Atrial fibrillation, or AFib, is a condition in which the heart’s upper chambers beat irregularly, often causing a rapid heartbeat. Some people with AFib also experience chest discomfort, shortness of breath or heart palpitations. Others may notice only mild fatigue during activity. And still others may feel no symptoms at all. AFib also increases the risk of stroke.

“That’s why it’s especially important to carefully manage AFib in the summer, when people may spend more time in the sun, lose fluids through sweating, and drink more alcohol on vacation, at barbecues and at other outdoor social gatherings,” said Archana Ramireddy, MD, a clinical electrophysiologist in the Smidt Heart Institute. “Older adults are especially affected by the heat, even if it may not seem obvious at first.”

In recognition of AFib Awareness Month in September—when Southern California often experiences some of its hottest weather—the Cedars-Sinai Newsroom spoke with Ramireddy about steps people with AFib can take to stay healthy.

What summer factors can trigger an AFib episode?

Hot weather can put added stress on the heart, but heat itself isn’t necessarily the primary concern. Dehydration is of special concern because people lose fluids through sweating. Older adults may be particularly susceptible to heat-related dehydration because the body’s ability to conserve fluids and regulate temperature can decline with age. Alcohol is another concern because it is a well-recognized trigger for AFib, and people tend to drink more during the summer while vacationing, spending time outdoors and attending social gatherings.

Should people with AFib drink plain water to stay hydrated, or do they need electrolytes?

Plain water is usually the best choice. Electrolyte drinks may be helpful in some circumstances, although individual needs vary based on heat exposure, activity level, how much a person has been sweating, and underlying health conditions.

What are the signs of dehydration?

Signs of dehydration can include dark urine, dizziness, dry mouth, fatigue, confusion and a rapid heartbeat. If symptoms are prolonged or severe, or if a person also is experiencing chest discomfort or shortness of breath, they should seek medical attention.

Is coffee off-limits for people with AFib?

One cup of coffee a day generally isn’t a concern. Even two cups may be acceptable, although for some patients I recommend switching extra servings to decaf or half-caf. It’s most important that people pay attention to their own bodies. If caffeine consistently triggers symptoms, cutting back is recommended. I’m far more concerned about the consumption of multiple energy drinks, because high doses of caffeine and other ingredients in these drinks can increase the risk of arrhythmias.

Is it safe for people with AFib to exercise in the summer?

I encourage regular exercise for my patients with AFib. If physical activity consistently triggers episodes, the underlying AFib should be evaluated and treated rather than simply avoiding exercise. That said, it’s best to avoid strenuous exercise during the hottest part of the day and to stay well-hydrated if outside in the heat. To combat overheating, seek air conditioning, drink plenty of water, take a cool shower or use cool towels.

What if a person thinks they may have AFib?

If a person has heart palpitations and isn’t sure what is causing them, capturing an episode can be key for diagnosis and treatment. This is where wearable devices, such as smartwatches, can play a role. If a device can record an ECG, or electrocardiogram, during an episode, a physician can review the tracing to determine whether it is consistent with AFib. Wearable devices have helped us identify more patients sooner, allowing us to begin treatment sooner. Preventing stroke is a major goal of AFib treatment. People who have been diagnosed with AFib should work with their healthcare team to determine whether further evaluation by a cardiac electrophysiologist is appropriate.

Read more from Cedars-Sinai Stories and Insights: Atrial Fibrillation—Know the Warning Signs

The multi-institutional study offers one of the clearest pictures of what happens during the earliest stages of disease. The findings could help researchers develop new ways to detect and prevent heart disease before plaque builds up inside arteries.

“We analyzed proteins and gene activity in coronary artery tissue from young adults who died of trauma and had no known coronary artery disease, and we found that more than half already had preclinical atherosclerosis,” said study first author Sarah Parker, PhD, an associate professor of Cardiology and Biomedical Sciences and co-director of the Proteomics and Metabolomics Core at Cedars-Sinai Health Sciences University. “This suggests that changes in cellular metabolism and communication begin before the inflammation long considered a hallmark of the disease.”

Published in the European Heart Journal, the study findings point to previously unrecognized molecular pathways—and a potential “master regulator” called MLXIPL—that could become targets for therapies aimed at preventing plaque from developing.

The Cedars-Sinai Newsroom spoke with Parker about the findings and how proteomics—the study of proteins—is helping researchers rethink the earliest stages of heart disease.

Why are proteins so important in understanding heart disease?

Proteins are the molecules that make cells function. They tell us how the body’s cells are responding to risk factors like cholesterol, blood pressure or smoking. Two people can have identical cholesterol levels, yet only one develops plaque. Proteins may help explain why. They provide a much more direct picture of what's happening inside the artery wall and may reveal why some people are more vulnerable to heart disease than others.

What did this most recent study reveal about the earliest stages of atherosclerosis?

Previous studies had shown that the earliest artery lesions can appear in the first decade of life. What we haven’t understood is what causes those early changes to progress into dangerous plaques that lead to heart attacks. In studying coronary artery tissue before people ever developed symptoms, we were able to capture some of the earliest molecular changes that appear to set the disease in motion. One of the biggest surprises was that we saw changes in cellular metabolism and communication before we saw the classic inflammatory signals traditionally associated with atherosclerosis.

To be clear, inflammation remains a defining feature of advanced atherosclerosis. What our study suggests is that important molecular changes begin much earlier. If we want to prevent plaque from forming, we need to understand those earliest changes—not just what happens after inflammation has already taken hold.

Explain MLXIPL, the potential ‘master regulator’ you identified.

We performed a master regulator analysis to identify the genes that may be coordinating these early events. Some of the regulators we found were exactly what we expected. But one stood out. MLXIPL is a transcription factor gene involved in cellular metabolism. Previous genetic studies have linked it to coronary artery disease through its role in the liver. Our findings suggest it may also play an important role directly within the artery wall. When we altered MLXIPL activity in lab-grown human artery tissue, we saw the protein changes we predicted. That makes it an exciting candidate for future therapies that interrupt disease before plaque develops.

How could these findings change atherosclerosis prevention?

Today, we estimate cardiovascular risk using factors such as high cholesterol, diabetes, smoking, age and family history. By the time plaque is visible on imaging, disease often is well underway. We hope to identify protein biomarkers in the blood that reveal what’s happening inside the artery wall much earlier. One day, a simple blood test could identify people who would benefit from preventive treatment before symptoms develop.

That said, our findings do not change current prevention recommendations. Managing cholesterol, blood pressure, diabetes, smoking, exercise and diet remain essential.

This study relied on a decades-long collaboration. Why was that essential?

This is a collaboration more than 20 years in the making. The project was spearheaded by proteomics pioneer Jennifer Van Eyk. (Van Eyk, PhD, is director of the Advanced Clinical Biosystems Research Institute in the Smidt Heart Institute at Cedars-Sinai and co-director of the Proteomics and Metabolomics Core.)

Our collaborators included investigators from many other institutions across the country. What began as a small group has grown into an ecosystem of investigators, trainees and collaborators. This kind of large-scale molecular study simply isn’t possible without that level of long-term partnership and shared expertise.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

The designation from the condition’s oldest patient organization is awarded to programs with the infrastructure and experience needed to provide high-quality care to people with pulmonary hypertension, a type of high blood pressure that occurs in arteries of the lungs.

Pulmonary hypertension can make it difficult for blood to circulate through the lungs, forcing the heart to work harder. In severe cases, the condition can lead to heart failure. People with pulmonary hypertension often need care from several specialists.

The Cedars-Sinai Pulmonary Hypertension Clinic includes six physicians and one nurse practitioner. The pulmonary hypertension program combines cardiology and pulmonology, which allows patients to access multidisciplinary care from experts in the disease. Providers care for more than 250 patients each year and address multiple aspects of the disease, including diagnosis, medication management, symptom control and disease progression.

“At Cedars-Sinai, pulmonary hypertension specialists collaborate with colleagues in rheumatology, congenital heart disease, critical care medicine, lung transplantation and other specialties to create treatment plans tailored to patients,” said Yuri Matusov, MD, assistant professor of Medicine at Cedars-Sinai. “We are proud to care for an extraordinarily diverse patient population, some of whom come from very far away for their care.”

The association noted several outstanding aspects of the Cedars-Sinai Pulmonary Hypertension Clinic including:

• A team that collaborates and provides timely evaluation and management of people who are hospitalized and continues to provide consistent care when they leave the hospital.
• Monthly conferences with specialists in the Southern California region that allow for the review of complex pulmonary hypertension cases, knowledge-sharing and regional care coordination.
• For people with advanced disease, access to top-notch heart, lung and thoracic transplant programs.
• A research program led by doctors investigating potential treatments.

“We are honored for our clinic to have received this designation, the highest recognition available to pulmonary hypertension programs in the United States,” said Dael Geft, MD, assistant professor of Cardiology in the Smidt Heart Institute at Cedars-Sinai. “Ultimately, the greatest reward is helping our patients live longer, healthier and more fulfilling lives.”

Read more on the Cedars-Sinai Newsroom: Unique Cell-Based Approach for Pulmonary Arterial Hypertension Shown to Be Safe

Gilliam, 32, suffered sudden cardiac arrest, an electrical malfunction of the heart that causes it to abruptly stop beating. The odds were stacked against him: Sudden cardiac arrest kills about 90% of those who experience it outside of a hospital. Survival depended on a chain of people acting within minutes.

A fellow dancer immediately started CPR. Other dancers ran out of the dance studio in search of an automated external defibrillator (AED) and found one at a nearby dentist’s office. A speech pathologist who had just completed CPR recertification and happened to be nearby used the AED to revive Gilliam’s heartbeat.

Paramedics then rushed Gilliam to the Cedars-Sinai Emergency Department, where he had another cardiac arrest. Surgeons placed Gilliam on extracorporeal membrane oxygenation (ECMO), a form of advanced life support that temporarily took over the work of his heart, giving it time to recover—or, if necessary, bridging him to a transplant.

Cedars-Sinai experts say Gilliam’s case illustrates the importance of bystander CPR and quick medical response.

“The key to G’bari surviving sudden cardiac arrest was the fast-acting individuals who provided CPR, facilitated the use of an AED, and the Cedars-Sinai Emergency Department and cardiothoracic surgery teams who began ECMO within the hospital,” said Evan Kransdorf, MD, PhD, assistant professor of Cardiology in the Smidt Heart Institute and one member of Gilliam’s team of physicians and surgeons.

During cardiac arrest, blood stops circulating, explained Pedro Catarino, MD, a cardiothoracic surgeon in the Smidt Heart Institute at Cedars-Sinai.

“The cells of the body, particularly the brain, will die within a few minutes without circulation,” Catarino said. “Gilliam’s heart was in and out of a rhythm that doesn’t sustain circulation, so the surgery team put him on emergency life support.”

Gilliam’s heart had ceased working, so he was listed in the organ donation system. After 12 days on life support, Gilliam received the news every transplant candidate hopes for: A donor heart had become available.

“Heart transplantation offers a new chance at life for patients like Gilliam,” Catarino said. “Gilliam is an athlete and can look forward to going back to his career with a heart that has a long lifespan.”

A pathology report showed Gilliam had a severe form of hypertrophic cardiomyopathy, an inherited condition that causes the heart muscle to thicken so that the heart cannot contract and pump blood properly. The condition likely caused Gilliam’s sudden cardiac arrest, his medical experts say.

“Many people with hypertrophic cardiomyopathy don’t have symptoms, and athletes who are used to pushing themselves to be out of breath might not realize they have it,” Kransdorf said.

Geneticists in the Smidt Heart Institute tested samples of Gilliam’s heart and found that he had a genetic variant associated with hypertrophic cardiomyopathy. Experts encourage anyone with a family history to be screened for the condition, which affects about 1 in 500 people. Gilliam’s close family members are undergoing genetic testing.

Gilliam, whose credits include performing with Bad Bunny and on Jimmy Kimmel Live!, is now in physical therapy and preparing to return to dance.

“With dancing, it feels like I'm able to be my most authentic self and be the most vulnerable version of myself. It makes me feel alive,” he said.

Prior to his medical emergency, Gilliam’s schedule consisted of dance classes and gym training five days a week. He hopes to return to intense days and to continue teaching dance to elementary school students and choreographing dancers on TV and film sets. His mother and girlfriend are supporting him, as are many friends, family members and fellow dancers.

“What I learned from this experience is everyone should be trained in CPR because you never know what's going to happen,” Gilliam said. “Even more so, be a person of service. If you have the opportunity to help someone, do it.”

Read more from Cedars-Sinai Stories and Insights—Sudden Cardiac Arrest: Genetic Cause More Common in Younger People

A new study led by Karlstaedt and published in Circulation reports that a specific enzyme plays an important role in keeping the heart beating. The discovery could help scientists create drugs that mimic the enzyme’s role and help people with heart failure, a condition in which the heart becomes too weak to pump blood properly.  

Karlstaedt, assistant professor of Cardiology in the Smidt Heart Institute at Cedars-Sinai, has spent more than a decade studying heart metabolism—the chemical process that powers the heart. She spoke with the Cedars-Sinai Newsroom about her dedication to uncovering treatments for the millions diagnosed with heart failure every year.

How is the heart’s metabolism different from the metabolism of other parts of the body?

There are thousands of tiny molecules called metabolites—including amino acids, glucose and fatty acids—that act as an energy source to help cells function properly. The heart is the only organ that can use almost any metabolite.

The heart is also unique because it never stops beating. It's not like other muscles, which can rest. Fueling heart cells requires fine-tuned, organized chemical reactions. The system functions perfectly until something disrupts it, and metabolism is at its center. 

What was one of the major discoveries that led to your current work? 

My colleagues and I published a study in 2016 in which we discovered that the heart uses unusual fuel-processing routes to adapt to metabolites released by cancer cells. It’s like in a city where you have streets and traffic moves along those streets. If a construction site suddenly blocks a street, traffic finds another way around. The heart does the same thing.

We also found that in response to cancer-related metabolic stress, the heart suddenly started using an unusual enzyme called ATP-dependent citrate lyase, or ACL. This enzyme drives the process that creates fatty acids, something we didn’t think happened in heart cells. But when we blocked ACL, the heart could not pump well. That told us this enzyme might be much more important for the heart than previously thought.

Could you describe your recent discovery?

We found that when ACL slows down, heart function drops. To make this discovery, we studied heart tissue samples from people with healthy hearts and people with failing hearts. We also observed ACL in the hearts of laboratory mice. When ACL activity decreased, meaning it no longer efficiently produced fatty acids, the heart tried to adapt by taking up more sugar and rewiring parts of its metabolism. But those changes did not fully protect the heart. Instead, the heart had less available energy and did not pump as well.

To dig deeper, we used CardioNet, our computational model of heart metabolism. The model pinpointed another enzyme, IDH1, that compensates for the loss of ACL. When we reduced IDH1 in our model, the heart could pump better. We're now studying whether future heart failure therapies could target IDH1.

What do you hope to accomplish as this work progresses?

Heart failure can look similar from one patient to another, but the underlying metabolic changes may be different. We hope to use our computational model to predict which fuel pathways are disrupted in people with heart failure and which treatments can get the heart working better. We are not there yet, but this study is an important step toward understanding heart failure as a disease of both mechanics and metabolism.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

“The majority of people who have a sudden cardiac arrest outside of a hospital will die, so the best protection is being aware of risk,” said Kyndaron Reinier, PhD, MPH, associate director of Epidemiology in the Center for Cardiac Arrest Prevention in the Smidt Heart Institute at Cedars-Sinai and an author of both studies. 

Sudden cardiac arrest happens when a problem with the heart’s electrical system causes the heart to stop beating. It is different from a heart attack, which is caused by a lack of blood flow to the heart. More than 350,000 people experience sudden cardiac arrest outside of a hospital in the U.S. each year, and only about 10% survive. 

Experts know that people with low left ventricular ejection fraction, when the heart’s main pumping chamber is weak and pumps less than it should, are at higher risk for sudden cardiac arrest. But this marker has become less effective and other indicators are needed to capture more people at risk.

“More than two-thirds of people who have cardiac arrest don’t have low left ventricular ejection fraction, so using this marker alone misses too many people,” Reinier said. 

A study published in the journal Circulation: Arrhythmia and Electrophysiology reports that warning symptoms combined with clinical history could predict imminent sudden cardiac arrest. A second study, published in the Journal of the American Heart Association (JAHA), reports that having more than one cardiac event over time could signal rising risk. 

Reading Warning Symptoms

In the Circulation: Arrhythmia and Electrophysiology study, investigators used machine learning to identify combinations of symptoms and medical history that best predicted sudden cardiac arrest in the near future. 

The study included people enrolled in two separate, longstanding studies in Oregon and Ventura County, California, that were founded by Sumeet Chugh, MD, director of the Center for Cardiac Arrest Prevention in the Smidt Heart Institute. The investigators compared 364 people who called 911 when experiencing symptoms such as chest pain and survived sudden cardiac arrest, with 313 people who called 911 for similar symptoms but did not experience sudden cardiac arrest. 

The analysis found that people with sudden cardiac arrest were more likely to have a combination of shortness of breath and diagnosed coronary artery disease or heart failure than people who did not experience sudden cardiac arrest. Seizure-like symptoms without chest pain or shortness of breath were also more common in people who experienced sudden cardiac arrest.

The investigators also found that chest pain combined with coronary artery disease predicted imminent arrest in women, while chest pain combined with heart failure predicted it in men. 

Warning symptoms most often occurred at least 15 minutes prior to the sudden cardiac arrest, a time frame that would make it possible to call 911. In earlier research, the investigators found that 81% of people delayed their 911 call, reducing their chances of successful revival by ambulance paramedics. 

These findings could be used to create risk-predicting algorithms for use by urgent care and emergency medicine providers, the investigators said. “While more research is needed, such risk prediction algorithms have the potential to avoid 911 call delays following warning symptoms of sudden cardiac arrest,” said Chugh, vice dean and chief AI health research officer at Cedars-Sinai.

Tracking Risk Over Time

The JAHA study was carried out in the Observational Study of Cardiac Arrest Risk (O.S.C.A.R.) cohort at Cedars-Sinai, established by Chugh, that has been tracking the health of approximately 400,000 residents of Los Angeles County from 2017 onward. Of these, the investigators followed more than 6,700 people hospitalized at Cedars-Sinai for heart failure and more than 2,900 people hospitalized in the health system for acute coronary syndrome, when an artery blockage reduces blood flow to the heart. 

Investigators found that patients in both groups who experienced a recurrent cardiovascular event faced a higher risk of sudden cardiac arrest. 

Patients who had a second coronary artery blockage were more than three times as likely to experience sudden cardiac arrest as those without a recurrence. Patients who were hospitalized a second time for heart failure were nearly twice as likely to experience sudden cardiac arrest. Risk climbed with each additional heart failure hospitalization. The investigators compared the findings to what was found in participants of the Framingham Heart Study, which enrolled participants about 50 years earlier. The results were similar, however the heart failure result in that study did not reach statistical significance.

Reinier said that physicians should consider sudden cardiac arrest as being more likely when a patient is hospitalized for a heart issue a second time.

“This may mean running additional tests,” Reinier said. “It may mean educating the patient about what cardiac arrest is and the importance of having a family member who knows to call 911 and start CPR immediately if their loved one collapses.”

Moving Beyond Dead Ends

Chugh, senior author of both studies, said the combined findings point toward a more flexible approach to prediction.

“Near-term and long-term predictions are parallel approaches that can help us move past roadblocks we face in preventing death from this lethal heart event,” Chugh said.

Additional research, including studies in different populations, are needed to confirm whether the factors the investigators studied could be used in prediction tools, study authors said. 

Cedars-Sinai investigators continue to study predictors of sudden cardiac arrest, and their work includes using AI to study patterns in heart tests called electrocardiograms and looking for genetic causes. 

Additional Cedars-Sinai authors in the Circulation: Arrhythmia and Electrophysiologystudy include Harpriya Chugh, BS; Vishnu Kadiyala, MD; Arayik Sargsyan, MPH; Audrey Uy-Evanado, MD; Kotoka Nakamura, PhD; Elizabeth Heckard, MS; Marco Mathias, BS.

Other authors include Tristan Grogan, MS; David Elashoff, PhD; Angelo Salvucci, MD; and Jonathan Jui, MD, MPH.

Funding: Dr. Chugh was funded by the National Heart Lung and Blood Institute, National Institutes of Health.

Additional Cedars-Sinai authors in the Journal of the American Heart Association study include Marita Knudsen Pope, MD, PhD; Harpriya Chugh, BS, MSHS; Thien Tan Tri Tai Truyen, MD; Marco Mathias, BS; and Audrey Uy-Evanado, MD.

Other authors include Honghuang Lin, PhD; Dan Atar, MD, Nichole Bosson, MD, MPH, and Emelia J. Benjamin, MD, ScM

Funding: The Framingham Heart Study is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health. Dr. Benjamin is partially funded by The National Heart, Lung, and Blood Institute, National Institutes of Health.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Shehata is a cardiac electrophysiologist, a doctor who specializes in diagnosing and treating problems with the heart’s electrical system. He has experience with a broad spectrum of heart rhythm disorders and also cares for people with heart failure and survivors of cardiac arrest.

“Over the past two decades, Dr. Shehata has emerged as a nationally recognized cardiac electrophysiologist and academic leader,” said Susan Cheng, MD, MMSc, MPH, chair of the Department of Cardiology in the Smidt Heart Institute. “His leadership will mean continued progress in this important field.”

As a researcher, Shehata has led groundbreaking clinical trials for new types of pacemakers and other technologies for treating heart rhythm disorders. He also studies ways that AI can be used to personalize care.

Shehata’s most recent research includes a trial of a new treatment for atrial fibrillation, which occurs when the upper chambers of the heart beat out of sync with the lower chambers of the heart. The treatment, pulsed field ablation, targets heart cells involved in an abnormal heart rhythm. The U.S. Food and Drug Administration approved several pulsed field ablation systems, including one studied by Shehata and other researchers, in 2024.

Shehata and colleagues have also studied leadless pacemakers, miniature devices that attach to the heart muscle and that, unlike traditional pacemakers, don’t require a battery and wires.

As division director, Shehata will oversee a program that provides research-backed care and trains new heart rhythm specialists. The program offers a two-year fellowship to medical school graduates seeking advanced knowledge and skills in electrophysiology.

“Through his leadership of the Interventional Electrophysiology Laboratory and the Clinical Cardiac Electrophysiology Fellowship Program, Dr. Shehata has expanded access to advanced therapies and enhanced the training of future electrophysiologists,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute and the Mark S. Siegel Family Foundation Distinguished Professor.

Shehata earned his medical degree from the University of California, San Diego, School of Medicine. He completed internal medicine residency training at UCLA and his cardiology fellowship training at Cedars-Sinai, where he was chief fellow. He also completed advanced fellowship training in cardiac electrophysiology at Cedars-Sinai. He served as faculty at UCLA before being recruited to join the cardiology faculty at Cedars-Sinai, where he is a professor of Cardiology.

U.S. News & World Report rates the Smidt Heart Institute a top 10 cardiovascular center in the U.S. and #1 in California.

Read more from Cedars-Sinai Stories and Insights: New AFib Treatment Helps Dad Regain His Heart Rhythm

His labored breathing and exhaustion prompted him to see his physician, who ordered a battery of tests. Aster’s diagnosis: A rare cancer called a neuroendocrine tumor was causing a condition called carcinoid heart disease, and causing his heart to fail.

With treatment at the Cedars-Sinai Neuroendocrine Tumor Multidisciplinary Clinic, Aster is now back on the trail, his bike, his board and the court.

“I went from wondering how long I have to live to understanding that this can be managed,” Aster said. “I feel better than I have felt in years.”

Aster’s symptoms came on slowly over several months: crushing fatigue, bloating, loss of appetite and swelling in his legs and feet. Blood tests ordered by his primary doctor were normal, but a CT scan showed tumors in his liver, which were eventually diagnosed as stage 4 neuroendocrine cancer.

“We received the diagnosis the day we dropped the youngest of our four kids off at college,” Orr said. “We had other plans, so we just had to reset.”

Unable to sleep the night they got the news, Orr—who Aster said was his caregiver and support throughout this difficult time and credits with helping save his life—spent hours online. She clicked her way to the Neuroendocrine Tumor Research Foundation. The organization, a resource for research funding, patient education and support, directed the couple to  the Neuroendocrine Cancer Foundation, which referred them to Cedars-Sinai and its multidisciplinary clinic.

“We were concerned about Ken’s neuroendocrine tumors, which had spread to his liver and were making it difficult for his stomach to work normally,” said Andrew Hendifar, MD, who leads the clinic and is a professor of Medicine at Cedars-Sinai. “But we knew from experience that his heart failure would have to be treated first. We didn’t have a minute to lose.”

Neuroendocrine tumors begin in neuroendocrine cells, which connect the nervous system with the hormone-producing endocrine system. They can occur anywhere in the body.

Aster’s began in his small bowel and produced a hormone called serotonin, which thickened two of his heart valves and caused them to leak. The condition is called carcinoid heart disease.

Prashanth Venkatesh, MD, assistant professor of Cardiology in the Smidt Heart Institute at Cedars-Sinai, is the cardiologist on the neuroendocrine team.

“The pulmonary valve, which sends blood from the heart to the lungs, is notoriously difficult to evaluate with standard imaging techniques because of its location in the chest and the relative rarity of pulmonary valve disease in adults,” Venkatesh said. “Significant pulmonary valve involvement in carcinoid heart disease is hence very easily missed.”

Venkatesh, a congenital heart specialist, often employs more extensive imaging techniques for patients born with structural heart defects. Aster’s results showed there was a leak in his pulmonary valve as well as a leak in his tricuspid valve. Both valves needed to be replaced.

“When there is a leaky valve, which we call regurgitation, some of the blood in the heart goes in the wrong direction,” said Raj Makkar, MD, vice president of Cardiovascular Innovation and Intervention at Cedars-Sinai and the Karsh Distinguished Chair in Interventional Cardiology in the Smidt Heart Institute. “With leaky pulmonary and tricuspid valves, the blood that is supposed to go into the lungs can leak back toward the upper chamber of the heart.”

Aster’s pulmonary valve was replaced via a minimally invasive procedure in which a catheter was threaded up through an artery in the groin to maneuver the valve into its proper place. Four weeks later, Makkar replaced Aster’s tricuspid valve using a similar procedure. 

“Patients with carcinoid heart disease are going through a lot because of the neuroendocrine tumor, and traditional valve replacement surgery puts them at higher risk for complications,” Makkar said. “We pioneered testing of transcatheter tricuspid valve replacement around five years ago, and this was the option we chose for Mr. Aster.”

To address the neuroendocrine tumors on Aster’s liver, Alexandra Gangi, MD, director of the Division of Surgical Oncology and co-director of the Neuroendocrine Tumor Multidisciplinary Clinc, chose another minimally invasive approach: tumor embolization.

“We accessed the tumors with a catheter, through the artery in the groin,” Gangi said. “This allows us to block off the blood flow to the specific arteries that feed the tumors. This starves the tumors, and results in shrinking and tumor control.”

So far, Aster has avoided surgery and chemotherapy because of the nature of neuroendocrine tumors and the expertise of his care team in sequencing his therapies based on his sypmtoms.

“I think the difference between metastatic neuroendocrine tumors and most other types of gastrointestinal cancers is that we’re playing the long game,” Gangi said. “We often do the least invasive thing and save more aggressive options for when we really need them. These tumors tend to recur, but prognosis is generally good and patients can live a long time with them.”

Additional treatment or surgical procedures might be on the horizon, but today, Aster is doing well.

“We feel very fortunate that we were able to identify this as early as we did and intervene in the way that we did,” Hendifar said. “A few years ago, even six months ago, Ken wouldn't have been a candidate for minimally invasive valve replacements. He would have required open-heart surgery, and I'm not sure if the outcome would have been as good.”

Aster describes his current health as “great.”

“I just started cycling again in January, 13 months after the second valve replacement,” Aster said. “Now I'm doing a 25-mile ride in the hills two or three times a week with no problem. My heart feels as normal as can be.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

The 52-year-old has always enjoyed a high-energy lifestyle, managing the intensity of producing films and television shows (Ladder 49, Flight Plan, Top Gear, Wheeler Dealers) by eating healthy, running and biking along the Los Angeles River. After his daughter was born in 2020, Nieminen assumed his constant exhaustion was the typical kind that comes with sleepless nights caring for a newborn. Still, he and his wife, Kaisa, found it odd that picking up his daughter left him depleted.

“My battery was constantly drained,” Nieminen said. “Being physically active all my life, it was quite alarming. Deteriorating this quickly when I’m just over 50 seemed sort of dramatic.”

Nieminen also noticed his heart seemed to beat too fast at times and occasionally it would skip a beat, so in 2023 he made an appointment with Cedars-Sinai cardiologist Ronit Zadikany, MD. Zadikany diagnosed him with atrial fibrillation, an irregular heart rhythm that occurs when the upper and lower chambers of the heart beat out of sync. The condition tends to worsen with time and can cause the heart to beat too slowly, too quickly or irregularly, impeding blood flow. Common symptoms include fatigue, heart palpitations, dizziness and reduced stamina. Left untreated, atrial fibrillation can cause a slew of cardiovascular complications—including stroke.

Nieminen’s cardiologist referred him to Christine M. Albert, MD, MPH, an expert in atrial fibrillation and chair of the Department of Cardiology in the Smidt Heart Institute. Albert recommended cardioversion, a procedure commonly used to reset the heart to a normal rhythm. The results made Nieminen feel like himself again, but only for a day. A second cardioversion combined with a medication known to work for many people also had temporary effects.

Albert was determined to find Nieminen a treatment that would have long-term results. She suggested he might benefit from catheter ablation, a procedure that destroys cells and creates a small scar within the heart, breaking up or insulating the electrical signals causing the heart to beat out of sync. She connected him with Michael Shehata, MD, a cardiac electrophysiologist in the Smidt Heart Institute.

Shehata was leading a clinical trial investigating a new catheter ablation called pulsed field ablation. Rather than create scars, pulsed field ablation targets heart cells involved in an abnormal heart rhythm.

Nieminen underwent the procedure in January 2024.

“When other options fail, this procedure can be life-changing for patients,” Shehata said.

Pulsed field ablation is done by threading a catheter through a vein in a patient’s leg until it reaches the top chambers of the heart. Once in place, a cardiologist sends a high-voltage electrical impulse through the catheter. The energy penetrates cell walls and destroys specific heart cells, preventing abnormal signals from causing an irregular heartbeat. The procedure takes 30 to 60 minutes.

“The energy is delivered specifically to heart cells without injuring nerve cells, smooth muscle cells, or other, healthy cells,” said Shehata, who is also director of the Interventional Electrophysiology Laboratory at the Smidt Heart Institute. “For some patients with atrial fibrillation, this procedure may be safer than conventional ablation procedures that destroy small areas of heart tissue.”

Following U.S. Food and Drug Administration approval of several pulsed field ablation systems, the procedure is now available for use outside of a clinical trial.

Advances in treatment couldn’t come at a better time. Atrial fibrillation is the most common type of irregular heartbeat and deaths related to the condition have been increasing for more than two decades, according to the U.S. Centers for Disease Control and Prevention.

Today, Nieminen is back to long runs and cycling through his neighborhood. He also works with local organizations to advocate for safe walking and biking paths in Los Angeles. Most importantly, he can now lift his daughter into the air like the high-energy dad he is.

A device that was implanted to record Nieminen’s heart rhythm shows proof of his progress: He has been free from atrial fibrillation since getting pulsed field ablation.

“Don’t hesitate to share with your doctors when something feels off because you feel like you’re being a hypochondriac or you think it’s too insignificant to bring up,” he said. “As you get older, it’s especially important to listen to your body, eat right and stay active, and that doesn’t necessarily mean doing a 10K. Everything your mom would tell you growing up: Stay active, eat healthy, get sleep and get checkups with your doctor. Mom knew what she was talking about.”

Read more on Cedars-Sinai Stories and Insights: Back Into Rhythm | Adjusting to an AFib Diagnosis

Smidt Heart Institute cardiologist Janet Wei, MD, is one of the authors of a maternal health report from the National Academies of Sciences, Engineering, and Medicine, a nonprofit organization that reviews published research and provides advice to the U.S. government. Wei, associate professor of Cardiology and Biomedical Sciences, sat down with the Cedars-Sinai Newsroom to explain how pregnancy affects women’s hearts.   

How does pregnancy increase cardiovascular risk?

Pregnancy acts as a stress test for the heart and can uncover, or even worsen, problems like high blood pressure and diabetes. During pregnancy, the heart must work harder to support a growing fetus, and cardiac stress often continues after delivery.

Cardiovascular disease is the leading cause of pregnancy-related death in the U.S., yet most of these deaths are preventable. The National Academies of Sciences, Engineering, and Medicine report on maternal health highlights that although 57% of cardiovascular-related deaths occur between seven days and one year postpartum, preventive care is often focused on the prenatal and immediate postpartum period.

What are two takeaways from the report?

The committee reviewed published medical research and gathered input from a wide range of stakeholders, including clinicians, professional societies, advocacy organizations and patients.

Several takeaways became clear. The report recommends, for example, that clinicians treat pregnant women with chronic hypertension so that their blood pressure is reduced to less than 140/90 millimeters of mercury.  This is because consistently elevated blood pressure during pregnancy can cause pregnancy complications and increase a woman’s risk for developing cardiovascular disease.

The new guidelines also recommended that clinicians caring for patients with postpartum hypertension or other hypertensive disorders give their patients home blood pressure monitors and use a program that allows the patients to report their readings. This way, clinicians can adjust treatment and set clear thresholds for action. 

Cedars-Sinai is already doing this through a postpartum blood pressure monitoring program that sends patients home with a blood pressure cuff and allows them to transmit readings to their care teams. (Kimberly Gregory, MD, MPH, director of the Division of Maternal-Fetal Medicine at Cedars-Sinai, served as an adviser to the National Academies committee that created the maternal health report.)

How often should women visit a doctor in the year after giving birth?

How frequently a woman should see her doctor during the postpartum period depends on her cardiovascular risk. 

Not every woman can easily see a doctor or health specialist—especially in rural areas or when cost is a concern. Therefore, the National Academies report recommends the Health Resources and Services Administration use its telehealth, rural health and maternal health programs to reduce geographic, financial and system barriers to preventive cardiovascular services.

What can pregnant women do to protect heart health?

The National Academies created a resource for women that includes the following advice:

Share your history. Tell your healthcare team your family history of heart disease, especially early heart attacks or strokes, and your pregnancy history, including any past complications.

Keep postpartum follow-up appointments on your calendar. It’s important not to miss these appointments because risk for complications continues through the first year after delivery.

Take warning signs seriously—trust your instincts. If something feels wrong during pregnancy or after birth, seek care right away and tell providers that you’re pregnant or that you gave birth recently.

Read more from Cedars-Sinai Stories and Insights: High Blood Pressure—What Women Need to Know

The study, “Real-World Outcomes of Transcatheter Tricuspid Valve Replacement: Analysis From the STS/ACC TVT Registry,” published in the Journal of the American Medical Association.

“These findings show that transcatheter tricuspid valve replacement is translating well from the clinical trial setting into routine practice across the United States,” said Raj Makkar, MD, vice president of Cardiovascular Innovation and Intervention at Cedars-Sinai, the Karsh Distinguished Chair in Interventional Cardiology in the Smidt Heart Institute, and corresponding author of the study. “In a large, older and medically complex patient population, we saw very high procedural success, near-complete elimination of tricuspid regurgitation, and rapid improvement in how patients feel and function.”

Tricuspid regurgitation occurs when the tricuspid valve does not close properly, allowing blood to flow backward in the heart. The condition is common in older adults and can lead to worsening heart failure symptoms, repeated hospitalization and increased risk of death.

Historically, open-heart surgery was often the only treatment option for this condition, but many older patients were not candidates because of age or other medical problems. Today, transcatheter tricuspid valve replacement offers a less invasive alternative in which doctors replace the damaged valve using a catheter, or tube, threaded through a blood vessel.

Researchers analyzed 1,034 attempted TTVR procedures performed between February 2024 and March 2025 at 82 medical centers across the U.S. The average patient age was 77.

The analysis found that more than 98% of patients had the valves successfully implanted. At 30 days post-procedure, more than 97% of patients had their condition improve to mild or minimal tricuspid regurgitation, and patients reported substantial improvement in symptoms, physical and social function, and quality of life.

Study authors note that early real-world outcomes were consistent with results from the TRISCEND II randomized trial of TTVR. Patients in this new study, however, experienced lower incidence of bleeding and heart block requiring electronic pacemaker implantation than patients participating in TRISCEND II. The current study also found that outcomes were generally consistent in patients with and without preexisting cardiac implantable electronic devices such as pacemakers, an important finding because these devices are common in patients with severe tricuspid valve disease.

“For patients with severe tricuspid regurgitation, treatment options have historically been limited, especially when surgery carries high risk,” said Aakriti Gupta, MD, assistant professor of Cardiology and study author. “What is especially encouraging here is that in real-world care, not just in a randomized trial, patients experienced meaningful improvement in symptoms and quality of life within only 30 days.”

Investigators said the results support the growing role of TTVR as a treatment option for patients with severe tricuspid regurgitation and highlight the importance of continued follow-up to understand longer-term outcomes.

Moody Makar, MD, associate professor of Anesthesiology at Cedars-Sinai, is also an author of the study.

Additional authors include Brian P. O’Neill, MD; Christina Lalani, MD; Rahul Sharma, MBBS; Pradeep Yadev, MD; Tiberio M. Frisoli, MD; Vinod Thourani, MD; Mackram F. Eleid, MD; James Lee, MD; Vasilis C. Babaliaros, MD; Christiane Haeffele, MD, MPH; Tanvir J. Bajwa, MD; Peter Flueckiger, MD; Robert J. Cubeddu, MD; Laura J. Davidson, MD; Ratnasari Padang, MBBS, PhD; Pedro Villablanca Spinetto, MD; Suhail Allaqaband, MD; Akhil Narang, MD; Mathew Williams, MD; Patrick Gleason, MD; Gilbert H.L. Tang, MD; Sahil Khera, MD; John P. Vavalle, MD; Isida Byku, MD; Jeremiah P. Depta, MD; Santiago Garcia, MD; Samir Kapadia, MD; Alan Zajarias, MD; Jake M. Chanin, MD; Susheel K. Kodali, MD; Howard C. Herrmann, MD; M. Andrew Morse, MD; George Petrossian, MD; Joseph A. Sivak, MD; Rebecca T. Hahn, MD; Yang Song, PhD; Martin B. Leon, MD; Robert W. Yeh, MD, MSc; Charles J. Davidson, MD.

The study was funded by Edwards Lifesciences.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

The findings, published in Science Translational Medicine, could one day improve management of heart failure, in which the heart fails to pump enough blood to meet the body’s need for blood and oxygen. Poor use of oxygen by the heart is an early indicator of heart failure, which affects nearly 7 million people in the U.S.

“Our study shows how MRI could be used to quickly and noninvasively determine heart oxygen use in the clinic,” said Hsin-Jung Yang, PhD, director of Cardiac Imaging Research in the Biomedical Research Imaging Institute and corresponding author of the study. “With further research and development, this advance could unlock new frontiers in early diagnosis, personalized therapy and next-generation treatments for heart failure.”

The current gold standard for measuring heart oxygen use, coronary sinus catheterization, requires threading a thin, flexible tube called a catheter from a patient’s neck or groin into the heart's main vein. The procedure, which takes 30 to 60 minutes and involves injection of a contrast dye to guide the catheter, is too invasive for routine heart oxygen monitoring.

MRI uses radio waves, a strong magnet and a computer to create detailed images of areas inside the body. Standard MRI can only produce clear images of the heart, which moves with every beat and every breath, if patients hold their breath at points during the exam. And in order to use these images to measure oxygen, doctors have to take multiple MRI scans—a process that takes several minutes—and draw blood at the same time.

“The system we designed addresses the motion of the heart,” Yang said. “Patients do not need to hold their breath, and it can give precise numbers within three minutes.”

The team proved the accuracy of its MRI method by using it to measure heart oxygen use in patients with and without heart failure, and comparing its readings to readings obtained by heart catheterization.

“Noninvasive testing that detects issues in the heart’s use of oxygen can provide an early warning that heart failure is developing,” Yang said. “Now that we have promising cardiometabolic therapies lined up, earlier detection may allow us to take steps to prevent and treat the condition.”

David Underhill, PhD, chair of the Department of Biomedical Sciences, said the study makes a major contribution toward improving healthcare for heart disease, the No. 1 cause of death.

“Along with its potential for saving lives through early intervention for heart failure, this accessible tool could offer new avenues for cardiac research,” Underhill said. “It could allow us to study patients who have risk for, but no symptoms of, heart failure without exposing them to catheterization, contrast or radiation.”

Additional Cedars-Sinai authors include Li-Ting Huang, Chia-Chi Yang, Archana Malagi, Xinqi Li, Ghazal Yoosefian, Xinheng Zhang, Ziyang Long, Xiaoming Bi, Janet Wei, Alan C. Kwan, C. Noel Bairey Merz and Debiao Li.

Other authors include Guan Wang, Henghui Zhang, Ranran Zhang, Hao Ho, Yuheng Huang, Michael D. Nelson, Anthony Christodoulou and Rohan Dharmakumar.

Funding: This work was supported by grants from National Institutes of Health (R01HL165211 to H.-J.Y. R01HL181091 to H.-J.Y., R01HL156818 to H.-J.Y., R01HL148788 to R.D., R01HL146158 to C.N.B.M., R01HL124649 to C.N.B.M., R01HL153500 to J.W., K23HL125941 to C.N.B.M., U54AG065141 to C.N.B.M., and U54AG094168-01 to C.N.B.M.), The Barbra Streisand Women’s Cardiovascular Research and Education Program to C.N.B.M., The Linda Joy Pollin Women’s Heart Health Program to C.N.B.M.,The Erika Glazer Women’s Heart Health Project to C.N.B.M., The Adelson Family Foundation to C.N.B.M., and US Department of Defense (HT94252510956 to H.-J.Y.).

Competing interests: C.N.B.M. serves as a director and holds stock in iRhythm. D. Li, A. G. Christodoulou, J. L. Shaw, Y. Xie, and C. Nguyen are inventors on US patent no. 10,436,871 (“Low-rank tensor imaging for multidimensional cardiovascular MRI”). H. J. Yang and C. C. Yang are inventors on a provisional US patent, US Prov 63/721,228 (PCT/US2025/055499, “Systems and methods for determining oxygen consumption using magnetic resonance imaging”). The other authors declare that they have no competing interests.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Throughout her career, Cheng has maintained National Institutes of Health funding for research aimed at uncovering the drivers of cardiovascular aging. She has authored more than 450 scientific studies, many appearing in high-impact journals, including JAMA, Circulation and The New England Journal of Medicine.

Cheng identified differences in how males and females develop elevated blood pressure and demonstrated how people vary in their responses to COVID-19 vaccines over time. Her research has garnered multiple awards and contributed to Cedars-Sinai’s reputation as an international leader in biomedical sciences.

“Dr. Cheng is the perfect leader to build and enrich our already flourishing Department of Cardiology,” said Shlomo Melmed, MB, ChB, dean of the Medical Faculty and executive vice president of Medicine and Health Sciences. “We welcome her to this academic leadership role and look forward to the contributions she will make in strengthening the Smidt Heart Institute.”

Cheng, who succeeds Christine M. Albert, MD, MPH, has served on the editorial boards of major professional journals and on leadership committees for the American Society for Clinical Investigation, the American Heart Association and the American College of Cardiology.

She founded the largest COVID-19 clinical research program on the West Coast at the outset of the pandemic in 2020. More recently, she has led research to investigate the public health effects of the 2025 Los Angeles wildfires.

Cheng has mentored dozens of junior faculty members in cardiology, anesthesiology, neurology, obstetrics and oncology, taking special pride in advising early-career investigators as well as high school and college students.

“I look forward to supporting the Smidt Heart Institute’s talented clinicians and researchers as they work to improve the lives of those affected by cardiovascular disease,” Cheng said.  

Cheng received her bachelor’s degree from Harvard College and her medical degree from McMaster University in Canada, as well as a master of medical science degree from the Massachusetts Institute of Technology and a master of public health degree from Harvard University. She completed her internal medicine training at Johns Hopkins University and cardiology training at Brigham and Women’s Hospital, where she served as associate director of the Cardiovascular Imaging Core Laboratory.

In her new role, Cheng will lead strategic clinical, research and educational growth for the Department of Cardiology. As the new department chair, she will hold the Stephen R. Corday, MD, Distinguished Chair in Cardiology.

“Dr. Cheng has strengthened our institution and made many meaningful contributions through her research laboratory since joining Cedars-Sinai seven years ago,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute and the Mark Siegel Family Foundation Distinguished Chair. “We are excited for her to continue developing our world-class cardiology department.”

Read more from the Cedars-Sinai Newsroom: Cedars-Sinai Reports Heart Attacks, General Illness Spiked After LA Fires

“Too often, when a young woman has heart disease symptoms, a physician will ignore those symptoms and tell her that she needs to lose weight,” said Bairey Merz, director of the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute at Cedars-Sinai. “That’s because heart disease symptoms in women can be very different from what men experience. So it’s crucial that women know what to look for.”

Although heart disease is the leading cause of death among women in the U.S., according to the Centers for Disease Control and Prevention, most heart disease research has been conducted on men. And even though rates of heart disease and heart attacks are increasing among women 35 to 54 years old, they are less likely to receive evidence-based treatments such as statins and more likely to be told they are “too young” to have heart disease, Bairey Merz said.

“These delays and dismissals have had serious consequences,” she said. “The Women’s Ischemia Syndrome Evaluation [WISE] study that I led for the National Heart, Lung, and Blood Institute helped us better understand that heart disease doesn’t always look the same in women. That insight ultimately pushed the field to rethink and improve how we diagnose and treat it.”

Despite these advances, women with heart disease are still more likely to be misdiagnosed, underdiagnosed or undertreated—sometimes delaying care that could save their lives.

“The good news is that heart disease is largely preventable,” Bairey Merz said. “And for women in particular—who may not experience obvious symptoms or whose symptoms are subtle—knowledge is a powerful prevention tool.”

To explain what women should watch for, the Cedars-Sinai Newsroom spoke with Bairey Merz about what women can do to protect their hearts and advocate for the healthcare they need.

What are some of the biggest myths about heart disease?

Many people believe that heart disease primarily affects men, that heart attacks always involve crushing chest pain, or that cancer is the top cause of death. In reality, heart disease kills more women than all cancers combined, yet fewer than half of women recognize it as their greatest health threat.

While men tend to develop cardiovascular disease earlier, women are more likely to experience poorer outcomes.

Why are heart attack rates increasing among younger women?

For decades, heart attack death rates declined sharply, thanks to improved research, standardized treatment guidelines, and widespread use of effective medications and procedures. While heart attack deaths are still much lower than they once were, the increase in heart problems among younger adults is concerning.

Researchers are looking into exact causes for the increase, but we know that contributing factors include low levels of physical activity and prolonged sedentary behavior, rising rates of diabetes and obesity, chronic stress, and environmental exposures such as air pollution.

What does a heart attack feel like for women?

The so-called “Hollywood heart attack”—tingling in the left arm that leads to sudden, crushing chest pain—is common in men and can occur in women as well. But many women experience subtler symptoms, including shortness of breath, nausea, unusual fatigue, back or jaw pain, or chest discomfort that doesn’t feel severe or dramatic.

Because these symptoms don’t match common expectations of a heart attack, they may be overlooked or dismissed. Anyone experiencing them should seek medical care immediately.

What causes heart attacks in women?

An increasing number of heart attacks are occurring in people without significant blockages in the major coronary arteries, a pattern seen more often in women. While men’s heart disease more commonly involves blockage in large arteries, women are more likely to experience dysfunction of the heart’s smaller blood vessels. This condition—called ischemia with no obstructive coronary artery disease [INOCA]—can cause reduced blood flow to the heart even when major arteries appear clear.

Even women who are physically fit can develop INOCA. In the past, if a woman had heart attack symptoms but a “normal” angiogram showing clear major arteries, her condition might not have been recognized. Continued awareness and ongoing education around INOCA are helping clinicians better diagnose and treat these patients.

What is a normal heart rate for women?

A normal resting heart rate for most adults is between 60 and 100 beats per minute, according to the American Heart Association. Because women’s hearts are typically smaller, their resting heart rate may run slightly higher than men’s. Women should consult their doctor if their resting heart rate is below 60 or above 100 beats per minute when not exercising.

How can women protect heart health and prevent heart disease?

Heart disease develops silently over decades. While heart disease can be managed with highly effective treatments, prevention is the most powerful strategy.

An estimated 80% of heart disease cases are preventable with lifestyle modifications. These include staying current with annual screenings and knowing cholesterol, blood pressure and blood sugar levels; exercising at least 30 minutes daily; breaking up prolonged sitting because a sedentary lifestyle is considered as strong a risk factor as smoking; managing stress; getting seven to nine hours of sleep; avoiding smoking; and following a nutritious diet.

A Mediterranean-style, largely plant-based diet rich in fruits, vegetables, nuts, beans, whole grains, olive oil and lean proteins is recommended. Parents are encouraged to help ensure their children make healthy food choices, too.

Heart health isn’t about deprivation. It’s about building lifelong habits that prevent disease before it starts.

Read more on the Cedars-Sinai Blog: High Blood Pressure—What Women Need to Know

Reid had been diagnosed with heart failure at Cedars-Sinai after experiencing fatigue and shortness of breath. The condition occurs when the heart is too weak to pump enough blood throughout the body, causing fluid to build up.

Reid told Good Morning America co-anchor Michael Strahan he initially dismissed his symptoms. He urged others—especially people of color—to seek medical care when something feels wrong.

“A lot of times, we don’t go because we don’t want the bad news, or we’re too busy just hustling, trying to make it from day to day,” Reid said. “And we … feel like we don’t got time, or we’ll get over it. Well, you might not.”

Jones told Good Morning America that during a follow-up visit, it was clear medications were no longer controlling Reid’s condition.

“He came in very swollen again,” she said, “and that is a little unusual in somebody who’s been started on treatment.”

DiChiacchio told Good Morning America that bloodwork revealed the condition was worsening and Reid needed an immediate heart transplant.

“So when we think about status for a heart transplant,” DiChiacchio said, “he was very high on that list because of how ill he was and really dealing with a kind of life or death situation.”

Days later a donor heart became available, and DiChiacchio and team successfully completed the transplant.

 Reid told Strahan he is grateful for a second chance at life.

“This thing is … a beautiful life,” he said. “And, you know, I wanna be around for it.”

According to the Centers for Disease Control and Prevention, 6.7 million U.S. adults have heart failure. Risk factors include high blood pressure, diabetes and coronary artery disease, though regular exercise, adequate sleep and proper nutrition can lower risk.

Click here to watch the entire segment of Good Morning America.

“Early on, I worked with a lot of patients with underlying illnesses such as asthma and chronic obstructive pulmonary disease [COPD] who experienced significant worsening of their symptoms due to wildfire smoke,” said pulmonologist Samuel Cohen, MD.

“Thankfully, most of those patients have improved now that the major trigger has subsided, and they’re back to a more baseline maintenance.”

Stephanie Koven, MD, a Cedars-Sinai primary care physician in Santa Monica, also treated many patients affected by the Palisades fire.

“Not only were we seeing flare-ups of asthma and emphysema for those in affected areas, but a significant increase in anxiety and depression,” Koven said. “I had patients in their 70s and 80s who were retired, and the home they were planning to live in for the rest of their lives was just gone.”

In addition to those retirees, Koven has cared for several members of the L.A. Fire Department who were on the front lines battling the blazes across Southern California.

“With firefighters, we’re most concerned about ongoing exposures over years,” Koven said. “Because of this, we’re more proactive with testing for things like heavy metals and PFAs, often called ‘forever chemicals.’ Firefighters also typically will receive earlier cancer screenings.”

While the general air quality has improved, Cohen said it’s possible that construction in the affected areas could rustle up particulate matter that may have previously settled in the soil.

“It’s especially important for workers in these areas to be sure they have appropriate respirators for protection,” Cohen said.

Koven agreed, adding that while residents who have moved back amid these construction zones may not need to wear masks in their own homes, they can still take other precautions.

“Using a HEPA filter in the home to help pull particulate matter from the air can be helpful,” Koven said. “If you’ve been to a burn site and are returning home, a general recommendation is to take off your shoes so you’re not tracking anything inside. You also could consider changing your outer layer of clothes when entering your home.”

Cohen also noted that some new smart thermostats can track air quality inside your home and will even set reminders for when to change your filters.

And if patients want to increase their overall respiratory health to combat any potential negative impact of returning to an affected area, Cohen says frequent cardiovascular exercise is key.

Both experts say it’s difficult to know yet what, if any, lingering health issues the public may experience because of the initial wildfire smoke exposure or rebuilding in and returning to burn areas.

“If you’re someone who will be moving back to these areas, it’s just important to make sure you’re in tune with how you’re feeling,” Cohen said. “If you begin to experience new-onset symptoms such as shortness of breath or a lingering cough, it’s time to speak to a medical professional.”

Read more on the Cedars-Sinai Blog: How Does Wildfire Smoke Affect Your Health?

, marks a major step toward bringing automated echocardiography reports into patient care.

An echocardiogram uses ultrasound to create images of the heart and the results are analyzed by cardiologists or sonographers trained to read the results.

“Our AI model addresses a critical need,” said David Ouyang, MD, adjunct assistant professor in the Smidt Heart Institute at Cedars-Sinai and co-corresponding author of the study. “Many hospitals and clinics, especially in rural areas, do not have cardiologists or sonographers on staff. By generating accurate automated reports for physicians, we could improve access to this important diagnostic technology.”

The AI model investigators created, called EchoPrime, is a type known as a foundation model. These models are trained on massive datasets and can perform multiple tasks, including assessing ultrasound images and evaluating clinical report text. EchoPrime was trained on greater than 10 times more data than prior AI foundation models for echocardiography, making it the largest such model to date, according to the investigators. EchoPrime analyzes ultrasound images, then produces a verbal summary of heart function and structure meant to assist clinicians in diagnosing a patient.

The team trained EchoPrime on more than 12 million videos paired with cardiologists’ written interpretations of the tests. They then tested the model on data from Kaiser Permanente Northern California, Cedars-Sinai Medical Center, Stanford Health Care, Beth Israel Deaconess Medical Center in Boston, and Chang Gung Memorial Hospital in Taiwan. The investigators found that EchoPrime outperformed other foundation models for interpreting echocardiograms and matched or exceeded the performance of AI models designed to perform a single ultrasound task. It was also able to detect rare diseases of the heart.

The investigators are now conducting randomized clinical trials that compare reports generated by EchoPrime with those produced by cardiologists and sonographers. The goal is to confirm the accuracy of the model and ensure it is useful to cardiologists.

“This remarkable study from Dr. Ouyang and colleagues builds on several years of AI-enhanced imaging science at Cedars-Sinai,” said Sumeet Chugh, MD, vice dean and chief artificial intelligence health research officer at Cedars-Sinai. “EchoPrime is a unique foundational model that could potentially democratize AI-powered echocardiography interpretation on a global scale.”

Other Cedars-Sinai authors include Milos Vukadinovic, I-Min Chiu, Debiao Li and Susan Cheng.

Other authors include Xiu Tang, Neal Yuan, Tien-Yu Chen, Paul Cheng and Bryan He.

Funding: D.O. discloses National Institutes of Health NHLBI grants R00HL157421, R01HL173526 and R01HL173487.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute at Cedars-Sinai, will give the George E. Brown Memorial Lecture at the American Heart Association Scientific Sessions 2025 in November in New Orleans. The Association created this lecture in 1935 to honor the memory of clinician and researcher George E. Brown, MD, and every year selects a distinguished scientist to share advances in cardiovascular science. Marbán will present “Discovery Arc From Cell Therapy to Novel Noncoding RNA Drugs.” Marbán’s laboratory was the first to isolate and culture human heart cells capable of repairing damaged tissue.

Also at Scientific Sessions, Jennifer Van Eyk, PhD, director of Basic Science Research in the Barbra Streisand Women’s Heart Center, will be honored with the 2025 Council on Basic Cardiovascular Sciences Distinguished Achievement Award.

Van Eyk, the Erika J. Glazer Chair in Women’s Heart Health, is an international expert in clinical proteomics, the study of proteins in the body and how diseases affect those proteins. Her work has shown that proteins surpass genes as a source of real-time insights on what’s happening—and what is going to happen—inside the body. Much of her research focuses on how heart disease affects men and women differently at the molecular level.

“It is a privilege to see Dr. Van Eyk honored by the Association for nearly three decades of work in cardiovascular research,” said Marbán, the Mark Siegel Family Foundation Distinguished Chair. “This recognition reflects her profound impact on science and patient care, and we commend her for her commitment to excellence as she continues to pioneer earlier detection for conditions such as cardiovascular disease.”

Among Van Eyk’s most recent efforts is the development of remote blood sampling, which allows people to mail in samples for analysis and leads to faster, more personalized health assessments.

“This award highlights the incredible progress we’ve made in using proteomics to understand heart disease,” said Van Eyk, director of the Advanced Clinical Biosystems Research Institute and professor of Cardiology, Biomedical Sciences and Pathology and Laboratory Medicine. “By studying proteins, we’re moving closer to detecting conditions like heart failure before symptoms appear. Our goal is to make early diagnosis as simple as mailing in a blood sample.”

Ananth Karumanchi, MD, professor of Medicine and director of the Renovascular Research Center, is the recipient of the Association’s 2025 Excellence Award for Hypertension Research—one of the highest honors in the field. Karumanchi, the Medallion Chair in Vascular Biology, received the Excellence Award for Hypertension Research at the American Heart Association Hypertension Scientific Sessions in September in Baltimore. The award honors scientists whose work has significantly advanced understanding and treatment of high blood pressure and related conditions.

Karumanchi’s work focuses on hypertension during pregnancy. His particular focus is preeclampsia, a serious blood pressure condition that can be fatal and increases a woman’s risk of heart disease, heart failure and stroke later in life. He is currently leading an international team studying how the placenta impacts heart health in mothers and infants. The project builds on Karumanchi’s earlier work, which pinpointed a protein in the blood that could help doctors detect preeclampsia earlier.

“I’m honored to have received this award from the American Heart Association,” Karumanchi said. “It underscores the dedication of our team as we work to better understand and treat hypertension and preeclampsia and improve cardiovascular health for mothers and babies.”

Jiun-Ruey Hu, MD, MPH, a fellow in interventional and structural cardiology in the Department of Cardiology, has also been selected as an Association award recipient. He will be recognized at this year’s Scientific Sessions as the winner of the 2025 Kidney in Cardiovascular Disease Educational Tools Contest.

Hu mentored a medical student (Sara Pollanen) in creating a digital tool to help clinicians treat patients with cardiorenal syndrome, a complex condition involving the heart and kidneys. Hu previously won the award from the Association in 2022 while completing his first fellowship at the Yale School of Medicine.

“The Cedars-Sinai Health Sciences University congratulates our faculty members on their well-deserved recognition from the American Heart Association,” said Shlomo Melmed, MB, ChB, executive vice president of Medicine and Health Sciences and dean of the Medical Faculty. “Their prestigious honor awards and novel discovery presentations reflect the finest in cardiovascular science and clinical care.” 

The 2025 Scientific Sessions meeting is chaired by Joanna Chikwe, MD, the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery in the Smidt Heart Institute.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

As chair of the Association’s Scientific Sessions 2025 Program Committee, Joanna Chikwe, MD, has led a redesign of the program to reflect both the challenges and the extraordinary advances shaping cardiovascular medicine and science today. Under her direction, the sessions will showcase pivotal late-breaking clinical trials that address major questions in the management of atrial fibrillation, valvular heart disease, heart failure and coronary disease.

A national leader in mitral valve reconstruction and robotic cardiac surgery, Chikwe is chair of the Department of Cardiac Surgery at Cedars-Sinai.

“It is an honor to guide this year’s American Heart Association programming and ensure that rigorous science is at the forefront of the meeting,” said Chikwe, the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery. “It will be wonderful to participate alongside dozens of faculty members and trainees from Cedars-Sinai.”

Chikwe will lead a session on advances in the management of mitral and tricuspid valve disease and will chair a session about robotic innovations in valvular heart disease surgery.

Also at the meeting, Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute, will present “Discovery Arc From Cell Therapy to Novel Noncoding RNA Drugs,” the George E. Brown Memorial Lecture. The Association’s Council on Basic Cardiovascular Sciences selected Marbán for this honor, which was established in 1935 in memory of clinician and researcher George E. Brown, MD.

In addition, Christine M. Albert, MD, MPH, chair of the Department of Cardiology, will participate in a discussion of the late-breaking science presentation “Dilemmas in Antithrombotic Therapy in AF Care Post Procedures.” Albert’s own research focuses on the epidemiology, risk stratification and prevention of sudden cardiac death and atrial fibrillation.

Janet Wei, MD, the Erika J. Glazer Chair in Women's Cardiovascular Research, Education and Innovation, will also discuss a late-breaking science presentation: “Approaches to Ischemic Heart Disease Before, During and After Hospitalization.”

Select Cedars-Sinai Experts

Several other Cedars-Sinai experts will be available for media interviews prior to and throughout the meeting.

Sumeet Chugh, MD, vice dean and chief artificial intelligence health research officer, will give a main tent talk on how generative AI can reduce clinician burden and enhance workflow. He can comment on AI research and how he is applying AI to study arrhythmias.

Joseph Ebinger, MD, associate professor of Cardiology and director of the Coronary Intensive Care Unit and Clinical Analytics, can discuss hypertension care and research.

Dominic Emerson, MD, associate director of the Cedars-Sinai Comprehensive Transplant Center and associate professor of Cardiac Surgery, can share advances in heart and lung transplantation, and evolving strategies for tricuspid valve endocarditis.

Aakriti Gupta, MD, interventional cardiologist and assistant professor of Cardiology, can discuss advances in valve disease treatment for young and moderate-risk patients.

Rose Tompkins, MD, director of the Adult Congenital Heart Program, can discuss the lifelong care of people born with a heart condition.

Media Contact

To arrange media interviews, contact Stephanie Cajigal—who will be onsite at #AHA25—at stephanie.cajigal@cshs.org or via mobile and What’s App: (United States) +1-347-806-2938.

“I noticed it most when I lay down to sleep,” said Scott, whose family has lived in Altadena for three generations. “I could hear wheezing, I could hear a lot of wheezing, which I had never experienced before.”

Scott is not the only one. Since the wildfires ravaged the area, residents have been seeking help for symptoms that indicate difficulty breathing, such as coughing, wheezing, chest tightness and fatigue.

“We know that heavy exposure to wildfire smoke can have a delayed and long-term impact on lung function,” said Talar Kavafyan, MD, medical director of the ambulatory care center at Huntington Health, an affiliate of Cedars-Sinai. “Following the devastating fires our community experienced in January, providing enhanced pulmonary care is an important step in recovery—and an important example of how Huntington is dedicated to improving community wellbeing.”

So dedicated that, in response to the potential health impact in the wake of the fires, Huntington Health recently expanded pulmonary medicine for the community at the Huntington Ambulatory Care Center (HACC).  

The expansion came just in time for Scott, who continued to have difficulty breathing months after the flames were extinguished. “I began to talk to my primary physician about it,” Scott said, “and I kept telling her I don't feel like I'm getting a good capacity of air.”

That is a symptom that Raj Dasgupta, MD, has heard from dozens of patients who lived through the wildfires.

“It's understandable to be concerned when someone is having difficulty breathing [dyspnea], which is the sensation of not being able to get enough air, tightness in the chest, or working harder to breathe,” said Dasgupta, associate professor of Clinical Medicine and associate program director of Huntington Health’s Internal Medicine Residency Program. “By offering a wider range of tests in an outpatient setting, we can potentially detect pulmonary issues earlier and initiate treatment more quickly, which can lead to better outcomes and help bring some peace of mind to our patients who might be experiencing pulmonary issues right here in our community.”

Conditions frequently treated by the center’s physicians include asthma; chronic bronchitis and bronchiectasis; persistent cough; chronic obstructive pulmonary disease (COPD); lung scarring, or fibrosis; and sarcoidosis, an autoimmune disease that causes growths on the lungs.

“When you arrive at HACC, the first step of treatment is to collect information about your lungs and their function,” Dasgupta said. “We do this by conducting a breathing test in our office called spirometry, which is a valuable tool for diagnosing, monitoring and evaluating lung function. It provides essential information for managing lung conditions and improving respiratory health. After additional tests and evaluations, we then discuss the next steps to best support your lung health. Remember,  difficulty breathing and coughing can have various causes, and it's essential to seek medical evaluation for a proper diagnosis and treatment.” 

The pulmonary clinic is open every second and fourth Tuesday of the month from 1–5 p.m. For an appointment, call (626) 397-5711.

Read more from the Cedars-Sinai Blog: How Does Wildfire Smoke Affect Your Health?

“We continue to expand the number of clinicians, surgeons and physician-scientists coming together to address the most challenging heart conditions,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute. “As our program grows, we remain committed to delivering care guided by extensive research.”

Fetal Cardiology

Mark Sklansky, MD, is a leader in fetal echocardiography, the detailed evaluation of the heart prior to delivery. He is medical director of Pediatric and Fetal Cardiology Outreach in the Smidt Heart Institute and Guerin Children's, where he uses ultrasound to identify heart conditions before birth and brings his expertise to the broader community.

Prenatal detection of heart problems allows fetal cardiologists, in partnership with obstetricians, maternal-fetal medicine specialists and neonatologists, to create a treatment plan for when the baby is born. In some cases, pediatric cardiac interventionalists, working with maternal-fetal medicine specialists, can perform a minimally invasive procedure to correct the heart defect before birth. In other cases, newborns can undergo lifesaving surgery or catheter-based therapies within hours after delivery.

Prior to joining Cedars-Sinai, Sklansky founded the Children’s Heart Center at UCLA where he was also chief of Pediatric Cardiology. He has authored or co-authored more than 100 scientific papers, including the American Heart Association’s scientific statement on the diagnosis and treatment of fetal cardiac disease.

Cardiac Surgery

Laura DiChiacchio, MD, PhD, is director of Extracorporeal Membrane Oxygenation, a form of life support that temporarily does the work of a person’s heart or lungs.

DiChiacchio also directs the Ex Situ Perfusion Program. Under DiChiacchio’s leadership, the team uses specialized machines to keep donor organs alive outside of the body and to improve the function of thoracic organs following transplantation. The team also conducts translational research on thoracic organ recovery and reconditioning. 

DiChiacchio is a cardiac surgeon who focuses on adult heart and lung transplantation. DiChiacchio completed a fellowship in thoracic transplantation and mechanical circulatory support in the Smidt Heart Institute Department of Cardiac Surgery and a fellowship in cardiothoracic surgery at the University of Utah.

Organ Preservation

As director of Heart and Lung Protection and Management, Yoshikazu Suzuki, MD, procures donor organs for patients awaiting transplant, ensuring safety and reliability through each step. He uses the latest technologies to ensure organs are well-preserved, and he is tasked with creating an accessible database of donor hearts and lungs.

Previously, Suzuki was clinical associate professor in the Division of Cardiovascular Surgery at the Perelman School of Medicine at the University of Pennsylvania.

Pediatric Interventional Cardiology

Stephen Nageotte, MD, is an interventional cardiologist, an expert in using minimally invasive procedures to diagnose and treat children and adults born with a heart condition. These procedures involve using a thin, flexible tube called a catheter to view the heart and repair anatomical abnormalities, such as narrowed blood vessels or an unclosed hole in the heart. Nageotte directs the Congenital Catheterization Laboratory in the Smidt Heart Institute and Guerin Children’s. 

Nageotte joins Cedars-Sinai from Loma Linda University Children’s Hospital, where he was director of the Pediatric Cardiac Catheterization Laboratory and an associate professor. Nageotte also conducts research and has authored several peer-reviewed papers on congenital heart disease and treatments.

The Smidt Heart Institute’s cardiology, heart and vascular surgery programs are rated in the top 10 in the U.S. and #1 in California by U.S. News & World Report.

Read more from the Cedars-Sinai Blog: Why Accreditation Matters in Choosing a Congenital Heart Program

“This novel program brings Cedars-Sinai’s exceptional expertise in heart care to a unique population: professional athletes and athletically minded individuals,” said Eli Friedman, MD, who has been appointed director of the Sports Cardiology Program.

The Sports Cardiology Program is part of the Department of Cardiology chaired by Christine Albert, MD. It is an extension of the sports medicine expertise already offered by Cedars-Sinai, where physicians serve as medical advisers for several elite sports teams. Cedars-Sinai also is the Official Medical Provider for the LA28 Olympic and Paralympic Games. 

“We offer specialized care for people who exercise and are concerned about heart health, whether or not they have been diagnosed with heart disease,” Friedman said. “Exercise and athleticism are wonderful priorities, but it’s important to ensure safety in those at risk.” 

The program also will evaluate athletes for heart conditions, and it can screen people for heart issues before they participate in a sport.

Friedman brings substantial experience to his new role. Before joining Cedars-Sinai, he was medical director of Sports Cardiology at Baptist Health South Florida in Miami and director of Sports Cardiology at the Miami Cardiac & Vascular Institute.

He has also been team cardiologist for more than a dozen professional and college sports organizations. Friedman has authored several scientific papers on athletes’ heart care and conducts research on cardiac conditions in athletes—as well as a genetic heart condition called hypertrophic cardiomyopathy, the most common cause of sudden cardiac arrest in young athletes. 

“Our region is among the most sports-conscious in the world. By building on our considerable strengths to establish the Sports Cardiology Program, the Smidt Heart Institute reaffirms its commitment to our community, and to LA28,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute and the Mark S. Siegel Family Foundation Distinguished Professor. “Under Dr. Friedman’s leadership and experience, we will build an outstanding program, helping athletes to continue doing what they love most.”

Read more from the Cedars-Sinai Blog: Can Exercise Make You Sharper and Happier?

Led by interventional cardiologist Raj Makkar, MD, the six-and-a-half-year award from the Patient-Centered Outcomes Research Institute (PCORI) will fund a multi-center clinical trial of patients 50 and older who were born with a bicuspid aortic valve, a condition in which the aortic heart valve has two flaps regulating the flow of blood rather than the normal three. People with this condition typically develop aortic stenosis, when the aortic valve becomes so narrow that it impedes blood flow out of the heart.

Bicuspid aortic valve is the most common congenital heart condition, affecting approximately 2% of people, but little data exists comparing current treatments.

Heart valve disease can cause subtle symptoms at first but progress to heart failure if not diagnosed and treated early. Both surgery and transcatheter procedures are currently used to treat aortic stenosis. Transcatheter procedures use a thin, flexible tube called a catheter to reach the damaged valve. They are considered minimally invasive and are often recommended for patients who are at high risk for complications during surgery.

“Transcatheter aortic valve replacement has changed the paradigm for nonsurgical treatment of aortic stenosis, but it needs to be studied more rigorously in patients with bicuspid aortic valves,” said Makkar, a principal investigator of the study and vice president of Cardiovascular Innovation and Intervention at Cedars-Sinai. “We look forward to addressing this important evidence gap with this PCORI-funded randomized controlled trial in collaboration with our esteemed co-investigators.”

Patients with bicuspid aortic valve stenosis enrolled in the clinical trial will be randomly assigned to have their aortic valve replaced via open-heart surgery or by a transcatheter procedure. Investigators will review results from both groups to understand which option results in better health outcomes.  

The inaugural director of the Karsh Division of Interventional Cardiology, Makkar is an authority in minimally invasive approaches to treating heart valve disease.

“The Smidt Heart Institute at Cedars-Sinai is a leader in both heart surgery and minimally invasive heart procedures,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute at Cedars-Sinai and the Mark S. Siegel Family Foundation Distinguished Professor. “This study reflects our commitment to advancing heart research and care.”

“This research is a prime example of how Cedars-Sinai fosters innovation and brings leading-edge and clinically effective research directly to patient care,” said Shlomo Melmed, MB, ChB, Cedars-Sinai's executive vice president of Medicine and Health Sciences and dean of the Medical Faculty. “The findings from this clinical trial will help doctors globally advise their patients born with a bicuspid aortic valve on the best and safest approach for treating their cardiac condition.”

The award has been approved pending completion of a business and programmatic review by PCORI and issuance of a formal award contract. PCORI is a non-profit organization with a mission to fund research designed to provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions.

Read more on the Cedars-Sinai Newsroom: $35M Gift Creates Karsh Division of Interventional Cardiology

 In 2021, Emerson and a team of Cedars-Sinai surgeons performed the world’s first robotic lung transplant. Since then, the medical center has completed the most robotic lung transplants in the world. The innovation uses tiny incisions to reduce pain, complications and recovery time.

Emerson, associate professor of Cardiac Surgery in the Smidt Heart Institute at Cedars-Sinai, will further strengthen and unify the thoracic and abdominal transplant arms of the Comprehensive Transplant Center, which ranks among the top 10 in the U.S. by volume. Emerson was also recently appointed program director of the Accreditation Council for Graduate Medical Education thoracic surgery residency and fellowship programs at Cedars-Sinai, an important role overseeing the education and training of junior surgeons. 

“Dr. Emerson’s leadership helped guide our teams to perform more transplants in 2024 than we ever have before, all while achieving exceptional patient outcomes,” said Irene Kim, MD, director of the Cedars-Sinai Comprehensive Transplant Center and the Esther and Mark Schulman Chair in Surgery and Transplantation Medicine.

Emerson will continue as associate surgical director of Heart Transplant and Mechanical Circulatory Support, director of Robotic Cardiac Surgery, and director of the Accreditation Council for Graduate Medical Education Fellowship Program. In addition, Emerson is on the editorial board of The Annals of Thoracic Surgery.

“It’s an honor to help give the opportunity for a longer life to the many people around the world who are desperate for a heart or lung transplant, as well as those patients in need of specialized cardiac surgery,” Emerson said.

Emerson’s research lab focuses on advanced machine perfusion techniques that better preserve and reduce damage to organs before they’re transplanted, which can boost success rates and improve the rates of transplants. His most notable contributions include a landmark study of lung transplantation for end-stage COVID-19 lung disease, published in the New England Journal of Medicine, and a national analysis of how devices that assist the heart called LVADs can improve outcomes in older adult patients, published in the Journal of the American College of Cardiology. Additionally, Emerson and Cedars-Sinai colleagues are leading the creation of a multi-institutional registry to better understand the benefits of robotic lung transplant.

“Dr. Emerson has been a remarkable colleague and role model for the cardiac surgery team,” said Joanna Chikwe, MD, professor and chair of the Department of Cardiac Surgery and the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery in the Smidt Heart Institute. “He also is a patient, kind and gifted teacher, training many surgeons who have gone on to lead successful transplant programs.”

Emerson’s research has been published in more than 100 peer-reviewed publications and journals, including the New England Journal of Medicine, Circulation, Journal of the American College of Cardiology, Journal of Thoracic and Cardiovascular Surgery, The Annals of Thoracic Surgery, European Journal of Cardio-Thoracic Surgery, The Journal of Heart and Lung Transplantation, and Circulation: Heart Failure.

Emerson earned his undergraduate degree and medical degree from the University of Washington. He completed his general surgery residency at Georgetown University Hospital and completed fellowships in cardiothoracic surgery and thoracic transplantation at Cedars-Sinai. He joined the Cedars-Sinai faculty in 2019.

Read more on the Cedars-Sinai Blog: The Wait for a New Heart

, whose research into sudden cardiac arrest has led to novel methods of predicting the usually fatal condition, has been promoted to vice dean and chief artificial intelligence health research officer at Cedars-Sinai.

Chugh was also honored recently with the Heart Rhythm Society’s 2025 Distinguished Scientist Award for clinical science. The award was presented April 26 during Heart Rhythm 2025 in San Diego. 

“This award recognizes Dr. Chugh’s dedication to understanding sudden cardiac arrest and preventing this deadly emergency,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute at Cedars-Sinai.

The Distinguished Scientist Award is given to an investigator who has made a lasting impact on patient care and the field of heart rhythm research. Chugh has dedicated his career to improving prediction and prevention of sudden cardiac arrest, a heart rhythm disorder that causes the heart to stop and often leads to instant death. He has published more than 275 scientific papers.

“I’m grateful to the Heart Rhythm Society for this recognition of our work and accept it on behalf of my colleagues and mentees at Cedars-Sinai,” said Chugh, the Pauline and Harold Price Chair in Cardiac Electrophysiology Research. “Our team is motivated to make a real impact on this deadly condition.”

According to the American Heart Association, more than 356,000 out-of-hospital cardiac arrests occur each year in the U.S. Nearly 90% of them are fatal.

Chugh’s team discovered a new method for identifying the best candidates for the implantable defibrillator, a lifesaving intervention. They also combined data from emergency responders, medical records and biological samples to predict imminent sudden cardiac arrest within hours to days of warning symptoms. Their work has improved identification of people at risk and led to the term “near-term prevention” of sudden cardiac arrest.

Chugh is also a leader in artificial intelligence research, which he has harnessed to improve prediction of sudden cardiac arrest.

In his new role as vice dean and chief artificial intelligence health research officer, Chugh will oversee the translation of AI research into clinical trials and patient care. He will lead the new Artificial Intelligence in Medicine Research Center (AIMRC), which will help departments and institutes incorporate AI into their research.

“Dr. Chugh is a foremost investigator in both heart rhythm and AI research,” said Jeffrey Golden, MD, executive vice dean for Research and Education at Cedars-Sinai. “His use of AI to assess the risk for sudden cardiac arrest has the potential to advance the field and save lives. We are eager for him to broaden his AI research experience to all areas of clinical care at Cedars-Sinai.”

In 2024, Chugh received the Distinguished Scientist Award for clinical science from the American College of Cardiology. He is a member of the American Society for Clinical Investigation and the Association of American Physicians, and is past president of the Association of University Cardiologists and the Cardiac Electrophysiology Society.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Coronary artery disease occurs when cholesterol deposits build up in the walls of the heart’s arteries, leading to formation of plaques that begin as areas of inflammation. When inflamed plaques grow large, they become prone to rupture, which can cause heart attack. Evolocumab is in a class of drugs called PCSK9 inhibitors that can dramatically reduce cholesterol.

“This discovery has important implications for understanding how evolocumab improves cardiovascular outcomes,” said Daniel S. Berman, MD, director of Cardiac Imaging in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai and principal investigator of the study published in JACC: Cardiovascular Imaging.

Investigators administered evolocumab to 47 patients, all of whom had substantial buildup of noncalcified plaque in their coronary arteries. This type of plaque is regarded as higher risk than calcified plaque because it is softer and more likely to rupture and cause harm.

Before and 18 months after treatment with evolocumab, investigators studied inflammation in the coronary arteries using radioactive sodium fluoride and imaging with positron emission tomography (PET). They also used coronary computed tomography angiography (CCTA) coupled with a novel artificial intelligence quantitative method developed at Cedars-Sinai to measure changes in inflammation and plaque volumes in the coronary arteries.

The scans showed that, on average, plaque inflammation decreased and noncalcified plaque became smaller with evolocumab.

“Most attention has been placed on the cholesterol-lowering effects of PCSK9 inhibitors,” said Donghee Han, MD, a Cedars-Sinai internal medicine resident who is also a researcher in Berman’s laboratory and joint first author of the study. “Our findings demonstrate that reducing inflammation may be an important mechanism for reducing the risk of heart attack with these powerful drugs.”

Other Cedars-Sinai authors include Rebekah Park, Heidi Gransar, Mark Hyun, John D. Friedman, Sean W. Hayes, Louise E. J. Thomson, Alan C. Kwan, Prediman K. Shah, Sarah Wetzel, Chloe Findling, Piotr J. Slomka and Damini Dey. Other authors include joint first author Evangelos Tzolos, Matthew Budoff, Jacek Kwiecinski and co-senior author Balaji K. Tamarappoo.

This study was supported in part by NIH grants 1R01HL148787-01A1 and R35HL161195, the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation and Amgen Inc.  

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Michelle Kittleson, MD, PhD, director of Post Graduate Medical Education in Heart Failure and Transplantation, received the American College of Cardiology 2025 Distinguished Teacher Award. Richard Wright, MD, an advanced heart failure and transplant cardiologist and board chair of Pacific Heart Institute, an affiliate of Cedars-Sinai, received the Master of the ACC Award. And postdoctoral researcher Andrew Lin, MBBS, PhD, under the mentorship of Damini Dey, PhD, professor of Biomedical Sciences at Cedars-Sinai, is the co-recipient of the Jagat Narula Award for Outstanding Scholarship from JACC: Cardiovascular Imaging.

“Congratulations to Dr. Kittleson, Dr. Wright and Dr. Lin on this notable recognition from the ACC and JACC,” said Christine Albert, MD, MPH, chair of the Department of Cardiology and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology. “We are proud of their substantial contributions to all aspects of cardiovascular medicine that encompass education, research and clinical care. It’s gratifying to see them receive recognition from their peers for their pioneering leadership in the field.”

The Distinguished Teacher Award recognizes a fellow of the ACC who has demonstrated innovative, outstanding teaching characteristics and compassionate qualities and has made major contributions to the field of cardiovascular medicine.

Kittleson, a professor of Cardiology, also is associate editor of the JACC. She is widely known as a participant in national educational efforts, including helping develop evidence-based cardiomyopathy and heart failure guidelines. She also is known for fostering an active and engaged social media community, sharing cardiology-related discussion points, questions and pearls of wisdom with followers.

“I’m humbled and grateful to be among the cardiovascular physicians and researchers nominated for and receiving this recognition from the American College of Cardiology,” Kittleson said. “Teaching is of great interest to me, and I consider it a privilege to teach new physicians as well as the public. As an academic medical center, we want our teaching to go far beyond the walls of Cedars-Sinai.”

The Master of the ACC Award honors fellows of the ACC who are consistent contributors to the goals and programs of the college and who have provided leadership in important college activities, serving with distinction for at least 15 years and providing leadership on various programs and committees.

Wright has served as president of the California Chapter of the ACC. He is a highly regarded lecturer and was co-author of the U.S. guidelines on management of patients with heart failure. He also is a previous recipient of the Specialist of the Year Award from the California Chapter of the ACC.

“The ACC is known for its pronounced focus on setting new standards in cardiovascular medicine,” Wright said. “I’ve enjoyed and learned much from my peers as part of the ACC over many years.”

Lin’s research focuses on coronary plaque phenotyping using coronary computed tomography and artificial intelligence techniques.

The Jagat Narula Award for Outstanding Scholarship was awarded to Lin and Márton Kolossváry, MD, PhD, based on their manuscript, “Coronary Plaque Radiomic Phenotypes Predict Fatal or Nonfatal Myocardial Infarction: Analysis of the SCOT-HEART Trial,” published in 2024 in JACC: Cardiovascular Imaging.

“I pursued cardiovascular research to be at the forefront of innovation and help advance evidence that improves care for patients with coronary heart disease,” Lin said. “I’m especially grateful to JACC for recognizing our research into ways to better predict heart attack risk.”

As the mentor for Lin and Kolossváry, Dey also expressed gratitude to JACC for recognition of their research and added, “We are committed to continuing important investigations into new ways of predicting and preventing heart attacks.”

ACC President Cathleen Biga, MSN, extended congratulations, saying, “These heart experts have each demonstrated exceptional work that will further the ACC’s mission to transform cardiovascular care and improve heart health for all.”

In addition to the awards presented at the ACC’s Annual Scientific Session, the California Chapter of the ACC named C. Noel Bairey Merz, MD, director of the Barbra Streisand Women's Heart Center, the 2024 Elliot Rapaport Cardiologist of the Year. Bairey Merz received the award at a Chapter meeting in January.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

A former pack-a-day smoker, Shaw fits the profile of someone at risk for an aneurysm, even though he quit smoking more than two decades ago. That’s because current and former smokers are significantly more likely to develop an aortic aneurysm than nonsmokers. High blood pressure and family history are also risk factors.

The danger can go hidden because aneurysms don’t typically cause symptoms, although they can sometimes lead to indigestion, as was the case for Shaw, or more subtle issues. If an aneurysm keeps growing, it can burst—most people in whom this happens die from internal bleeding. That’s why vascular surgeons urge people like Shaw to get imaging tests that can help physicians find an aneurysm.

“If you have a family history of an aortic aneurysm, or you are a smoker, you should be screened,” said Cedars-Sinai vascular surgeon Elizabeth Chou, MD.

Chou explained that people at risk can see a primary care doctor, a cardiologist or a vascular surgeon for an imaging test such as an ultrasound or CT scan. Studies report that among people who get screened, about 3%-8% are diagnosed with abdominal aortic aneurysm.

An electrician and handyman who likes to stay active, Shaw had choices to make to prevent life-threatening rupture: minimally invasive catheter-based surgery or open surgery through an incision?

When Shaw met Chou, he learned his best option for his condition and lifestyle was an open surgery, where Chou and team would create an incision in the abdomen, sew a tube to the healthy parts of the aorta, and remove the aneurysm.

For people who have a smaller aortic aneurysm, a vascular surgeon will recommend an annual CT scan to see if it grows.

“Some aneurysms do not grow for many years,” said Chou, who is also assistant professor of Vascular Surgery in the Smidt Heart Institute at Cedars-Sinai. “Some people may never need surgery or any sort of repair, only routine monitoring.” She added that research is underway to help physicians understand why some aneurysms grow and some stay the same.

If an aneurysm reaches a certain size—about 5 ½ centimeters in men and 5 centimeters in women—a vascular surgeon typically recommends surgery.

Some patients may benefit from a minimally invasive surgery, during which a catheter is threaded through an incision in a patient’s groin until it reaches the aneurysm. The surgeon positions a tube in the area of the aneurysm and relines the aorta and aneurysm to divert blood flow into the relined aorta and away from the aneurysm. This option is usually recommended for patients who are older, frail, and generally wouldn’t recover well from an open surgery.  Some people also choose this option because they prefer a less invasive approach and are willing to undergo annual follow-ups to make sure the relining remains intact.

Shaw felt confident in Chou’s recommendation for an open surgery

“I live on a ranch,” he said. “I toss around bales of hay and 50-pound bags of horse feed. I need to be totally well. Anything other than a completely replaced artery was not acceptable because of my lifestyle.”

Chou said the most important part of the process is for patients to understand what the aneurysm is and how it affects their life.

“There are pros and cons to open surgery, minimally invasive surgery, and watching and waiting,” she said. “Our utmost priority is ensuring that each patient is comfortable with their decision. What we want people to know is that they need to be screened, and we will take the next steps together.”

After almost a week of recovery in the hospital and four weeks of recovery with light activity at home, Shaw returned to horseback riding on his ranch in Santa Maria, California.

“This could have ruptured at any time,” he said. “I was a walking time bomb. Now I’m totally healthy.”

Read more on the Cedars-Sinai Newsroom: Smidt Heart Institute Opens Aortic Surveillance Clinic

Children with Duchenne typically lose the ability to walk by age 12 and die at a young age, commonly because their heart becomes so weak it can no longer pump blood.

“When we discovered he had Duchenne muscular dystrophy, I really felt like the sky had fallen down. I mean, that was my world,” Jayasuriya said from her home in Newport Beach, California, where she lives with her husband and Dusty.

Duchenne is caused by a mutation on the X chromosome and mostly affects boys. Jayasuriya was determined to find a potential treatment for her son and the approximately 20,000 other children diagnosed with Duchenne around the world each year.

Jayasuriya read a 2011 article in The Economist that described how Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute at Cedars-Sinai, was studying how heart stem cells might repair heart damage. A light bulb went off. She requested a meeting with Marbán and the two forged a mission-filled friendship.

In 2013 Jayasuriya raised $150,000 through her organization, Coalition Duchenne, to fund preliminary research. Now 32, Dusty stands to potentially benefit from a cell therapy created from research Marbán has pursued for decades and that his mother helped fund.

The U.S. Food and Drug Administration (FDA) is currently evaluating deramiocel, a cell product that is based on Marbán’s discoveries. If approved, deramiocel would be the first treatment for the heart damage that often kills young people with Duchenne muscular dystrophy.

Children with Duchenne first show problems with walking or moving their arms. Their heart deterioration isn’t obvious until the heart is close to failing.

“The heart is turning into leather inside their chest,” Marbán said. “They're not aware of it until they're much older because the heart has some reserve, but it ends up being heart failure that accounts for most of the deaths from Duchenne.”

Marban is scheduled to discuss his work at a Feb. 25 FDA virtual workshop on cell therapies. The workshop is open to the public and attendees must register here. Marban's presentation is part of a four-scientist panel, “Cell Therapies for Niche Indications: Clinical Insights and Future Directions.”

The Research Begins 

More than 20 years ago, Marbán became interested in using pluripotent stem cells, which can turn into almost any cell in the body, to reprogram heart cells to generate an electrical pulse in people with abnormal heart rhythms—a biological pacemaker. However, given their propensity to migrate and create tumors, such stem cells were not realistically ready for clinical testing. Marbán and colleagues then turned their attention to isolating from the adult human heart a special type of cell capable of repairing damaged tissue.

“The dogma at the time was that once the heart is injured, it's permanent and it doesn't recover,” Marbán said.

In his laboratory, then at Johns Hopkins University, Marbán developed a technique, starting with a small human heart biopsy, to enable heart cells to self-assemble into microscopic clusters called cardiospheres. He and his team further cultured cardiospheres so that they would dissociate into cardiosphere-derived cells or CDCs. The CDCs could be grown in a laboratory and given back to the patient from whose heart they were taken.

When Marbán joined Cedars-Sinai in 2007 as the inaugural director of the Smidt Heart Institute, he began translating his basic work on CDCs into therapeutic studies in patients. Clinical trials showed heart attack patients who received infusions of their own CDCs into their hearts had some regrowth of healthy heart muscle. Curiously, additional research revealed it wasn’t the cells themselves that did the repair.

Ahmed Ibrahim, PhD, MPH, once a PhD student in Marbán’s lab who is now assistant professor of Cardiology at Cedars-Sinai, discovered that CDCs secrete tiny fat droplets called exosomes. These exosomes are full of molecules that support heart repair. This revelation meant that rather than biopsy a patient's heart, grow the cells and inject those cells into the same patient a month later, investigators could use donor hearts to prepare thousands of doses of CDCs that could be available “off the shelf.” Donor hearts are typically donated for transplantation but may be used for research if they cannot be used for a suitable recipient for technical reasons.

Duchenne and Heart Disease

Jayasuriya piqued Marbán’s interest in Duchenne heart disease. He began to study the effects of CDCs in laboratory mice with a genetic defect mirroring that in Duchenne patients. Working with Marbán, Smidt Heart Institute Assistant Professor Russell Rogers, PhD, discovered that CDCs worked well in Duchenne mice when given intravenously, leading to clinical trials in patients with Duchenne. The research verified CDCs could improve heart and muscle function in boys and young men with Duchenne.

The biotechnology company Capricor Therapeutics licensed Marbán’s technology and conducted additional clinical trials that led the company to apply for FDA approval of CDCs, now known as deramiocel, in December 2024. If deramiocel is approved, patients with Duchenne could receive an intravenous infusion of the therapy every three months.

“Our hope is that this therapy will meaningfully slow the progression of the disease and extend patient lives,” Marbán said.

Investigators in Marbán’s laboratory group are continuing to study what makes exosomes from CDCs potent.

“CDCs work by secreting tiny vesicles packed with genetic material,” Rogers said. “We are looking into the possibility that some of this genetic material may be effective when delivered on its own.”

For Dusty, who has lived longer than most people with Duchenne, the potential therapy is a chance to save his heart.   

“This is great news for older people with Duchenne like me,” he said. “This could make a true difference and impact on my life.”

Jayasuriya said the approval would be a game changer. She encourages parents of children with a rare disease like Duchenne not to give up hope.

“There may be something that works for another condition that can actually work for the condition your child has,” she said. “You just never know. There are no rules.”

Read more on the Cedars-Sinai Newsroom: Cell-Derived Therapy May Help Repair Abnormal Heart Rhythm

“To see this level of investment in women’s heart health is remarkable,” said Arthur J. Ochoa, JD, senior vice president of Advancement and chief advancement officer at Cedars-Sinai. “Philanthropists like Erika Glazer are changing the face of healthcare and bringing advanced care to so many of our patients.”

Glazer’s journey into heart care began in 2013, when she established the Erika J. Glazer Chair in Women’s Heart Health. The funds generated by the chair’s endowment supported the work of Jennifer Van Eyk, PhD, an expert in the study of proteins whose research focuses on sex differences in heart disease. Van Eyk is director of Basic Science Research in the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute at Cedars-Sinai, director of the Advanced Clinical Biosystems Institute and professor of Cardiology, Biomedical Sciences and Pathology and Laboratory Medicine.

“Science is an uncharted territory,” said Glazer. “I wanted to help ensure that women were not left behind when it comes to heart health and research.”

Glazer further widened her philanthropic focus in 2016 when she established the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science, currently occupied by Susan Cheng, MD, MPH, MMSc, director of the Institute for Research on Healthy Aging and division director of Population Health Sciences in the Smidt Heart Institute at Cedars-Sinai.

Then in 2023, Glazer funded her third chair at Cedars-Sinai—the Erika J. Glazer Chair in Women’s Cardiovascular Research, Education and Innovation. The inaugural chairholder is Janet Wei, MD, FACC, associate medical director of Cedars-Sinai’s Biomedical Imaging Research Institute, director of the Cardiovascular Disease Fellowship program in the Smidt Heart Institute, and associate professor of Cardiology and Biomedical Sciences at Cedars-Sinai. 

Righting a Wrong

Glazer’s philanthropic inspiration was sparked by her growing awareness of the underrepresentation of women in heart research, coupled with the need for greater gender equity in the United States.

“Women’s heart disease impacts everyone, in that all of us have a mother, a sister, a daughter, and/or a wife,” said Glazer, who at age 16 spent time interning at Cedars-Sinai—known then as Cedars of Lebanon—in the cardiology laboratories. “We must do more, we must do better, and we must do it now.”

While she considered a career in healthcare, Glazer opted to join her father, Guilford Glazer, in real estate development.

Glazer has made a name for herself in the male-dominated fields of construction and sports. A successful equity investor, she currently is a co-owner of the NBA’s Golden State Warriors.

“If it’s your passion, nothing should stand in your way,” Glazer said.

In addition to aiding Cedars-Sinai’s mission to attract and retain exceptional investigators, in 2016, Glazer also pledged $7.2 million for the Erika J. Glazer Women’s Heart Research Initiative at the Barbra Streisand Women’s Heart Center to support investigations into heart failure with preserved ejection fraction (HFpEF), a type of heart failure that primarily affects women.

“We are increasingly thankful to Erika Glazer—our colleague, our friend and our partner—for helping us to uncover the secrets of women’s heart health and disease,” said C. Noel Bairey Merz, MD, FACC, director of the Barbra Streisand Women’s Heart Center, and the Irwin and Sheila Allen Chair in Women’s Heart Research. “She is a doer, and she is changing the face of heart disease for women and men.”

A Champion for Women

Wei, the newest chairholder supported by Glazer, is awed by the woman behind its creation.

“I’m honored to join an inspiring group of women leaders who have benefited from the vision and generosity of Erika Glazer,” Wei said. “She is a champion for women’s heart health and is providing opportunities for my colleagues and me to advance the research, education and innovations that will save lives.”

 Read more from Discoveries: Women’s Health and Sex Differences—Research Update

People living with tricuspid valve disease are gaining more treatment options, driven by research from Cedars-Sinai investigators and collaborators at other leading medical institutions.

Traditionally, cardiothoracic surgeons have repaired or replaced the tricuspid valve during open-heart surgery and only when absolutely necessary; such surgeries are complex and risky. Now, an increasing number of studies show that cardiac interventionalists can successfully use minimally invasive catheter-based techniques. Catheter-based procedures offer an alternative for patients who are not candidates for open-heart surgery.

Raj Makkar, MD, vice president of Cardiovascular Innovation and Intervention and the inaugural director of the Karsh Division of Interventional Cardiology in the Smidt Heart Institute at Cedars-Sinai, and his team of experts treat more than 10,000 patients every year. Makkar sat down with the Cedars-Sinai Newsroom to explain advances for patients with tricuspid valve disease.

What is tricuspid regurgitation, and who does it affect?

Tricuspid regurgitation is a condition where the tricuspid valve fails to close properly, allowing blood to flow backward into the right atrium. Studies estimate that severe regurgitation occurs in up to 4% of individuals 75 and older and is often linked with conditions like heart failure, atrial fibrillation or pulmonary hypertension. Women are more frequently affected, and because the condition often develops slowly, many patients are diagnosed at advanced stages when symptoms like swelling, fatigue and breathlessness impact them.

How has treatment for tricuspid valve disease evolved?

For decades, tricuspid regurgitation was largely overlooked, often addressed only during surgeries for other heart valves. Today, advances in minimally invasive treatments like transcatheter edge-to-edge repair (TEER) and transcatheter tricuspid valve replacement (TTVR) are providing new hope. These innovative procedures offer safe and effective options for high-risk patients who previously had limited or no treatment alternatives, focusing on enhancing quality of life.

Cedars-Sinai investigators, in collaboration with colleagues from other leading institutions, recently conducted a clinical trial involving patients with severe tricuspid regurgitation. The study, published in the New England Journal of Medicine, found that patients who underwent catheter-based tricuspid valve replacement combined with medical therapy reported significantly greater improvements in symptoms and quality of life compared with those receiving medical therapy alone. These findings mark a significant step forward in the treatment of this historically neglected condition.

When might a minimally invasive procedure be the best approach?

Minimally invasive procedures for the tricuspid valve are generally the only option for older or frail patients, who are unable to withstand traditional open-heart surgery. A TEER procedure, which inserts clips in the valve to reduce leakage, works well for many, but is less effective for those with complex valve anatomy. In such cases, TTVR, which replaces the valve entirely, may be a better option.

How do you discuss options with patients?

At the Smidt Heart Institute, physicians discuss the case as a group and review imaging findings and other information to determine whether a transcatheter procedure, minimally invasive surgery, medical intervention alone or a clinical trial is best for each patient.

Selecting the right treatment involves careful evaluation of the patient’s health, anatomy and goals. We prioritize improving quality of life, particularly for patients experiencing severe fatigue and breathlessness.

Disclosures: Dr. Makkar reports research grants from Edwards Lifesciences, Abbott Vascular, Boston Scientific, JenaValve and Medtronic; he has received travel support from Edwards Lifesciences, JenaValve, Abbott Vascular and Boston Scientific.

Read more on the Cedars-Sinai Blog: Treatment Options for Heart Valve Disease

Raphael Louise Wasserman, who was born with a serious heart condition, has had more medical interventions in the first months of his life than some adults will ever have. But now, he and his family are looking forward to a life filled with more birthday celebrations than doctors’ appointments.  

Raphael and his twin sister, Antonia, who was born without a heart condition, celebrated their birthdays on Valentine’s Day, Feb. 14, at Cedars-Sinai Guerin Children’s. They were joined by their mothers, friends and family as well as the nurses, physicians and staff members who took care of them.

“Heart defects are the most common birth defect,” said Richard Kim, MD, director of Pediatric and Congenital Heart Surgery and surgical director of the Guerin Family Congenital Heart Program in the Smidt Heart Institute and Guerin Children’s. “Thankfully, we can now intervene early so babies and young children can get better quickly.”

Mothers Claire and Ashley credit the close attention their children received with getting Raphael the care he needed. Soon after he was born, a nurse noticed Raphael had a heart murmur. A couple of days later, he had open-heart surgery to fix the malformations that were preventing his heart from pumping blood properly.

But one issue remained: One of Raphael’s heart blood vessels had become so narrow it was affecting his heart. In August, Raphael became one of the first children to receive the first stent specifically designed for babies and children. The stent was studied at Cedars-Sinai, and Evan Zahn, MD, director of the Pediatric Congenital Heart Program at Guerin Children’s and the Smidt Heart Institute, helped develop it. The stent’s design allowed it to be placed during a minimally invasive procedure rather than through an open-heart surgery.

“It was so rewarding to care for Raphael, who had especially complicated structural heart defects,” said fetal and pediatric cardiologist Myriam Almeida-Jones, MD. “Thanks to our team-based approach and our latest advances, we were able to improve Raphael’s heart so he and his family can have many more milestones to celebrate.”

Read more on the Cedars-Sinai Blog: Q&A—Congenital Heart Defects

That’s what she’s been doing since she was 22, when she was diagnosed with dilated cardiomyopathy, a rare disease that causes the heart muscle to weaken and, eventually, stop pumping blood.

After college graduation, Epps-Manuel began her career in special education. She grew up with a brother with special needs, and Epps-Manuel believed she had found her calling. But one day in 2010, during her first job as a teaching assistant, she came home feeling like she had just run a marathon. She couldn’t catch her breath. An emergency physician discovered her heart was enlarged, and the next day, a cardiologist diagnosed Epps-Manuel with dilated cardiomyopathy.

Just three years earlier, the former intramural college volleyball player had given birth to a healthy boy, and she had never had health issues. No one in her family was known to have a heart condition.

Epps-Manuel’s type of dilated cardiomyopathy is idiopathic, meaning the cause is unknown.

“It was very hard mentally,” she said. “I started having issues with palpitations and had to start wearing an external defibrillator. It was just one thing after another.”

To give herself more flexibility, Epps-Manuel left her elementary school job, moved in with her parents and started a ministry and service center for people with cognitive disabilities.

A few years after she was diagnosed, surgeons at Baylor University Medical Center in Texas implanted a left ventricular assist device (LVAD) to help Epps-Manuel’s heart pump blood. Less than two years later, she received a second LVAD after the first one caused a major blood clot in the cannula of the device’s pump.

In December 2014, Epps-Manuel received a long-awaited heart transplant in Texas, which was followed by difficulties. Medications she took to keep her body from rejecting her new heart so severely injured a kidney that she had to undergo a kidney transplant in 2022. Ten years after the heart transplant, her heart also started to fail. That’s when her Texas doctors referred her to the Smidt Heart Institute at Cedars-Sinai. Tyler Gunn, MD, assistant professor of Cardiac Surgery, led the team of physicians, nurses and operating room staff who performed the transplant.

“When I first met Destany in April 2024 she was very sick, but she was physically fit and had a lot of life ahead of her,” Gunn said.

Epps-Manuel’s case pushed the limits of what surgeons can do.

“With each additional redo surgery, different parts of the heart, tissues and bone fuse together and it becomes much more technically challenging to operate,” Gunn said. “These surgical considerations are why centers from across the nation refer their most difficult cases to Cedars-Sinai.”

Although Epps-Manuel has spent much of her adult life facing life-or-death situations, waiting for her second heart transplant made her feel especially hopeless. She credits the support program led by Rebecca Hedrick, MD, director of Consultation Liaison Services in the Department of Psychiatry and Behavioral Neurosciences, with helping her through her sickest period. The program taught her coping tactics such meditation and helped her use virtual reality to calm her mind. 

“You have to feel your feelings, but you can't stay there,” she said. “You have to have a mindset to fight.”

Epps-Manuel’s second heart transplant took place in October 2024 during a nine-hour operation at the Smidt Heart Institute. A life-support machine called cardiopulmonary bypass temporarily did the work of Epps-Manuel’s heart and lungs. It took surgeons two hours to carefully dissect the bands of scar tissue around the old heart and remove it, a process that typically takes 30 minutes.

Another challenge the Smidt Heart Institute faced was that Epps-Manuel had developed antibodies to the first transplant, so there was a high risk that any future donor heart would be quickly rejected.

Jon Kobashigawa, MD, director of the Heart Transplant Program at Cedars-Sinai and a world expert in preventing and treating organ rejection, managed Epps-Manuel’s care pre- and post- transplant. He created an aggressive immunotherapy plan to stop her body from rejecting the new heart.

Epps-Manuel and her mother lived in Los Angeles for months while she waited for her transplant and recovered afterward. She missed being able to tour colleges with her son, but she is now healthy enough to travel back and forth between her home in Cedar Hill, Texas, and Cedars-Sinai, where she continues to receive desensitization therapy for donor antibodies. She’s excited to volunteer with her ministry again and watch her son compete in senior-year football and track.

“Destany has an incredible, upbeat attitude, which contributes to her recovery,” Kobashigawa said. “She is a joy to care for and continues to inspire our collective team.”

Read more on the Cedars-Sinai Blog--Heart Disease: When to Get a Second Opinion

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People with metabolic disease who have three or more cardiovascular risk factors—such as high blood sugar, low levels of HDL (good) cholesterol and high blood pressure—often develop cardiovascular disease and kidney disease. People who have two or more of these diseases or are at risk of developing them are described by medical experts as having cardiovascular-kidney-metabolic (CKM) syndrome.

“We need additional research to understand the biologic processes that cause men and women to experience disease differently,” said Susan Cheng, MD, MMSc, MPH, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science in the Department of Cardiology in the Smidt Heart Institute, and co-corresponding author of the study. “The more we know, the better we’ll be able to prevent women from dying from less severe forms of CKM syndrome.” 

The number of people with CKM syndrome increased steadily from 1988 to 2018, according to investigators. They also found stage 3 disease occurred more among men (from 18.9% to 22.4%) as compared with women (13.9% to 15.2%). Although women were less likely to develop stage 3 disease, they were more likely to die during any stage of the disease.

Other authors include: Hongwei Ji, Charumathi Sabanayagam, Kunihiro Matsushita, Ching-Yu Cheng, Tyler Hyungtaek Rim, Bin Sheng, Huating Li, Yih-Chung Tham, and Tien-Yin Wong.

Funding: This study was funded in part by the National Key Research and Development Program of China (grant 2022YFC2502800), the National Natural Science Foundation of China (grants 82388101 and 82103908), the China Postdoctoral Science Foundation (grant 2024M751733), the Beijing Natural Science Foundation (grant IS23096), the Shandong Provincial Natural Science Foundation (grant ZR2021QH014), the Shuimu Scholar Program of Tsinghua University (grant 2023SM196), the National Postdoctoral Innovative Talent Support Program (grant BX20230189), the Erika J Glazer Family Foundation, and the National Institutes of Health grant U54AG065141.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Heart failure occurs when the heart cannot pump enough blood and oxygen to support the body’s other organs. This condition can cause fatigue, shortness of breath, swelling, other debilitating symptoms and shorten life. Heart attacks, which damage the heart muscle, are among the most common causes.

The new study, published in European Heart Journal, analyzed the effect of administering a small molecule known as PR-364 to adult male laboratory mice that endured a heart attack, also known as myocardial infarction. Data showed this treatment preserved the heart’s pumping power and mitigated the progression of heart failure in the treated mice versus mice that were not treated.

To uncover why PR-364 had such a profound impact, the investigators performed additional laboratory experiments using mouse tissue and cells along with human cardiomyocytes, the cells that make up the heart muscle. They also analyzed changes in proteins in mice that had received the drug.

The data indicated that PR-364 enhanced the functioning of mitochondria, the small structures in cells that generate energy to power biochemical reactions. Healthy mitochondria are critical drivers of the processes that protect and repair the heart and other muscles. PR-364 altered the mitochondria in several beneficial ways:

• By increasing mitophagy, the process by which the mitochondria that have been damaged by a heart attack are destroyed and cleared from the body, which aids repair of the heart muscle
• By increasing production of new mitochondria
• By improving the overall functioning of the mitochondria

“Taken together, these effects suggest how PR-364 helped prevent the development of heart failure after heart attacks in laboratory mice,” said Jennifer Van Eyk, PhD, professor of Cardiology in the Smidt Heart Institute at Cedars-Sinai and director of the Advanced Clinical Biosystems Institute at Cedars-Sinai. “While our data does not prove that PR-364 would have this impact on patients, it points to a unique, promising path toward developing heart failure strategies for survivors of heart attacks.” Van Eyk was co-corresponding author of the study along with Roberta Gottlieb, MD, formerly of Cedars-Sinai.

Van Eyk said the next steps in this research are threefold: to study whether a second-generation version of PR-364 may be more effective, to determine whether there are differences in responses based on gender and to delve more deeply into how PR-364 works.

Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute at Cedars-Sinai, said the new study’s findings are especially important, given that more people than ever are surviving heart attacks.

“Although several drugs have reduced injury in mice after a heart attack, almost all are preventive: They must be given beforehand. Unfortunately, no one has a crystal ball predicting just when a heart attack will occur in real life,” Marbán said. “What is particularly noteworthy here is the fact that improved recovery was seen when PR-364 was administered a full two hours after the heart attack, improving the likelihood of successful translation to patients.”

Other Cedars-Sinai authors include co-first authors Lizhuo Ai and Juliana de Freitas Germano, and Chengqun Huang, Marianne Aniag, Savannah Sawaged, Jon Sin, Reetu Thakur, Deepika Rai, Yang Song, Honit Piplani, Robert M. Mentzer and Aleksandr Stotland. Other authors include Christopher Rainville, David E. Sterner, Suresh Kumar and Tauseef R. Butt.

Disclosure of interest: The authors declare no conflicts of interest. The Parkin activating compound PR-364 was provided by Progenra Inc., which did not interfere with the results and conclusions presented here. Progenra Inc. plans to file patents on PR-364.

Funding: This work was supported by the National Institutes of Health (NIH) grants R01-HL144509 (J.E.V.E. and R.A.G.), R01-HL132075-01A (J.E.V.E. and R.A.G.), 1 R01 HL155346-01 (E.M. and J.E.V.E.), and1R43HL162163-01 (Progenra, Inc.). L.A. is supported by the California Institute for Regenerative Medicine (CIRM) Scholar Training Program (CIRM EDUC4-12751). A.S. is supported by the Cedars-Sinai Research Institute Winnick award AWD00001135-400023. Progenra’s work was supported by Michael J Fox Foundation, New York, USA. As well, the Erika J Glazer Endowed Chair in Women’s Heart Health (J.E.V.E.) and the Smidt Heart Institute and Cedars-Sinai Medical Center funds to J.E.V.E. for proteomic analysis.

Follow Cedars-Sinai Academic Medicine on LinkedIn for more on the latest basic science and clinical research from Cedars-Sinai.

“Rather than have this hanging over us while thinking of rebuilding, I decided I wanted to be operating at an optimum physical level,” Booher, 45, said. “My husband and I looked at each other and said, ‘This is tragic, but it doesn’t change the immediate plan. We’ll move on to the next step.’”

Booher and husband, Steve, along with their three greyhounds, evacuated their home on Jan. 7. He didn’t have time to pack the collection of comic books he has written. The next day, they learned the house was gone. By Jan. 9, Booher was at the Smidt Heart Institute at Cedars-Sinai for surgery to repair one of his heart’s valves.  

A few months prior, Booher had been diagnosed with mitral valve regurgitation, a condition in which the heart’s mitral valve doesn’t close as it should. Mitral valve regurgitation can cause heart failure, strokes and even sudden death, but it often goes unnoticed because symptoms are subtle. Booher’s fatigue, which he chalked up to his active lifestyle, was one such overlooked sign.

Joanna Chikwe, MD, chair of the Department of Cardiac Surgery at Cedars-Sinai, spent last Wednesday reassuring patients who were watching the Sunset fire from the hospital’s windows that they were in the safest place to be.

“I called patients already scheduled to have open-heart surgery to see what they wanted,” she said. “When I saw David’s address I thought, ‘He’ll never want to proceed. He must be overwhelmed.’ But I was astonished and inspired by his resolve. He told me, ‘Let’s fix my heart so I can rebuild my life.’”

Chikwe repaired the faulty heart valve through a tiny incision with the help of a robot, and Booher, recuperating at a friend’s home a few days later, already feels transformed.

“It boggles my mind that they went into my heart, repaired my valve, and now I feel so healthy,” he said. “The change has been remarkable. I feel like my heart is working efficiently. I feel clearheaded.”

Booher is coming to terms with not being able to go back to a community he loves. Altadena is a special place for him, a mix of architecture, mom-and-pop shops and tight-knit neighbors. He and his husband plan to spend time at their cabin in Big Bear where he’ll continue to write.

“Emotionally, it is starting to sink in,” he said. “When I was in the hospital, I was recovering, so I didn’t have the chance to internalize what happened. I have an incredible support system as I am working through my grief of losing everything. I’m grateful our dogs are safe, we are safe and have a place to stay. And I’m grateful for a healthy heart. That’s what we have to hold on to.”

 Read more on the Cedars-Sinai Blog: Treatment Options for Heart Valve Disease

The Karsh family’s contribution will advance care and research across the field of interventional cardiology at the medical center. Interventional cardiology is a branch of medicine focusing specifically on minimally invasive, catheter-based procedures to correct structural heart problems such as leaking valves. The gift is in honor of Martha’s mother, Sybil Lubin, a now-healthy and active 94-year-old who experienced a catastrophic mitral valve rupture two years ago. She credits Raj Makkar, MD, and the interventional cardiology team at Cedars-Sinai with saving her life.

Makkar is the inaugural director of the Karsh Division of Interventional Cardiology and will also serve as the Karsh Distinguished Chair in Interventional Cardiology. An authority in advanced catheter-based therapies, Makkar’s team of experts treat more than 10,000 patients annually. Makkar says his mission is to perform and teach other physicians how to perform these advanced therapies so that many more patients can and will benefit.

“Our interventional cardiology programs are available around the clock to provide urgent care to those who need it most,” said Makkar. “Thanks to the incredible generosity of the Karsh family, we not only are able to sustain this critical service but also enhance and grow it. Their gift makes them true partners in our mission, helping us continue to provide the highest level of care, and we are deeply grateful for their support.”

Cardiovascular disease remains the leading cause of death globally, as cited by the World Health Organization. Cedars-Sinai ranked #1 in California and #6 nationally for Cardiology, Heart & Vascular Surgery in U.S. News & World Report’s "Best Hospitals 2024-25" listings. The newly established interventional cardiology division will treat conditions including valvular defects, electrical rhythm disorders, heart muscle dysfunctions and congenital heart disease.

The Karsh family says mindful merging of a common mission is the basis for their partnership with Cedars-Sinai. “’Education, Community, Democracy’ is a motto of our foundation,” the family said. “With this gift, we aim to amplify our commitment to both our community and medical education. Ultimately, what we hope to contribute to the world of medicine on a global scale with Cedars-Sinai is a powerful testament to what results from intention put into action.”

Peter L. Slavin, MD, president and CEO of Cedars-Sinai, expressed his gratitude for the Karsh family’s generosity and commitment to the highest quality care.

“The Karsh family has an enduring commitment to transformative medicine, and they’re building an even more profound legacy of philanthropy with the Karsh Division of Interventional Cardiology,” said Slavin. This new gift adds to their past visionary contribution that birthed the nationally ranked Karsh Division of Gastroenterology and Hepatology. Both enterprises address vital areas primed for innovative, groundbreaking advancements with the resources required for our patients.”

Read more on the Cedars-Sinai Newsroom: Smidt Heart Institute Advances Valve Replacement

Daukayev is a beloved ballet teacher and the owner of Los Angeles-based Marat Daukayev School of Ballet with his wife of 28 years, Pamela. Daukayev also is known around the world for his 20-year career as a leading male dancer in numerous international ballet tours.

Outwardly, the Russian-born dancer seemed the picture of good health. Though he was managing high blood pressure under the care of an interventional cardiologist, Daukayev said he felt healthy and showed no signs of slowing down. 

So, it was a surprise in the early morning of Feb. 6, 2023, when an episode of severe chest pain sent him racing to the Cedars-Sinai Emergency Department. There, he was evaluated by cardiologist Mamoo Nakamura, MD, who immediately whisked Daukayev to the Cardiac Catheterization Laboratory in the Smidt Heart Institute, where Daukayev received two lifesaving stents. A week later, when Daukayev’s electrical heart function became unstable, he returned to the cath lab for a third stent.

“If he came in even two or three hours later, things could be very different,” Nakamura said. “It is very fortunate that he came to us just in time.”

After his hospitalization, Daukayev returned home and adhered closely to doctors’ instructions, walking daily and eating healthfully. Just four weeks later, he was back at his dance studio, teaching daily. By August, when rehearsals began for his studio’s annual production of Pyotr Ilyich Tchaikovsky's “The Nutcracker Suite,” he was fully recovered.

“Marat has made tremendous progress,” Nakamura said. “This is a major success story for the treatment of a heart attack.”

Today, Daukayev reflects on his health journey and says that it’s a strange thing when the body you count on every day of your life suddenly stops working.

“My whole life’s training has been to make the body do the impossible,” he said. “But suddenly, I was forced to put my body completely and fully in someone else’s hands.”

Daukayev will lead four “Nutcracker” performances on Dec. 7 and Dec. 8 at California State University Los Angeles’ The Luckman Theater. Daukayev plans to dance alongside 105 ballet students who have waited all year for this annual performance.

“I am so lucky,” Daukayev said, “and I feel so alive.”

To purchase tickets for “The Nutcracker” this weekend, visit theater.maratdaukayev.org/nutcracker-performances/.

Read more from the Cedars-Sinai Blog: A Better Model of Heart Disease Prediction

The study, published in Circulation: Cardiovascular Imaging, details how investigators trained a deep learning program to look for patterns in a commonly used heart test called computed tomography angiography. The results showed that plaque volumes increased with age and were higher in male patients. Women presented with lower plaque volumes compared to men of the same age. Patients in higher percentiles for plaque volume (which takes into account these differences in age and gender) were more likely to experience a heart attack.

Patients typically have a computed tomography angiography for chest pain. The AI software can measure plaque in the coronary arteries and also provide a percentile score for a patient’s age and gender.

When plaque builds up in the arteries, it can lead to a condition called atherosclerosis, in which arteries harden and narrow. If blood supply to the heart is reduced, a heart attack may result. The condition also can lead to heart failure, stroke and loss of limbs.

“The use of AI to measure coronary plaques will significantly influence clinical practice,” said Damini Dey, PhD, professor of Biomedical Sciences at Cedars-Sinai and corresponding author of the study. “In addition to telling a patient their total plaque volume, it may be easier to understand their heart attack risk from plaque volumes relative to other patients of similar age and sex.”

Other Cedars-Sinai authors involved in the study include Robert J.H. Miller, MD; Nipun Manral, MSc; Andrew Lin, MBBS, PhD; Aakash Shanbhag, MSc; Caroline Park, BSc; Aditya Killekar, MSc; Priscilla McElhinney, BSc; Aryabod Razipour, MD; Kajetan Grodecki, MD, PhD; Alan C. Kwan, MD; Donghee Han, MD; Keiichiro Kuronuma, MD; Guadalupe Flores Tomasino, MD; Jolien Geers, MD; Heidi Gransar, MSc; Sebastien Cadet, MSc; Daniel S. Berman, MD; and Piotr J. Slomka, PhD.

Other authors include Jacek Kwiecinski, MD, PhD; Aditya Killekar, MSc; Hidenari Matsumoto, MD, PhD; Aryabod Razipour, MD; Markus Goeller, MD; Mohamed Marwan, MD; MSc; Balaji K. Tamarappoo, MD, PhD; Victor Y. Cheng, MD; Stephan Achenbach, MD; Stephen J. Nicholls, MBBS, PhD; Dennis T. Wong, MD, PhD; Lu Chen, MD; J. Jane Cao, MD; Marc R. Dweck, MBChB, PhD; David E. Newby, MD, PhD; Michelle C. Williams, MBChB, PhD.

Dr. Miller has received consulting fees and research support from Pfizer. S. Cadet, Dr. Slomka, Dr. Dey, and Dr. Berman received software royalties from Cedars-Sinai Medical Center and report equity in APQ Health Inc. outside of the current work. Dr. Berman, Dr. Slomka, and Dr. Dey hold a patent (US8885905B2/WO2011069120A1, Method and System for Plaque Characterization). Dr. Grodecki reports grants or contracts from the Foundation for Polish Science and Polish Society of Cardiology. Dr. Kwan reports partial effort support from the Doris Duke Charitable Foundation Grant. Dr. Kuronuma is supported by grants from The Society of Nuclear Medicine and Molecular Imaging Wagner-Torizuka Fellowship and Nihon University School of Medicine Alumni Association .S. Cadet reports financial support from the Miriam and Sheldon G Adelson Medical Research Foundation Grant. Dr. Nicholls reports grants or contracts from AstraZeneca, New Amsterdam Pharma, Amgen, Anthera, Eli Lilly, Esperion, Novartis, Cerenis, The Medicines Company, Resverlogix, InfraReDx, Roche, Sanofi-Regeneron, and LipoScience; and consulting fees from AstraZeneca, Amarin, Akcea, Eli Lilly, Anthera, Omthera, Merck, Takeda, Resverlogix, Sanofi-Regeneron, CSL Behring, Esperion, and Boehringer Ingelheim. Dr Dweck reports consulting fees from Novartis, Jupiter Bioventures, and Silence Therapeutics; and payment or honoraria from Pfizer and Novartis. Dr. Newby reports a grant from the British Heart Foundation (RE/24/130012, CH/09/002, and RG/F/22/110093) and Wellcome Trust. Dr. Williams has given talks for Canon Medical Systems, Siemens Healthineers and Novartis. The other authors report no conflicts.

The study was supported by grants from the National Heart, Lung, and Blood Institute, USA (1R01HL148787–01A1 and R01HL151266), the Miriam & Sheldon G Adelson Medical Research Foundation, and a grant from the Winnick Family Foundation.

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Radiation therapy is part of the standard treatment for advanced lung cancer, but can cause heart rhythm abnormalities, also called arrhythmias.

In a study published in the peer-reviewed journal JACC: CardioOncology, Cedars-Sinai and Harvard University investigators devised a way to predict, based on the area of the heart exposed to radiation, the type of heart arrhythmia that can result. These findings could help radiation oncologists reduce lung cancer patients’ risk of arrhythmias and identify patients who may need additional cardiac monitoring.

“In this study, radiation oncologists, cardiologists, electrophysiologists and artificial intelligence specialists worked together to intricately map radiation exposure for lung cancer therapy to different regions of the heart,” said Katelyn Atkins, MD, PhD, assistant professor of Radiation Oncology at Cedars-Sinai Cancer, assistant professor of Cardiology at Cedars-Sinai and first author of the study. “We observed that radiation exposure to key structures such as pulmonary veins, coronaries, and atria was associated with distinct arrhythmia types, potentially pointing to unique pathways of injury.”

Additional authors: Samuel C. Zhang, MD; Christopher Kehayias, PhD; Christian Guthier, PhD; John He, BA; Jordan O. Gasho, BS; Mina Bakhtiar, MD; Katrina D. Silos, BA; David E. Kozono, MD, PhD; Paul C. Zei, MD; Anju Nohria, MD; Andriana P. Nikolova, MD, PhD; Raymond H. Mak, MD.

Funding: Dr. Mak has received grant funding from AstraZeneca and ViewRay. Dr. Nohria has received research support from Bristol Myers Squibb; and has received consulting fees from Altathera Pharmaceuticals, AstraZeneca, Bantam Pharmaceuticals, Regeneron Pharmaceuticals, and Takeda Oncology.

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The program’s findings, published in Circulation, may help clinicians identify patients whose mitral valve regurgitation is manageable with medication as well as patients with more severe cases who would benefit from a minimally invasive valve repair procedure or surgery.

“Mitral regurgitation is a common but often missed valvular heart disease. It can be challenging to precisely assess the disease severity, which is critical to know which patients can take a watch-and-wait approach and which should proceed to an intervention,” said David Ouyang, MD, a cardiologist in the Department of Cardiology in the Smidt Heart Institute, an investigator in the Division of Artificial Intelligence in Medicine, and corresponding author of the study. “The program we developed may one day be used by doctors when considering the best treatment approach for individual patients.”

The AI program further cements the Smidt Heart Institute’s longstanding leadership in heart valve care. Interventionalists with the Smidt Heart Institute are believed to have performed more mitral valve repairs than any other center in the U.S., with outcomes that place Cedars-Sinai among the top-performing programs nationally. The Smidt Heart Institute team has also completed more than 1,500 robotic mitral valve repairs with a near 100% success rates.

“This could improve how we identify patients with mitral regurgitation, which is becoming more prevalent in our aging population, and to personalize treatment even more so than we already do,” said Raj Makkar, MD, associate director of the Smidt Heart Institute, vice president of Cardiovascular Innovation and Intervention for Cedars-Sinai and a leader in treating mitral valve disease.

The heart has four valves that open and close to move blood throughout the body. In some people the mitral valve, located on the left side of the heart, does not close properly, which allows blood to flow backwards, a condition called mitral valve regurgitation. The condition prevents enough blood from circulating throughout the body and, over time, can lead to shortness of breath, arrhythmia and heart failure.

“At Cedars-Sinai we are pursuing the use of AI as a complementary tool in diagnosing and treating conditions such as mitral valve regurgitation,” said Sumeet Chugh, MD, director of the Division of Artificial Intelligence in Medicine and the Pauline and Harold Price Chair in Cardiac Electrophysiology Research.

In developing the new program, investigators used more than 58,000 transthoracic echocardiograms from Cedars-Sinai. Echocardiograms are video images of patients’ hearts taken by ultrasound and is the most common way to assess mitral regurgitation. The investigators tested the program on echocardiograms from 1,800 patients at Cedars-Sinai as well on echocardiograms from 915 patients from Stanford Healthcare in Northern California.

The model was able to automatically identify moderate and severe mitral valve regurgitation with high precision.

“Our deep learning model analyzed videos from more than 50,000 echocardiogram studies and can pinpoint the most relevant and important videos to assess mitral regurgitation severity,” said first author Amey Vrudhula, a fellow at Cedars-Sinai.

To treat severe mitral valve regurgitation, experts at the Smidt Heart Institute at Cedars-Sinai rely on either the minimally invasive TEER procedure or minimally invasive surgery. All patients meet with an interventional cardiologist as well as a cardiac surgeon before making their treatment decision.

Other Cedars-Sinai authors involved in the study include Grant Duffy B.S., Milos Vukadinovic B.S^., Susan Cheng, M.D., M.M.Sc., M.P.H.

This work was supported in part by the Sarnoff Cardiovascular Research Award, research grants NIH R01-HL131532, NIH R01-HL142983, R00 HL157421, and R01HL173526.

Read more from the Cedars-Sinai Blog: Treatment Options for Heart Valve Disease

Safaa, weighing just 1.1 pounds, was in the Neonatal Intensive Care Unit (NICU) at Cedars-Sinai Guerin Children’s.

“Shortly after Safaa was born, pandemic lockdowns were implemented and only one visitor was allowed in the hospital at a time, so we had to take turns visiting her in the NICU,” Cardello said. “We were not only scared of getting germs at the hospital, but we were scared of bringing germs into the hospital and harming Safaa.”

Safaa experienced a number of health challenges in those early days, including bronchopulmonary dysplasia, or premature lung disease, because her lungs were not fully developed. Additionally, her physicians discovered Safaa had an extremely narrow upper airway, making it difficult for her to breathe without medical intervention.

“I would honestly say Safaa had the smallest windpipe I’ve ever seen,” said Irina Dralyuk, MD, a pediatric pulmonologist at Cedars-Sinai Guerin Children’s and one of Safaa’s consistent care providers.

To bypass her narrow airway, Safaa’s doctors performed a tracheostomy, a procedure to create an opening in the neck that extends to the trachea, allowing easier breathing and enabling oxygen to reach the lungs.

Safaa graduated from the Cedars-Sinai Guerin Children’s NICU four months later, in July 2020, but her airway issues were not solved, so she went home with the tracheostomy tube in her neck.

Fixing Safaa’s Airway

“When I first met Safaa, her airway opening was only a couple of millimeters wide,” said Gene Liu, MD, director of Academic Otolaryngology for Cedars-Sinai Medical Center and a pediatric ear, nose and throat specialist for Cedars-Sinai Guerin Children’s. “And even though she was growing, her windpipe needed help to expand.”

Hoping to avoid a major surgical procedure on her neck that would come with additional risks, Safaa’s family and their care team opted for a less invasive approach using a balloon dilation to gradually widen her airway over time.

“Every few months, we would look at Safaa’s airway with a fiberoptic camera, and the balloon dilation procedure would gently push open the airway little by little until it became a very nice, normal-looking airway,” Liu said.

In March 2024, shortly after Safaa’s 4^th birthday, her tracheostomy tube was removed.

Becoming Like Family

Through four years of appointments and procedures, the Cardello family and Safaa’s Cedars-Sinai care team became quite close.

“Safaa got to know us really well and I think that helped when she would come in for her balloon dilation,” Dralyuk said. “I would always meet her and her family in pre-op and either Dr. Liu or I would carry her back to the procedure area. She’s a tough cookie. She and her parents have done an amazing job.”

Dralyuk said she especially loves to hear Safaa say her name. “Early on, we didn’t know what Safaa’s voice might sound like due to her narrow airway and whether there may be any residual damage to her vocal cords. Now when I see her, and I hear, ‘Hi Dr. Dralyuk,’ it is really special.”

Ahmadi Cardello said she and her family are thankful for the care and attention they received.

“The advice Drs. Liu, Dralyuk and all of Safaa’s other doctors gave us always felt like it was something they would recommend for their own child,” Ahmadi Cardello said. “We didn’t feel alone.”

What’s Next for Safaa

Now that her tracheostomy tube has been removed, Safaa and her parents are waiting patiently for the stoma, or the hole where the tube was previously located, to close. That typically happens on its own in a few months.

Prior to the removal, many things that would be normal for a toddler were risky for Safaa as they could cause infection of the stoma.

“I can’t wait to teach her how to swim,” Cardello said, “It’ll be fun to finally take her to the park and let her play in the sand. We haven’t been able to do that until now.”

Ahmadi Cardello is relieved. “Now that Safaa’s tracheostomy has been removed, I feel like we can all breathe a little easier,” she said.

Read more from the Cedars-Sinai Blog: Common Breathing Problems in Kids and How to Treat Them

Acute coronary syndrome refers to any condition that involves the blockage of blood flow to the heart, such as a heart attack.

The investigators previously reported the immune system of patients with acute coronary syndrome seems to be reactive to LL-37. Other studies have reported that LL-37 triggers an immune response that plays a role in autoimmune diseases such as psoriasis and systemic lupus. This led the investigators to hypothesize that LL-37 might contribute to an immune response that increases inflammation and leads to a tightening of blood vessels.

In this new study, published in JACC: Basic to Translational Science, the research team reports that LL-37 binds to antibodies, forming complexes that then bind to and activate platelets. These activated platelets form clots and can restrict blood flow.

“Platelets that normally should be quiescent become active in acute coronary syndrome, and they stay active even after a heart attack,” said Paul Dimayuga, PhD, research associate professor in the Department of Cardiology in the Smidt Heart Institute and first and corresponding author of the study. “Our data suggest the immune complex formed by antibodies against LL-37 adds to the platelet activation.”

To conduct the study, the investigators collaborated with the laboratory of Daniel Berman, MD, in the Smidt Heart Institute and the Department of Imaging. The laboratory is collecting blood plasma from study participants who undergo coronary artery CT imaging to evaluate their risk for a heart attack. They are following the patients over time to learn how the composition of their plasma changes.

The investigators studied the composition of the blood plasma of patients who went on to have a heart attack, as well as the blood plasma of patients who did not. Patients who suffered a heart attack had significantly higher levels of LL-37 antibodies before the heart attack than people who did not experience a heart attack. The investigators also found that people with acute coronary syndrome had increased levels of immune complexes that formed between these antibodies and LL-37.

Experiments demonstrated these complexes have the propensity to activate platelets, suggesting a novel immune-mediated pathway of platelet activation during a heart attack and potentially a target for therapy.

With additional research, the investigators hope to understand why some people have higher levels of LL-37 antibodies than others.

“The question is: Is there a biological process that drives certain people to have an immune response to LL-37, but not others?” Dimayuga said. “We would like to study the immune cells of these individuals to see if there is something peculiar about these cells.”

Other Cedars-Sinai investigators who worked on the study include Kuang-Yuh Chyu, MD, PhD; Xiaoning Zhao, PhD; Jianchang Zhou, PhD; Nicole Wai Man Lio, BS; Fernando Chernomordik, MD; Daniel Berman, MD; Prediman K. Shah, MD; and Bojan Cercek, MD, PhD.

Funding: The Heart Foundation, Eisner Foundation, Peterson Foundation, Corday Foundation, Spielberg Fund (Los Angeles, CA [PS]); The Eleanor and Harold Foonberg Endowed Chair in Cardiac Intensive Care Fund (Los Angeles, CA [BC]); Academic Affairs Department, Cedars-Sinai Medical Center (Los Angeles, CA), The Lydia Kitner Scholarship for Advanced Cardiovascular Training, the Milovicz grant for the Development of the Future Generation of Leaders in Medicine, and the Prof. Arieh Roth Scholarship from the Working Group in Acute Cardiac Care of the Israel Heart Society (Israel [FC]).

Read more in Cedars-Sinai Discoveries Magazine: A Better Model of Heart Disease Prediction

As of June, Kobashigawa became president of the society, leading an organization of more than 5,000 clinicians and other healthcare professionals who work in the field of organ transplantation. His responsibilities include working to ensure the organization fulfills its strategic vision of advancing the field of transplantation and improving patient care by promoting research, education, advocacy, organ donation and service to the community.

Kobashigawa will also represent the American Society of Transplantation in discussions with government agencies and policymakers about organ transplant legislation.

“Dr. Kobashigawa’s experience and passion make him the ideal person to serve as a national and international voice in all matters related to organ transplantation,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute and the Mark S. Siegel Family Foundation Distinguished Professor. “He has already advanced this field greatly through his clinical work and scientific discoveries and continues to be a strong advocate for standardizing decisions and processes related to transplantation.”

Kobashigawa was instrumental in expanding the Comprehensive Transplant Program at Cedars-Sinai, one of the largest transplant programs in the world.

“Dr. Kobashigawa was instrumental in the development of our world-renowned medical and surgical program, known for changing the lives of patients previously told they were out of options,” said Christine Albert, MD, MPH, chair of the Department of Cardiology and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology.

An expert in diagnosing heart failure, Kobashigawa also is director of the Advanced Heart Disease Division in the Smidt Heart Institute. He evaluates patients for heart transplants and medically manages their health before and after transplantation. Kobashigawa has been part of seminal research studies that have led to the use of novel therapies to prevent and treat organ rejection.  

In addition to his clinical and research expertise, Kobashigawa is known for developing standards for the field of transplantation. He has organized 17 national and international conferences that have led to guidelines on critical issues such as organ allocation, organ failure diagnosis and organ rejection.

Kobashigawa has held several leadership positions in transplantation organizations. He is a past president of the International Society of Heart and Lung Transplantation and past chair of the American College of Cardiology/American Heart Association Committee on Heart Failure and Transplantation. He also has served as a member of several United Network for Organ Sharing committees. He has published more than 480 peer-reviewed research publications and was recognized with the 2023 Lifetime Achievement Award from the International Society for Heart and Lung Transplantation.

“It is an honor to lead the American Society of Transplantation, a prestigious organization with which I have long been involved,” said Kobashigawa, the DSL/Thomas D. Gordon Chair in Heart Transplantation Medicine at Cedars-Sinai. “I look forward to working with esteemed colleagues to advance transplantation policy, research and public education.”

Read more on the Cedars-Sinai Blog: Transplant Saves Bishop at the Heart of His Community

Cingolani, director of Cardiogenetics and Preclinical Research in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai, is exploring new ways to help patients with ventricular tachycardia (VT), a recurring, abnormally fast and irregular heartbeat that starts in the lower chambers, or ventricles, of the heart. If VT lasts for more than a few seconds at a time, it can be life-threatening.

Current therapies for recurrent VT are not very effective and have unpleasant side effects. Cingolani is studying the effectiveness of a novel, noninvasive cell-based therapy to treat VT. His approach uses stem cell-derived exosomes—tiny fluid-filled sacs found in cells—to help regrow healthy heart muscle and prevent disruptive electrical signals. His next step is to move his promising research into a first-in-human clinical trial.

Thanks to a $6 million grant from the California Institute for Regenerative Medicine (CIRM), the state’s taxpayer-funded stem cell research initiative, Cingolani is closer to that goal.

Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute and the Mark S. Siegel Family Foundation Distinguished Professor, said the funding is the first-ever CIRM grant focused on VT as well as the first to receive clinical research funding from CIRM for the use of exosomes as a therapy.

“This grant is the most advanced offered by the California Institute for Regenerative Medicine to fund the laborious studies required to procure regulatory approval for first-in-human trials,” Marbán said. “The new approach to treating VT is based 100% on Cedars-Sinai discoveries.”

The Cedars-Sinai Newsroom recently talked with Cingolani, an associate professor of Cardiology, to learn more about his quest to find an effective new treatment for VT.

Tell us about VT and why it can be such a serious heart condition.

VT is caused by faulty electrical signaling in the heart and sometimes develops after a heart attack. Patients experience a very fast heart rate—often 150 times a minute or more. A normal resting heart rate for adults is between 60 and 100 beats a minute. The rapid heartbeat may only last for a few seconds, but during that time, the heart is beating so fast that it can’t get enough blood to the rest of the body. Patients may feel a fluttering in the chest, chest pain, shortness of breath and dizziness or lightheadedness as a result. If VT is not treated, it can lead to cardiac arrest, which is when the heart stops beating. In fact, VT is the most common cause of sudden cardiac arrest.

How is VT typically treated?

Right now, there are several treatment options, but none of them are optimal. They include medications that are not very effective and cause unpleasant side effects, an implantable cardioverter-defibrillator (or ICD) that provides an internal shock to correct the heartbeat, and a procedure called catheter ablation. This is a complex procedure that destroys the abnormal heart tissue that’s causing the rapid heartbeat. Unfortunately, ablation also destroys healthy heart tissue in the process. Another drawback is that ablation is often limited to patients who can access specialized centers that perform the procedure.

How do exosomes work to treat VT?

Exosomes are tiny vesicles, secreted by cells, that naturally heal heart scars. The idea is to infuse the exosomes into diseased heart muscle that is predisposed to VT with the goal of decreasing scar tissue and preventing VT. Current ablation procedures destroy heart tissue and tend to worsen heart function. Even when they work, VT often recurs over time. Our therapy might prevent VT without those limitations.

How does CIRM grant funding help future patients?

The grant is significant because it allows us to complete the necessary preclinical research as well as the safety and efficacy studies that are needed before the therapy moves into a clinical trial for patients. It represents a unique opportunity to advance our therapy to the next level and potentially be able to treat patients with ventricular arrhythmias in a better way, without destroying healthy heart tissue. I’m grateful to the California Institute for Regenerative Medicine for helping us advance this science.

How quickly might we see a clinical trial for patients?

We are aiming to obtain permission from the FDA [Food and Drug Administration] to perform a first-in-human study within the next two years. This would be an exciting development for research and for patients.

Read more on the Cedars-Sinai Blog: Cardiac Rhythm Disorders & Advanced Therapeutic Program for Ventricular Tachycardia

El estudio se publica en la revista Gastroenterology.

“Descubrimos que ser mujer, fumar o tener antecedentes de intervenciones quirúrgicas para tratar la enfermedad de Crohn o la colitis ulcerosa aumenta el riesgo de que los pacientes desarrollen otras afecciones inflamatorias graves”, afirma la Dra. Talin Haritunians, coautora principal del estudio y profesora asociada de Medicina en Cedars-Sinai.

“Las variaciones genéticas de la EII, así como la localización de la enfermedad en el tracto gastrointestinal, también se asociaron con el desarrollo de manifestaciones debilitantes extraintestinales de la enfermedad que afectan a los ojos, las articulaciones, la piel, el hígado y la columna vertebral”, señaló Haritunians.

En el estudio multicéntrico participaron más de 12.000 sujetos: el mayor estudio de manifestaciones extraintestinales de la EII realizado hasta la fecha, según los investigadores. Los científicos analizaron a pacientes que padecían al menos una de las siete afecciones diferentes que se producen fuera del intestino, entre ellas psoriasis, inflamación ocular y espondilitis anquilosante, una enfermedad que puede degenerar la columna vertebral o las caderas.

Los investigadores también identificaron factores genéticos, clínicos e inmunológicos asociados a la colangitis esclerosante primaria -una enfermedad que daña el hígado- y a la artritis periférica dolorosa que afecta a las articulaciones pequeñas y grandes del cuerpo.

“Estas manifestaciones inflamatorias fuera del intestino afectan a cerca del 40% de nuestros pacientes con EII. Estos trastornos pueden tener un efecto muy importante en la calidad de vida y, en algunos casos, son potencialmente mortales. Nuestros hallazgos nos ayudarán a identificar a los pacientes con riesgo de desarrollar estas afecciones”, afirma el Dr. Dermot McGovern, PhD, autor del estudio y director de Investigación Traslacional de Cedars-Sinai en el Instituto F. Widjaja Inflammatory Bowel.

McGovern espera que los hallazgos también sirvan de guía para desarrollar nuevos tratamientos terapéuticos para los demás trastornos y que también puedan abordar la inflamación intestinal subyacente.

“Nuestros hallazgos clínicos en este estudio arrojan luz sobre los factores de riesgo de morbilidad asociados a la EII. Nuestros hallazgos genéticos resaltan vías que son objetivos de medicamentos o terapias existentes en desarrollo. Estos descubrimientos son fundamentales para desarrollar enfoques más personalizados para el tratamiento de la EII y sus diversas manifestaciones”, comenta McGovern, titular de la Cátedra Joshua L. y Lisa Z. Greer de Genética de la Enfermedad Inflamatoria Intestinal y director de Salud de Precisión de Cedars-Sinai.

Otros autores de Cedars-Sinai que han participado en el estudio son Michelle Khrom, Shishir Dube, Gregory J. Botwin, Shaohong Yang, Emebet Mengesha, Dalin Li, Takeo Naito, Nirupama N. Bonthala, Christina Ha, Gil Melmed, Shervin Rabizadeh, Gaurav Syal, Stephan R. Targan Eric Vasiliauskas y David Ziring. Otros autores: Millie Long, Lori Robbins, Steven R. Brant, Judy Cho, Richard H. Duerr, John Rioux, Phil Schumm, Mark Silverberg, Ashwin N. Ananthakrishnan, William A. Faubion, Bana Jabri, Sergio A. Lira, Rodney D. Newberry, Robert S. Sandler, Ramnik J. Xavier, Subra Kugathasan, David Hercules y R. Balfour Sartor.

Esta investigación ha sido financiada en parte por el Instituto de Investigación en Inmunobiología e Inflamación Intestinal de la Fundación F. Widjaja. El Biobanco de EII MIRIAD del Cedars-Sinai cuenta con el apoyo del Instituto de Investigación en Inflamación Intestinal e Inmunobiología de la Fundación F. Widjaja, las subvenciones de los Institutos Nacionales de Salud/Instituto Nacional de Diabetes y Enfermedades Digestivas y Renales (NIH/NIDDK) (P01 DK046763 y U01 DK062413), y The Leona M and Harry B Helmsley Charitable Trust (DPBM y SHARE Consortium).

Conflicto de intereses: Dermot McGovern es consultor de MERCK, Prometheus Biosciences (adquirida por MERCK), Takeda y Prometheus Labs.

and their Cedars-Sinai colleagues can detect a type of abnormal heart rhythm that can go unnoticed during medical appointments, according to a new study.

The study’s findings, published in npj Digital Medicine, suggest AI could one day be employed to analyze images from a common imaging test called an echocardiogram, which uses sound waves to capture pictures of the heart.

Abnormal heart rhythms are often caused by—and also lead to—heart structure abnormalities. Researchers hypothesized that an AI program trained to analyze echocardiograms might help clinicians detect early, subtle changes in the hearts of patients with undiagnosed arrhythmias.

“We were able to show that a deep learning algorithm we developed could be applied to echocardiograms to identify patients with a hidden abnormal heart rhythm disorder called atrial fibrillation,” said Neal Yuan, MD, a staff scientist with the Smidt Heart Institute and first and corresponding author of the study. “Atrial fibrillation can come and go, so it might not be present at a doctor’s appointment. This AI algorithm identifies patients who might have atrial fibrillation even when it is not present during their echocardiogram study.”

During atrial fibrillation, the heart's upper chambers sometimes beat in sync with the lower chamber and sometimes they do not, making the arrhythmia often difficult for clinicians to detect. In some people, atrial fibrillation causes no symptoms. In others, it can cause heart palpitations, fatigue, shortness of breath, dizziness, and other symptoms that interfere with daily life. Left untreated, atrial fibrillation can cause stroke and heart failure.

An estimated 12.1 million people in the United States will have atrial fibrillation in 2030, according to the Centers for Disease Control and Prevention (CDC). Deaths related to atrial fibrillation have been increasing for more than two decades, according to CDC data.

“We’re encouraged that this technology might pick up a dangerous condition that the human eye would not while looking at echocardiograms,” said David Ouyang, MD, a cardiologist in the Department of Cardiology in the Smidt Heart Institute and a researcher in the Division of Artificial Intelligence in Medicine, and a senior author of the study. “It might be used for patients at risk for atrial fibrillation or who are experiencing symptoms associated with the condition.”

The team trained a program to study more than 100,000 echocardiogram videos from patients with atrial fibrillation. The program distinguished between echocardiograms showing a heart in sinus rhythm (a period of normal heart beating) and echocardiograms showing a heart in an irregular heart rhythm. The program predicted which patients in sinus rhythm had experienced or would develop atrial fibrillation within 90 days.

The model evaluating the images performed better than estimating risk based on known risk factors.

“The fact that this program predicted which patients had active or hidden atrial fibrillation could have immense clinical applications,” said Christine M. Albert, MD, MPH, chair of the Department of Cardiology in the Smidt Heart Institute and a study author. Being able to identify patients with hidden atrial fibrillation could allow us to treat them before they experience a serious cardiovascular event.”

Other Cedars-Sinai investigators who worked on the study include Nathan R. Stein, MD; Grant Duffy; Roopinder K. Sandhu, MD; Sumeet S. Chugh, MD; Peng-Sheng Chen, MD; Carine Rosenberg,^, Susan Cheng, MD, and Robert J. Siegel, MD.

This work was funded in part by the National Institutes of Health (K99 HL157421, R01HL139829), grants OT2OD028190, AHA 23IPA1052289, the Burns & Allen Chair in Cardiology Research, and Cedars-Sinai.

Read more from the Cedars-Sinai Blog: Atrial Fibrillation—Know the Warning Signs

The design and evaluation of EchoCLIP, described in a manuscript published in the peer-reviewed journal Nature Medicine, suggest that an EchoCLIP interpretation of a patient’s echocardiogram provides clinician-level evaluations of heart function, assessment of past surgeries and devices, and may assist clinicians in identifying patients in need of treatment. The EchoCLIP foundation model also can identify the same patient across multiple videos, studies and timepoints as well as recognize clinically important changes in a patient’s heart. 

“To our knowledge, this is the largest model trained on echocardiography images,” said corresponding author David Ouyang, MD, a faculty member in the Department of Cardiology in the Smidt Heart Institute and in the Division of Artificial Intelligence in Medicine. “Many previous AI models for echocardiograms are only trained on tens of thousands of examples. In contrast, EchoCLIP’s uniquely strong performance in image interpretation is a result of its training on almost tenfold more data than existing models.”

“Our results suggest that large datasets of medical imaging and expert-adjudicated interpretations can serve as the basis for training medical foundation models, which are a form of generative artificial intelligence,” Ouyang said. He said this advanced foundation model can soon help cardiologists in the assessment of echocardiograms by generating preliminary assessments of cardiac measurements, identify changes that happen over time, and common disease states.

The team of investigators built a dataset of 1,032,975 cardiac ultrasound videos and corresponding expert interpretations to develop EchoCLIP. Key takeaways from the study include:

• EchoCLIP displayed strong performance when assessing cardiac function using heart images.
• The foundation model could identify implanted intracardiac devices like a pacemaker, implanted mitral valve repairs and aortic valves from the echocardiogram images.
• EchoCLIP accurately identified unique patients across studies, identified clinically important changes such as having undergone heart surgery, and enabled the development of a preliminary text interpretation of echocardiogram images.

“Foundation models are one of the newest areas within generative AI, but most models do not have enough medical data to be useful in the healthcare arena,” said Christine M. Albert, MD, MPH, chair of the Department of Cardiology in the Smidt Heart Institute and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology.

Albert, who was not involved in the Nature Medicine study, said, “This novel foundation model integrates computer vision interpretation of echocardiogram images with natural language processing to augment cardiologists’ interpretation of echocardiograms.” 

Cedars-Sinai investigator and first author Kai Christensen was also involved in the study. Other authors involved in the research include Milos Vukadinovic and Neal Yuan.

Ouyang is funded by NIH NHLBI grant R00HL157421.

Read more from the Cedars-Sinai Blog: The Human Factor of Artificial Intelligence  

The phone rang 30 minutes later.  

“When I picked up the phone, I thought it would be family or friends calling to wish us a happy new year,” Schulz said. “Instead, it was someone from the Smidt Heart Institute at Cedars-Sinai saying they had a heart match for me and asking how soon I could get there.”

Those early moments of 2024 catapulted a chaotic yet beautiful series of events that led to Schulz’s new heart—which was implanted on Jan. 1.

Schulz first sought help at Cedars-Sinai in October 2019. The congestive heart failure he had been diagnosed with several years earlier had become advanced and his heart was giving out.

“At that point, I was so sick that the first hospital I went to said they couldn’t treat me, and they were telling my wife to contact family to say goodbye,” Schulz said. “Thankfully, my wife wouldn’t accept that as an answer and told them to call other hospitals. Several others also rejected me, but eventually, Cedars-Sinai said yes.”

“When Mr. Schulz arrived at Cedars-Sinai, he was critically ill,” said Dominic Emerson, MD, associate surgical director of Heart Transplant and Mechanical Circulatory Support in the Smidt Heart Institute. “We needed to stabilize him quickly to save his life.”

The first course of treatment for Schulz was extracorporeal membrane oxygenation, or ECMO—an often lifesaving treatment where blood is pumped outside of a patient’s body to a portable heart-lung machine, giving the patient’s own organs a rest.

After a period on ECMO, Schulz was stable enough for Emerson and team to surgically place a left ventricular assist device, also known as an LVAD. An LVAD is a mechanical device implanted inside the chest that helps the heart pump oxygen-rich blood to the rest of the body. For Schulz, it would serve as a bridge to transplant, said Lawrence Czer, MD, medical director of the Heart Transplant Program in the Smidt Heart Institute.

“LVAD placement is a major open-heart surgery, and some patients experience a prolonged recovery, but Mr. Schulz was a model patient following the procedure,” Czer said. “He followed all our recovery instructions including walking, watching his nutrition, keeping detailed records, and coming to clinic weekly at first. As a result, he recovered quite well with no complications.”

Several months later, in August 2020, Schulz was placed on the heart transplant list—and the wait began.

“This was early in the COVID-19 pandemic, and it was a really difficult time for my family and especially for my three children,” Schulz said.

While he did well with his LVAD, Schulz said he still felt limited. “My youngest son, who was 6 at the time, wanted me to play with him, and I just wasn’t physically able to do as much as we both wanted.”

But the New Year’s Day phone call changed everything. He arrived at Cedars-Sinai with his family a few hours later, ready to receive the medical center’s first transplanted heart of 2024. Emerson was the transplant surgeon on call when Schulz came into the hospital for his procedure.

“Because we can’t predict when a donor match will be available and when transplants will happen, as surgeons, we don’t always get the opportunity to perform transplants on patients we’ve previously worked with,” Emerson said. “But it’s fantastic when we do. It’s very rewarding to be part of the patient’s entire care arc.”

Schulz said even some of the same nurses who helped him through his recovery in 2019 cared for him following his transplant.

“I am so grateful to the team at Cedars-Sinai for the care I received during both of my experiences,” Schulz said. “The compassion they showed not only to myself, but to my wife and my family, was excellent.”

Now a few months post-transplant, Schulz says he is feeling great. When asked if he made any New Year’s resolutions for himself when he received his new heart, he said he is looking forward to more family trips with his wife and their three kids. Schulz is also excited to feel strong enough to play soccer with his youngest son, Sebastian—something he hasn’t been able to do for many years.

April is Donate Life Month, which promotes awareness about organ, eye and tissue donation and honors those who gave the gift of life. As he experiences this new lease on life, Schulz also shares his gratitude to his donor and the donor’s family.

“I understand this is an incredible gift I’ve been given, and it wouldn’t have been possible without my donor and their family,” Schulz said. “It’s not something I will take for granted. I’m grateful every day.”

Read more from Cedars-Sinai Discoveries Magazine: Heartfelt Support

at Cedars-Sinai and colleagues report that women with Type 2 diabetes diagnosed with hypertension before age 50 may benefit from intensive blood pressure treatment.

The findings, published in Diabetes Care, show the risk of developing cardiovascular disease is reduced in women with Type 2 diabetes diagnosed with hypertension in middle age who underwent intensive blood pressure treatment. This risk was not reduced in women diagnosed with hypertension at age 50 or older, or in men.  

“We have known for some time that women with Type 2 diabetes have greater cardiovascular disease risks than men with Type 2 diabetes,” said Susan Cheng, MD, MPH, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science in the Department of Cardiology in the Smidt Heart Institute, and co-corresponding author of the study.

“We also know blood pressure in women rises faster than in men. Given these two findings, we wanted to find out whether certain women might benefit from more intensive treatments,” added Cheng, who is also director of the Institute for Research on Healthy Aging in the Smidt Heart Institute.

Blood pressure readings measure the force of blood pushing against the walls of the arteries. The readings measure two numbers: The larger number (systolic) is the pressure when your heart beats, and the smaller number (diastolic) represents the pressure between beats.

Experts define intensive blood pressure treatment as aiming to achieve and maintain a blood pressure below 120 mmHg systolic. Standard blood pressure treatment aims to achieve and maintain a reading less than 140 mmHg systolic. Uncontrolled blood pressure can damage the arteries and cause heart attack, stroke and other cardiovascular issues.

Intensive blood pressure treatment typically involves higher doses of antihypertensive drugs but can also involve increasing the number of antihypertensive drugs a patient is taking to achieve the blood pressure target.

The investigators analyzed data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which randomized 4,733 people with Type 2 diabetes to intensive or standard antihypertensive treatment targets. A total of 3,792 participants provided their age at hypertension diagnosis.

Women with Type 2 diabetes and early-onset hypertension who received intensive compared to standard antihypertensive treatment had significantly fewer strokes, heart attacks, and other cardiovascular events over the course of 4 ½ years than women with Type 2 diabetes and hypertension diagnosed at a later age.  

“This study could help clinicians consider situations where more intensive lowering of blood pressure may be beneficial,” said Christine M. Albert, MD, MPH, chair of the Department of Cardiology in the Smidt Heart Institute and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology. “Research findings such as these remind us that we have to consider individual differences, including differences between women and men and between people who developed their conditions earlier or later in life.”

Prospective studies are needed to validate these findings, according to the authors.

“This may be the first study to suggest intensive antihypertensive treatment is a preferred approach for women with Type 2 diabetes and early-onset hypertension,” said Joseph Ebinger, MD, associate professor of Cardiology in the Department of Cardiology in the Smidt Heart Institute and one of the study’s authors. “Our results are in line with the well-known adage that treating hypertension soon after diagnosis prevents many health issues later in life.”

Alan Kwan, MD, assistant professor in the Department of Cardiology at Cedars-Sinai, also worked on the study. Other authors include Hongwei Ji, MD; Karen Reue, PhD; Jennifer C. Sullivan, PhD; and John Shyy, PhD.

This work was funded in part by part by the National Natural Science Foundation of China (82103908), the Natural Science Foundation of Shandong Province (ZR2021QH014), Shuimu Scholar Program of Tsinghua University, National Postdoctoral Innovative Talent Support Program (BX20230189), and National Institutes of Health (grants U54-AG065141, U54-HL170326, and U54-HL169191).

Read more from the Cedars-Sinai Blog: Cedars-Sinai Investigators Exploring the Connection Between the Microbiome and Diabetes