Libin LifeThe Libin Cardiovascular Institute of Alberta Magazine

Fall 2013

libininstitute.org

ElEctron Microscopy toMographyDonald Welsh, phD maps3D views of cell-to-cell communication

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

shedding light on genetic heart Disease

shc Wellness Kitchen

Diagram of a trabecula Dissection

R e s e A R C h e d u C A T I o n C A R e d e L I v e R y

MESSAGE FROM THE DIRECTOR

Marking a Milestone in 2014

Dr. Todd AndersonDirector

Libin Cardiovascular Institute of Alberta

Libin Life is published twice a year by the Libin Cardiovascular Institute of Alberta, an entity of the University of Calgary and Alberta Health Services (Calgary Zone). The Libin Life mission is to share news and information about the Institute’s impact in research, education and patient care.

Institute Director Dr. Todd Anderson

Director of Research Dr. Ed O’Brien

Education Council Chair Donald Welsh, PhD

Associate Director Al-Karim Walli

Editor Lynda Sea

Editorial CommitteeAmber Arsneau, Barb Jones, Shannon Perry, Judy Siu, Al-Karim Walli, Suzanne Welsh

Copy Editors Judy Siu, Susan Wilmot

ContributorsJohn Arispizabal, Amber Arsneau, Connie Bryson, Pieter de Tombe, Gregory Harris, Dr. Debra Isaac, Trudie Lee, David (DaWei) Liu, Tiffany Neil, Julia McGregor, Todd Buchanan Photography, Wes Raymond Photography, Suddha Sircar, Judy Siu, Monique de St. Croix, Dr. Henk ter Keurs, MD, PhD

Design and Layout Steven Tov

Printer McAra Printing

Libin Cardiovascular Institute of AlbertaFoothills Medical Centre C830A, 1403 29 Street NW Calgary, AB, T2N 2T9

P 403.210.6271 E libin@ucalgary.ca W libininstitute.orgTwitter @libininstitute

Editorial InquiriesLynda SeaCommunications Coordinatorlsea@ucalgary.ca

Send comments, requests for magazine copies, digital magazine issue subscriptions or change of mailing address notifica-tions to libin@ucalgary.ca. Please request permission to reproduce any part of this publication. All rights reserved. © 2013 Libin Cardiovascular Institute of Alberta

Libin Life

2 LIBIN LIFE

I hope you have all had some time off this summer and are energized for

another rewarding academic year. The Libin Cardiovascular Institute of Alberta will celebrate its 10th anniversary in January of 2014. Since the Institute was formed on January 27, 2004, we have had lots to be proud of and to highlight to our stakeholders. As such, we are planning a series of events next year to mark this important milestone. We are celebrating what we have accomplished to date and more importantly, we look forward to a very bright future. On October 1, we are hosting Dr. Eric Topol, Director of the Scripps Translational Science Institute, as the recipient of the 2012 Libin/AHFMR

Prize in Cardiovascular Research. Dr. Topol is a pioneer in the world of cardiovascular medicine and has published more than 800 manuscripts which have been cited over 75,000 times. He has made practice-changing observations in the area of myocardial infarction, interventional cardiology, anti-platelet therapy and more recently, genomics and individualized medicine. He has embraced social media and technology to connect to the public in a way that few other researchers have done. Dr. Topol is truly an engaging speaker and he will surely entertain and educate us. Finally, I wish to highlight the work being done by Libin members in the Cardiovascular Health and Stroke Strategic Clinical Network (SCN). As one of two foundational projects of the network, the Vascular Risk Reduction Initiative (VRRI) is a multi-pronged approach to cardiovascular health promotion and disease prevention. The program is taking a provincial approach to best clinical practices, research and knowledge translation, and working with primary care networks. The goal is to decrease the burden of cardiovascu-lar risk factors by utilizing innovative approaches. We are grateful to our many members who are investing their talents to improve care delivery within Alberta. This work aligns with the Libin Institute’s emerging priority of vascular medicine and the University of Calgary’s research priority of chronic disease. The SCN’s newly developing partnership with Alberta Health Services and Alberta Innovates - Health Solutions will also create excellent research opportunities for our clinician-scientists. Enjoy the fall season. I look forward to celebrating our ongoing successes together.

“We are celebrating what we have accomplished to date and more importantly, we look forward to a very bright future.”

contents // fall 2013

lIBIn lIfe 3

care delIveryEat, Play, LiveHighlights from The Wellness Kitchen at the South Health Campus’ Wellness Centre

Sometimes Bigger is BetterWhy having a city-wide cardiac sciences program benefits Calgary and beyond

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

researchLandmark Study Tracks Toll of Hypertension on 3.5 Million Canadians

Recent Funding Successes

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

Dr. Brenda Gerull: Shedding Light on Genetic Heart Disease

educatIonStudying Syncope Why Aren’t More Women Getting Cardiac Rehab? Sharing ScienceLibin Research Day showcases the diversity of cardiovascular-science research at the Institute

Diagram of a DissectionDr. Henk ter Keurs, MD, PhD shares the story behind his oft-used illustration of a trabecula dissection

13

18

20

2 Message from the director

5 news & highlights

6 awards & accolades

19 community engagement

20 libin abroad 24 spotlight on trainees

departMents

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

11

8

9

18

21

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

13

10

16

1617

2122

24

22

16

24

Connect with Us • libininstitute.org

Follow @libininstitute for the latest news from Libin. Join the conversation on cardiovascular health research, education and patient care

Like us on Facebook and discover updates on events, media coverage and highlights from the Institute

Visit libininstitute.wordpress.com for the latest news via our blog and share your comments

Libin members, for research resources, we are now on Sharepoint (intranet.ucalgary.ca/research/Libin)

Upcoming Events

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

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

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

About The CoverElectron microscopic tomography (ET) is a method of producing 3D images of cells to show the macromolecular structures in a cell including membranes, fibres and vesicle complexes. This is a 3D model of an endothelial cell communicating to smooth muscle cells through projections. Donald Welsh, PhD and Nadia Maarouf, a PhD candidate in his lab, are currently using this new microscopy technique to study ion channels and protein trafficking in endothelial cells to smooth muscle cells and their role in cell-to-cell communication and blood flow.

4 LIBIN LIFE

November 16, 2013Cardiac Surgery Silver Jubilee Black Tie Gala

October 1, 20132012 Libin/AHFMR Prize Public Lecture

September 7-11, 2014ISRA 2014

LIBIN LIFE 5

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

What’s the big question your own research is focused on?“I have spent the last several years focusing on the question: ‘How can we evaluate imaging as a therapy?’ It may seem paradoxical, but I believe that the performance of an imaging test can be therapeutic. For example, we consider the introduction of a new tool or technique for a surgical procedure to be evolution of a therapy. What we are doing is not so different—we are using imaging tools to develop novel techniques to perform cardiovascular procedures. We hope to determine if imaging can substantially impact therapeu-tic outcomes in patients with cardiovascular disease. I focus on heart failure and arrhythmia because of their high burden of clinical outcomes, such as heart failure admissions and sudden cardiac death. These two areas are also ideally suited to the unrivaled capacity of MRI to characterize myocardial scar, a strong predictive marker of response to therapy in these populations. One example of our work is a multi-centre trial assessing the impact of 3D cardiac scar model-ing to navigate pacemaker leads to healthy tissue in patients receiv-ing Cardiac Resynchronization Therapy (CRT).”

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

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

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

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

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

E-books now available for Hearts, Minds & Vision Libin history book

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

The Big PictureNEWS & HIGHLIGHTS

Eric Topol Receives 2012 Libin/AHFMR PrizeRenowned cardiovascular scientist Dr. Eric Topol is the recipient of the 2012 Libin/AHFMR Prize for Excellence in Cardiovascular Research. This prize is awarded to an outstanding international researcher whose work has had a major impact on cardiovascular health. As author of The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care and director of the Scripps Translational Science Institute in California, Topol is one of the top 10-most cited researchers in medi-cine. In 2012, he was voted the most influential physician executive in the United States in a poll conducted by Modern Health Care. He has led many trials that have shaped contemporary treatment for heart disease and has even been named one of the 12 Rock Stars of Science by GQ Magazine. On October 1, Topol visits the University of Calgary for a free public lecture. Past recipients of this award have included Dr. A. John Camm, Dr. Valentin Fuster, Dr. James T. Willerson and Dr. Eugene Braunwald. —Lynda Sea

On June 12, the City of Calgary gave out 17 Calgary Awards to citizens and groups for their contribution to the community and Dr. Eldon R. Smith, OC was the recipi-ent of the Grant MacEwan Lifetime Achievement Award. This award honours an individual who has made significant contributions and brought recognition to the com-munity, and has improved the quality of life for Calgarians. “I was delighted and feel very honoured to receive this award,” says Smith, Professor Emeritus and former dean, Faculty of Medicine at the University of Calgary. “I am particularly pleased to receive a reward named for Dr. Grant MacEwan. I met him back in the 80s when he was doing research on another of his many books. He was a very impressive man who has made major contributions to Calgary, to Alberta and Canada.” Smith, one of the pre-eminent academic cardiologists in Canada over the past 30 years, has defined the direction that cardiovascular care has taken in southern Alberta as physician, educator, researcher and administrative leader.He recruited those who would lead Calgary to become one of the strongest cardiology centres in Canada. He is chair of the Libin Cardiovascular Institute of Alberta’s Strategic Advisory Board. In 2006, Eldon was appointed by the Federal Minister of Health to chair the steering committee for a national task force on heart health, The Canadian Heart Health Strategy and Action Plan. He is an Officer of the Order of Canada.

Vision of a Cure

6 LIBIN LIFE

In May, Dr. Anne M. Gillis was named Global Calgary Woman of Vision for her inspiring accomplishments as a pioneering female cardiologist and a professor of medicine. If you ask about her bigger vision, she’ll tell you the mission behind her life’s work is finding a cure to end suffering and sudden death from heart rhythm disorders. “The field has changed so much with advances in technology and we’re one of the few specialties or areas in medicine where you actually cure people of their disorder and alter their lives in a very positive way,” she says. She recognizes that it’s an audacious goal, but as Immediate Past President of the Heart Rhythm Society (HRS), a Professor of Medicine at the University of Calgary and a cardiologist at the Foothills Medical Centre, she is committed to tackling life-threatening heart rhythm disorders and developing new treatments to prevent sudden cardiac death. Gillis was instrumental in making the Foothills Medical Centre the first centre outside of the U.S. to intro-duce remote monitoring of ICDs (implantable cardiac defibrillators). —LS

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

AWARDS & ACCOLADES

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

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

Top

ol p

hoto

by

John

Ariz

piz

abal

, Sm

ith

pho

to b

y W

es R

aym

ond

Pho

tog

rap

hy, G

illis

pho

to b

y To

dd

Buc

hana

n Ph

oto

gra

phy

LIBIN LIFE 7

Dr. William Ghali, Director of the Institute for Public Health and Professor in Medicine and Commu-nity Health Sciences, was one of five University of Calgary faculty members awarded the 2013 Killam Annual Professorship. This prestigious award recognizes those who have demonstrated excellence in research and teaching for 10 years or more, while serving their academic discipline and community. Ghali is a professor and practicing physician. His research explores ways to best utilize routinely collected data to improve the health system. He holds a Government of Canada Research Chair in Health Services Research, and is also funded as a Health Scholar by Alberta Innovates - Health Solutions (AIHS). —LS

William Ghali awarded Killam Professorship

Dr. Douglas Hamilton, MD, PhD is one of the recipients of the University of Alber-ta’s (U of A) 2013 Distinguished Alumni Award. This award is the U of A Alumni Association’s most prestigious honour which recognizes living U of A graduates whose achievements have earned them national or international prominence. Hamilton is a Clinical Associate Professor, Faculty of Medicine and member of the Libin Cardiovascular Institute, Institute for Public Health and W21C at the University of Calgary

(UCalgary). He completed his Bachelors and Masters in Electrical Engineer-ing at U of A and his MD and PhD at UCalgary. Hamilton worked at NASA where he supported numerous Space Shuttle and International Space Sta-tion missions and served as flight surgeon for Canadian astronaut Robert Thirsk in 2009. He also made notable engineering contributions for which he was awarded NASA’s Exceptional Engineering Achievement Medal in 2012. Hamilton also provided care to Houston’s impoverished population and was the lead night physician at the Astrodome providing relief to evacuees of Hurricane Katrina. He also was previously recognized as UCalgary’s Distinguished Alumni in 2000. —Julia MacGregor

Douglas Hamilton Receives U of A’s Distinguished Alumni Award

Clinical Assistant Professor Dr. Sarah G. Weeks received the 2012 Clinical Adjunct Award in Under-graduate Medical Education from the Faculty of Medicine, University of Calgary. This award is presented to a clinical or adjunct faculty mem-ber, nominated by their Department Heads and selected by a Faculty Promotions Committee for their excellence in teaching. Weeks says teaching is a definite passion of hers. She enjoys the challenge of trying to make complex medical concepts more understandable. “Today’s students are going to be looking after my family in the next few years” she says. “I believe we owe it to them to give them the best possible training.” —LS

Dr. James Stone is a Clinical Professor of Medicine (Cardiac Sciences) at the University of Calgary and Director of Research at the Cardiac Wellness Institute of Calgary (CWIC). This spring, he was recognized by the

Faculty of Medicine with the Clinical Faculty Research Award. He has had an outstanding academic year publish-ing more than 10 papers with his colleagues and students. His clinical and research focus is on cardiac rehabilitation and chronic cardiovascular disease care. Stone is currently involved with more than eight different national guidelines committees—three of which he chairs. He is the current Chairperson and Editor-in-Chief of the CACR (Canadian Association of Cardiac Rehabilition) Canadian Guidelines for Cardiac Rehabilitation and Cardiovascular Disease Prevention. —LS

James Stone Recognized with Clinical Faculty Research Award

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

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

Gha

li p

hoto

by

Tiff

any

Nei

l

Department of Cardiac Sciences Awards

Sarah Weeks receives Teaching Award from Faculty of Medicine

Dr. Anand Joshi Dr. Israel (Sonny) Belenkie

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

8 LIBIN LIFE

CARE DELIVERY

Photos and Story by Lynda Sea

Visit the Wellness Centre at the new South Health Campus (SHC) in Calgary and one of the first things you’ll see is a floor-ceiling-climbing wall

where kids are playing. To the left of this, a bright welcom-ing kitchen space next door looks like something out of a cooking show. You can’t help but remind yourself that you’re in an acute care hospital. Given SHC’s emphasis on wellness services and health promotion, it’s no surprise that smart food preparation, mindful eating and good nutrition are major tenets of the building’s Wellness Kitchen, which opened in May 2013. “We want to provide food, cooking, nutrition education for staff, patients and their families in an effort to create a community of wellness,” says April Matsuno, consultant and dietitian for the Wellness Kitchen. “It’s about helping people make better shopping, cooking and eating decisions because of that education.” The Wellness Kitchen hosts a variety of activities includ-ing hands-on cooking courses and demonstrations in the kitchen run in partnership with ATCO Blue Flame Kitchen.

YMCA Summer Day Camp classes also bring in young kids and encourage them to learn to make fun and healthy snacks. For patients and their families and staff, there are plans to offer educational sessions focused on managing conditions and chronic illnesses such as hypertension, diabetes and celiac disease. “We are also in the works of developing a low sodium class for heart failure patients,” says Matsuno. Patient-focused classes are filled via recruitment by dietitians in specific units. Matsuno says she’s currently working collab-oratively with clinicians and in the evolution of the Wellness Kitchen’s program development, she’s aiming to attract more allied health professionals to utilize the space and improve their own skills to better help patients. “How many times have you heard from your doctor, ‘you should eat more fish.’ Well, what does that mean exactly? We want to show you it’s not that difficult to make healthier foods, it’s not more costly and it doesn’t take hours and hours in the kitchen.” The SHC Wellness Centre is the first in the country to integrate a YMCA into a hospital setting. There is also a Patient and Community Resource Centre and an AHS Knowledge Resource Service.

Eat, Play, Live

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

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

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

“We have all heard the saying, ‘Big things come in small packages.’ While that is generally true, wouldn’t we all love abig collection of such small packages? When it comes to the cardiovascular sciences, this is precisely what we have in Calgary. People are often amazed when I tell them that the Libin Cardiovascular Institute of Alberta is comprised of 1,500 individuals, has the largest division of cardiology in the country numbering 60 or so cardiologists and 10 cardiac surgeons, and is based out of four hospital sites in Calgary. We also have a presence at additional sites in the community and in a large distributed compliment of basic and transla-tional research spaces across the University of Calgary. Both cardiac surgery and cardiology roll into our city-wide health services based department of cardiac sciences, paralleling our university-based department of cardiac sciences. We don’t have to navigate the departments of medicine and surgery in the same way as most centres. All of this, bench-to-bedside, catheterization lab to rehab centre, wards to clinics, basic science experiments to clinical trials coordination, and city-limit to city-limit, is Libin. We are one. Certainly, there are some challenges being a citywide program. It is not easy to point to the Libin Institute because it is not in one building, in one place. It is hard to have a town hall as no arrangement could ever fit every-one’s schedule or be where everyone wanted it. But all that being said, we are not much different from a large extended family with aunts, uncles, cousins, in-laws and out-laws. We actually do agree on the big things. At the end of the day, it is about the advancement of our science, the success of our students, and the health and happiness of our patients. We’ve always got your heart covered.”

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

Sometimes BIGGER Is Better

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

1. YMCA Day Camp counsellors show a group of 10-13 year-olds the simple steps in making healthier smoothies2. April Matsuno, consultant and dietitian with the Wellness Kitchen3. The kids learn how to use fresh ingredients like spinach, blueberries and rice milk to make their drinks4. After the hour-long smoothie session wraps up, the YMCA Day Camp group hams it up for a group photo

1

2 3

4Top photo courtesy of Tourism Calgary

10 LIBIN LIFE

Cardiac Sciences, By the NumbersLooking back at the 2012-2013 year in clinical cardiac care delivery with high-lights from the Annual Report of the Clinical Department of Cardiac Sciences and the Clinical Care Component of the Libin Cardiovascular Institute of Alberta

Compiled by Judy Siu • Typography by Steven Tov

LIBIN LIFE 11

FEATURE

Story & Photos by Lynda Sea • Scans by Nadia Maarouf

L ook at any text book image of a biological cell and you’l l f ind the requisite par ts: the nucleus, ribosomes, mitochondria and other various

organelles with a lot of empty space. But in fact, cel ls are jam-packed with proteins and the spatial relation-ship between all the cellular structures is a significant research area ripe for study. One of the cellular structures of par ticular interest to biomedical researcher Donald Welsh, PhD Associ-ate Professor of Physiology and Pharmacology at the University of Calgary, is the endoplasmic reticulum (ER), the site of protein synthesis and calcium storage in cells. “It controls calcium and also produces proteins, packages them and sends vesicles to the membrane,” he says. “We’re interested in the ion channels, the pores in the membranes, that let ions move in and out—that’s what controls the electrical activit ies and in turn, every process in your body.”

Standard grids being prepped for TEM (Transmission Electron Microscopy)

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

With electron microscopy tomography, Donald Welsh, PhD, is mapping 3D models of the endothelial-smooth muscle contact in arteries to reveal a clearer picture behind cellular communication

NEw DImENsIoNs

His research focuses on how these ion channels and gap junctions (intercellular pores) control the electrical activity of smooth muscle/endothelial cells and conse-quently, the ability of arteries to contract and relax. Welsh’s work is currently looking at the role of ‘protein trafficking’ in setting the diameter of blood vessels which is the primary determinant behind blood flow. Unlike most researchers who are still using traditional microscopy methods which offer two-dimensional images, Welsh is utilizing the technique of electron microscopy tomography (ET) to produce higher-resolution 3D images of his cells. At 40-100x higher resolution than light microscopy or confocal microscopes, ET allows Welsh to get a more accurate and comprehensive view of the cellular structure as a whole entity. “By only looking at things in two dimensions, you can misinterpret as you’re just seeing one slice of it,” he says. “With tomograms, you’re not just getting one picture—you get a 3D view.”

Welsh first approached the Microscopy and Imaging Facility (MIF) at the Univer-sity of Calgary three years ago and realized how electron tomography could help his research. His team currently employs the use of the facility’s F20 FEG transmission electron microscope (TEM) to look at their biological samples. “With tomography, you have a high energy electron beam to shoot through the thick sample,” says Tobias Fürstenhaupt, PhD facility manager at MIF. This allows use of thicker samples which are 250-nanometers thick and not just the typical 40-70 nanometres. “It gives you the whole content of the cell and then you can digitally slice through them in areas and see how close certain organelles come to each other.” Tomograms are a complex and time-intensive process and Welsh’s PhD student, Nadia Maarouf, knows this all too well. She is the one who preps the biological tissue to look at under the microscope to generate a tomogram; itself, a four week process. Then, Maarouf traces and deconvolutes the images to create a 3D model which can be rotated for a full view on the computer. She can easily spend another month doing so. In total, Welsh and his team currently have six completed 3D models. They are aiming to publish their findings by the end of the year. “It has given me a better insight into what the cells are like,” says Maarouf. “One observation that is replicated in all models is that most of the ER is located at the base with a small amount located at the tip of the projections. This finding raises new questions concerning calcium dynamics, protein trafficking and cell-to-cell communi-cation.” Supported by the visual information provided by these tomograms, Welsh pro-poses a different way of looking at ion channel regulation which challenges some of the current thinking in his field. “My approach has always been to see the bigger picture,” he says. “We try to dig deeper, approach questions from different angles, and bring new tools and techniques to the field.”12 LIBIN LIFE

“By only looking at things in two dimensions, you can misinterpret as you’re just seeing one slice of it. With tomograms, you’re not just getting one picture—you get a 3D view.” –Donald Welsh, PhD

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

A complete 3D model of the endothelial-smooth muscle contact in an artery

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

A slice of electron tomographic recon-struction that denotes contact between endothedial and smooth muscle cells

Making WavesTracing the impact of Dr. John V. Tyberg as mentor, researcher and educator on the cardiovascular sciences fieldBy Lynda Sea with files from Hearts, Minds Vision: Roots of the Libin Cardiovascular Institute of Alberta • Photos by Pieter de Tombe

A highly experienced cardiovascular physiologist with a reputation for his work in cardiac mechanics, Dr. John V. Tyberg, MD, PhD is a Professor of Cardiac

Sciences, Physiology and Pharmacology at the University of Calgary. His research is focused on wave motion in the arteries and veins, the dynamics of ventricular ejection and filling, pericardium-mediated ventricular interaction and venous capacitance. “From when I was knee-high, I thought I wanted to be a mechanical engineer but then I became interested in medicine and physiology instead. I became interested in the heart because it moves,” says Tyberg. “At university, I took as broad a background as I could. If you are in medicine, and you’re going to treat people, you’d better understand about the human condition.” Born in Wisconsin, he studied pre-med at Bethel College at St. Paul and did his graduate and medical degrees at the University of Minnesota in Minneapolis. He completed his post-doctoral research fellowship with Dr. Edmund Son-neblick at Harvard Medical School. Tyberg would go onto to work at both Cedars-Sinai Medical Centre and the Cardiovas-cular Research Institute at the University of California before coming to Calgary. “John Tyberg was a pivotal recruit for me since our basic research interests were similar,” says Dr. Eldon R. Smith, OC, Professor Emeritus, University of Calgary who recruit-ed Tyberg to Calgary in 1981. “His appointment allowed me to continue with some experimental investigation without the day-to-day responsibilities of running the lab. John has been a most valued colleague and friend ever since.”

LIBIN LIFE 13

“I thought I wanted to be a mechanical engineer but then I became interested in medicine and physiology instead. I became interested in the heart becauseit moves.”— Dr. John v. Tyberg

Dr. John V. Tyberg in his HIRC lab.

Phot

o of

Dr.

John

V. T

yber

g by

Lyn

da S

ea

14 LIBIN LIFE

During his career, Tyberg has played a major role as a mentor, educator, researcher, and author of numerous academic papers in high ranked journals. He has supervised more than thirty graduate students and postdoctoral research fellows, and inspired them to achieve remarkable successes. One resident researcher, Dr. Douglas R. Hamilton, MD, PhD later became a NASA flight surgeon and biomedical engineer. Dr. Nairne Scott-Douglas, MD, PhD, Head, Division of Nephrology and Clinical Associate Professor of Medicine, remem-bers first working in Tyberg’s lab in 1982 doing his undergraduate degree in physiology. He says Tyberg encouraged him to go into medical school and he returned to the lab do his PhD from 1983 to 1988. “Everything I am doing now and have today, I owe to John—it was built on what he gave me. The one word that describes John is respect. He teaches you that your ethics, how you act and treat people is more important than anything else,” says Scott-Douglas. “He often espouses views that are contrary to the current dogma in physiology and he does that time and time again and has proven himself right.” In 1985, Tyberg published a significant paper in Circulation validat-ing the flat balloon method to measure pericardial pressure. Prior to this, it was assumed pericardial pressure equaled zero and he showed how this was not true. This tool to measure pericardial pressure is the standard reference method still in use today. “I was lucky to work with one of the leading researchers in the world in cardiac mechanics,” says Dr. Otto Smiseth, a postdoctoral fellow from 1982 to 1984 who worked on this pericardial study with Tyberg. He is now a Professor of Medicine and head of the Division of Cardiovascular and Pulmonary diseases at Oslo University Hospi-tal in Oslo, Norway.

Smiseth is currently the personal physician for His Majesty, Harald V, the King of Norway. He credits Tyberg with inspiring his career interest in diastolic heart failure. “He’s exceptionally creative, collaborative and focused. The big impact for me from John Tyberg has not been just the research but it’s also his school of thinking. Good work was the most important thing. He never compromised quality. John’s one of the fundamental guys.” Earlier this June, a coterie of colleagues, students and former collaborators gathered in Kananaskis for a symposium in his honour and to celebrate Tyberg’s 75th birthday. Speakers flew in from Taiwan, Norway and the U.S. and their presentations covered the whole gamut of dynamic properties of the heart and blood vessels to clinical cardiology. “We came together to celebrate John’s birthday, his contributions to research, and his tremendous impact on his trainees and collabora-tors,” says lab manager Cheryl Meek. She has worked with Tyberg for the last 32 years. “This lab is a go-to spot and John’s knowledge is so vast that there’s a touch point for everyone,” she says. “I’ve taken the teamwork he teaches and everything out into my life. He’s had a huge impact not only on my work life but my personal life too.” In examining the man behind the research, it’s obvious that Tyberg has had a rich legacy and continues to assert his relevance in the field of cardiovascular research dealing with classical physiology from basic sciences to its clinical implications. As one of his major collaborators, Dr. Israel (Sonny) Belenkie, says, “He has lots of great ideas. He’s a terrific scientist and never compromises the science. If I had not had my sabbatical year (1986) in the [Tyberg] lab, and continued to work with him after that, I am certain I would not have spent as much time and effort in research as I did.”

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

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

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

By Gregory Harris • Photos by Lynda Sea

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

blood pressure 20 years ago. Sarpal realized she had to deal with the stress and depression she felt. She enrolled in an six-week Better Choices, Better Health program offered by Alberta Health Services (AHS), which teaches the healthy benefits of lifestyle choices like diet, exercise and meditation. “I’m still on low doses of medication for high blood pressure, but I now have a much greater sense of well-being,” she says. “I’m eating better and I exercise at least twice a week.” High blood pressure or hypertension—sometimes called a silent killer because it has no warning signs or symptoms—is a condition of increased force against the walls of the arteries as blood flows through them. Anyone who lives with untreated high blood pressure faces increased risks from heart attack, heart failure and stroke. But now, researchers at the Libin Cardiovascular Institute of Alberta have pinpointed specific segments of the population at greatest risk of those health outcomes. A landmark research study that tracked 3.5 million Canadians with high blood pressure for up to 12 years found that men, the elderly and people living in low-income or rural areas generally have poorer health outcomes than other segments of the population. “Until now, we haven’t had benchmark infor-mation on the overall state of the population,” says Dr. Hude Quan, MD, PhD the lead author of the paper, U of C professor and co-chair of the Quality Improvement Committee of the AHS Cardiovascular Health & Stroke Strategic Clinical Network. “These findings will enable us to determine in the future whether our prevention and treatment approaches in addressing hypertension are having an impact.”

The study shows mortality rate among hypertensive Canadians from all causes was 22.4 per 1,000 person years, meaning about 22 deaths would be expected among 1,000 hypertensive persons observed for one year. Researchers speculate that health outcomes could be poorer for the elderly due to what are called co-morbidities, or additional diseases or health conditions. Hypertensive men may

fare worse than women because of negative lifestyle factors, such as smoking or alcohol consumption, and it’s well established that low-income populations generally have poorer overall health than those in higher socio-economic groups. “Although treatment and control of hyperten-sion in Canada has improved over the last decade, at least one in five Canadians has high blood pressure,” says Dr. Norman Campbell, one of the study’s co-authors. “Globally, almost one in three has hyper-tension and it’s the leading cause of disability

worldwide.”

Landmark Study Tracks Toll of Hypertension on 3.5 Million Canadians

RESEARCH

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

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

16 LIBIN LIFE

Dr. Matthew James’ project on “Predicting the need for community care for chronic kidney disease follow-ing hospitalization with acute kidney injury” was awarded a CIHR Oper-ating Grant. His study will use data from Alberta and Ontario to develop and evaluate a tool that will identify high risk individuals who require more intensive follow-up in the community, and low risk people who can safely receive routine follow-up.

By the Numbers Of the 3.5 million people included in research study: 29.4 % were under 50 35.6 % were aged 50-64 35 % over 65 48.2 % of sample were male

Dr. Hude Quan MD, PhD (left) and Dr. Norman Campbell (right)INSET Gurmit Kaur Sarpal

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

R E C E N TFUNDINGS U C C E S S E S

BY JUDY SIU

Dr. Matthew James’ project on “Predicting the need for community care for chronic kidney disease follow-ing hospitalization with acute kidney injury” was awarded a CIHR Oper-ating Grant. His study will use data from Alberta and Ontario to develop and evaluate a tool that will identify high risk individuals who require more intensive follow-up in the community, and low risk people who can safely receive routine follow-up.

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

Photo and Story by Lynda Sea

Ask Kathryn King-Shier, PhD, what her ultimate goal is behind her research and she doesn’t miss a beat.“I want every coronary syndrome patient to have

quick and effective access to healthcare,” she says. King-Shier is a Professor in the Faculty of Nursing and the Department of Community Health Sciences at the University of Calgary. Known for her innovative work in identifying symptoms of heart health issues in women and ethnic groups in Canada, she has a multi-method research program where she focuses on cardiac recovery and determinants of heart health decisions. She is currently looking at the sex and ethnic variations in acute coronary syndrome (ACS) symptoms and the access to care among different ethnic groups including the European (Caucasians), South Asian and Chinese population. The study is recruiting 1,827 patients from 14 sites across Canada, mostly from Toronto, Vancouver and Calgary and look-ing at presentation differences among those three groups. It is the largest and most encompassing study about ethnic and sex differences in cardiac symptoms and access to care done in Canada and globally, to date. “Seven years ago, we did a health record audit in the Calgary Health Region and noticed that Chinese and South Asians were wait-ing longer than Caucasians to come in to hospital. This may have been the reason why the Chinese and South Asians also were less likely to receive throm-bolytic therapy,” she says.

LIBIN LIFE 17

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

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

Kathryn King-Shier

Language barriers, dependency on family members as well as cost concerns are just some of the potential reasons that delay some people from getting themselves care in a timely manner, says King-Shier. Once findings from this major study are available, King-Shier says, “The next challenge will be to look at how this information can be disseminated to the different knowledge users.” Her next project will be focusing on how different ethnic groups learn health information best, “so we can really make sure this information gets into the hands of potential patients.” King-Shier first worked as an ICU nurse at the old Holy Cross Hospital. She says her exposure to the site’s cardiac care program inspired her to focus on cardiovascular health when she decided to do her Masters and PhD and pursue active research. Her frequent collaborators include Dr. Hude Quan, MD, PhD (Community Health Sciences) and Dr. Nadia Khan from the University of British Columbia (UBC) on the ethnocultural studies. She also currently works with Dr. Paul Fedak, MD, PhD on the Kryptonite studies.

Examining ethnic and sex differences in acute coronary syndrome patients and in access to cardiac care

Story by Connie Bryson • Photos by Trudie Lee

T hirty-seven years ago, 14-year-old Belinda Coffin (now Belinda Osborne) waved goodbye to her older brother Brent as he dropped her off at Sea Cadets on his way

to play hockey. It was the last day she saw Brent alive. Everyone thought it was a brain hemorrhage. Little did the Coffin family know, the cause of death was actually a genetic disease that would play further havoc with their lives. In the 1990s, Belinda’s brother Barry nearly died when his heartbeat raced out of control while he was playing hockey. He was treated and diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC), a condition where the heart muscle breaks down over time and is replaced by fat and scar tissue. This process can affect the heart’s electrical system, causing an abnormal heart rhythm (arrhythmia). In some cases, a prolonged arrhythmia can result in fainting or sudden cardiac death. Last summer, the disease struck again. Belinda’s nephew, a military pilot, was playing soccer when his heart stopped. He was revived and successfully treated. This latest brush with death prompted many members of the family to seek genetic testing for ARVC. The condition is inherited and caused by defects in desmosomes, which are structural components of the heart responsible for maintaining cell-to-cell adhesions. The child of an affected parent will have 50 per cent chance of inheriting the abnormal gene. But it gets complicated. “Not every person who inherits the genetic predisposition to ARVC will have the same initial presentation, symptoms, age of onset, or even develop clinical signs of the disease at all,” says Dr. Brenda Gerull, a cardiologist, geneticist, and cardiac researcher. In 2004, Gerull found the first gene for ARVC. She says many unknowns still ex-ist such as what factors might protect some carriers of the abnormal gene from developing clinical signs of ARVC. Although implanting a cardiac defibrillator (a device that shocks the heart into a steady rhythm when it detects a life-threatening

arrhythmia) in everyone with the mutation for ARVC might seem like a solution, it’s far from practical. “ARVC patients tend to be much younger,” explains Gerull. “They could be living with the device for 50 years or more. It’s not a trivial matter. We have to consider the risk of sudden cardiac death for these patients. We need a bet-ter handle on who is at risk so we can personal-ize treatment.” Along with University of Calgary co-leads Dr. Henry Duff, an electrophysiologist and cardiac researcher, and SR Wayne Chen, PhD, a basic scientist, Gerull has assembled a team of researchers to study the mechanisms behind ARVC and to develop a personalized strategy for predicting arrhythmias. “ARVC is a complex disease that involves an understanding of molecular, physiologic, and genetic mechanisms,” she says. “That’s why we’ve designed an integrated program that involves an interdisciplinary team with wide-ranging expertise. Looking ahead, we believe that the insights gained from this study will also provide new information for the treatment of arrhythmias in more common cardiac diseases, such as heart failure.” A key aspect of the research will be translat-ing the results to clinical care. Gerull has already established a genetic heart rhythm clinic where cardiologists, geneticists, counsellors, and social workers all work together. Belinda, who works as a nurse in Calgary, has been to the clinic. Genetic testing revealed that she carries the ARVC mutation. Her two teenage daughters are now being tested. “We’re very priv-ileged in Alberta to have access to this advanced genetic testing,” she says.

Shedding Light on Genetic Heart DiseaseLibin researchers study the mechanisms behind arrhythmogenic right ventricular cardiomyopathy (ARVC) to develop a personalized strategy for predicting arrhythmias

18 LIBIN LIFE

CRIO FundingGerull, Duff and Chen’s work is funded by the Alberta Innovates – Health Solutions Collaborative Research and Innovation Opportu-nities (CRIO) program. The three-year study began early in 2013. The project aims to 1) Identify the factors that account for the reasons why not all people with the mutation for ARVC actually develop the disease 2) Understand better the mechanisms behind those arrhythmias 3) Assess the effectiveness of two drugs in suppressing arrhythmias.

The full version of this article origi-nally appeared in Health Solutions Spring 2013. It has been condensed and reprinted with permission from Alberta Innovates - Health Solutions. (aihealthsolutions.ca)

Dr. Brenda GerullLEFT Belinda Osborne

COMMUNITY ENGAGEMENT

LIBIN LIFE 19

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

and festivities got underway with a build-your-own burger station and face-painting. There was also a green-screen photo booth where individuals could pose with zany props and costumes and get their photos taken with fun animal backgrounds. Zookeepers brought out an alpaca to the west lawn and kids and their families got a close encounter of the animal kind. Institute director Dr. Todd Anderson said a few words of thanks to guests for attending as well as recognized the collective efforts of the cardiovascular community’s hard work in cardiac sciences across the city. The day was a great way to celebrate the health care practitioners, nurses, lab staff, grad students, researchers and trainees for their contributions to cardiac sciences in Calgary. Thanks to everyone who came out and we look forward to seeing you at next year’s event!

Wild at Heart

Earlier this April, more than 125 people connected with the Heart and Stroke Foundation (HSF) and visited the University of Calgary to tour research labs at the Libin Cardiovascular Institute of Alberta and the Hotchkiss Brain Institute. Guests included HSF CEO Donna Hastings, donors, staff and volunteers, captains and canvassers who’ve participated in Heart and Stroke’s door-to-door campaigns. Each tour stream visited three labs where attendees got a chance to peek into research spaces, ask direct questions to the researchers and to see, first-hand, what their fundraising efforts are supporting. Speakers from Libin included Elena Di Martino, PhD, Dr. Ed O’Brien, Dr. John V. Tyberg, MD, PhD and Dr. Henry Duff among others. Di Martino is a biomedical engineer who is working to develop a mechanical imaging sys-tem to study heart and blood vessels and the development of engineered blood vessels. Dr. Ed O’Brien studies vascular biology and is particularly interested in heat shock proteins that could have the potential to prevent hardening and subsequent damage to arteries. The Heart and Stroke Foundation has been a long-standing partner of the Libin Cardiovascular Institute of Alberta, funding research that has impacted the lives of millions of Canadians.

Heart and Stroke Lab Tours

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

Photos by Suddha Sircar

20 LIBIN LIFE

Despite the high prevalence of cardiac disease and its causes, there is currently no structured cardiac care system in Guyana. For the last decade, there

has been an ongoing effort by Libin member Dr. Kishan Narine to improve cardiac care in the South American country. “When I was there in 2002, because of a lack of cardiac care, patients who needed cardiac interventions were sent abroad,” says Narine, a cardiothoracic surgeon. Recognizing the urgent need for cardiac care and im-proved health care in general, the Government of Guyana has joined this effort with current focus on cardiac and renal disease, both in terms of treatment, prevention and education. The focus at present is to make these services locally available with Libin support, says Narine. Libin members led by Dr. Debra Isaac include Dr. Nairne Scott-Douglas, Dr. Wayne Warnica, Dr. Nanette Alvarez, Dr. Todd Anderson and Dr. Narine who are collaborating with Dr. Serdar Yilmaz, former Medical Director of Southern Alberta Transplant Program. They are working with the Government of Guyana to develop a strategy for chronic disease management. In Guyana, non-communicable diseases (NCDs), also known as chronic disease, account for more than 70 per cent of deaths. The four main types of NCDs are cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Many of these deaths are preventable with ongoing and early care. Dr. Isaac first went to Georgetown, Guyana’s capital, to help implement a program to educate public hospital physicians in cardiac ultrasound diagnostics, a program supported by the Institute. She says it became clear in her various visits that there was a considerable gap between providing diagnoses and providing quality care to patients with chronic diseases.

LIBIN ABROAD

“There are opportunities to work with the public health system to make a big difference,” says Isaac. She has now established an ultra sound training program that trains doc-tors both in the urban and rural outreach centers. This pro-gram has also evolved to include obstetrical ultrasound. Yilmaz is currently assisting with the establishment of renal care and transplant services in Guyana. He set up an Electronic End Stage Renal Disease Registry and dialysis access database. He is also teaching Dialysis Access Surgery to a local surgeon. He is collaborating with Scott-Douglas, Head of the Division of Nephrology to set up a chronic kidney disease and dialysis program that will support a future transplant program in the country. There are plans to train local health care providers. Yilmaz has already selected a local surgeon from Guyana to train with him in both Canada and Guyana to conduct renal transplant procedures. The team’s combined effort in introducing a Multidis-ciplinary Chronic Disease Management model and provid-

ing clinical skills and train-ing to health care providers has been recognized by the Government of Canada as the Canada-Guyana Partnership for Health Care Development, as announced by former High Commissioner of Canada in Guyana, Mr. David Devine. In addition to chronic disease treatment, a partnership with the University of Guyana has also been forged and the ul-

trasound program was integrat-ed into the local curriculum. “Our next step is to expand the model to include heart

failure, hypertension, diabetes, and lung disease in the public hospital clinic, with outreach to the community health clin-ics, thus increasing the ability to improve health care deliv-ery and outcomes,” says Isaac. Under Warnica’s guidance, a cardiac intensive care unit is being built. “This project wouldn’t have been possible without the support and commitment of Todd Anderson and Al-Karim Walli,” emphasizes Narine. “Their support was crucial.”

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

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

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

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

Dr. Nairne Scott-Douglas

Dr. Kishan Narine

(L-R) Mr. Sheik Amir (chief of medical staff, GPHC), Dr. Debra Isaac, Dr. Serdar Yilmaz, His Excellency Donald Ramotar (president of Guyana), Dr. Kishore Persaud, Mr. Michael Khan (CEO GPHC), Hon. Dr. Bheri Ramsaran (Minister of Health of Guyana).

For Dr. Teresa Kieser, her recent trips to Almaty and Astana, Kazakhstan have been a career highlight. Kieser’s rewarding experience in this Central Asian republic began with a published study in 2010 to evaluate transit-time flow (TTF) as a tool to detect technical errors in bypass grafts, intra-operatively, and to predict outcomes. According to Keiser, measuring TTF gives the surgeon the chance to revise problematic grafts or identify other problems while the chest is still open. “The bottom line is, if you use this and you have a good graft in the operating room, the chances are you are going to have a good result in your patient,” she says. The findings led to worldwide attention and were included in the ESC/EACTS “Guidelines on Myocardial Revascularization” devel-oped by the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS).

Kieser in Kazakhstan:Transit-Time Flow (TTF)

Earlier this year, Dr. Tanvir Chowdhury Turin, MBBS, PhD, associate member of the Libin Institute and Assistant Professor of Community Health Sciences at the University of Calgary wrote and independently published a 144-page book in Bangladesh about blood pressure. Its title in Bengali, Satkahon: Rokto Chap, translates in English to Everything about Blood Pressure. Jagriti Publica-tions published 500 copies of the book which was launched at the Mother Language Book Fair in Dhaka in February. “It introduces the fundamentals of blood pressure, both high and low, but with special focus on high blood pres-sure,” says Turin. The book explains the causes of the blood pressure-problem, other associated chronic diseases, complications, control and preventive initiatives. The various chapters outline themes behind basic understanding of how our bodies’ circulation system works. It includes information on high blood pressure (HBP) and its relationship to diabetes, stress, pregnancy and children and dietary issues. It offers strategies for controlling HBP at the personal and

community level. Turin wanted readers to be informed about the basics in order to ask the proper questions about their health with their physicians. He sees it as a resource to help the Bangladeshi community make informed decisions in their lifestyle modification efforts to prevent or control hypertension. Looking forward, Turin says there’s potential plans to reach the South Asian community in Calgary where there are more than 5,000 in the Bangladeshi community. —Lynda Sea

Turin Publishes Blood Pressure Book in Bangladesh

EDUCATION

Why Aren’t More Women Getting Cardiac Rehab?Despite the fact that women with coronary artery disease (CAD) derive greater benefit from attending cardiac rehabilitation than men, they are less likely to be referred and less likely to attend. Dr. Jillian Colbert, an echocardiography fellow at the University of Calgary discovered this in her study “Cardiac Rehabilitation Referral and Attendance in Women: A High Risk Population with Two Strikes Against It.” Colbert and her colleagues suspect the reason for low attendance and referral is due to a number of factors: family obligations, trans-portation issues and putting their own health last. She presented her findings earlier this spring at the American College of Cardiology’s 62nd Annual Scientific Session (ACC.13). She won “Best FIT Poster” for her abstract; this designation repre-sents the top 3% scoring percentile of accepted posters from fellows in training. Colbert collected her data from a cohort of almost 26,000 patients from the APPROACH and CWIC databases. She cites Dr. Billie-Jean Martin, Dr. Sandeep Aggarwal, Trina Hauer and the APPROACH group as key collaborators. Dr. James Stone is her research supervisor.

Syncope expert Dr. Robert S. Sheldon is running a few ran-domized controlled trials called POST (Prevention of Syncope Trials) to look at different interventions for vasovagal syncope—one of the most common causes of fainiting. He points to a phenomenon where there’s improvement in vasovagal syncope patients who come for their first visit. To examine the prevalence of syncope rates dropping or even stopping, Sheldon’s student Payam Pournazari did a comprehensive meta-analysis and literature review of system-atically acquired clinical trials. They found about 1400 patients had a median number of four faints in the preceding year, more than 98% of them had fainted in that year, and they had been fainting for years. Of these, about 50% just stopped completely. Pournazari’s poster “Meta Analysis of Factors Predicting Spontaneous Remission in Frequent Vasovagal Syncope” was one of 20 Featured Posters at the 2013 Heart Rhythm Society 34th Annual Scientific Sessions. This abstract has also been accepted for oral presentation on October 17 at the Canadian Cardiovascular Congress during Vascular 2013 in Montreal.

Studying Syncope

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

This in turn garnered the attention of Dr. Serik Mendykulov in Astana, Kazakhstan when they purchased the Medistim VeriQc, the newest device of TTFM. This machine now combines assessment of both function and anatomy of bypass grafts with the addition of an ultrasound probe. Kieser’s first trip to Kazakhstan in October 2010 came as a promise to speak and train fellow physi-cians on the new technology and ended with two successful surgeries. Recently, she returned to follow up with two workshops, a talk and a surgery. While Kieser finds her visits extremely reward-ing, she is met by many cultural barriers. Female cardiac surgeons are a rarity worldwide, and most

staff and surgeons in Kazakhstan do not speak English. Despite these challenges, Kieser hopes to expand on the partnership by bringing surgeons from Kazakhstan to Calgary to observe Canadian techniques in the future, and return with them to apply the training. —Amber Arsneau

22 LIBIN LIFE

Sharing Science

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

This year’s theme was heart electrophysiology. The day opened with opening remarks from Donald Welsh, PhD, Chair of the Libin Education Committee and Dr. Todd Anderson, Director of the Libin Institute. Dr. Ed O’Brien, the Institute’s Research Director then delivered a presentation about the future of research at Libin. Eleven trainees presented Rapid Fire Talks and fielded questions from the audience. During lunch, more than 20 judges and general attendees engaged with the trainees at their posters. There were a total of 63 posters in the showcase. In the afternoon, SR Wayne Chen, PhD, HSF/Libin Professor, Physiology & Biophysics and Biochemistry & Molecular Biology presented his latest research on ryanodine-receptor- associated cardiac arrhythmias and cardiomyopathies. Dr. Brenda Gerull followed up by delivering her talk on “Arrhythmogenic Cardiomyopathy: From Bench to Bedside.” She shared research she’s working on involving examining gene mutations that cause predominant left-ventricular arrhythmogenic cardiomyopathy in homogygous carriers in Hutterite populations. Dr. Mark Anderson, Head of Internal Medicine at the University of Iowa – Carver College of Medicine, delivered the 2013 Dr. E.R. Smith Lecture. He spoke on the multifunctional Ca2+/calmodulin dependent protein kinase II (CaMKII) and shared his discoveries on its relationship to myocardial dysfunction and arrhythmias. Special thanks to all the speakers, our sponsors Zymmetrix and Innovate Calgary, philanthropist Tine Haworth and her family and everyone who came out for this event.

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

POSTER COMPETITION WINNERS

CLIN

ICA

L TR

AIN

EE TRAINEE Dr. Jillian D. ColbertABSTRACT TITLE Cardiac Rehabilitation Referral and Attendance in Women: A high risk population with two strikes against itSUPERVISOR Dr. James Stone

GRA

D S

TUD

ENT TRAINEE Osama Harraz

ABSTRACT TITLE Protein Kinase A Regulation of T-type Calcium Channels in Cerebral Arterial Smooth MuscleSUPERVISOR Donald Welsh, PhD

POST

DO

CTO

RAL

FELL

OW

TRAINEE Ramesh MishraABSTRACT TITLE Endothelial Kca Channels Regulate Blood Pressure in a Large Animal ModelSUPERVISOR Andrew Braun, PhD

(L-R) Jonathan Lytton, PhD, Donald Welsh, PhD and Dr. Mark AndersonDr. Eldon R. Smith (left) and Dr. Robert Sheldon (right) engage with trainees at the Poster Competition Showcase

There were 63 posters in total in the Poster Competition Showcase

Illustrations by David (DaWei) Liu

“This is one of the illustrations David (DaWei) Liu made for us to explain how we obtain ultra-thin muscles (trabeculae) from the right ventricle of the rat heart. Back in the mid-to-late 80s, we had needed more help keeping our lab clean. David was quite happy to help us out with regular maintenance of the lab. His wife Pauline worked in the Foothills. One Christmas, Pauline stopped me in the hallways of the Foothills and gave me a fantastic 1 by 1½ foot drawing of a cocker spaniel. I was baffled by the beauty of the drawing and asked her for the source. David appeared to be the artist. I was deeply embarrassed to have asked a man with those talents to do menial tasks in the lab. Next time I saw David, he agreed to help me with artwork for our science projects. I had always made these drawings myself but they were very simple as I am not an artist. So I made the sketches while we peered through the microscope together and David turned the sketches into real artwork. People always ask, how do you get those muscles and the answer is well, take a look at the next slide. I’ve been using these drawings in very highly respected international meetings and still continue to use them whenever we present our work. It’s also in my teaching slides for new students. The drawing is big and the heart of the rat is very small. You have to know what you’re looking at when you are in the lab and this helps tremendously. Shortly after turning into our scientific illustrator, David decided to go completely in the art direction and became a well-respected teacher of art and a highly appraised artist in Calgary.”

D I A G R A M O F A

Dr. Henk ter Keurs shares the story behind his oft-used illustrations of a trabecula dissection

SR Wayne Chen, PhD

POSTER COMPETITION WINNERS

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

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

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

TRAINEE Xixi TianABSTRACT TITLE Abnormal Termination of Ca2+ Release Is a Common Defect of RyR2 Mutations Associated with CardiomyopathiesSUPERVISOR SR Wayne Chen, PhD

Dr. Brenda Gerull

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

TOP Right ventrical wall cutBOTTOM Cutting the tricuspid valve

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

NathaN BraceyCurrent Pursuit MD/PhD Student

suPervisor Dr. Henry Duff

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

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

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

ryaN MillsCurrent Pursuit Post-doctoral researcher in Vascular Biochemistry, University of Calgary

suPervisor Michael Walsh, PhD

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

researCh interests Protein biochem-istry and investigating how proteins accomplish important biological functions. He is using a model system involving the rat tail artery to under-stand the role of tyrosine phosphory-lation of a protein called Pyk2 in smooth muscle cells. This biochemi-cal process may be important for how the cells process signals such as hormones and medicinal drugs to regulate blood flow.

about Me “I have a twin brother. I also studied university level Mandarin Chinese concurrently with my PhD, and am currently learning ballet and martial arts.”

MarNi arMstroNgCurrent Pursuit PhD in Cardiovascular and Respiratory Sciences

suPervisor Dr. Ron Sigal

Degrees Bachelor of Science in Kinesiology (2002), Simon Fraser University; Registered Clinical Exercise Physiologist, American College of Sports Medicine

researCh interests To better integrate “exercise as medicine” into diabetes and cardiovascular health care delivery. Her research examines the utility of pre-exercise stress testing in people with diabetes, along with how to improve adherence to exercise interventions in people with Type 2 diabetes.

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

Dr. JilliaN colBertCurrent Pursuit Subspecialty Fel-lowship in Adult Echocardiography

suPervisor Dr. Lisa Welikovitch

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

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

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

SPOTLIGHT ON TRAINEES

Compiled by Amber Arsneau • Photo by Lynda Sea

FSCLOGO