Libin Life - Summer 2008 by Libin Institute

World Class APPROACH to Research and Cardiovascular Care In a world overflowing with information, how do we make the leap to knowledge?

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Traboulsi’s Travels In this issue, “Libin Beyond Borders” profiles the overseas work of Dr. Dean Traboulsi, who recently visited India.

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Leading the Charge – National Heart Health Strategy Dr. Eldon Smith and other nationally renowned experts from the Libin Institute participate in forming a national heart health strategy.

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Mona Libin CICU Cardiac Intensive Care Unit at the Foothills Medical Centre named for local philanthropist.

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S u m m e r 2008

A Cave to make Batman Jealous Virtual reality allows researchers to walk through the heart

he CAVE at the University of Calgary is an immersive virtual reality environment. Using four walls of projection combined with a tracking system, a 3D mouse and special stereo glasses, the system allows for depth of scene and seamless interaction. If science fiction movies set centuries from now come to mind, that’s a pretty good touchstone. “Before the CAVE, we had 2D visualization,” states Dr. Christoph Sensen, Director of the CAVE. “The major enhancement that the CAVE brings is two-fold: higher resolution through a cubed display and the ability to interact with objects in virtual reality similar to real objects.”

both a Cardiovascular Surgeon as well as a PhD Scientist. Having the right people and the right tools bodes extremely well for the future of the Libin Institute and cardiovascular sciences in Calgar y! For more information about the CAVE, visit: http://cave.ucalgar y.ca

“Our system is unique worldwide. It has four layers: (a) the physical hardware, (b) the JAVA 3DTM programming language, (c) the JABIRU middleware layer, which we wrote to interact with objects in virtual reality and (d) a complete model of the male adult anatomy, which we built with Kasterstener Inc. from Red Deer, AB.” Asked about interest from outside the University of Calgar y, Dr. Sensen adds, “We are in the process of teaming up with several institutions right now to expand our work from the Genomic field into Education, Patient Consultation, Surgical Planning and Execution and Metabolomic Studies.” So what does this mean for the Libin Cardiovascular Institute of Alberta? “On the clinical front, the possibilities for using the CAVE are very exciting,” says Dr. Paul Fedak, a Cardiovascular Surgeon and Scientist with the Libin Institute. “The CAVE provides input mechanisms allowing for imaging data, such as that from an MRI, to be used to recreate a real patient’s heart. This could allow for planning of complex surgeries in three dimensions, and potentially even model repairs.” “The opportunities in training and research are just as intriguing. The complexities of organs such as the heart are extremely difficult to internalize from pages of a book. At the same time, leveraging such a unique tool for quantitative analysis in three dimensions while studying, as an example, changes in a failing heart, is unparalleled with what has been available ‘til now.” Of course, tools and spaces need to be mated with the best minds for research to flourish. Dr. Fedak delivers on this front, as he is almost as unique as the CAVE itself. One of only a handful of individuals across the countr y with his combination of credentials, Dr. Fedak is

A Fishy Story That Is No Red Herring Z

ebrafish may seem like an odd focus for researchers interested in the cardiovascular sciences as they apply to humans, but in fact they are the perfect species for collaboration in this area. While zebrafish may not breathe air, run on treadmills, or answer research sur veys, what they do offer is a window of sorts into the development of blood vessel networks similar to those in our own bodies.

“As vertebrates they share both the genes and the structure of the cardiovascular system with us” See The Zebrafish pg 2

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about the Libin Institute please visit www.LibinInstitute.org

The Zebrafish – Cardiovascular Research Connection D r. Sarah Childs, Associate Professor of Molecular Biology at the University of Calgar y and a member of the Libin Cardiovascular Institute of Alberta, has been working at identifying genes involved in angiogenesis, the process by which new blood vessels develop. Interestingly, essentially all of the known genes involved in the establishment of the early vascular system are common between fish and mammals. Zebrafish are of particular interest because they develop as transparent, externally fertilized embr yos, thus allowing for obser vation under microscope of their development during all stages of embr yogenesis. Additionally, the life cycle of zebrafish is rather short at only three to four months from fertilization to the reproductive stage, which is an added bonus when investigating the workings of genes.

Slowly but surely the mysteries are being solved, and while there is a way to go, paths of research are in place and many minds are in gear!

“As vertebrates they share both the genes and the structure of the cardiovascular system with us,” Dr. Childs highlights. “Their fecundity (up to 200 eggs per pair of parents) allows us to rapidly do experiments, and to undertake genetic analysis.” Over a period of many years, careful experimentation, analysis and screening have yielded a number of gene mutations related to vascular malformations. Using fish with these mutations, Dr. Child’s lab is working on various areas of potential discover y. Specifically, they are looking at how the identified genes impact the development and operation of blood vessels, and how these mechanisms relate to human diseases.

Relating Basic Research to Humans

everal conditions exist involving the breakdown of blood vessels, an example of which are human aneur ysm syndromes. The mechanism of this disorder is a weakening of the bond between endothelial cells and the adjacent layer of cells on the outside of blood vessels. This dissociation between vessel lining and supporting cells occurs in one of the mutations being worked with in the lab. Dr. Childs and lab are asking which specific molecular level pathways are being impacted in these mutants, and whether the problem lies within the endothelial cells, or in the adjacent supporting cells. A goal of their research is to apply their findings in fish to identify whether the same genes are involved in human genetic aneur ysm or stroke syndromes.

The extended families of the zebrafish at the University of Calgary are well traveled. While the original few were flown in from Harvard years ago (where Dr. Childs conducted her post-doctoral work) subsequent to further experimentation, analysis and screening cycles, many Calgary fish have been shipped to other research sites around the world.

MEMORY LANE Reminiscing through the past of Cardiac Sciences in Calgar y The photo to the left contains some familiar faces from the Foothills Cardiology Department 25 years ago in May of 1983. Who do you recognize? Standing Left to Right Dr. Alan White, Dr. Israel “Sonny” Belenkie, Dr. Dante Manyari, Dr. D. George Wyse, Dr. Henr y Duff, Dr. Eldon R. Smith, Dr. L. Brent Mitchell, Dr. Don Meldrum, Dr. John Tyberg, Dr. Jim Cohen Seated Left to Right (Fellows) Dr. Otto Smiseth, Dr. Jim Hansen, Dr. Iris Kingma, Dr. Peter Russell, Dr. Michael Frais, Dr. Colin Nath

Image courtesy of the University of Calgary Archives UARC 84.005_42.16_01

A World Class APPROACH to Research & Cardiovascular Care I

nformation is often available in abundance, but without guarantee of quality or relevance. How do we go from information to knowledge – that which is truly meaningful and valuable in developing superb cardiovascular programs? Dr. William Ghali, Research Director of APPROACH and a member of the Libin Cardiovascular Institute of Alber ta, is working hard at answering this question, and the results of his ef for ts have been par ticularly impactful, as evidenced by the over 150 papers he has published. Of all the research done with data from APPROACH, Dr. Ghali points to a subset of papers focused on methodology and data quality as being cited again as again, thus having resulted in a global rethink on research methodologies and validity. One example of many is a publication from the Annals of Internal Medicine (Sex differences in access to coronar y revascularization after cardiac catheterization: importance of detailed clinical data) that addressed questions around perceptions of gender discrimination against women in cardiovascular clinical decision making. Careful analysis of the data, normalizing for age, comorbidities and

coronar y anatomy, found that there was actually no difference between the genders in referral rates. This was a highly unexpected

result contrar y to previously reported un-normalized data and the beliefs of a vast number of clinicians.

APPROACH’s mission is to collect and process information to improve cardiac care for all Albertans The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) is an ongoing, prospective data collection initiative that began in 1995. APPROACH collects data for all patients undergoing cardiac catheterization in Alberta. Patients are followed long-term, with information also collected at the time of angioplasty, and at time of coronary artery bypass graft (CABG) surgery. In 2004, APPROACH expanded data collection to include acute coronary syndrome (ACS) admissions through an initiative called Heart Alert. The goal of this initiative is to improve cardiac care services by further enhancing communication between health care professionals across Alberta. Information will now also be collected into the APPROACH database when patients are admitted with a cardiac emergency (rather than only when a patient undergoes an angiogram). • Implemented in 103 acute care hospitals in Alberta • Currently consists of over 150,000 patient entries The Libin Cardiovascular Institute of Alberta is proud to recognize their members, APPROACH Principle Investigator Dr. Merril Knudtson, APPROACH Research Director Dr. William Ghali and their multidisciplinar y team, for their exceptional contributions not only at the local level, but also nationally and internationally.

Dr. William Ghali is a Professor in the Depar tments of Medicine and Community Health Sciences at the University of Calgary. He holds a Canada Research Chair in Health Ser vices Research, the Buchanan Chair in General Inter nal Medicine, and a Health Scholar Award from the Alber ta Heritage Foundation for Medical Research. He is widely published with over 150 publications in national and international journals, and holds funding from multiple sources, including the Canadian Institutes for Health Research (CIHR) and the Alberta Heritage Foundation for Medical Research. He has received numerous awards and distinctions since assuming his faculty position at the University of Calgary in 1996, with recent highlights including his receipt of a Distinguished Alumnus Award from the Boston University School of Public Health in 2005 and his selection as one of Canada’s Top 40 under 40 in 2003. Ghali WA, Faris PD, Galbraith PD, Norris CM, Curtis MJ, Saunders LD, Dzavik V, Mitchell LB, Knudtson ML; Alber ta Provincial Project for Outcome Assessment in Coronar y Heart Disease (APPROACH) Investigators. Sex dif ferences in access to coronar y revascularization after cardiac catheterization: impor tance of detailed clinical data. Ann Intern Med. 2002 May 21;136(10):723-32.

Leading World Experts Participate in Cardiac Surgery Program Review A s part of the Libin Cardiovascular Institute’s commitment to continuous improvement, experts from the International Expert Advisor y Committee, chaired by our own Dr. George Wyse, are invited to review various elements of the Institute each year. The first quarter of 2008 included a review of the Cardiac Surger y program with a visit from Dr. Patrick M. McCarthy, Chief of Cardiothoracic Surger y and Co-Director of the Bluhm Cardiovascular Institute at Northwestern University, and Dr. Richard Novick, Professor and Chair, Division of Cardiac Surger y at the University of Western Ontario.

Doctors McCarthy and Novick met with the members of the Division of Cardiac Surger y as well as members of the multidisciplinar y surgical team to help identify key strengths and opportunities for the program. The primar y objective of this review was to receive advice and guidance from the international experts which will enable the division to further grow and develop. It was noted that “the basic science relationships that have been established with the new cardiac surger y labs are extremely important, and provide an

outstanding opportunity for future development, as well as the training of the next generation of academic cardiac surgeons.” Dr. McCarthy and Dr. Novick identified that “the Libin Cardiovascular Institute, while still relatively new, adds important possibilities for program development and a unified structure for all of cardiovascular clinical care, research and educational efforts.”

Beyond our Borders: Traboulsi’s Travels “It is said that knowledge increases with distribution, while wealth decreases by that act. How true it is!” participate in an annual conference organized by the Syrian American Medical Society, a nonprofit, non-political organization in support of various professional, educational, humanitarian, and cultural activities. On a few occasions, Dr. Merril Knudtson, Dr. George Wyse, Dr. Bob Sheldon and Dr. Jim Hansen, all nationally renowned experts from the Libin Institute, were able to accompany Dr. Traboulsi on his educational adventures. Visiting the capital city of Damascus as well as a number of other cities, the various Libin delegations were able to deliver numerous lectures and perform cardiac procedures mentoring many Syrian specialists. As a personal initiative, Dr. Traboulsi also delivered used but suitable equipment, valuable to the Syrian context.

r. Sanjay Kumar Chugh of New Delhi, India, has a long-standing connection to Calgar y which started about a decade ago. At that time, Dr. Chugh started his fellowship in the University of Calgar y’s Inter ventional Cardiology program. Completion of this program, however, was really only the beginning of the stor y. Early in 2008, Dr. Dean Traboulsi, Director of the Cardiac Catheterization laborator y and Inter ventional Cardiology at the Libin Institute, took a trip to India at the request of Dr. Chugh. Visiting the capital New Delhi and the famous city of Jaipur, the trip also included stops at smaller rural centres. Providing guidance and engaging in dialogue with over four hundred medical specialists along the way, expertise and experience from Calgary was shared by way of academic lectures and hands-on training in inter ventional laboratories thousands of kilometers away. Dr. Traboulsi is no stranger to sharing his knowledge beyond our borders, and as it turns out, his passion is infectious. Over the last number of years, Dr. Traboulsi has traveled to Syria to

“I feel very fortunate to have had the opportunity to complete my postgraduate medical training in Canada and to have had the good fortune to live and practice in Calgary,” says Dr. Traboulsi. “I do feel that I have a responsibility to share my knowledge and expertise with the medical community in less fortunate countries. I earned my medical degree in a third world country where very few graduates are fortunate enough to go abroad to pursue higher education. It is important to me that I return the favor and help improve the medical care and medical education in Image courtesy of the University of Calgary Archives UARC 84.005_56.22_02 the third world.”

Heart and Stroke Foundation Research Lab Tours I

n April 2008, the Libin Institute was honored to host volunteers of the Heart and Stroke Foundation of Alberta, NWT and Nunavut, at an event which allowed them to tour through research labs at the University of Calgar y and the Foothills Medical Centre. It is because of such generosity of Heart and Stroke Foundation supporters that researchers at the Libin Institute can continue with their vital work.

It’s amazing what happens when you put your heart into it!

Libin Cardiovascular Institute of Alberta members playing key roles on CHHS-AP • Dr. Eldon Smith, Editor-in-Chief of the Canadian Journal of Cardiology, is Chair of the CHHS-AP Steering Committee

y November of 2008, the Steering Committee of the Canadian Heart Health Strategy and Action Plan (CHHS-AP) will have delivered their final report to the federal Minister of Health – the culmination of two years hard work. On October 23, 2006, the Honourable Tony Clement announced funding for the development of a new hear t health strategy to fight cardiovascular disease in Canada. At that time, Dr. Eldon Smith, Chair of the Libin Institute’s Strategic Advisor y Board, was appointed as Chair of the

• Dr. Norman Campbell, Canadian Chair in Hypertension Prevention and Control, is a member on the Steering Committee as well as Co-Chair of the “Preventing, detecting and controlling major risk factors” theme working group

CHHS-AP Steering Committee.

• Dr. W illiam Ghali, Research Director of the Alberta Provincial Project for Outcomes Assessment in Coronar y Heart Disease and Canada Research Chair in Health Ser vices Research, is Co-Chair of the “Timely access to quality acute care and diagnostics” theme working group

The purpose of the CHHS-AP is to reduce the growing burden and loss due to cardiovascular disease in Canada, and as such, the leadership of Dr. Smith will have broad and long-lasting national impact.

• Dr. Merril Knudtson, Principal Investigator of the Alberta Provincial Project for Outcomes Assessment in Coronar y Heart Disease, is a Member of the “strengthening information systems for monitoring, management, evaluation and policy development” theme working group

The Cardiac Surgery Residency Training Program I n July 2007, Dr. Julie Leal joined Ian Maxwell to become the second trainee of the Cardiac Surger y training program of the University of Calgar y. The training program is lead by Dr. John Burgess who joined the Division of Cardiac Surger y in 2001 and has played an integral role in the establishment of the Training Program at the University of Calgar y. During a recent internal review of the program lead by Dr. Norm Schachar, Dr. Richard Buckley, and Dr. Andrew Grant of the University of Calgar y, Dr. Burgess was formally recognized as being an “involved, committed, energetic and enthusiastic Program Director.” Cardiac Surger y is the branch of surger y concerned with diseases of the pericardium, heart and great vessels. Upon successful completion of the program a trainee is expected to function as an independent consultant with respect to the diagnosis and management of patients with cardiovascular disease, including the provision of surgical inter vention and postoperative care. At present there are 10 residency training programs in Cardiac Surger y in Canada comprising of full and affiliated

programs. Approximately 10 Canadian trainees sit for the Royal College examination each year. It is anticipated that over the next several years the demand for cardiac surgeons in this countr y will greatly increase. It has been estimated by the Canadian Consensus Study (1996), access to cardiac revascularization, that by the year 2010, there will be a deficit of at least 90 cardiac surgeons. This estimate does not take into consideration the changing activities of Cardiac Surgeons with more emphasis being placed on research, administration and teaching in addition to clinical care.

The training program has been closely integrated with that of the Division of Cardiology within the Libin Cardiovascular Institute of Alberta and is associated with the University of Alberta Cardiac Residency Training program for training in Pediatric and Cardiac Transplantation surger y. In addition to recognizing the Program Director, the recent internal review also commended the work of the “extraordinar y program administrator, and the strong enthusiastic, multi-specialty Residency Training Program committee for CV Surger y.”

The Cardiac Surgery Residency Training program is a six year training program with residents entering from the Canadian Residency Matching Service (CaRMS). Successful applicants will spend the first two years of residency in a series of rotations which include: General Surgery, Internal Medicine, Emergency Medicine, Pediatrics, Cardiac Surgery and in the Intensive Care Unit. The following years are spent in longer more focused and specific rotations in vascular surgery, cardiac surgery, thoracic surgery, pediatric cardiac surgery and one year as a senior resident in adult cardiac surgery.

For more information regarding this program please contact: Program Director: Dr. J. Burgess Program Administrator: Christina Faulkner Mailing Address: c /o Dr. J. Burgess C880 1403 29 ST NW Calgar y, AB T2N 2T9 Canada Email: christina.faulkner@calgar yhealthregion.ca Phone: 403.944.2011 Fax: 403.270.3715

The Libin Cardiovascular Institute is proud to remember and honour a beloved supporter and friend, Mona Libin

n April 24th, 2008, the Cardiac Intensive Care Unit at the Foothills Medical Centre in Calgar y, Alberta was officially named the Mona Libin Cardiac Intensive Care Unit. Mona was a tireless volunteer and a generous philanthropist for the betterment of health for Calgarians over many years. Mona was instrumental in creating the Alvin and Mona Libin Foundation and the Libin Cardiovascular Institute of Alberta. Together with her husband Alvin, she was a tremendous supporter of cardiovascular health care, research and education.

“ There are many things in life that will catch your eye, but only a few will catch your heart … pursue those” – Michael Nolan 1403 - 29th Street NW Calgar y, AB, Canada T2N 2T9 T 403.944.4391 F 403.944.2906 E shauna.wilkinson@calgar yhealthregion.ca W www.libininstitute.org