orthostatic Tachycardia Syndrome (POTS), a rare nervous-system disorder that causes an unusual increase in heart rate in patients who are in an upright position, causing them to feel faint and hampering their quality of life.

Morillo’s work has been recognized internationally throughout his career. Most recently, he was awarded a Golden Caliper Award from the Latin American Pacing/EP Society &

Brazilian Society of Cardiac Arrhythmias, but he has earned other prestigious awards, such as the Charles Pfizer Research Award, the National Academy of Medicine – Aventis Clinical Research Award and the Award for Best Researcher from the Sociedad Colombiana de Cardiologia.

He is excited about the Libin team.

“We are hoping to create a syncope fainting research hub here,” said Morillo, who was selected as one of the 10 most influential Hispanic-Canadians in 2010.

Raj, who was recently named president-elect of the American Autonomic Society and heads Alberta Health Service’s Calgary Autonomic Investigation and Management Clinic, is also a POTS, orthostatic hypotension and syncope expert with clinical research trials currently underway.

He said the vision of Libin’s syncope and autonomic dysfunction team is to build on previous and ongoing research, collaborate with experts from other disciplines, and use the tools and platforms already available for Institute members to better the lives of individual patients. —DS

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• Includes stroke, heart attacks, chronic kidney disease, diabetes, and diseases of the aorta

VASCULAR HEALTH

ENABLING CARDIOVASCULAR HEALTH THROUGH TRANSFORMATIVE RESEARCH

LIBIN CARDIOVASCULAR INSTITUTE OF ALBERTA

FIVE -yEAR

WHy WE CARE Cardiovascular disease is the leading cause of death worldwide Canadians suffer from 70,000 heart attacks and 50,000 strokes annually Cardiovascular disease costs $25 billion annually The incidence of diabetes has doubled in 10 years

PRIORITIES

• Delivering precision treatments • Developing costeffective ways of using scarce resources while optimizing patient care

OUR SCIENTISTS ARE

• Detecting the prevalence of cardiovascular risk factors across the province to reduce heart attacks

• Includes sudden cardiac death, abnormal heart beats, and fainting

WHy WE CARE Sudden cardiac death is the leading cause of premature death globally Sudden cardiac death kills 40,000 Canadians annually Atrial fibrillation affects about 350,000 Canadians annually and can lead to stroke

ARRHyTHMIAS & AUTONOMIC DySFUNCTION

• Discovering what makes the heart beat at the molecular level

LIBIN LIFE 15

CARE DELIVERY

CARDIOVASCULAR INTENSIVE CARE UNIT ON CUTTING EDGE

By Dawn Smith The Cardiovascular Intensive Care Unit (CVICU) at Foothills Medical Centre (FMC) is on the cutting edge when it comes to treating heart attacks after open-heart surgery.

After 18 months of work and training, CVICU staff have implemented a new protocol, based on European guidelines, to treat the special group of patients. The unit is the first in Alberta to do so.

Kari Litzenberger, CVICU manager, explained the unit exclusively cares for approximately 1,200 post-operative patients annually, noting the group has an increased risk of cardiac arrest.

Patients have undergone a sternotomy, an incision in their sternum, or breastbone, and may have internal bleeding that can constrict the heart and stop it from beating properly.

“We have implemented three new procedures plus an early chest-opening protocol (where the chest is reopened to reach the heart),” said Litzenberger.

She explained in other patient groups, chest compressions are used before defibrillation machines, but in this patient group, defibrillation is used first to prevent injury due to the chest being opened in surgery. If that doesn’t bring the heart back into normal rhythm, the chest is reopened to relieve heart pressure, which may be enough to bring the heart back to normal rhythm. The next step is gentle massaging of the heart.

Litzenberger said cardiac fellows Dr. Julie Robichaud and Dr. Andre Ferland spearheaded the protocol to improve patient outcomes.

Staff members Chris Coltman, clinical nurse educator, and Kristin Robertson, clinical resource nurse, helped train the CVICU’s 85 nurses, 17 respiratory therapists and nine intensive care physicians,

running simulations (SIMS) with the help of Mirette Dubé, FMC’s lead SIMS consultant.

Coltman said staff has quickly adopted the new protocol, explaining the new procedures are intuitive.

“Everyone bought into it; it just makes sense,” he said, adding the team is already using the procedure, which was implemented in March 2017.

According to Litzenberger, a side benefit of the new protocol is a more effective and efficient team, with an improved grasp on roles.

Robertson is pleased implementation of the new protocol has been a success. “It is all about improved outcomes for our patients,” she said.

PROJECT AIMS TO SAVE HEALTH-CARE DOLLARS

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The Cumming School of Medicine’s department of cardiac sciences was awarded an Alberta Health Services (AHS) grant in March for a proposal aiming to save patients time, travel and money and to reduce the burden on the health-care system.

The proposal, “Calgary CIED (Cardiac Implantable Electrical Device) Clinic Referral Process: An Opportunity to Rationalize Cardiac Testing and Improve the Patient Experience,” is led by Libin Cardiovascular Institute of Alberta member F. Russell Quinn, MD, PhD. Quinn is pleased the proposal will receive a portion of the $325,000 in total project funding provided by the Chief Medical Office and Calgary Zone Medical Affairs’ Quality Improvement Initiative competition, which garnered 33 submissions.

The goals of the project are to cut down on unnecessary and redundant testing and reduce the number of patients who are referred to the CIED Clinic for an Implantable Cardioverter-Defibrillator (ICD) but don’t receive one because they don’t meet the criteria or choose to not go ahead with the procedure.

Reducing the number of patients referred to the CIED Clinic will save the health-care system money, improve the patient experience and make the clinic more efficient for its staff. The goal is to measure and report the results by April 2018.—DS

PROGRAM EASING TRANSITION FOR YOUNG CONGENITAL HEART PATIENTS

T

here’s something new at the Southern Alberta Adult Congenital Heart Disease Clinic, located at the Peter Lougheed Centre.

Dr. Nanette Alvarez, the clinic’s director, said staff at the clinic is working to develop a transition program to facilitate the transfer of patients from the Alberta Children’s Hospital to the adult clinic when they reach the age of 18.

Alvarez said although the concept is not new, the program, which will ramp up services over the next year, fills a much-needed niche for patients with congenital heart diseases.

“A lot of patients are lost to care when they transition into adulthood and don’t follow up with an adult cardiologist,” said Alvarez, a Cuumming School of Medicine clinical assistant professor in the department of cardiac sciences whose work focuses on echocardiography and adult congenital heart disorders. “We recognize the need for a more easily accessible, standardized and comprehensive program.”

Alvarez said the clinic gets about six referrals from the Alberta Children’s Hospital per week, noting that some patients may develop complications later in life that will require medical or surgical interventions, making it critical they follow up with experts.

According to Alvarez, the transition can be difficult for some patients, many of whom have previously relied on their parents or guardians to manage their health care.

Alvarez says that while staff at the clinic don’t exclude parents from participating, they do encourage patients to become their own advocates and learn to manage their own care.

Besides assessment, treatment and follow-up for adults with a known or suspected structural congenital heart condition, the clinic provides support for patients and their families with a multidisciplinary team including social workers and nurses, and facilitates referrals to subspecialties such as cardiac and vascular surgery, obstetrics and gynecology and genetics.

There are numerous supports in place for patients, including family planning and career counselling services.—DS

NEw DEVICE REDUCES RISk OF STROkE

D

octors in the Libin Institute’s electrophysiology labs have a new way to reduce the risk of stroke in a group of patients suffering from atrial fibrillation (AF), a condition that can increase the risk of stroke due to an improperly beating heart.

Drs. Stephen Wilton, Vikas Kuriachan and Carlos Morillo have implanted five left atrial appendage occlusion devices since the therapy was introduced at the Foothills Medical Centre (FMC) in the fall of 2016.

The devices close the left atrial appendage, a finger-like structure that originates from the left atrium, varies in shape and size and can be a site of blood clot formation in AF patients.

According to Andrew Mardell, clinical nurse educator for cardiac specialty clinics at the FMC, most AF patients at high risk for strokes are treated with blood thinners.

However, a subset of patients, often those with renal problems or previous severe bleeding, can’t take blood thinners. Therefore, they have an increased risk of forming clots, which can lead to serious strokes and reduced quality of life.

“There is now a therapy we can offer them,” said Mardell, noting the incidence of stroke is decreased through the atrial appendage occlusion procedure.

Diane Schmidt, a registered nurse and a manager in cardiac sciences at FMC, said the therapy, which involves inserting the device through a catheter where it expands and blocks off the appendage opening, is a great option.

“It gives patients another alternative when other therapies are not appropriate,” she said, adding patients that have undergone the procedure can usually go home after just one night in hospital.

Although the occlusion devices were approved in Europe in 2009, in North America their use is relatively new. The FMC is the only site in Alberta where the device is used.

Mardell said the new procedure, which required specialized training for physicians and registered nurses, will likely result in millions of dollars in savings to Alberta Health Services.

With an average of more than 50,000 strokes in Canada and an annual cost of more than $2.5 billion, left atrial appendage occlusion will provide options.

Patients needing the procedure can be referred to FMC’s cardiac arrhythmia clinic directly.—DS

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EDUCATION

2017 TINE HAWORTH CARDIOVASCULAR RESEARCH DAY The 2017 Tine Haworth Cardiovascular Research Day, held in April at the University of Calgary’s Foothills Campus, was a huge success. The full-day event brought together students, faculty and guests. The event, made possible by the generosity of Calgary’s Tine Haworth, included a poster competition, trainee talks, and scientific presentations from Libin Institute members Paul Fedak, MD, PhD, Vaibhav Patel, PhD, and Rob Rose, PhD. Milica Radisic, PhD, a University of Toronto Professor and Canada Research Chair in Functional Cardiovascular Tissue Engineering, presented the E.R. Smith Lectureship, sharing details about her innovative work in bioengineering functional tissues.

Photos by Dawn Smith

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Photo by Dawn Smith

ExpANDINg HORIzONS Trainee earns scholarship to train abroad

By Dawn Smith

A

lthough Saman Rezazadeh, MD, PhD, is nearing completion of his cardiology specialty training at the Cumming School of Medicine, his education isn’t complete.

Rezazadeh is starting an electrophysiology fellowship at the University of Calgary, but he won’t be confining his study to Alberta.

Part of his studies will occur in Amsterdam, where he will split his time between clinical practice and basic science research.

His plans just got simpler thanks to the Canadian Heart Rhythm Society’s decision to award Rezazadeh the 2017 George Mines Travelling Fellowship for $57,000 to assist him in his studies abroad.

“I am excited,” said Rezazadeh. “In addition to the honour of being recognized by the Canadian Heart Rhythm Society, this funding completely took away any worries I had about the cost of living in Europe.”

Rezazadeh’s studies began in 1998 at the University of British Columbia (UBC), and his interest in studying the mechanisms behind abnormal heart rhythms began early.

During his honours undergraduate degree in physiology, Rezazadeh worked in a basic science lab with a focus on electrophysiology. This experience piqued his interest in the area.

That interest grew when, after completing his undergraduate degree, Rezazadeh worked at a biotech company, where he was encouraged to complete a masters degree in electrophysiology.

“That led to a doctorate,” said Rezazadeh, explaining it was always his intention to become a medical doctor, so after completing his doctorate, he enrolled in medical school at UBC.

After completing his internal medicine program at UBC in 2014, Rezazadeh came to the University of Calgary to complete his cardiology training with Dr. Hank Duff as his mentor.

Rezazadeh is excited about the opportunity to learn at the University of Amsterdam under the mentorship of Arthur Wilde, MD, PhD, whose focus is on different aspects of inherited arrhythmias, and Dr. Connie Bezzina, who conducts translational research aimed at identifying genetic risk factors underlying cardiac disorders.

Rezazadeh hopes the knowledge he gains while away will be useful in his clinical and research endeavours in Calgary.

According to Rezazadeh, he is thrilled to be part of the electrophysiology group at the Libin Institute because of the “unique opportunity for clinicians and basic scientists to work together.”

“You don’t see that often,” he said of the collaboration.

Rezazadeh explained patients with inherited arrhythmias are often at a risk of sudden cardiac death, which can occur at a young age.

“If you pick up the disease early and modify it… you can have a huge impact in the trajectory of their life,” he said.

Rezazadeh hopes his work in the lab will help further understanding of the mechanisms behind the mutations and how to treat patients with these defects more effectively. The doctor is pleased to combine his love of research with clinical work.

“That’s the beauty of working in an academic environment,” said Rezazadeh.

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EDUCATION

fOllOwINg IN

big fOOTsTEps

TRAINEE wINs sAME pREsTIgIOUs INTERNATIONAl AwARD As MENTOR

Photo by Dawn Smith

A part of the Libin Cardiovascular Institute of Alberta’s cardiac surgical residency program, Holly Mewhort, MD, PhD, received international recognition for her work in cardiac research.

Mewhort won the Vivien Thomas Young Investigator Award from the American Heart Association, a prestigious accolade given to early investigators who are focusing on fundamental and applied surgical research.

Mewhort’s research was conducted as part of her doctorate studies, which she completed in June 2016 under the supervision of Libin Institute’s Paul Fedak, MD, PhD, a cardiac surgeon and basic/ translational researcher who directs the Marlene and Don Campbell Family Cardiac Research Laboratory at the Cumming School of Medicine.

Mewhort’s research investigates the use of biomaterial in regenerating and restoring

Holly Mewhort, MD, phD, and her mentor, paul fedak, MD, phD, display their Vivien Thomas Young Investigator Awards, won years apart.

heart tissue in patients who had previously suffered a heart attack.

The material, CorMatrix-ECM, a connective tissue matrix that Mewhort describes as providing the scaffolding that holds cells together and influences their behaviour and survival, is surgically applied to damaged heart tissue to trigger healing.

Mewhort’s research in this area began four years ago in the lab and has had great success.

In preclinical trials, the project has shown that this bio-material can restore function to damaged heart muscle by promoting the formation of new blood vessel networks—a process called vasculogenesis.

The investigators have completed a pilot clinical trial, which saw the patch applied to the heart tissue of a handful of patients during coronary bypass surgery.

The results haven’t been published yet, but the data looks promising.—DS

CARDIOlOgY REsIDENT HONOURED fOR OUTCOMEs REsEARCH

Dr. Derek Chew received an honourable mention in the American College of Cardiology’s Young Investigator Awards.

20 LIBIN LIFE

Cardiology resident Dr. Derek Chew received an honourable mention in the American College of Cardiology’s Young Investigator Awards in the category of Outcomes Research.

Chew, who is nearing the completion of his residency, earned the accolade for studying the cost effectiveness of left ventricular assist devices (LVAD) in cardiac transplant ineligible patients, a project he undertook with the supervision of the Libin Cardiovascular Institute of Alberta’s Dr. Derek Exner, a cardiologist, heart rhythm specialist and professor in the department of cardiac sciences in the Cumming School of Medicine.

Chew said he was surprised to learn he was one of six finalists in the competition, which receives submissions from all over North America, as well as the Middle East and Europe.

“The recognition was wonderful,” said Chew, who explained he attended the ACC’s

66th annual Scientific Session in the United States where he presented his work to a panel of judges.

Chew studied the cost effectiveness of utilizing LVADs, surgically implanted mechanical heart pumps, as a permanent therapy for patients in advanced heart failure within the Canadian health-care setting.

Chew explained that, at least in Canada, LVADs are usually given to patients waiting for a heart transplant and less commonly used as a permanent therapy for patients ineligible for a transplant.

However, with improvements in technology, the use of LVADs for this purpose is more likely to increase, explained Chew.

Chew’s research showed that while LVADs save lives and improve quality of life for patients, using LVADs as a permanent solution does not meet the current threshold to be considered cost effective.—DS

gATEwAY

TO THE HEART

REsEARCH

MAPPING THE

By Dawn Smith

T

he last few months have been busy, but highly gratifying, for the Libin’s S.R. Wayne Chen, PhD. The researcher was awarded the Heart and Stroke Foundation of Alberta, NWT & Nunavut Chair in Cardiovascular Research in January 2017, a much-needed support to further the work of his lab.

This new appointment was a result, in part, of the innovative work underway in the Chen lab, which has resulted in Chen’s work being published in high impact journals. In fact, Chen was the co-corresponding author, alongside Professor Nieng Yan of Tsinghua University in China, which was published in of about 20,000 amino acids in four subunits that come together to Science, one of the top scientific journals in the world, in form the RyR2 ryanodine receptor—the largest ion channel known October 2016. in the human body.

The paper details how researchers can Chen explained the RyR2 receptor was now see in three dimensions, for the first mapped using a technology called single-particle time, ryanodine receptors—intracellular electron cryomicroscopy, in which pictures proteins found within cardiac cells that were taken of the receptors at cryogenic mediate the release of calcium ions, which temperatures from many different perspectives are critical in muscle contraction in the and three-dimensional composites created using heart. the images.

Properly functioning cardiac ryanodine Researchers were able to reconstruct the receptors (RyR2) are critical in allowing the RyR2 receptors to 4.4-Å (Angstrom) and 4.2-Å heart to beat normally. resolutions for the closed and open states of This paper builds on Chen’s previous the ryanodine receptor gates, respectively. breakthrough paper, published in Nature Chen said moving forward, he trusts that magazine in January 2014. better resolutions of the cardiac ryanodine Chen is pleased with the recent work. receptors will be achieved, adding it is a great He says being able to visualize the structure time to be involved in research in this area. of the calcium release channels as they “Now that the structure is available, we may open and close is key in developing new be able to manipulate how easy or hard it is to treatments for patients with arrhythmias, open or close the calcium channel,” said or abnormal heartbeats.

Chen, explaining new treatments may now be “That’s why basic science is so possible with better outcomes for patients. s.R. wayne Chen, phD, and his team have important,” said Chen. “If you don’t really successfully mapped the type 2 ryanodine Libin Institute Director, Dr. Todd understand how something works, it’s receptor RyR2.

Anderson, agrees. difficult to do anything about it.”

“Dr. Chen’s cutting-edge research evaluating Chen said defects in ryanodine receptors, how cardiac cells handle calcium has changed our understanding of which he refers to as calcium gateways, may allow calcium to flow the causes of lethal heart rhythms and provides opportunity for novel through at the wrong time or at the wrong pace. life-saving therapies,” he said. “New medications that target the This problem is associated with a number of cardiac issues, ryanodine receptor will undoubtedly translate into improved patient including ventricular tachycardia and ventricular fibrillation, common care.” forms of arrhythmia that can lead to sudden cardiac death.

Chen said resolving the three-dimensional structure of the cardiac ryanodine receptor was a challenging task, as the structure is made up

LIBIN LIFE 21

RESEARCH Photo by Adrian Shellard

$3 MILLION GRANT TO BRING PRECISION MEDICINE TO HEART PATIENTS

I

By Dawn Smith & Kelly Johnston, Cumming School of Medicine

t is the most common congenital heart defect: bicuspid aortic valve (BAV), a genetic condition in which patients are born with two flaps in their aortic heart valve instead of the usual three, and yet there isn’t a personalized approach for preventing the complications resulting from this defect.

That’s something the Cumming School of Medicine’s Dr. Paul Fedak, and Alex Barker, PhD, of Chicago’s Northwestern University Feinberg School of Medicine, hope to change with a five-year clinical research study.

Supported by a prestigious and highly competitive $3.3 million National Institutes of Health (NIH) RO1 grant, Fedak and Barker will use 4D-Flow MRI, a cutting-edge imaging technique that allows visualization of three-dimensional blood flow in real time, and tissue analysis to inform personalized treatment for BAV patients.

The research study will also involve an interdisciplinary UCalgary team including Dr.. James White, Director of the Stephenson Cardiac Imaging Centre and Elena Di Martino, PhD, associate professor at the Schulich School of Engineering.

The results of the study may cut down on the number of unnecessary open-heart surgeries while also identifying and targeting those who are at highest risk and need it most.

“Not all BAV patients are the same, yet they are currently treated the same when it comes to timing and extent of surgery,” said Fedak, cardiac surgeon and professor in the departments of Cardiac sciences and surgery and member of the Libin Cardiovascular Institute.

“Through this study we can give clinicians and surgeons the tools they need to create precise, individualized treatment plans for patients.”

“Each patient’s condition is unique. We are developing state of

22 LIBIN LIFE

the art MRI techniques to help with the assessment of their condition to develop the best plan of treatment,” said Barker, a bioengineer and assistant professor in the department of radiology at the Feinberg School of Medicine.

“The use of this novel imaging technology can provide a better understanding of the underlying cause of aortic aneurysms in addition to identifying the patients who are most at risk of complications. The proposed study will link MRI images directly with patient tissue and blood samples and may discover important new biomarkers that can predict individual patient risks.”

BAV affects more than seven million people in North America, and 50 per cent of them will require a life-saving intervention such as open-heart surgery.

Blood flow through a bicuspid valve is abnormal—similar to water through a hose when you put your thumb over it—and the altered flow can create an erratic flow pattern increasing pressure in susceptible vessel areas. This increased pressure can cause stress on the walls of the aorta, causing them to dilate and potentially erupt in what is known as an aortic dissection, which can be fatal.

Fedak’s NIH grant will allow for an advanced tissue analysis for a larger group of patients (450) over the next five years, the largest series in the world.

Research reported in this article was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R01HL133504. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

SECRETS

OFA

MENTOR

Retired researcher shares secrets of his career

By Dr. Robert Miller Libin Institute trainee Dr. Robert Miller sat down with Henk ter Keurs, MD, PhD, in June 2017 to talk about his 45-year career as a researcher and clinician. Dr. ter Keurs recently retired from research.

WHAT MADE YOU WANT TO PURSUE A CAREER IN RESEARCH? Simple curiosity. Also, my father made seismic geophysics instruments; therefore, he was always working on what happens when you explode dynamite and listen to the echo of that ‘bang’ coming back from the earth’s crust.

Wondering how things work came naturally.

HOW LONG HAVE YOU BEEN AT THE LIBIN INSTITUTE AND WHAT MOTIVATED YOU TO STAY? I am originally from Holland, where I was a clinical cardiologist and researcher. My faculty in the Netherlands expected me to become department head, but department heads don’t have a lot of time for their curiosity. I knew John Tyberg, MD, PhD, and respected him enormously; he and Dr. Eldon Smith brought me here to conduct research with support of the Alberta Heritage Foundation For Medical Research, which I have been doing since 1984.

After my arrival, I also resumed my clinical career. What kept me here were the great colleagues and brilliant students.

Photo by Dawn Smith

WHAT HAS BEEN THE FOCUS OF YOUR WORK FOR THE LAST 20 YEARS? For the last four decades, my focus has primarily been on looking at cardiac function.

My early work was studying the mechanisms of how heart muscles contract at the level of cells or smaller. But while doing this research, we had the annoying problem of some of the muscles being studied developing arrhythmias, which made it difficult to conduct experiments.

This problem, however, led to a 20-year focus on the mechanisms behind the development of arrhythmias, including how the components of calcium handling by the cell affect the heartbeat. The bottom line is that we turned the nuisance of damaged muscles into a study of the mechanisms behind arrhythmias and much grant-supported work.

Henk ter Keurs, MD, PhD, poses alongside Dr. Robert Miller. The duo met to discuss ter Keurs’ long clinical and research career.

WHAT IS YOUR GREATEST ACHIEVEMENT? Discovery of length-dependent activation of the cardiac sarcomere underlying Starling’s Law, which represents the relationship between stroke volume and end diastolic volume. This work led to the discovery of arrhythmias caused by non-uniform contractile properties, and the subsequent discovery of the role of the Purkinje cells in arrhythmias.

WHAT ADVICE WOULD YOU GIVE TRAINEES WHO WANT TO PURSUE A CAREER IN RESEARCH? Be curious, gain knowledge, use logic and have fun. With so many brilliant minds in competition with you, you have to be prepared to work harder than the other folks —especially if you hope to divide your time between clinical work and research.

IS THERE A TRAINEE THAT STANDS OUT? There have been so many brilliant students over the years who went on to amazing careers all over the globe. I wrote down eight names: Pieter de Tombe (USA , now Great Britain), Peter Backx (Ontario), Marcel Daniels (The Netherlands), Hamid Banijamali (Calgary), Amir Landesberg (Israel), Masahito Miura (Japan), Bruno Stuyvers (Newfoundland and Labrador) and Cecilia Ferrantini (Italy).

Henk ter Keurs, MD, PhD, graduated with a doctorate in physiology in 1970 and a medical doctor degree in Leiden, Netherlands, in 1972.

He completed cardiology training in 1983. He was the Established Investigator of the Netherlands Heart Foundation (1976-1981). He came to Calgary in 1984, working in the faculty of medicine at the University of Calgary and at the Foothills Hospital. Dr. ter Keurs is an AHFMR Senior Investigator and received the AHFMR Medical Scientist 25 year award in 2009. Her Majesty Queen Beatrix of The Netherlands bestowed him with a Knighthood in the Order of the Dutch Lion in 2001. His research program and clinical interests are centered around the causes and treatment of heart failure.

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ROBERT ROSE, PHD Robert Rose, PhD, joined the Libin Institute in January 2017 as an associate professor in the departments of cardiac sciences and physiology and pharmacology at the University of Calgary’s Cumming School of Medicine. The basic/translational researcher was recruited from Dalhousie University, where he directed a research lab and was a faculty member in the department of physiology for almost a decade. Rose completed his PhD in cardiac electrophysiology at the University of Calgary in 2005 before pursuing postdoctoral training at the University of Toronto in 2008. Rose’s research interests are in the study of cardiac arrhythmias that occur either due to underlying genetic mutations or in the setting of common forms of heart disease, such as high blood pressure, heart failure or diabetes. More specifically, Rose’s lab studies dysfunction and disease of the sinus node, the heart’s natural pacemaker, and arrhythmias in the atria. Rose has two major Canadian Institutes of Health Research grants for studying the role of natriuretic peptides in heart disease and for researching cardiac arrhythmias in diabetics. He has published approximately 40 peer-reviewed articles and several book chapters.

VAIBHAV PATEL, PHD

DR. MICHELLE KEIR

NEW

Vaibhav Patel, PhD, joined the Libin Institute in January 2017, as a basic scientist and assistant professor in the department of physiology and pharmacology at the University of Calgary’s Cumming School of Medicine. Patel earned his PhD in pharmacology at M.S. University of Baroda, India in 2011 before completing a postdoctoral fellowship at the University of Alberta’s department of medicine. Patel’s research interest is in the role of intercellular communications in cardiac and vascular disease. Currently, he is studying the role of exosomes in intercellular communications and modulation of the renin-angiotensin system’s impact on vascular disease. He has a special interest in diabetic cardiovascular complications.

Dr. Michelle Keir joined the division of cardiology as an adult congenital heart disease cardiologist in March 2017. Keir obtained her medical degree from the University of Ottawa in 2008 and completed her internal medicine residency and a fellowship in adult cardiology at the University of Saskatchewan. Keir completed an adult congenital heart disease fellowship at the University of Toronto in 2016. Her focus is on complex congenital heart disease and aortopathy. Her research interests include transition, congenital coronary anomalies, aortopathies, heart failure in complex adult congenital heart disease and mixed-methods research. Prior to medical school, Keir was a traffic reporter for CBC in Ottawa.

AARON PHILLIPS, PhD Aaron Phillips, PhD, a translational researcher with a focus on developing solutions for autonomic and cardiovascular dysfunction in spinal cord injury and other neurological conditions, arrived at the Libin Institute in the fall of 2017. Phillips completed his PhD and a postdoctoral fellowship in the Division of Physical Medicine and Rehabilitation at the University of British Columbia. He has received numerous awards, including a Killam Postdoctoral Fellow Research Prize. Phillips said autonomic and cardiovascular disease is the primary health priority in those living with spinal cord injury. In fact, it is the primary cause of death in these individuals, which is why Phillips wants to develop new therapies and interventions for this group. Phillips is “ecstatic” to be at the Libin. “I am excited to be joining forces with the world-class team of scientists and clinicians at the Libin,” he said, noting the infrastructure and support he receives from leadership also influenced his decision to join the institute.

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RECRUITS

DR. CARLOS MORILLO Dr. Carlos Morillo joined the Libin Institute in October 2016 as the chief of cardiology. Morillo is a cardiac electrophysiologist and professor in the departments of cardiac sciences and medicine at the University of Calgary’s Cumming School of Medicine. He also holds an adjunct professorship at McMaster University. Dr. Morillo trained as a cardiac electrophysiologist at Western University in London, Ontario and completed a postdoctoral fellowship sponsored by the Heart & Stroke Foundation of Canada in cardiovascular autonomic physiology.

Morillo’s main research interests are related to the development of clinicial trials in the area of cardiac arrhythmias, syncope and treatment of Chagas Disease.

He is internationally renowned in several fields including atrial fibrillation, neurocardiogenic syncope, Chagas disease, Postural Orthostatic Tachycardia Syndrome (POTS) and clinical trials.

Morillo has published more than 285 articles in peer-reviewed journals and 35 book chapters. He has received numerous prestigious awards including the Golden Caliper Award from the Latin American Pacing EP Society & Brazilian Society of Cardiac Arrhythmias; the Charles Pfizer Research Award; the National Academy of Medicine – Aventis Clinical Research Award; and the Award for Best Researcher from the Sociedad Colombiana de Cardiologia. Morillo was named one of the 10 most influential Hispanic-Canadians in 2010.

JENNIFER THOMPSON, PhD Jennifer Thompson, PhD, received her doctorate in physiology at Western University in London, Ontario. Her research interest is in the long-term effects to the vascular system to individuals subjected to suboptimal or adverse conditions in the womb. Thompson explained that until recently, researchers believed chronic diseases, such as type 2 diabetes, were caused by a combination of genetic and lifestyle factors, but they now know fetal conditions can affect long-term health. Thompson’s ongoing work involves studying mouse models to observe how an altered womb affects the blood vessels of offspring and how additional factors, like a high-fat diet in the offspring, exacerbate disease risk.

She is also examining molecular mechanisms in these animals. One goal of her work is to determine if altered gene expression is occurring in altered womb environments—caused not only by gestational diabetes, but also by maternal obesity, a related area of interest. If so, she said researchers may one day identify biomarkers to predict the increased risk of cardiovascular disease and diabetes in individuals whose womb environment was altered.

DR. MARIA FIGURA Dr. Maria Figura joined the division of cardiology in February 2017. Figura, who is originally from Slovakia, received her medical degree from the Comenius University in Bratislava, Slovakia. She obtained her masters degree in medical science from UCalgary’s Cumming School of Medicine and her medical residency training in internal medicine at the University of Alberta. Afterwards, she completed cardiology training at UCalgary and a fellowship in advanced heart failure and cardiac transplantation at the University of Alberta.

DR. AHMED ABDI ALI Dr. Ahmed Abdi Ali joined the division of cardiology as a clinical assistant professor and general cardiologist in February 2017. Ali, who is originally from Somalia, graduated with his medical degree from the University of British Columbia in 2010. He completed his internal medicine residency at the University of Calgary’s Cumming School of Medicine in 2013, and his cardiology fellowship from the UCalgary in 2016. Ali’s focus is on cardiac rehabilitation. Before university, Ali was an elementary school teacher at a refugee camp in Kenya.

LIBIN LIFE 25

Thanks to all the sponsors, donors and guests of the 2017

Proceeds from this year’s gala will help purchase cutting-edge experimental imaging equipment for basic science researchers at the Libin Institute and provide grants for our clinical researchers. The funds will help us achieve our goal of enabling cardiovascular health through transformative research.

With your support, we are creating greatness!

GOLD SPONSORS

SILVER SPONSORS

BRONZE SPONSORS

Balmon Investments

Arthur J.E. Child Foundation

VIP TABLE SPONSORS /

Dr. Todd Anderson

Lighthearted

BCW Architects The Beddoe Family

The McCaig Family Dr. Chris Eagle

/

Dr. Eldon Smith OC Ken Stephenson

/

DONORS Jenny Belzberg Carrie and Mitchell Brody Coril Holdings Ltd. Brian Felesky Lois and Richard Haskayne Ken King

Marilyn Libin William Lister McLeod Law LLP Verda and Duncan McNeill The Paperny Family Charitable Foundation

EVENT PARTNERS:

The Philip and Harriet Libin Family Foundation Riddell Family Charitable Foundation Rogers Insurance Ltd. Sam Switzer and Family

Shaw Communications Inc. Superior Lodging Corporation Titan Energy Services Ltd. Antoine VandenBrink

@LibinI

nstitute

#LibinB

eat

DONOR PROFILE

ELEANOR & WAYNE CHIU

By Dawn Smith

W

ayne and Eleanor Chiu are committed to making Motivated by an entrepreneurial spirit, Wayne started a an impact on the community and the next few small companies in the late 1980s and founded Trico generation.

Homes in 1982.

That commitment recently motivated the couple to donate The couple joined forces in 1998 when Eleanor left the $1.5 million for the new Chiu Family/AstraZeneca Chair in oil and gas industry to work for Trico Homes. The working Health Promotion and Disease Prevention at the Libin partnership between the couple has been a good one, as Cardiovascular Institute of Alberta. evidenced by the growth and success of the company.

Both Wayne, the founder and CEO of Trico Homes and an Personally, the partnership has also been successful: Wayne Order of Canada recipient, and Eleanor, the company’s Chief and Eleanor recently celebrated their 35th anniversary and are Financial Officer, are celebrated for their philanthropic efforts, the proud parents of three children, to whom they are passing facilitated through the Trico Charitable Foundation (TCF). on their values of hard work, good ethics, education, and, Eleanor said their commitment to contributing to the most importantly, giving back. community is a product of their upbringing and faith.

Eleanor said she requires that her children receive higher “We grew up in a large family during hard times when education, explaining she believes it is critical to creating a everyone had to chip in to allow people to even survive, so better future, not just for individuals, but for all of society. sharing is almost second “Education trains nature,” she said. “I’m people how to think, grateful that our solve problems parents were very and excel,” said generous towards people Eleanor, adding it is in need. Even though this belief that has they struggled, they were motived them to very good examples for provide financial us to follow.” support to Calgary Wayne and Eleanor’s education facilities, youth was spent humbly, including the Libin being raised in Hong Institute, which is Kong by parents from part of the Cumming mainland China.

School of Medicine.

Times were hard and “Education is both Wayne and Eleanor about thoughtlearned the value of good leadership and ethics and hard work inspiring people to alongside their parents in continue to find family businesses and in ways to improve and their homes. advance.”

Wayne came to Canada The desire to leave Sarah and Hude Quan, PhD, pose with Eleanor and Wayne Chiu, OC, (middle to finish high school and a lasting legacy is above) at an appreciation event for the Chiu family and AstraZeneca Canada in his engineering degree what prompted the April 2017. at the University of Chiu family Manitoba before returning to Hong Kong in 1980 to work in specifically to support the Libin’s new chair, which was construction for two years. awarded to Professor Hude Quan, PhD, an internationally He met Eleanor during one of his summer breaks and the two renowned leader in health services research methodology. continued their relationship while he was overseas, mostly via Quan has been busy creating a health collaborative, P2 letters.

Cardiovascular Health: Person to Population Research Shortly after their wedding in 1982, Wayne and Eleanor Collaborative, and the future looks bright for this group. moved to Calgary. They both worked while Eleanor “The impacts of this program will be far bigger than simply completed her accounting degree from the University of finding a cure for a disease,” said Eleanor. “The impacts Calgary. aren’t just to the patients, but also to their families, the community and the next generation.”

LIBIN LIFE 27

Come learn more about the Libin Institute’s research priorities for the next five years.

Visit us at booth 418

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