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JACC: Journal of the American Collgege of Cardiology
CLINICAL INNOVATORS
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been created for the JACC family of
ournals.
about this therapy and the outcomes you found?
I was recently privileged to be part of an investigative team that evaluated a unique stem cell preparation to improve the clinical outcome in patients
with ischemic cardiomyopathy. Ixmyeolcel-T is a
multicellular therapy produced from the patient’s
own bone marrow that contains a variety of
mononuclear cells including mesenchymal stem
cells and M2 macrophages that can potentially aid
the repair of and reduce the inflammation of ischemic cardiomyopathy. My interest in this research
was stimulated by the fact that there were no good
therapies available for patients with end-stage
heart failure due to irreversibly damaged myocardium. We conducted a multicenter, randomized,
prospective, blinded clinical trial in patients with
advanced heart failure. We found a statistically
significant benefit in the primary endpoint of a
composite of all cause death, hospitalization and
unplanned clinic visits for heart failure decompensation compared to controls. Although the mechanism of benefit remains uncertain, I believe that
this largest randomized trial of cell therapy for
heart failure supports the potential benefit of cell
therapy for this very ill patient population that has
few therapeutic options.
The set-ups for sub-specialty journals
follow the colors and typography
developed for the 2014 print edition
redesign.
The “JACC Journals” sub-brand logo
s intended to be an umbrella for the
entire family of journals.
phy, continues. I am involved in several projects
assessing the ability of contrast ultrasound to
assess coronary disease, ischemic memory using
targeted microbubble markers, and intracavitary
flow dynamics. We have just completed some
work on the long term follow up of echo markers of diastolic dysfunction, and are linking these
descriptors to ultimate outcome such as heart
failure and atrial fibrillation. I have also become
interested in population health, and am involved
with the Be There project to reduce heart attacks
and strokes. I am pursuing several studies evaluating the use of cell therapy for cardiac disease,
and am collaborating with a bioengineer to label
stem cells and track their location and survival
in the myocardium after injection. We still do not
have a good method to identify and track stem
cells after they are injected into humans, and
this ability would be fundamental to understanding the mechanism and best application of this
therapy clinically.
JACC Sub-Specialty Journals
JACC Journals Umbrella
The “JACC Perspectives” sub-brand
ogo is used to promote that particular
Accepting the
online series of content packages.
risk of
failure
JACC
Perspecti ves
and persistence
Usage guidelines for the JACC family
in achieving
of logos follow those for the ACC
the ultimate
ogo. Primary usage preference is for
goal are critical
the signature version, with the stack
for successful
version used in cases where horizontal
innovation.
You are a key player in San Diego’s successful
“Be There” campaign to address cardiac risk
factors. What is unique about this campaign?
Be There, the Project to Make San Diego a Heart
Attack and Stroke Free Zone, is one of the projects
that I am involved with that I am proudest of.
Physicians from virtually all the major medical
systems in San Diego have come together to collaborate to reduce heart attacks and strokes in our
county. I have the honor of serving as Executive
Committee chair of this group. We aim to energize
physicians to aggressively pursue evidence based
risk reduction measures for their patients, and to
activate patients to adhere to medications and a
healthy lifestyle. To energize physicians, we meet
monthly at a “University of Best Practices” to share
the most effective protocols to reduce cardiovascular risk. To accomplish the latter goal, we appeal to
patients to alter behavior so that they can survive
to “be there” as an important presence in the lives
of loved ones. We have succeeded in obtaining a
grant from the Innovations Center of Medicare
and Medicaid Innovation and are enrolling 4,000
individuals to receive intensive risk reduction measures including a bundle of medications, health
care coaches, and for many participants, wireless
blood pressure monitoring. We are attempting
to establish a boilerplate for a community effort
to decrease heart attacks that can be utilized
throughout the United States.
space is consrained, as in tower ads.
What is the focus of your current research?
My current research is divided into several different areas. My longstanding (career long) interest
in cardiac imaging, particularly echocardiogra-
40 CardioSource WorldNews
tance of an innovation may not mean the innovation is wrong, but may mean that it has not been
properly understood. So, accepting the risk of
failure and persistence in achieving the ultimate
goal are critical for successful innovation. Great
innovative successes typically require an individual to undertake a substantial risk of failure.
You have written about the importance
of a willingness to take risks and fail as
being necessary for medical innovation—
characteristics that are not inherent in many
physicians. What needs to happen to foster the
innovative process in future physicians?
In studying the characteristics of several very
successful medical innovators who had converted
discoveries into clinical practice, it became apparent that their initial attempts at innovation often
had not been successful. Physicians, as a group,
are very high achievers who are accustomed to
performing at a very high level and being very
successful. They are particularly averse to the
concept of possibly failing. However, failure need
not be the end of a process, and in fact may lead
to an understanding of what is necessary for success. In addition, the lack of immediate accep-
As you look back on your career, what have
been some of the most rewarding milestones?
As I look back on my career, there are a number
of milestones that stand out. Very early in my
career I was fortunate enough to be selected as
a finalist for the Young Investigators Competition of the ACC. Although I did not win, just
being a finalist encouraged me that I could be a
productive researcher and provide useful new
information. When my laboratory first injected
contrast microbubbles into the coronary arteries of canines and visualized myocardial opacification, this opened up the field of myocardial
contrast echo as a method to examine myocardial
perfusion. When I was first appointed as Chief
of Cardiology, it was an important milestone in
that I became responsible for individuals and
programs other than myself and my own. In fact,
I am most proud of the individuals whose training I have contributed to and who have gone on
to be great contributors to the profession themselves. Of course, having the honor of serving as
the president of the ACC and America Society
of Echocardiography have been extraordinary
experiences and have given me the opportunity to
give back to the profession. Perhaps the crowning
milestone was being selected as editor-in-chief of
JACC. Being entrusted to evaluate the research of
others was an awesome and sacred responsibility,
and the opportunity to insure that the best new
information was presented to readers provided
another great opportunity to contribute to the
profession. ■
Katlyn Nemani, MD, is a physician
at New York University.
American College of Cardi
June 2016