Cardiology | Mount Sinai Today

The Mount Sinai Hospital Receives Highest Honors for Cardiac Surgery

Updated on Jul 19, 2022 | Cardiology, Featured

From left: Ismail El-Hamamsy, MD, PhD, Director of Aortic Surgery, Mount Sinai Health System; Ahmed El-Eshmawi, MD, Clinical Director of the Mitral Valve Repair Center at The Mount Sinai Hospital; Percy Boateng, MD, National Director of the Mitral Valve Repair Center at The Mount Sinai Hospital; David H. Adams, MD, Cardiac Surgeon-in-Chief and Chair of Cardiovascular Surgery, Mount Sinai Health System; Anelechi Anyanwu, MD, Surgical Director of Heart Transplantation and Mechanical Circulatory Support, Mount Sinai Health System; Robin Varghese, MD, MS, FRCSC, Director of Cardiovascular Critical Care, Mount Sinai Health System; Zdravka Zafirova, MD, Director of the Cardiovascular Intensive Care Unit, The Mount Sinai Hospital; and Menachem Weiner, MD, Director of Cardiothoracic Anesthesia, The Mount Sinai Hospital.

The Mount Sinai Hospital is world renowned for its expertise in cardiac valve surgery. That legacy continues as it received recent top ratings for patient safety and superior outcomes from the New York State Department of Health and the Society of Thoracic Surgeons, in addition to the 2022 Mitral Valve Repair Reference Center Award from the American Heart Association and the Mitral Foundation.

In one of the significant outcomes reports, Adult Cardiac Surgery 2016-2018, the New York State Department of Health found that The Mount Sinai Hospital performed better than the state safety average for isolated valve surgeries and combined valve and CABG procedures, while performing more of these procedures—3,108—than any other hospital in the state.

The report also awarded its highest quality rating for cardiac valve surgery to David H. Adams, MD, Cardiac Surgeon-in-Chief, Mount Sinai Health System, and the Marie-Josée and Henry R. Kravis Professor and Chair of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai.

During the study period, Dr. Adams’s safety results were significantly better than the state average for isolated valve surgery and combined valve and coronary artery bypass graft (a risk adjusted mortality rate of 0.18 compared to the State average of 2.10), while performing 1,001 of the procedures—more than any other surgeon in New York State.

“It is a real honor to be recognized by the state for our commitment to quality at Mount Sinai,” Dr. Adams said. “Our ability to achieve positive outcomes for our patients and maintain a high degree of safety with a high volume of cases exemplifies the considerable skills, discipline, and dedication of our entire multidisciplinary team—including our anesthesiologists, intensivists, residents, nursing and perfusion staff, clinical coordinators, and the incredible group of cardiologists and sub-specialists that help take care of our patients. I am proud of all of them and of the exacting standards we have set for the care of our patients at Mount Sinai.”

“The health and safety of our patients is our priority, now and always,” said Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital. “All of us at Mount Sinai are very proud to be recognized for our commitment to quality care and our outcomes in cardiac surgery, and we continue to draw inspiration from that to do even better.”

Recognized by Society of Thoracic Surgeons

The team’s standards have also earned honors from the Society of Thoracic Surgeons (STS), which recognized The Mount Sinai Hospital with its distinguished three-star rating based on Mount Sinai’s commitment to patient care and the outcomes it achieved in three categories: mitral valve repair and replacement (MVRR), coronary bypass surgery (CABG), and aortic valve replacement and CABG (AVR-CABG).

The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in health care, and Mount Sinai’s performance places it among the elite in all three categories in the United States and Canada. Historically, 20 percent of participating centers have received the three-star rating for CABG, and 4 to 7 percent have received it for AVR and CABG.

“This star rating system is the premier clinical way of rating hospitals based on their performance and it is exciting that STS has named Mount Sinai the best of the best in three categories,” said Julie Swain, MD, Vice Chair and Professor of Cardiovascular Surgery at Icahn Mount Sinai. “There are very few centers that achieve a three-star rating in multiple specialties, which reinforces the fact that we are among the top hospitals in the world when it comes to performing safe, successful mitral valve, coronary bypass, and other cardiac operations.”

Mitral Valve Repair Reference Center Award

The program was also honored to receive the American Heart Association – Mitral Valve Repair Reference Center Award, which recognizes medical centers that have a demonstrated record of superior clinical outcomes and a commitment to reporting and measuring mitral valve repair-related metrics. It also promotes the centers that have received this award to improve access to quality care among patients nationwide.

“This prestigious award is a testament not just to the excellence of our surgeons but also to our comprehensive team approach to all aspects of patient care from first consultation to post-operative follow-ups,” Dr. Swain said. “We have been refining that approach, and the system that supports it, for years through ongoing quality assessments and we are seeing the results of that effort in the honors we receive and, more important, the results we achieve for our patients.”

Non-Hispanic Blacks Found Twice as Likely to Have Atherosclerosis as Hispanics in Study of Young Adults in Harlem

Updated on Jul 15, 2022 | Cardiology, Diversity and Inclusion, Featured, Research

A unique Mount Sinai study focused on a multiethnic, underserved community in Harlem found that young non-Hispanic Black adult participants were twice as likely to have atherosclerosis as young Hispanic adults.

The research, published in the Journal of the American College of Cardiology in July 2022, is part of the FAMILIA Project at Mount Sinai Heart, a pioneering trial created by Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.

The new study is one of the first to evaluate atherosclerosis—the plaque build-up in the arteries that can lead to a heart attack or stroke—in asymptomatic young populations. Its findings emphasize the importance of early screening and lifestyle interventions in high-risk minority groups to improve their cardiovascular (CV) health.

Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.

“What’s interesting about this study is that Black individuals appear to be more vulnerable to atherosclerosis early in life than people of Hispanic origin, even when adjusting for known cardiovascular and lifestyle risk factors such as smoking, unhealthy diet, lack of exercise, high blood pressure, and cholesterol,” Dr. Fuster says. “This can then put them at increased risk of cardiovascular disease, suggesting the existence of emerging or undiscovered cardiovascular risk factors in this population.”

The study is part of a multinational effort to intervene early in the lives of children, their caretakers, and teachers so they can form a lifetime of heart-healthy habits. These new results come after highly successful interventions involving more than 500 preschoolers, caretakers, and educators at 15 Head Start schools in the Harlem section of Manhattan, an urban area that is socioeconomically disadvantaged—a situation commonly linked to higher rates of obesity, heart disease, and other health issues.

The FAMILIA team focused on 436 adults, including preschoolers’ family members, caretakers, teachers, and school staff. Of that group, 147 participants were non-Hispanic Black and 289 were Hispanic, with an average age of 38; 80 percent were women. Non-Hispanic white, Asian, and Native American groups each formed a small proportion of participants (2.3 percent, 2.3 percent, and 0.3 percent respectively) and people in those groups were excluded from the analysis.

Each participant answered a comprehensive questionnaire at the start of the study, addressing their nutrition, physical activity, tobacco use, and alcohol consumption, and whether they had conditions such as heart disease, hypertension, diabetes, or a family history of health problems. They also had their weight recorded, and blood pressure and cholesterol checked.

Overall cardiovascular risk factors were prevalent for both ethnic groups at baseline. Thirty percent of non-Hispanic Black participants had hypertension, almost triple the rate of the Hispanic group, 11 percent. Conversely, non-Hispanic Black participants had lower rates of dyslipidemia—unhealthy levels of lipids/fat in the blood (18 percent) compared to the Hispanic group at 27 percent, and better eating habits, consuming more fruits and vegetables. Researchers used these data to calculate a predicted cardiovascular risk score for each group. They found the overall risk of having a cardiovascular event in 10 years was low for both Blacks and Hispanics—around four percent for both groups.

Participants also had 3D vascular ultrasounds to determine if they had atherosclerosis in their carotid (neck) and femoral (leg) arteries. These vascular ultrasounds pointed to a significant discrepancy between the groups. Overall, nine percent of participants had subclinical atherosclerosis (nearly one in ten participants showed at least one artery with plaque). Also, the rate of plaque build-up in the arteries was two times higher among non-Hispanic Blacks than Hispanics. The results were consistent even after adjusting for classic cardiovascular risk factors including age, sex, body mass index, hypertension, diabetes, and cholesterol; lifestyle factors including diet, physical activity, and tobacco use; and socioeconomic factors such as employment status.

The study noted some limitations and areas for further investigation. “The population included in the study was from a speciﬁc area, Harlem, with known intrinsic health disparities compared with other areas in New York City,” the study said. “This could, to some extent, limit our results’ generalizability.” In addition, “Given the heterogeneity among racial and ethnic groups, assessing associations between self-reported racial or ethnic identity and disease is complex and is vulnerable to confounding due to the effects of socioeconomic inequality, environmental disparity, unequal access to care, and other possible emerging or unknown CV risk factors.”

However, the study is one of the ﬁrst to assess the presence of subclinical atherosclerosis by 3D vascular ultrasounds in an underrepresented younger population, the research team says, and it contributes to the understanding of higher rates of CV disease observed at an early age in disadvantaged communities.

“These findings may in part help to explain the observed differences in cardiovascular disease prevalence between racial and ethnic groups,” Dr. Fuster says. “Until underlying biological factors and other undiscovered cardiovascular risk factors are better understood and can be addressed by precision medicine, affordable noninvasive imaging techniques such as the portable 3D vascular ultrasounds used in this study, which are easily used and affordable, can be an important form of early detection in underserved communities, and provide valuable information about population disparities and increase the precision of health promotion and prevention programs.”

Dr. Fuster and his team will expand the FAMILIA program to schools across the five boroughs of New York City starting in September 2022. This project will also evaluate how family socioeconomic status and teachers’ characteristics may affect the implementation and efficacy of school-based health promotion programs.

The FAMILIA project was funded by a grant from the American Heart Association.

Learn more about Mount Sinai Heart

Prestigious Award Named in Honor of Valentin Fuster, MD, PhD, by American College of Cardiology

Updated on Jun 30, 2022 | Cardiology, Featured

The American College of Cardiology (ACC) has established a new award in honor of Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.

The first “Valentin Fuster Award for Innovation in Science” was announced at ACC’s 71st Annual Scientific Session in Washington on Monday, April 4. It was presented to Dr. Fuster to honor his significant contributions to cardiovascular medicine as a champion of scientific research and an innovator in the delivery of science through novel mechanisms, and his international voice on the importance of embracing scientific inquiry to improve the care of cardiovascular patients and promote life-long heart health.

The award will be given to a single physician annually for the next 15 years.

Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, right, with Dipti Itchhaporia, MD, FACC, President of the American College of Cardiology.

“I am grateful to have this award established in my honor. I am proud to begin this legacy and hope this motivates others to have a significant impact in the field of cardiovascular medicine,” Dr. Fuster said. “I look forward to meeting future honorees and learning about their contributions to combating heart disease and promoting health.”

Dr. Fuster is currently the Editor in Chief of the Journal of the American College of Cardiology (JACC), which ranks among the top cardiovascular journals in the world for its scientific impact. He is a past president of both the American Heart Association and the World Heart Federation. He is a member of the National Academy of Medicine, where he served as chair of the Committee on Preventing the Global Epidemic of Cardiovascular Disease, and was a Council member of the National Heart, Lung and Blood Institute. Dr. Fuster was also President of the Training Program of the American College of Cardiology.

Dr. Fuster’s research is unparalleled in areas relating to the causes, prevention, and treatment of cardiovascular disease globally, and spans the full range from hardcore basic science and molecular biology through clinical studies and large-scale multinational trials to population health and global medicine. He has 35 worldwide honorary degrees and is the most highly cited Spanish research scientist of all time, according to Google Scholar.

In addition to Dr. Fuster, four other top cardiovascular physicians from Mount Sinai Heart received prestigious honors at the ACC Scientific Session.

George Dangas, MD, PhD, Professor of Medicine (Cardiology) and Director of Cardiovascular Innovation at the Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai, was awarded the 2022 Master of the ACC Award by the American College of Cardiology. This recognizes and honors his consistent contributions to the goals and programs of the ACC and his leadership in important College activities. Recipients of this award must be members of the College for at least 15 years and have served with distinction and provided leadership on various College programs and committees.

Robert Rosenson, MD, Professor of Medicine (Cardiology) and Director of Cardiometabolic Disorders at Icahn Mount Sinai, and Gilbert Tang, MD, MSc, MBA, Professor of Cardiovascular Surgery at Icahn Mount Sinai, received the 2022 Simon Dack Award for Outstanding Scholarship for their exceptional contributions to JACC for their peer reviews. Dr. Rosenson and Dr. Tang are among five physicians to earn this distinguished honor for 2022. Criteria include reviewing more than 11 papers a year and being on time with their reviews 100 percent of the time. This is the sixth time Dr. Rosenson will receive this award, and the second time for Dr. Tang.

William Whang, MD, Associate Professor of Medicine (Cardiology) at Icahn Mount Sinai, has been named an Elite Reviewer for the Simon Dack Award for Outstanding Scholarship for contributing high-quality critiques to the journal. Criteria include reviewing more than nine papers a year and reviewing on time 85 percent of the time. Dr. Whang is among 10 physicians to receive this honor for 2022. This will be Dr. Whang’s second time receiving the Elite Reviewer award. He is also a two-time past recipient of the Simon Dack award.

First-Time Mother Receives Life-Saving Aortic Surgery

Updated on Jun 30, 2022 | Cardiology, Featured, Patient Stories

From left, Ismail El-Hamamsy, MD, PhD, Yulia Nurikyan, and Percy Boateng, MD.

A first-time mother received life-saving heart surgery at The Mount Sinai Hospital, thanks to her quick response to her symptoms and knowledge of her family’s health history, says a leader of her surgical team, Ismail El-Hamamsy, MD, PhD, Director of Aortic Surgery, Mount Sinai Health System, and first author of a recent paper on aortic dissection repair during the COVID-19 pandemic.

The patient, Yulia Nurikyan, was 38 weeks pregnant and had not been feeling well, with a backache that she thought was caused by her late-stage pregnancy. In mid-May, in the heat of the COVID-19 pandemic, she woke up at 5 am with a heavy feeling in her throat. She got out of bed for a glass of water, then fainted. Her husband, Antoan, quickly called 911, and an ambulance rushed her to Elmhurst Hospital in Queens.

Ms. Nurikyan told the medical team at Elmhurst that her father had died of an aortic dissection in his 40s, so they ordered a CT scan and other diagnostic tests, which showed that she had a bicuspid aortic valve. This was crucial information. About half of patients with this heart defect develop an aortic aneurysm, an enlargement of the vessel that can lead to aortic dissection. This is a tear in the inner layer of the aorta, the main blood vessel that brings oxygenated blood to the rest of the body. Some people with an aortic dissection feel no pain, but common symptoms are severe sudden pain in the upper back or chest, shortness of breath, and dizziness or fainting.

Ms. Nurikyan underwent an emergency C-section, delivering a baby girl, Livia. She held her daughter for a few minutes, then she was rushed to The Mount Sinai Hospital for emergency heart surgery, since the imaging tests suggested that her aorta was about to rupture, which could have proved fatal.

Yulia and Antoan Nurikyan with baby Livia.

“In cardiac surgery, this situation is at the top of the list of emergencies,” says Dr. El-Hamamsy, who treated Ms. Nurikyan as soon as she arrived. Dr. El-Hamamsy, senior faculty in Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, is an expert in the repair of aortic dissection and recently published a study that found a significant decline in reported cases during the COVID-19 crisis.

In the study, published in May in the Journal of the American College of Cardiology, researchers compiled data on surgical repair of acute Type A aortic dissection in 11 New York City hospitals from January 1, 2018, to April 15, 2020, counting March 1, 2020, as the first day of the COVID-19 pandemic in the city. The study found that these surgical repairs fell 76 percent after the COVID-19 pandemic began—from 12.8 cases per month before the pandemic to 3 cases per month after the pandemic.

The investigators presented several potential reasons for the decline, suggesting, for example, that some aortic dissection patients did not call for help, fearing COVID-19 infection; or busy first responders were delayed in providing aid; or overburdened emergency departments may have missed or delayed diagnoses. The study said, “Although no causal relationship can be firmly established among the drop in type A aortic dissections, the COVID-19 outbreak in New York City, and the increase in at-home deaths since the last week of March 2020, this gives pause for thought.”

Ms. Nurikyan experienced a Type A aortic dissection. In a successful procedure, Dr. El Hamamsy repaired her bicuspid aortic valve, removing some of the injured blood vessel and replacing it with a synthetic graft, working with David H. Adams, MD, the Marie-Josée and Henry R. Kravis Professor and Chair of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, and the Cardiac Surgeon-in-Chief of the Mount Sinai Health System, and Percy Boateng, MD, Assistant Professor of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai.

Ms. Nurikyan’s baby, Livia, had remained at Elmhurst, placed in neonatal intensive care because of fluid in her lungs. Ms. Nurikyan and daughter spent a week at separate hospitals, and her husband could not visit either of them due to safety rules during the pandemic, though the hospitals kept them in touch through video calls. The family was happily reunited on May 23, when Ms. Nurikyan was picked up by her husband and they went together to get Livia. “My baby was the one who got me through it,” she said in an article on her care in the Daily News. She said she was grateful for her healthier heart and for the compassionate and expert care her new family received.

Ms. Nurikyan’s quick response to her symptoms was crucial, Dr. El-Hamamsy says, a point reinforced by the recent study. “It is critical, as we adjust to the pandemic, to balance the public health imperative of social distancing with the individual need to consult in the presence of sudden severe symptoms. Furthermore, additional resources, ranging from telemedicine to numbers of first responders, should be greatly increased,” the study concluded. “This serves as a word of caution for cities yet to experience a surge in COVID-19 cases, as well as for future similar events.”

Learn more about Mount Sinai Heart

Go Red for Women Celebrates Heart Health

Updated on Feb 26, 2020 | Cardiology, Community, Featured

Health fairs were held throughout the Mount Sinai Health System to raise awareness of women’s risk for disease. Above, the fair at The Mount Sinai Hospital.

Eat healthy, get plenty of exercise, manage stress, and know your numbers. This was some of the crucial advice dispensed at health fairs held throughout the Mount Sinai Health System in honor of Go Red for Women Day® on Friday, February 7. The fairs, which were spearheaded by the nurses of Mount Sinai Heart, also provided nutritious snacks and free health screenings. Go Red is an initiative of the American Heart Association with the goal of increasing the awareness that heart disease is the No. 1 cause of death for women. Says Beth Oliver, DNP, RN, Senior Vice President, Cardiac Services, Mount Sinai Health System: “We want all women to understand the importance of knowing their numbers—their cholesterol levels, weight, blood sugar, and blood pressure—and to understand the risks of stress, smoking, and a sedentary lifestyle.”

Mount Sinai Heart leaders and event organizers, from left: Miriam Challenger, Ambulatory Clinic Supervisor; Beth Oliver; DNP, RN, Senior Vice President, Cardiac Services, Mount Sinai Health System; Annapoorna S. Kini, MD, Director, Cardiac Catheterization Laboratory,The Mount Sinai Hospital; Mary Ann McLaughlin, MD, Medical Director, Cardiac Health Program; Maya Barghash, MD, Assistant Professor of Medicine (Cardiology); and Khalilah James, NP.

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Landmark Study on Aspirin for High-Risk Heart Patients Is Led by Mount Sinai

Oct 21, 2019 | Cardiology, Featured, Research

Roxana Mehran, MD, center, principal investigator of the TWILIGHT study, with leading collaborators in the study, from left, Annapoorna S. Kini, MD; Valentin Fuster, MD, PhD; Juan J. Badimon, PhD; George Dangas, MD, PhD; Usman Baber, MD, MS; and Samin K. Sharma, MD.

High-risk patients who have undergone a coronary stent procedure may not require long-term aspirin, according to a groundbreaking global study led by Roxana Mehran, MD, Director of the Center for Interventional Cardiovascular Research and Clinical Trials, Mount Sinai Heart, and the Mount Sinai Professor in Cardiovascular Clinical Research and Outcomes, Icahn School of Medicine at Mount Sinai.

“We showed that withdrawal of aspirin after three months in patients already on ticagrelor, a potent antiplatelet regimen, reduced bleeding significantly without the harm of increasing death or heart attacks,” says Dr. Mehran, global principal investigator of “Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention” (TWILIGHT), which was published in September 2019 in The New England Journal of Medicine.

Says Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, “I am proud of our team for achieving such great success with our collaborators in the United States and around the world on this pioneering clinical trial.”

The study addresses long-standing questions about the treatment of high-risk patients after percutaneous coronary intervention (PCI), also known as angioplasty, which opens blocked arteries and restores normal blood flow to the heart. “The same patients who are at high risk for ischemic events—such as heart attack or stroke caused by blocked blood vessels—are also at high risk for bleeding events,” says Dr. Mehran. “You have to find the right balance in therapies, and it is not easily found.”

In the current standard of care, high-risk patients who have received a cardiac stent are advised to take dual-antiplatelet therapy (DAPT)—both aspirin and a drug from a class of strong antiplatelet medications called P2Y12 inhibitors, of which ticagrelor is one. These two medications prevent heart attack or stroke by reducing the risk of blood clots. DAPT combines two drugs with similar effects, Dr. Mehran says, like using both “a shotgun and slingshot” for self-defense. TWILIGHT examined the impact of taking ticagrelor alone versus ticagrelor plus aspirin on clinically relevant bleeding among high-risk patients.

Investigators enrolled 9,006 patients at 187 sites in the United States, Canada, Europe, and Asia. They were high risk, meaning they met criteria such as having long or complex lesions in coronary arteries, or disorders such as diabetes or chronic kidney disease. All patients had undergone PCI with at least one drug-eluting stent and were prescribed aspirin and ticagrelor. After a three-month course of DAPT, the 7,119 patients without major adverse events were randomized to take either DAPT or ticagrelor with a placebo for 12 months. Among patients who took DAPT, 7.1 percent had major bleeding, compared with 4 percent of those who took ticagrelor and a placebo, and there was no difference in the risk for heart attack, death, or stroke between the groups. “This simpler approach saved many bleeding events and preserved the benefit of the single potent blood thinner,” says Usman Baber, MD, MS, Assistant Professor of Medicine (Cardiology), Icahn School of Medicine, who was lead author of the study with Dr. Mehran, and Chair of the TWILIGHT Clinical Coordinating Center.

The results were corroborated by a sub-study led by Juan J. Badimon, PhD, Professor of Medicine (Cardiology), and Director of Atherothrombosis Research at Mount Sinai Heart. Using a tool he is renowned for developing, the Badimon Chamber, researchers measured the thrombogenicity or “stickiness” of the blood in a group of 42 TWILIGHT patients, testing samples taken before and after they completed the 12-month treatment. Like the clinical study, the study of blood samples found that withdrawing aspirin caused no additional clot formation.

“The findings are particularly important and have the potential to change PCI practice,” says a co-author of the TWILIGHT study, Samin K. Sharma, MD, Director of Clinical and Interventional Cardiology at The Mount Sinai Hospital, and Anandi Lal Sharma Professor of Medicine in Cardiology.

Dr. Mehran expressed profound gratitude to Mount Sinai, which was the global sponsoring organization of TWILIGHT. “This study gives you an idea of the things we are able to do as an institution,” she says, “bringing together all of our resources to answer important questions for physicians and enhance the outcome for patients.”

The drug ticagrelor is made by AstraZeneca, which provided Mount Sinai with an unrestricted grant to perform the investigator-initiated study. Dr. Mehran has received financial compensation as an advisory board member for AstraZeneca in the past, and she and Dr. Baber have received consulting fees from AstraZeneca in the past.

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