Libin Life Fall 2013

Libin Life Research

Education

Care Delivery

Fall 2013

The Libin Cardiovascular Institute of Alberta Magazine

libininstitute.org

Electron Microscopy Tomography Donald Welsh, PhD maps 3D views of cell-to-cell communication

Landmark Study Tracks Toll of Hypertension on 3.5 Million Canadians Why having a city-wide cardiac sciences program benefits Calgary and beyond

SHC Wellness Kitchen

Shedding Light on Genetic Heart Disease

Diagram of a Trabecula Dissection

Libin Life

MESSAGE FROM THE DIRECTOR

Marking a Milestone in 2014

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hope you have all had some time off this summer and are energized for another rewarding academic year.

The Libin Cardiovascular Institute of Alberta will celebrate its 10th anniversary in January of 2014. Since the Institute was formed on January 27, 2004, we have had lots to be proud of and to highlight to our stakeholders. As such, we are planning a series of events next year to mark this important milestone. We are celebrating what we have accomplished to date and more importantly, we look forward to a very bright future.

On October 1, we are hosting Dr. Eric Topol, Director of the Scripps Translational Science Institute, as the recipient of the 2012 Libin/AHFMR Prize in Cardiovascular Research. Dr. Topol is a pioneer in the world of cardiovascular medicine and has published more than 800 manuscripts which have been cited over 75,000 times. He has made practice-changing observations in the area of myocardial infarction, interventional cardiology, anti-platelet therapy and more recently, genomics and individualized medicine. He has embraced social media and technology to connect to the public in a way that few other researchers have done. Dr. Topol is truly an engaging speaker and he will surely entertain and educate us.

Finally, I wish to highlight the work being done by Libin We are celebrating members in the Cardiovascular Health and Stroke Strategic what we have Clinical Network (SCN). As one of two foundational accomplished projects of the network, the Vascular Risk Reduction to date and more Initiative (VRRI) is a multi-pronged approach to importantly, we look cardiovascular health promotion and disease prevention. forward to a very The program is taking a provincial approach to best bright future. clinical practices, research and knowledge translation, and working with primary care networks. The goal is to decrease the burden of cardiovascular risk factors by utilizing innovative approaches. We are grateful to our many members who are investing their talents to improve care delivery within Alberta. This work aligns with the Libin Institute’s emerging priority of vascular medicine and the University of Calgary’s research priority of chronic disease. The SCN’s newly developing partnership with Alberta Health Services and Alberta Innovates - Health Solutions will also create excellent research opportunities for our clinician-scientists.

Enjoy the fall season. I look forward to celebrating our ongoing successes together.

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Dr. Todd Anderson Director Libin Cardiovascular Institute of Alberta

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Libin Life is published twice a year by the Libin Cardiovascular Institute of Alberta, an entity of the University of Calgary and Alberta Health Services (Calgary Zone).

The Libin Life mission is to share news and information about the Institute’s impact in research, education and patient care.

Institute Director Dr. Todd Anderson Director of Research Dr. Ed O’Brien Education Council Chair Donald Welsh, PhD Associate Director Al-Karim Walli Editor Lynda Sea Editorial Committee Amber Arsneau, Barb Jones, Shannon Perry, Judy Siu, Al-Karim Walli, Suzanne Welsh Copy Editors Judy Siu, Susan Wilmot Contributors John Arispizabal, Amber Arsneau, Connie Bryson, Pieter de Tombe, Gregory Harris, Dr. Debra Isaac, Trudie Lee, David (DaWei) Liu, Tiffany Neil, Julia McGregor, Todd Buchanan Photography, Wes Raymond Photography, Suddha Sircar, Judy Siu, Monique de St. Croix, Dr. Henk ter Keurs, MD, PhD Design and Layout Steven Tov Printer McAra Printing Libin Cardiovascular Institute of Alberta Foothills Medical Centre C830A, 1403 29 Street NW Calgary, AB, T2N 2T9 P 403.210.6271 E libin@ucalgary.ca W libininstitute.org Twitter @libininstitute Editorial Inquiries Lynda Sea Communications Coordinator lsea@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. © 2013 Libin Cardiovascular Institute of Alberta

contents // fall 2013

departments

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features

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New Dimensions

Using electron microscopy tomography to map 3D models of cells, Donald Welsh, PhD gets a clearer view of endothelial-smooth muscle contact in arteries

Making Waves

Tracing the impact of Dr. John V. Tyberg, MD, PhD as mentor, researcher and educator on the cardiovascular sciences field

care delivery Eat, Play, Live Highlights from The Wellness Kitchen at the South Health Campus’ Wellness Centre Sometimes Bigger is Better Why having a city-wide cardiac sciences program benefits Calgary and beyond

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research Landmark Study Tracks Toll of Hypertension on 3.5 Million Canadians Recent Funding Successes

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Dr. Brenda Gerull: Shedding Light on Genetic Heart Disease

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Cardiac Sciences, By the Numbers Looking back at the 2012-2013 year in clinical cardiac care delivery

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2 Message from the Director 5 News & Highlights 6 Awards & Accolades 19 Community Engagement 20 Libin Abroad 24 Spotlight on Trainees

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Kathryn King-Shier, PhD: Examining Ethnic and Sex Differences in Acute Coronary Syndrome Patients

Education Studying Syncope Why Aren’t More Women Getting Cardiac Rehab?

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Sharing Science Libin Research Day showcases the diversity of cardiovascularscience research at the Institute Diagram of a Dissection Dr. Henk ter Keurs, MD, PhD shares the story behind his oft-used illustration of a trabecula dissection

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Connect with Us • libininstitute.org Follow @libininstitute for the latest news from Libin.

Join the conversation on cardiovascular health research, education and patient care Like us on Facebook and discover updates on events, media coverage and highlights from the Institute Visit libininstitute.wordpress.com for the latest news via our blog and share your comments Libin members, for research resources, we are now on Sharepoint (intranet.ucalgary.ca/research/Libin)

Upcoming Events October 1, 2013 2012 Libin/AHFMR Prize Public Lecture As one of the top 10 most-cited researchers in medicine, Dr. Eric Topol is the Director of Scripps Translational Science Institute in La Jolla, California. He is considered the world’s foremost authority on wireless medicine and is our keynote speaker and recipient of the 2012 Libin/AHFMR Prize For Excellence in Cardiovascular Research. (Libin Lecture Theatre, Health Sciences Centre, UCalgary Foothills Campus; 6:30-8:00 pm)

November 16, 2013 Cardiac Surgery Silver Jubilee Black Tie Gala The Foothills Hospital first opened a dedicated cardiac surgical unit in July 1988. The unit’s first heart operation (coronary artery bypass graft) was performed in September 1988. Celebrate 25 years on September 11 for a golf tournament at the Banff Springs Golf Course. Then, mark your calendars for the Silver Jubilee Black Tie Gala on November 16 at The Fairmont Palliser Hotel Crystal Ballroom.

September 7-11, 2014 ISRA 2014 The 11th International Symposium on Resistance Arteries (ISRA), Molecular Machinery to Clinical Challenges, will bring together an international group of scientists with interests in resistance vasculature at the foundational and applied level. Donald Welsh, PhD is Chair of the Lead Organizing Committee. The keynote speaker for ISRA 2014 is Dr. Costantino Iadecola. His research and clinical career focuses on brain dysfunction as a result of stroke and dementia. The thematic symposia will center on ion channels, imaging, cytoskeletal dynamics, calcium sensitation, endothelial function, genetic regulation and vascular pathology. (The Banff Centre, Banff, Alberta; isra2014.org)

About The Cover Electron microscopic tomography (ET) is a method of producing 3D images of cells to show the macromolecular structures in a cell including membranes, fibres and vesicle complexes.

This is a 3D model of an endothelial cell communicating to smooth muscle cells through projections. Donald Welsh, PhD and Nadia Maarouf, a PhD candidate in his lab, are currently using this new microscopy technique to study ion channels and protein trafficking in endothelial cells to smooth muscle cells and their role in cell-to-cell communication and blood flow.

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NEWS & HIGHLIGHTS

The Big Picture Q+A with Dr. James White, Director of The Stephenson Cardiovascular MR Centre

In August 2013, Dr. James White joined the Libin Cardiovascular Institute of Alberta as the new Director of The Stephenson Cardiovascular MR Centre. He relocated from London, Ontario where, for the last six years, he was the Director of the Cardiovascular MR Clinical Research Program at Western University. He is cross-appointed in Cardiac Sciences, Diagnostic Imaging and Internal Medicine. White graduated from internal medicine and cardiology training at Western University and in 2007, completed a two-year imaging fellowship at Duke University.

What led you to your current focus on imaging?

“I began my interest in cardiac imaging early on in my education.

In fact, I was in high school when I was given my first opportunity to work with the imaging scientists at the Robarts Research Institute in London, Ontario. This first project performing early validation work for 3D intra-coronary ultrasound had a substantial impact on my future career. My focus in cardiovascular MRI was born during my cardiology fellowship years. With no cardiac MRI service at the training centre at this time, my decision to pursue this approach for a research study necessitated learning the technique myself, and as such, a deep respect for its challenging and technical nature developed. This respect grew into appreciation and then into a passion for the field that has not yielded to date.”

What’s the big question your own research is focused on?

“I have spent the last several years focusing on the question: ‘How can we evaluate imaging as a therapy?’ It may seem paradoxical, but I believe that the performance of an imaging test can be therapeutic.

For example, we consider the introduction of a new tool or technique for a surgical procedure to be evolution of a therapy.

What we are doing is not so different—we are using imaging tools to develop novel techniques to perform cardiovascular procedures.

We hope to determine if imaging can substantially impact therapeutic outcomes in patients with cardiovascular disease. I focus on heart failure and arrhythmia because of their high burden of clinical outcomes, such as heart failure admissions and sudden cardiac death.

These two areas are also ideally suited to the unrivaled capacity of MRI to characterize myocardial scar, a strong predictive marker of response to therapy in these populations. One example of our work is a multi-centre trial assessing the impact of 3D cardiac scar modeling to navigate pacemaker leads to healthy tissue in patients receiving Cardiac Resynchronization Therapy (CRT).”

What areas of cardiovascular imaging, specifically in CMRI, offer greatest opportunity for impactful research?

“The new paradigm of ‘image-guided therapeutics’ promises to deliver substantial impact for imaging research over the next decade.

For decades, we have accepted and promoted the migration of imaging research from technical development, to clinical feasibility testing, and onto larger scale cohort studies to determine predictive or prognostic value. However, evaluation of a technique’s impact on patient care and clinical outcomes remains poorly studied and rarely engaged. A new era of image-guided therapy is emerging that closely links imaging with interventions. For example, we can use imaging (either pre-procedural or intra-procedural) to guide delivery of an intervention, and in doing so, determine its impact on procedural success or outcomes. There are several ways how this linkage can be tested. The use of images to predict response to a therapy and provide a navigational model for optimal delivery is of particular interest, and provides a direct pathway to link imaging performance to therapeutic outcomes.”

Outside of work, what brings you to Calgary? What are you most looking forward to?

“I have three children and they are the true joys of my life. My wife and I are looking forward to opportunities to introduce them to the natural wonders of Alberta and to develop our family’s new future here in Calgary. As a keen photographer, I am personally looking forward to the abundance of ‘great-shot’ moments that hiking in the Rockies will provide.” —As told to Al-Karim Walli

E-books now available for Hearts, Minds & Vision Libin history book Hearts, Minds & Vision: Roots of the Libin Cardiovascular Institute of Alberta, 1930-2010 (Kingsley Publishing, 2012) tells the story of Libin researchers and clinicians who dedicate themselves to saving, extending and improving the health and lives of southern Albertans. Authors Dr. D. George Wyse, MD, PhD, Dr. J. Robert Lampard, Barbara Kermode-Scott and Al-Karim Walli capture 80 years of changes in the local cardiovascular landscape and share inspiring human stories of the people behind the diagnoses, treatments and life-saving research.“The book is a great record of what has gone on in Calgary,” says Dr. Eldon R. Smith, OC, Professor Emeritus at the University of Calgary and former Dean of the Faculty of Medicine.

Now you can read all about the Institute’s history on your digital e-reader. Order your digital copy through Kobo, Amazon or iTunes. The print copy retails for $24.95 and is available through the University of Calgary bookstore.

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AWARDS & ACCOLADES Eric Topol Receives 2012 Libin/AHFMR Prize Renowned cardiovascular scientist Dr. Eric Topol is the recipient of the 2012 Libin/AHFMR Prize for Excellence in Cardiovascular Research. This prize is awarded to an outstanding international researcher whose work has had a major impact on cardiovascular health.

As author of The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care and director of the Scripps Translational Science Institute in California, Topol is one of the top 10-most cited researchers in medicine. In 2012, he was voted the most influential physician executive in the United States in a poll conducted by Modern Health Care. He has led many trials that have shaped contemporary treatment for heart disease and has even been named one of the 12 Rock Stars of Science by GQ Magazine. On October 1, Topol visits the University of Calgary for a free public lecture. Past recipients of this award have included Dr. A. John Camm, Dr. Valentin Fuster, Dr. James T. Willerson and Dr. Eugene Braunwald. —Lynda Sea

(L-R) Heather MacEwan (daughter of Grant MacEwan), Dr. Eldon R. Smith, OC and Mayor Naheed Nenshi

On June 12, the City of Calgary gave out 17 Calgary Awards to citizens and groups for their contribution to the community and Dr. Eldon R. Smith, OC was the recipient of the Grant MacEwan Lifetime Achievement Award. This award honours an individual who has made significant contributions and brought recognition to the community, and has improved the quality of life for Calgarians.

“I was delighted and feel very honoured to receive this award,” says Smith, Professor Emeritus and former dean, Faculty of Medicine at the University of Calgary. “I am particularly pleased to receive a reward named for Dr. Grant MacEwan. I met him back in the 80s when he was doing research on another of his many books. He was a very impressive man who has made major contributions to Calgary, to Alberta and Canada.”

Smith, one of the pre-eminent academic cardiologists in Canada over the past 30 years, has defined the direction that cardiovascular care has taken in southern Alberta as physician, educator, researcher and administrative leader.

He recruited those who would lead Calgary to become one of the strongest cardiology centres in Canada. He is chair of the Libin Cardiovascular Institute of Alberta’s Strategic Advisory Board.

In 2006, Eldon was appointed by the Federal Minister of Health to chair the steering committee for a national task force on heart health, The Canadian Heart Health Strategy and Action Plan. He is an Officer of the Order of Canada.

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Vision of a Cure In May, Dr. Anne M. Gillis was named Global Calgary Woman of Vision for her inspiring accomplishments as a pioneering female cardiologist and a professor of medicine. If you ask about her bigger vision, she’ll tell you the mission behind her life’s work is finding a cure to end suffering and sudden death from heart rhythm disorders.

“The field has changed so much with advances in technology and we’re one of the few specialties or areas in medicine where you actually cure people of their disorder and alter their lives in a very positive way,” she says. She recognizes that it’s an audacious goal, but as Immediate Past President of the Heart Rhythm Society (HRS), a Professor of Medicine at the University of Calgary and a cardiologist at the Foothills Medical Centre, she is committed to tackling lifethreatening heart rhythm disorders and developing new treatments to prevent sudden cardiac death. Gillis was instrumental in making the Foothills Medical Centre the first centre outside of the U.S. to introduce remote monitoring of ICDs (implantable cardiac defibrillators).

—LS

Bill Clinton and Dr. Anne M. Gillis at Heart Rhythm 2013. Clinton was keynote speaker at the Denver event in May 2013.

Topol photo by John Arizpizabal, Smith photo by Wes Raymond Photography, Gillis photo by Todd Buchanan Photography

A Lifetime Achievement: Dr. Eldon R. Smith Honoured at Calgary Awards

William Ghali awarded Killam Professorship

Sarah Weeks receives Teaching Award from Faculty of Medicine

Dr. William Ghali, Director of the Institute for Public Health and Professor in Medicine and Community Health Sciences, was one of five University of Calgary faculty members awarded the 2013 Killam Annual Professorship. This prestigious award recognizes those who have demonstrated excellence in research and teaching for 10 years or more, while serving their academic discipline and community.

Ghali is a professor and practicing physician. His research explores ways to best utilize routinely collected data to improve the health system. He holds a Government of Canada Research Chair in Health Services Research, and is also funded as a Health Scholar by Alberta Innovates - Health Solutions (AIHS). —LS

Clinical Assistant Professor Dr. Sarah G. Weeks received the 2012 Clinical Adjunct Award in Undergraduate Medical Education from the Faculty of Medicine, University of Calgary. This award is presented to a clinical or adjunct faculty member, nominated by their Department Heads and selected by a Faculty Promotions Committee for their excellence in teaching.

Weeks says teaching is a definite passion of hers. She enjoys the challenge of trying to make complex medical concepts more understandable. “Today’s students are going to be looking after my family in the next few years” she says. “I believe we owe it to them to give them the best possible training.” —LS

Douglas Hamilton Receives U of A’s Distinguished Alumni Award Dr. Douglas Hamilton, MD, PhD is one of the recipients of the University of Alberta’s (U of A) 2013 Distinguished Alumni Award. This award is the U of A Alumni Association’s most prestigious honour which recognizes living U of A graduates whose achievements have earned them national or international prominence.

Hamilton is a Clinical Associate Professor, Faculty of Medicine and member of the Libin Cardiovascular Institute, Institute for Public Health and W21C at the University of Calgary (UCalgary). He completed his Bachelors and Masters in Electrical Engineering at U of A and his MD and PhD at UCalgary. Hamilton worked at NASA where he supported numerous Space Shuttle and International Space Station missions and served as flight surgeon for Canadian astronaut Robert Thirsk in 2009. He also made notable engineering contributions for which he was awarded NASA’s Exceptional Engineering Achievement Medal in 2012.

Hamilton also provided care to Houston’s impoverished population and was the lead night physician at the Astrodome providing relief to evacuees of Hurricane Katrina. He also was previously recognized as UCalgary’s Distinguished Alumni in 2000. —Julia MacGregor

James Stone Recognized with Clinical Faculty Research Award Dr. James Stone is a Clinical Professor of Medicine (Cardiac Sciences) at the University of Calgary and Director of Research at the Cardiac Wellness Institute of Calgary (CWIC).

This spring, he was recognized by the Faculty of Medicine with the Clinical Faculty Research Award. He has had an outstanding academic year publishing more than 10 papers with his colleagues and students.

His clinical and research focus is on cardiac rehabilitation and chronic cardiovascular disease care. Stone is currently involved with more than eight different national guidelines committees—three of which he chairs. He is the current Chairperson and Editor-in-Chief of the CACR (Canadian Association of Cardiac Rehabilition) Canadian Guidelines for Cardiac Rehabilitation and Cardiovascular Disease Prevention. —LS

Ghali photo by Tiffany Neil

Department of Cardiac Sciences Awards Congratulations to the following recipients of the Libin Institute’s annual Cardiac Sciences Awards: Dr. Jillian Colbert wins the L.B. Mitchell Research Fellowship Award which is given to an outstanding cardiology and cardiology subspecialty fellow or cardiac surgery resident annually.

Anand Joshi receives the Peter Russell Clinical Cardiology Fellowship Award. He recently just moved to Ottawa to complete his echocardiography fellowship after spending three years in Calgary doing his cardiology fellowship. Dr. Israel (Sonny) Belenkie takes home the Cardiology Resident Teaching Award which is chosen by the cardiology fellows and presented to an outstanding cardiologist for his or her teaching. —LS

Dr. Anand Joshi

Dr. Israel (Sonny) Belenkie

Pictured Above (L-R) Dr. Brent L. Mitchell, Dr. Jillian Colbert, Dr. Ed O’Brien

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CARE DELIVERY

Eat, Play, Live

ATCO Blue Flame Kitchen Chef JP Gerritsen preps the SHC Wellness Kitchen for a cooking class. (Photo courtesy of ATCO Blue Flame Kitchen)

The Wellness Kitchen at the South Health Campus’ Wellness Centre emphasizes healthy food preparation, mindful eating and good nutrition for all Photos and Story by Lynda Sea

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isit the Wellness Centre at the new South Health Campus (SHC) in Calgary and one of the first things you’ll see is a floor-ceiling-climbing wall where kids are playing. To the left of this, a bright welcoming kitchen space next door looks like something out of a cooking show. You can’t help but remind yourself that you’re in an acute care hospital.

Given SHC’s emphasis on wellness services and health promotion, it’s no surprise that smart food preparation, mindful eating and good nutrition are major tenets of the building’s Wellness Kitchen, which opened in May 2013.

“We want to provide food, cooking, nutrition education for staff, patients and their families in an effort to create a community of wellness,” says April Matsuno, consultant and dietitian for the Wellness Kitchen. “It’s about helping people make better shopping, cooking and eating decisions because of that education.”

The Wellness Kitchen hosts a variety of activities including hands-on cooking courses and demonstrations in the kitchen run in partnership with ATCO Blue Flame Kitchen.

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YMCA Summer Day Camp classes also bring in young kids and encourage them to learn to make fun and healthy snacks. For patients and their families and staff, there are plans to offer educational sessions focused on managing conditions and chronic illnesses such as hypertension, diabetes and celiac disease.

“We are also in the works of developing a low sodium class for heart failure patients,” says Matsuno. Patientfocused classes are filled via recruitment by dietitians in specific units. Matsuno says she’s currently working collaboratively with clinicians and in the evolution of the Wellness Kitchen’s program development, she’s aiming to attract more allied health professionals to utilize the space and improve their own skills to better help patients.

“How many times have you heard from your doctor, ‘you should eat more fish.’ Well, what does that mean exactly? We want to show you it’s not that difficult to make healthier foods, it’s not more costly and it doesn’t take hours and hours in the kitchen.”

The SHC Wellness Centre is the first in the country to integrate a YMCA into a hospital setting. There is also a Patient and Community Resource Centre and an AHS Knowledge Resource Service.

For more information on the Wellness Kitchen, visit albertahealthservices.ca/ Facilities/SHC/page60.asp

Sometimes BIGGER Is Better

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Why having a city-wide cardiac sciences program benefits Calgary and beyond

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1. YMCA Day Camp counsellors show a group of 10-13 year-olds the simple steps in making healthier smoothies 2. April Matsuno, consultant and dietitian with the Wellness Kitchen 3. The kids learn how to use fresh ingredients like spinach, blueberries and rice milk to make their drinks 4. After the hour-long smoothie session wraps up, the YMCA Day Camp group hams it up for a group photo

We have all heard the saying, ‘Big things come in small packages.’ While that is generally true, wouldn’t we all love a big collection of such small packages? When it comes to the cardiovascular sciences, this is precisely what we have in Calgary. People are often amazed when I tell them that the Libin Cardiovascular Institute of Alberta is comprised of 1,500 individuals, has the largest division of cardiology in the country numbering 60 or so cardiologists and 10 cardiac surgeons, and is based out of four hospital sites in Calgary.

We also have a presence at additional sites in the community and in a large distributed compliment of basic and translational research spaces across the University of Calgary.

Both cardiac surgery and cardiology roll into our citywide health services based department of cardiac sciences, paralleling our university-based department of cardiac sciences. We don’t have to navigate the departments of medicine and surgery in the same way as most centres.

All of this, bench-to-bedside, catheterization lab to rehab centre, wards to clinics, basic science experiments to clinical trials coordination, and city-limit to city-limit, is Libin. We are one.

Certainly, there are some challenges being a citywide program. It is not easy to point to the Libin Institute because it is not in one building, in one place. It is hard to have a town hall as no arrangement could ever fit everyone’s schedule or be where everyone wanted it. But all that being said, we are not much different from a large extended family with aunts, uncles, cousins, in-laws and out-laws. We actually do agree on the big things. At the end of the day, it is about the advancement of our science, the success of our students, and the health and happiness of our patients.

We’ve always got your heart covered.

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Al-Karim Walli is the Associate Director at the Libin Cardiovascular Institute of Alberta.

Top photo courtesy of Tourism Calgary

Cardiac Sciences, By the Numbers Looking back at the 2012-2013 year in clinical cardiac care delivery with highlights from the Annual Report of the Clinical Department of Cardiac Sciences and the Clinical Care Component of the Libin Cardiovascular Institute of Alberta Compiled by Judy Siu • Typography by Steven Tov

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FEATURE

Nadia Maarouf and Donald Welsh, PhD at the Microscopy and Imaging Facility

Standard grids being prepped for TEM (Transmission Electron Microscopy)

L New Dimensions With electron microscopy tomography, Donald Welsh, PhD, is mapping 3D models of the endothelial-smooth muscle contact in arteries to reveal a clearer picture behind cellular communication Story & Photos by Lynda Sea • Scans by Nadia Maarouf

ook at any text book image of a biological cell and you’ll find the requisite par ts: the nucleus, ribosomes, mitochondria and other various organelles with a lot of empty space. But in fact, cells are jam-packed with proteins and the spatial relationship between all the cellular str uctures is a significant research area ripe for study.

One of the cellular str uctures of particular interest to biomedical researcher Donald Welsh, PhD Associate Professor of Physiolog y and Phar macolog y at the University of Calgar y, is the endoplasmic reticulum (ER), the site of protein synthesis and calcium storage in cells.

“It controls calcium and also produces proteins, packages them and sends vesicles to the membrane,” he says. “We’re interested in the ion channels, the pores in the membranes, that let ions move in and out—that’s what controls the electrical activities and in turn, ever y process in your body.”

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His research focuses on how these ion channels and gap junctions (intercellular pores) control the electrical activity of smooth muscle/endothelial cells and consequently, the ability of arteries to contract and relax. Welsh’s work is currently looking at the role of ‘protein trafficking’ in setting the diameter of blood vessels which is the primary determinant behind blood flow.

Unlike most researchers who are still using traditional microscopy By only looking at things in two methods which offer two-dimensional images, Welsh is utilizing the dimensions, you can misinterpret technique of electron microscopy tomography (ET) to produce higheras you’re just seeing one slice of it. resolution 3D images of his cells. At 40-100x higher resolution than light microscopy or confocal microscopes, ET allows Welsh to get a With tomograms, you’re not just more accurate and comprehensive view of the cellular structure as a getting one picture—you get a 3D whole entity.

“By only looking at things in two dimensions, you can misinterpret as view.

–Donald Welsh, PhD you’re just seeing one slice of it,” he says. “With tomograms, you’re not just getting one picture—you get a 3D view.”

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A slice of electron tomographic reconstruction that denotes contact between endothedial and smooth muscle cells

The 3D modelling process where contour lines are drawn around key cellular structures

Welsh first approached the Microscopy and Imaging Facility (MIF) at the University of Calgary three years ago and realized how electron tomography could help his research. His team currently employs the use of the facility’s F20 FEG transmission electron microscope (TEM) to look at their biological samples.

“With tomography, you have a high energy electron beam to shoot through the thick sample,” says Tobias Fürstenhaupt, PhD facility manager at MIF. This allows use of thicker samples which are 250-nanometers thick and not just the typical 40-70 nanometres. “It gives you the whole content of the cell and then you can digitally slice through them in areas and see how close certain organelles come to each other.”

Tomograms are a complex and time-intensive process and Welsh’s PhD student, Nadia Maarouf, knows this all too well. She is the one who preps the biological tissue to look at under the microscope to generate a tomogram; itself, a four week process.

Then, Maarouf traces and deconvolutes the images to create a 3D model which can be rotated for a full view on the computer. She can easily spend another month doing so.

In total, Welsh and his team currently have six completed 3D models. They are aiming to publish their findings by the end of the year.

“It has given me a better insight into what the cells are like,” says Maarouf. “One observation that is replicated in all models is that most of the ER is located at the base with a small amount located at the tip of the projections. This finding raises new questions concerning calcium dynamics, protein trafficking and cell-to-cell communication.”

Supported by the visual information provided by these tomograms, Welsh proposes a different way of looking at ion channel regulation which challenges some of the current thinking in his field.

“My approach has always been to see the bigger picture,” he says. “We try to dig deeper, approach questions from different angles, and bring new tools and techniques to the field.”

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A complete 3D model of the endothelialsmooth muscle contact in an artery

The Tecnai F20 is a 200 kV Transmission Electron Microscope (TEM) specifically designed for highest resolution, elemental analysis and tomography

Making Waves Tracing the impact of Dr. John V. Tyberg as mentor, researcher and educator on the cardiovascular sciences field

By Lynda Sea with files from Hearts, Minds Vision: Roots of the Libin Cardiovascular Institute of Alberta • Photos by Pieter de Tombe

Dr. John V. Tyberg in his HIRC lab.

Photo of Dr. John V. Tyberg by Lynda Sea

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highly experienced cardiovascular physiologist with a reputation for his work in cardiac mechanics, Dr. John V. Tyberg, MD, PhD is a Professor of Cardiac Sciences, Physiology and Pharmacology at the University of Calgary.

His research is focused on wave motion in the arteries and veins, the dynamics of ventricular ejection and filling, pericardium-mediated ventricular interaction and venous capacitance.

“From when I was knee-high, I thought I wanted to be a mechanical engineer but then I became interested in medicine and physiology instead. I became interested in the heart because it moves,” says Tyberg. “At university, I took as broad a background as I could. If you are in medicine, and you’re going to treat people, you’d better understand about the human condition.”

Born in Wisconsin, he studied pre-med at Bethel College at St. Paul and did his graduate and medical degrees at the University of Minnesota in Minneapolis. He completed his post-doctoral research fellowship with Dr. Edmund Sonneblick at Harvard Medical School. Tyberg would go onto to work at both Cedars-Sinai Medical Centre and the Cardiovascular Research Institute at the University of California before coming to Calgary.

“John Tyberg was a pivotal recruit for me since our basic research interests were similar,” says Dr. Eldon R. Smith, OC, Professor Emeritus, University of Calgary who recruited Tyberg to Calgary in 1981. “His appointment allowed me to continue with some experimental investigation without the day-to-day responsibilities of running the lab. John has been a most valued colleague and friend ever since.”

“I thought I wanted to be a

mechanical engineer but then I became interested in medicine and physiology instead. I became interested in the heart because it moves. — Dr. John V. Tyberg

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In June 2013, colleagues, students and former collaborators gathered in Kananaskis for a symposium to celebrate Dr. John V. Tyberg’s 75th birthday

“I was lucky to work with one of the leading researchers in the world in cardiac mechanics. The big impact for me from John Tyberg has not been just the research but it’s also his school of thinking. Good work was the most important thing.”— Dr. Otto Smiseth

Dr. John V. Tyberg MD, PhD and Dr. Douglas R. Hamilton, MD, PhD

During his career, Tyberg has played a major role as a mentor, educator, researcher, and author of numerous academic papers in high ranked journals. He has supervised more than thirty graduate students and postdoctoral research fellows, and inspired them to achieve remarkable successes. One resident researcher, Dr. Douglas R. Hamilton, MD, PhD later became a NASA flight surgeon and biomedical engineer.

Dr. Nairne Scott-Douglas, MD, PhD, Head, Division of Nephrology and Clinical Associate Professor of Medicine, remembers first working in Tyberg’s lab in 1982 doing his undergraduate degree in physiology. He says Tyberg encouraged him to go into medical school and he returned to the lab do his PhD from 1983 to 1988.

“Everything I am doing now and have today, I owe to John—it was built on what he gave me. The one word that describes John is respect. He teaches you that your ethics, how you act and treat people is more important than anything else,” says Scott-Douglas. “He often espouses views that are contrary to the current dogma in physiology and he does that time and time again and has proven himself right.”

In 1985, Tyberg published a significant paper in Circulation validating the flat balloon method to measure pericardial pressure. Prior to this, it was assumed pericardial pressure equaled zero and he showed how this was not true. This tool to measure pericardial pressure is the standard reference method still in use today.

“I was lucky to work with one of the leading researchers in the world in cardiac mechanics,” says Dr. Otto Smiseth, a postdoctoral fellow from 1982 to 1984 who worked on this pericardial study with Tyberg. He is now a Professor of Medicine and head of the Division of Cardiovascular and Pulmonary diseases at Oslo University Hospital in Oslo, Norway.

14 LIBIN LIFE

Dr. Otto Smiseth

Smiseth is currently the personal physician for His Majesty, Harald V, the King of Norway. He credits Tyberg with inspiring his career interest in diastolic heart failure.

“He’s exceptionally creative, collaborative and focused. The big impact for me from John Tyberg has not been just the research but it’s also his school of thinking. Good work was the most important thing.

He never compromised quality. John’s one of the fundamental guys.”

Earlier this June, a coterie of colleagues, students and former collaborators gathered in Kananaskis for a symposium in his honour and to celebrate Tyberg’s 75th birthday. Speakers flew in from Taiwan, Norway and the U.S. and their presentations covered the whole gamut of dynamic properties of the heart and blood vessels to clinical cardiology.

“We came together to celebrate John’s birthday, his contributions to research, and his tremendous impact on his trainees and collaborators,” says lab manager Cheryl Meek. She has worked with Tyberg for the last 32 years.

“This lab is a go-to spot and John’s knowledge is so vast that there’s a touch point for everyone,” she says. “I’ve taken the teamwork he teaches and everything out into my life. He’s had a huge impact not only on my work life but my personal life too.”

In examining the man behind the research, it’s obvious that Tyberg has had a rich legacy and continues to assert his relevance in the field of cardiovascular research dealing with classical physiology from basic sciences to its clinical implications.

As one of his major collaborators, Dr. Israel (Sonny) Belenkie, says, “He has lots of great ideas. He’s a terrific scientist and never compromises the science. If I had not had my sabbatical year (1986) in the [Tyberg] lab, and continued to work with him after that, I am certain I would not have spent as much time and effort in research as I did.”

RESEARCH

Landmark Study Tracks Toll of Hypertension on 3.5 Million Canadians

By Gregory Harris • Photos by Lynda Sea

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urmit Kaur Sarpal, a 65-year-old Calgarian, knows the importance of making lifestyle changes to help bring hypertension under control. She was diagnosed with high blood pressure 20 years ago.

Sarpal realized she had to deal with the stress and depression she felt. She enrolled in an six-week Better Choices, Better Health program offered by Alberta Health Services (AHS), which teaches the healthy benefits of lifestyle choices like diet, exercise and meditation.

“I’m still on low doses of medication for high blood pressure, but I now have a much greater sense of well-being,” she says. “I’m Dr. Hude Quan MD, PhD (left) eating better and I exercise at least twice a week.” and Dr. Norman Campbell (right) High blood pressure or hypertension—sometimes called a silent INSET Gurmit Kaur Sarpal killer because it has no warning signs or symptoms—is a condition of increased force against the walls of the arteries as blood flows through them.

Anyone who lives with untreated high blood pressure faces increased risks from heart attack, heart failure and stroke. But now, The study shows mortality rate among hypertensive Canadians researchers at the Libin Cardiovascular Institute of Alberta have from all causes was 22.4 per 1,000 person years, meaning about pinpointed specific segments of the population at greatest risk of 22 deaths would be expected among 1,000 hypertensive persons those health outcomes. observed for one year. Researchers speculate that health outcomes A landmark research study that tracked 3.5 million Canadians could be poorer for the elderly due to what are called co-morbidities, with high blood pressure for up to 12 years found that men, the or additional diseases or health conditions. Hypertensive men may elderly and people living in low-income or rural fare worse than women because of negative lifestyle areas generally have poorer health outcomes than By the Numbers factors, such as smoking or alcohol consumption, other segments of the population. and it’s well established that low-income populations Of the 3.5 million people “Until now, we haven’t had benchmark inforgenerally have poorer overall health than those in included in research study: mation on the overall state of the population,” higher socio-economic groups. says Dr. Hude Quan, MD, PhD the lead author “Although treatment and control of hyperten29.4 % were under 50 of the paper, U of C professor and co-chair of sion in Canada has improved over the last decade, at 35.6 % were aged 50-64 the Quality Improvement Committee of the AHS least one in five Canadians has high blood pressure,” 35 % over 65 Cardiovascular Health & Stroke Strategic Clinical says Dr. Norman Campbell, one of the study’s co48.2 % of sample were male authors. “Globally, almost one in three has hyperNetwork. “These findings will enable us to determine in the future whether our prevention tension and it’s the leading cause of disability and treatment approaches in addressing hypertension

worldwide.” are having an impact.”

The study is a product of the HOST group, or the Hypertension Outcome and Surveillance Team. The Canadian Institutes of Health Research, the Libin Cardiovascular Institute of Alberta and Hypertension Canada supported the project. The study was published in May 2013 by the Canadian Journal of Cardiology.

RECENT

FUNDING SUCCESSES

BY JUDY SIU 16 LIBIN LIFE

Dr. Ed O’Brien and Justin MacDonald, PhD receive the Leaders Opportunity Fund from the Canadian Foundation for Innovation (CFI) for their “Laboratory for Novel Vascular Antiinflammatory Therapies” to explore the processes involved in the development and treatment of inflammatory vascular diseases like atherosclerosis, or hardening of the arteries.

Fainting affects about 50 per cent of Canadians. It is the cause of 1-2 per cent of emergency room visits. Dr. Robert Sheldon was awarded an Operating Grant from the Canadian Institutes of Health Research (CIHR) to further study the effectiveness of a drug called metoprolol, which may help prevent the reflex that causes a drop in blood pressure that leads to fainting.

Dr. Matthew Jam “Predicting the ne care for chronic ki ing hospitalization injury” was award ating Grant. His from Alberta and and evaluate a too high risk individua intensive follow-up and low risk peopl receive routine fol

Kathryn King-Shier Examining ethnic and sex differences in acute coronary syndrome patients and in access to cardiac care Photo and Story by Lynda Sea

A

sk Kathryn King-Shier, PhD, what her ultimate goal is behind her research and she doesn’t miss a beat.

“I want every coronary syndrome patient to have quick and effective access to healthcare,” she says.

King-Shier is a Professor in the Faculty of Nursing and the Department of Community Health Sciences at the University of Calgary. Known for her innovative work in identifying symptoms of heart health issues in women and ethnic groups in Canada, she has a multimethod research program where she focuses on cardiac recovery and determinants of heart health decisions.

She is currently looking at the sex and ethnic variations in acute coronary syndrome (ACS) symptoms and the access to care among different ethnic groups including the European (Caucasians), South Asian and Chinese population.

The study is recruiting 1,827 patients from 14 sites across Canada, mostly from Toronto, Vancouver and Calgary and looking at presentation differences among those three groups. It is the largest and most encompassing study about ethnic and sex differences in cardiac symptoms and access to care done in Canada and globally, to date.

“Seven years ago, we did a health record audit in the Calgary Health Region and noticed that Chinese and South Asians were waiting longer than Caucasians to come in to hospital.

This may have been the reason why the Chinese and South Asians also were less likely to receive thrombolytic therapy,” she says.

mes’ project on eed for community idney disease follown with acute kidney ded a CIHR Opers study will use data Ontario to develop ol that will identify als who require more p in the community, le who can safely llow-up.

Donald Welsh, PhD receives a CIHR Operating Grant to further explore the function and regulation of T-type calcium channels in cerebral circulation. This research will further our knowledge of how biological stimuli and calcium channels regulate vessel diameter and brain blood flow.

Language barriers, dependency on family members as well as cost concerns are just some of the potential reasons that delay some people from getting themselves care in a timely manner, says King-Shier.

Once findings from this major study are available, KingShier says, “The next challenge will be to look at how this information can be disseminated to the different knowledge users.” Her next project will be focusing on how different ethnic groups learn health information best, “so we can really make sure this information gets into the hands of potential patients.”

King-Shier first worked as an ICU nurse at the old Holy Cross Hospital. She says her exposure to the site’s cardiac care program inspired her to focus on cardiovascular health when she decided to do her Masters and PhD and pursue active research.

Her frequent collaborators include Dr. Hude Quan, MD, PhD (Community Health Sciences) and Dr. Nadia Khan from the University of British Columbia (UBC) on the ethnocultural studies. She also currently works with Dr. Paul Fedak, MD, PhD on the Kryptonite studies.

Dr. Guanmin Chen , MD, PhD and Dr. Hude Quan, MD, PhD received a CIHR Operating Grant to develop an enhanced method to measure chronic disease burdens using health administrative data.

Dr. Ed O’Brien received a Grant in Aid from The Heart and Stroke Foundation (HSF) to further explore Heat Shock Protein 27 to provide insights into the potential for developing a clinically relevant therapeutic strategy for preventing, stabilizing and/or regressing vascular lesions.

LIBIN LIFE 17

Shedding Light on Genetic Heart Disease Libin researchers study the mechanisms behind arrhythmogenic right ventricular cardiomyopathy (ARVC) to develop a personalized strategy for predicting arrhythmias Story by Connie Bryson • Photos by Trudie Lee

T

hirty-seven years ago, 14-year-old Belinda Coffin (now Belinda Osborne) waved goodbye to her older brother Brent as he dropped her off at Sea Cadets on his way to play hockey. It was the last day she saw Brent alive. Everyone thought it was a brain hemorrhage. Little did the Coffin family know, the cause of death was actually a genetic disease that would play further havoc with their lives.

In the 1990s, Belinda’s brother Barry nearly died when his heartbeat raced out of control while he was playing hockey. He was treated and diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC), a condition where the heart muscle breaks down over time and is replaced by fat and scar tissue. This process can affect the heart’s electrical system, causing an abnormal heart rhythm (arrhythmia). In some cases, a prolonged arrhythmia can result in fainting or sudden cardiac death.

Last summer, the disease struck again.

Belinda’s nephew, a military pilot, was playing soccer when his heart stopped. He was revived and successfully treated. This latest brush with death prompted many members of the family to seek genetic testing for ARVC. The condition is inherited and caused by CRIO Funding defects in desmosomes, which are structural Gerull, Duff and Chen’s work is funded by the Alberta Innovates components of the heart responsible for – Health Solutions Collaborative maintaining cell-to-cell adhesions. The child Research and Innovation Opportuof an affected parent will have 50 per cent nities (CRIO) program. The threechance of inheriting the abnormal gene. But it year study began early in 2013. gets complicated.

The project aims to 1) Identify the “Not every person who inherits the genetic factors that account for the reasons predisposition to ARVC will have the same why not all people with the initial presentation, symptoms, age of onset, mutation for ARVC actually or even develop clinical signs of the disease develop the disease 2) Understand better the mechanisms behind at all,” says Dr. Brenda Gerull, a cardiologist, those arrhythmias 3) Assess the geneticist, and cardiac researcher. effectiveness of two drugs in In 2004, Gerull found the first gene for suppressing arrhythmias.

ARVC. She says many unknowns still exist such as what factors might protect some carriers of the abnormal gene from developing The full version of this article originally appeared in Health Solutions clinical signs of ARVC. Spring 2013. It has been condensed Although implanting a cardiac defibrillator and reprinted with permission from (a device that shocks the heart into a steady Alberta Innovates - Health Solutions. rhythm when it detects a life-threatening (aihealthsolutions.ca) 18 LIBIN LIFE

Dr. Brenda Gerull LEFT Belinda Osborne

arrhythmia) in everyone with the mutation for ARVC might seem like a solution, it’s far from practical.

“ARVC patients tend to be much younger,” explains Gerull. “They could be living with the device for 50 years or more. It’s not a trivial matter. We have to consider the risk of sudden cardiac death for these patients. We need a better handle on who is at risk so we can personalize treatment.”

Along with University of Calgary co-leads Dr. Henry Duff, an electrophysiologist and cardiac researcher, and SR Wayne Chen, PhD, a basic scientist, Gerull has assembled a team of researchers to study the mechanisms behind ARVC and to develop a personalized strategy for predicting arrhythmias.

“ARVC is a complex disease that involves an understanding of molecular, physiologic, and genetic mechanisms,” she says. “That’s why we’ve designed an integrated program that involves an interdisciplinary team with wideranging expertise. Looking ahead, we believe that the insights gained from this study will also provide new information for the treatment of arrhythmias in more common cardiac diseases, such as heart failure.”

A key aspect of the research will be translating the results to clinical care. Gerull has already established a genetic heart rhythm clinic where cardiologists, geneticists, counsellors, and social workers all work together.

Belinda, who works as a nurse in Calgary, has been to the clinic. Genetic testing revealed that she carries the ARVC mutation. Her two teenage daughters are now being tested. “We’re very privileged in Alberta to have access to this advanced genetic testing,” she says.

COMMUNITY ENGAGEMENT

Wild at Heart On May 26, nearly 500 people attended Wild at Heart, Libin’s annual get-together of clinicians, researchers, staff, trainees and their families at the Calgary Zoo. The Libin Institute welcomed its guests for a private function on the west lawn across from the Elephant Crossing area for a family barbecue day.

Families and friends arrived shortly before lunch and festivities got underway with a build-yourown burger station and face-painting. There was also a greenscreen photo booth where individuals could pose with zany props and costumes and get their photos taken with fun animal backgrounds. Zookeepers brought out an alpaca to the west lawn and kids and their families got a close encounter of the animal kind. Institute director Dr. Todd Anderson said a few words of thanks to guests for attending as well as recognized the collective efforts of the cardiovascular community’s hard work in cardiac sciences across the city.

The day was a great way to celebrate the health care practitioners, nurses, lab staff, grad students, researchers and trainees for their contributions to cardiac sciences in Calgary.

Thanks to everyone who came out and we look forward to seeing you at next year’s event!

Photos by Suddha Sircar

Photos by Monique de St. Croix & Al-Karim Walli

Heart and Stroke Lab Tours Earlier this April, more than 125 people connected with the Heart and Stroke Foundation (HSF) and visited the University of Calgary to tour research labs at the Libin Cardiovascular Institute of Alberta and the Hotchkiss Brain Institute. Guests included HSF CEO Donna Hastings, donors, staff and volunteers, captains and canvassers who’ve participated in Heart and Stroke’s door-to-door campaigns.

Each tour stream visited three labs where attendees got a chance to peek into research spaces, ask direct questions to the researchers and to see, first-hand, what their fundraising efforts are supporting. Speakers from Libin included Elena Di Martino, PhD, Dr. Ed O’Brien, Dr. John V. Tyberg, MD, PhD and Dr. Henry Duff among others. Di Martino is a biomedical engineer who is working to develop a mechanical imaging system to study heart and blood vessels and the development of engineered blood vessels. Dr. Ed O’Brien studies vascular biology and is particularly interested in heat shock proteins that could have the potential to prevent hardening and subsequent damage to arteries.

The Heart and Stroke Foundation has been a long-standing partner of the Libin Cardiovascular Institute of Alberta, funding research that has impacted the lives of millions of Canadians.

LIBIN LIFE 19

LIBIN ABROAD

(L-R) Dr. Sarah Lalman, Dr. Thashana Teekah, Dr. Angelina Dhani, Dr. Arnelle Sparman; graduates from 2013 echo education program

Dr. Angelina Dhani performing an echocardiogram in the GPHC echo lab

Dr. Wayne Warnica in the Libin-sponsored GPHC echo lab with one of the donated TEE probes

Canada/Guyana Partnership for Health Care Development A team of medical professionals from the University of Calgary collaborate to implement multidisciplinary chronic disease management models in Guyana

Dr. Nairne Scott-Douglas

Dr. Kishan Narine

“There are opportunities to work with the public health system to make a big difference,” says Isaac. She has now established an ultra sound training program that trains doctors both in the urban and rural outreach centers. This proespite the high prevalence of cardiac disease and gram has also evolved to include obstetrical ultrasound. its causes, there is currently no structured cardiac Yilmaz is currently assisting with the establishment of care system in Guyana. For the last decade, there renal care and transplant services in Guyana. He set up an has been an ongoing effort by Libin member Dr. Kishan Electronic End Stage Renal Disease Registry and dialysis Narine to improve cardiac care in the South American access database. He is also teaching Dialysis Access Surgery country. to a local surgeon. He is collaborating with Scott-Douglas, “When I was there in 2002, because of a lack of cardiac Head of the Division of Nephrology to set up a chronic care, patients who needed cardiac interventions were sent kidney disease and dialysis program that will support a future abroad,” says Narine, a cardiothoracic surgeon. transplant program in the country. There are plans to train Recognizing the urgent need for cardiac care and imlocal health care providers. Yilmaz has already selected proved health care in general, the Government of Guyana a local surgeon from Guyana to train with him in both has joined this effort with current focus on cardiac and Canada and Guyana to conduct renal transplant procedures. renal disease, both in terms of treatment, prevention and The team’s combined effort in introducing a Multidiseducation. The focus at present is to make these services ciplinary Chronic Disease Management model and providlocally available with Libin support, says Narine. ing clinical skills and trainLibin members led by Dr. Debra Isaac ing to health care providers include Dr. Nairne Scott-Douglas, Dr. has been recognized by the Wayne Warnica, Dr. Nanette Alvarez, Government of Canada as the Dr. Todd Anderson and Dr. Narine who Canada-Guyana Partnership are collaborating with Dr. Serdar Yilmaz, for Health Care Development, former Medical Director of Southern as announced by former High Alberta Transplant Program. They are Commissioner of Canada in working with the Government of Guyana Guyana, Mr. David Devine. to develop a strategy for chronic disease In addition to chronic disease management. treatment, a partnership with In Guyana, non-communicable diseases the University of Guyana has (NCDs), also known as chronic disease, also been forged and the ulaccount for more than 70 per cent of (L-R) Mr. Sheik Amir (chief of medical staff, GPHC), Dr. Debra Isaac, Dr. Serdar Yilmaz, His Excellency Donald trasound program was integratdeaths. The four main types of NCDs are Ramotar (president of Guyana), Dr. Kishore Persaud, ed into the local curriculum. cardiovascular diseases, cancers, chronic Mr. Michael Khan (CEO GPHC), Hon. Dr. Bheri “Our next step is to expand respiratory diseases and diabetes. Many of Ramsaran (Minister of Health of Guyana). the model to include heart these deaths are preventable with ongoing failure, hypertension, diabetes, and lung disease in the public and early care. hospital clinic, with outreach to the community health clinDr. Isaac first went to Georgetown, Guyana’s capital, ics, thus increasing the ability to improve health care delivto help implement a program to educate public hospital ery and outcomes,” says Isaac. Under Warnica’s guidance, a physicians in cardiac ultrasound diagnostics, a program cardiac intensive care unit is being built. supported by the Institute. She says it became clear in her “This project wouldn’t have been possible without the various visits that there was a considerable gap between support and commitment of Todd Anderson and Al-Karim providing diagnoses and providing quality care to patients Walli,” emphasizes Narine. “Their support was crucial.” with chronic diseases.

20 LIBIN LIFE

D

Kieser in Kazakhstan: Transit-Time Flow (TTF)

For Dr. Teresa Kieser, her recent trips to Almaty and Astana, Kazakhstan have been a career highlight. Kieser’s rewarding experience in this Central Asian republic began with a published study in 2010 to evaluate transittime flow (TTF) as a tool to detect technical errors in bypass grafts, intra-operatively, and to predict outcomes. According to Keiser, measuring TTF gives the surgeon the chance to revise problematic grafts or identify other problems while the chest is still open.

“The bottom line is, if you use this and you have a good graft in the operating room, the chances are you are going to have a good result in your patient,” she says.

The findings led to worldwide attention and were included in the ESC/EACTS “Guidelines on Myocardial Revascularization” developed by the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS).

In 2011, transit-time flow measurement (TTFM) received recommendation by the National Institute for Health and Clinical Excellence (NICE) for routine use within the UK’s national health system, National Health Service (NHS).

This in turn garnered the attention of Dr. Serik Mendykulov in Astana, Kazakhstan when they purchased the Medistim VeriQc, the newest device of TTFM. This machine now combines assessment of both function and anatomy of bypass grafts with the addition of an ultrasound probe.

Kieser’s first trip to Kazakhstan in October 2010 came as a promise to speak and train fellow physicians on the new technology and ended with two successful surgeries. Recently, she returned to follow up with two workshops, a talk and a surgery.

While Kieser finds her visits extremely rewarding, she is met by many cultural barriers. Female cardiac surgeons are a rarity worldwide, and most staff and surgeons in Kazakhstan do not speak English. Despite these challenges, Kieser hopes to expand on the partnership by bringing surgeons from Kazakhstan to Calgary to observe Canadian techniques in the future, and return with them to apply the training.

—Amber Arsneau

Turin Publishes Blood Pressure Book in Bangladesh

Earlier this year, Dr. Tanvir Chowdhury Turin, MBBS, PhD, associate member of the Libin Institute and Assistant Professor of Community Health Sciences at the University of Calgary wrote and independently published a 144-page book in Bangladesh about blood pressure.

Its title in Bengali, Satkahon: Rokto Chap, translates in English to Everything about Blood Pressure. Jagriti Publications published 500 copies of the book which was launched at the Mother Language Book Fair in Dhaka in February.

“It introduces the fundamentals of blood pressure, both high and low, but with special focus on high blood pressure,” says Turin. The book explains the causes of the blood pressure-problem, other associated chronic diseases, complications, control and preventive initiatives. The various chapters outline themes behind basic understanding of how our bodies’ circulation system works. It includes information on high blood pressure (HBP) and its relationship to diabetes, stress, pregnancy and children and dietary issues. It offers strategies for controlling HBP at the personal and community level.

Turin wanted readers to be informed about the basics in order to ask the proper questions about their health with their physicians.

He sees it as a resource to help the Bangladeshi community make informed decisions in their lifestyle modification efforts to prevent or control hypertension. Looking forward, Turin says there’s potential plans to reach the South Asian community in Calgary where there are more than 5,000 in the Bangladeshi community. —Lynda Sea

EDUCATION Studying Syncope

Why Aren’t More Women Getting Cardiac Rehab?

Syncope expert Dr. Robert S. Sheldon is running a few randomized controlled trials called POST (Prevention of Syncope Trials) to look at different interventions for vasovagal syncope— one of the most common causes of fainiting. He points to a phenomenon where there’s improvement in vasovagal syncope patients who come for their first visit.

To examine the prevalence of syncope rates dropping or even stopping, Sheldon’s student Payam Pournazari did a comprehensive meta-analysis and literature review of systematically acquired clinical trials. They found about 1400 patients had a median number of four faints in the preceding year, more than 98% of them had fainted in that year, and they had been fainting for years. Of these, about 50% just stopped completely.

Pournazari’s poster “Meta Analysis of Factors Predicting Spontaneous Remission in Frequent Vasovagal Syncope” was one of 20 Featured Posters at the 2013 Heart Rhythm Society 34th Annual Scientific Sessions. This abstract has also been accepted for oral presentation on October 17 at the Canadian Cardiovascular Congress during Vascular 2013 in Montreal.

Despite the fact that women with coronary artery disease (CAD) derive greater benefit from attending cardiac rehabilitation than men, they are less likely to be referred and less likely to attend. Dr. Jillian Colbert, an echocardiography fellow at the University of Calgary discovered this in her study “Cardiac Rehabilitation Referral and Attendance in Women: A High Risk Population with Two Strikes Against It.” Colbert and her colleagues suspect the reason for low attendance and referral is due to a number of factors: family obligations, transportation issues and putting their own health last.

She presented her findings earlier this spring at the American College of Cardiology’s 62nd Annual Scientific Session (ACC.13).

She won “Best FIT Poster” for her abstract; this designation represents the top 3% scoring percentile of accepted posters from fellows in training. Colbert collected her data from a cohort of almost 26,000 patients from the APPROACH and CWIC databases. She cites Dr. Billie-Jean Martin, Dr. Sandeep Aggarwal, Trina Hauer and the APPROACH group as key collaborators. Dr. James Stone is her research supervisor.

Sharing Science

Libin Research Day showcases the diversity of cardiovascular science-research at the Institute and promotes public discourse amongst experts, donors, staff and students

There were 63 posters in total in the Poster Competition Showcase

22 LIBIN LIFE

POSTER COMPETITION WINNERS CLINICAL TRAINEE

n March 28, the Libin Institute held its 2013 Research Day and more than 150 staff, students, researchers and physicians came out for a day of presentations, posters, awards, lunch and reception.

This year’s theme was heart electrophysiology. The day opened with opening remarks from Donald Welsh, PhD, Chair of the Libin Education Committee and Dr. Todd Anderson, Director of the Libin Institute. Dr. Ed O’Brien, the Institute’s Research Director then delivered a presentation about the future of research at Libin.

Eleven trainees presented Rapid Fire Talks and fielded questions from the audience.

During lunch, more than 20 judges and general attendees engaged with the trainees at their posters. There were a total of 63 posters in the showcase.

In the afternoon, SR Wayne Chen, PhD, HSF/Libin Professor, Physiology & Biophysics and Biochemistry & Molecular Biology presented his latest research on ryanodine-receptorassociated cardiac arrhythmias and cardiomyopathies. Dr. Brenda Gerull followed up by delivering her talk on “Arrhythmogenic Cardiomyopathy: From Bench to Bedside.” She shared research she’s working on involving examining gene mutations that cause predominant left-ventricular arrhythmogenic cardiomyopathy in homogygous carriers in Hutterite populations.

Dr. Mark Anderson, Head of Internal Medicine at the University of Iowa – Carver College of Medicine, delivered the 2013 Dr. E.R. Smith Lecture. He spoke on the multifunctional Ca2+/calmodulin dependent protein kinase II (CaMKII) and shared his discoveries on its relationship to myocardial dysfunction and arrhythmias.

Special thanks to all the speakers, our sponsors Zymmetrix and Innovate Calgary, philanthropist Tine Haworth and her family and everyone who came out for this event.

GRAD STUDENT

O

Dr. Eldon R. Smith (left) and Dr. Robert Sheldon (right) engage with trainees at the Poster Competition Showcase

POST DOCTORAL FELLOW

(L-R) Jonathan Lytton, PhD, Donald Welsh, PhD and Dr. Mark Anderson

TRAINEE Dr. Jillian D. Colbert ABSTRACT TITLE Cardiac Rehabilitation Referral and Attendance in Women: A high risk population with two strikes against it SUPERVISOR Dr. James Stone

TRAINEE Osama Harraz ABSTRACT TITLE Protein Kinase A Regulation of T-type Calcium Channels in Cerebral Arterial Smooth Muscle SUPERVISOR Donald Welsh, PhD

TRAINEE Ramesh Mishra ABSTRACT TITLE Endothelial Kca Channels Regulate Blood Pressure in a Large Animal Model SUPERVISOR Andrew Braun, PhD

DIAGRAM OF A

Dr. Henk ter Keurs shares the story behind his oft-used illustrations of a trabecula dissection Illustrations by David (DaWei) Liu

Dr. Mark Anderson delivers 2013 Dr. E.R.Smith Lecture

SR Wayne Chen, PhD

Dr. Brenda Gerull

TRAINEE Jeff Ma ABSTRACT TITLE Angiotensin-Converting Enzyme Inhibitors / Angiotensin Receptor Blockers and Risk of Contrast Induced Acute Kidney Injury: Systematic Review and Meta-analysis SUPERVISOR Dr. Matthew James

TRAINEE Zhan Shi ABSTRACT TITLE Glycogen synthase kinase-3β stimulates myocardin activity in human vascular smooth muscle cells SUPERVISOR Dr. Xi-Long Zheng, MD, PhD

“This is one of the illustrations David (DaWei) Liu made for us to explain how we obtain ultra-thin muscles (trabeculae) from the right ventricle of the rat heart. Back in the mid-to-late 80s, we had needed more help keeping our lab clean. David was quite happy to help us out with regular maintenance of the lab. His wife Pauline worked in the Foothills.

One Christmas, Pauline stopped me in the hallways of the Foothills and gave me a fantastic 1 by 1½ foot drawing of a cocker spaniel. I was baffled by the beauty of the drawing and asked her for the source. David appeared to be the artist. I was deeply embarrassed to have asked a man with those talents to do menial tasks in the lab. Next time I saw David, he agreed to help me with artwork for our science projects.

I had always made these drawings myself but they were very simple as I am not an artist. So I made the sketches while we peered through the microscope together and David turned the sketches into real artwork. People always ask, how do you get those muscles and the answer is well, take a look at the next slide.

I’ve been using these drawings in very highly respected international meetings and still continue to use them whenever we present our work. It’s also in my teaching slides for new students.

The drawing is big and the heart of the rat is very small. You have to know what you’re looking at when you are in the lab and this helps tremendously.

Shortly after turning into our scientific illustrator, David decided to go completely in the art direction and became a wellrespected teacher of art and a highly appraised artist in Calgary.”

Dr. Henk ter Keurs, MD, PhD is a professor in Physiology & Pharmacology. His studies have led to theories of pump function of the normal heart and arrhythmias with non-uniform wall motion due to ischemic heart disease.

TRAINEE Xixi Tian ABSTRACT TITLE Abnormal Termination of Ca2+ Release Is a Common Defect of RyR2 Mutations Associated with Cardiomyopathies SUPERVISOR SR Wayne Chen, PhD

TOP Right ventrical wall cut BOTTOM Cutting the tricuspid valve

SPOTLIGHT ON TRAINEES

Nathan Bracey Current Pursuit Supervisor

MD/PhD Student

Dr. Henry Duff

Bachelor of Science, Pharmacology, University of Alberta (2008)

Degrees

Research Interests In response to insufficient blood flow or high blood pressure, cells within the heart called fibroblasts become activated and generate a scar or fibrosis. While initially beneficial for wound healing, chronic and unregulated fibrosis worsens heart function and leads to progression of disease. He’s aiming to better understand how these proteins function in longstanding heart disease and fibrosis and ultimately to determine their suitability as potential drug targets. Specifically, he’s studying NLRs, proteins that are expressed in a variety of cell types including cardiac fibroblasts.

About Me “Medicine was actually the third career choice on my list, behind rockstar and NHL hockey player. So when I’m not working, I’m either playing guitar or ice hockey with friends.”

Ryan Marni Armstrong Mills Current Pursuit PhD in Cardiovascular and Respiratory Sciences Supervisor

Dr. Ron Sigal

Degrees Bachelor

of Science in Kinesiology (2002), Simon Fraser University; Registered Clinical Exercise Physiologist, American College of Sports Medicine To better integrate “exercise as medicine” into diabetes and cardiovascular health care delivery. Her research examines the utility of pre-exercise stress testing in people with diabetes, along with how to improve adherence to exercise interventions in people with Type 2 diabetes.

Research Interests

About Me “I am a huge live music fan and in the summer, you will find me swaying and bopping at various music festivals. One of my favorites is the Calgary Folk Music Festival where you can see legendary acts and discover surprising unknowns all under the bright blue Alberta sky.”

Dr. Jillian Colbert

Current Pursuit Post-doctoral researcher in Vascular Biochemistry, University of Calgary Supervisor

Michael Walsh, PhD

Bachelor of Science (2005) and PhD (2011) in Cellular Neurochemistry, The University of Melbourne (Australia)

Degrees

Protein biochemistry and investigating how proteins accomplish important biological functions. He is using a model system involving the rat tail artery to understand the role of tyrosine phosphorylation of a protein called Pyk2 in smooth muscle cells. This biochemical process may be important for how the cells process signals such as hormones and medicinal drugs to regulate blood flow.

Research Interests

About Me “I

have a twin brother.

I also studied university level Mandarin Chinese concurrently with my PhD, and am currently learning ballet and martial arts.”

Subspecialty Fellowship in Adult Echocardiography

Current Pursuit

Supervisor

Dr. Lisa Welikovitch

Degrees Bachelor of Science (Hons), Biochemistry & Microbiology, Dalhousie University (2003); MD (2007) and Graduate Diploma, Clinical Epidemiology (2010), Memorial University; FRCPC Internal Medicine, Memorial University(2011), Adult Cardiology, University of Calgary (2013)

Efficacy of drug-eluting stents in coronary artery disease, statin-induced diabetes mellitus. Most recently, she studied sex disparities in cardiac rehabilitation referral, attendance and mortality in patients with coronary artery disease.

Research Interests

About Me “I

am an east-coaster transplanted to the west and I am continually enamored by the mountains. When I am not studying, I like to run along Calgary’s beautiful Bow River pathway or explore Alberta with my husband. It has been truly been a privilege to train at the Libin Cardiovascular Institute.”

Compiled by Amber Arsneau • Photo by Lynda Sea

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