Excellent Care and Leading Innovation: UT Medicine Cardiology

By Maggie Behringer
Tuesday, November 15, 2016

With its doctors’ ability to quarterback comprehensive cardiac and vascular treatment, extensive involvement in clinical research and technology development, and deep commitment to the local South Texas population, the Department of Cardiology at UT Medicine is quickly becoming the area’s preferred choice for cardiovascular care.

When a patient presents with anything from chest pain to a foot ulcer, the physicians of UT Medicine Cardiology complete a full cardiovascular disease risk assessment and can serve as the point of contact within a network of specialists to provide comprehensive, holistic treatment.

“We can be the quarterback,” says Anand Prasad, MD, FACC, UT Medicine cardiologist, Associate Professor of Medicine and Freeman Heart Association Professor in Cardiovascular Disease at the UT School of Medicine at San Antonio, who specializes in vascular medicine.

For the diagnosis of vasculitis, for example, Dr. Prasad partners with dermatologists. For a blood clot or hypercoagulable state, he works with hematologists. In the arena of limb salvage, he works with primary care providers and podiatrists to improve arterial supply to nonhealing wounds and avoid amputation.

Marc Feldman, MD, interventional cardiologist and Medical Director of UT Medicine Cardiology, provides management for general cardiology cases and intervention in the catheterization lab.

“We have physicians who are very good clinicians and who are also involved in clinical research. They are not only caring for patients, but also solving healthcare problems at the same time.”
— Marc Feldman, MD, Professor of Medicine and UT Medicine Cardiologist

Both specialists, along with their colleagues, couple their clinical work with ongoing translational research. Through their research, Drs. Feldman and Prasad are committed to better understanding cardiac and vascular diseases and their treatment, to better serve patients.

“It’s exciting to know that when you see problems in your clinical practice, you have the tools and the teammates to solve them,” Dr. Feldman says.

Steven Bailey, MD, Chief, Department of Cardiology, with medical students at University Hospital

The Tech Advantage

In Dr. Feldman’s experience, the endeavor to solve problems in clinical care frequently leads to the development of new technologies. To date, he has been instrumental in establishing three new treatment concepts, each of which has led to patented cardiac devices. The first dealt primarily with stenting treatment, while the second involved the use of light to understand the composition of coronary blockages or stenosis.

Marc Feldman, MD, UT Medicine cardiologist and Director, Cardiology Research and Innovation

The third is called CardioVol, which Dr. Feldman developed while working with Admittance Technologies. CardioVol’s low-power circuit, which can be used with implantable defibrillators and cardiac resynchronization therapy hardware, delivers electric charges to the heart through the patient’s existing pacemaker leads. The information gathered provides the most accurate measure of blood volume and the amount of blood ejected with each heart beat (stroke volume). These real-time measurements can, in turn, act as a warning system of an arrhythmic event and prevent a false shock for patients with implantable defibrillators or aid in real-time adjustments for patients undergoing cardiac resynchronization therapy.

The information CardioVol provides related to blood pressure and volume can also help manage patient care in cases of heart failure, particularly in avoiding readmission to the hospital.

“We know that in some patients, daily measures like patients weighing themselves are not adequate to keep patients out of hospitals,” Dr. Feldman says. “We also know the heart will begin to increase in pressure and volume up to 10 days in advance of admission for a cardiac event, which can provide us time to be more aggressive in treating them because we can have this early warning.”

By gauging the amount of blood in the heart at rest (diastole), the CardioVol device can warn both the patient and his or her physician in the event that the heart begins to dilate. Most recently, Admittance Technologies completed a 30-patient trial pairing CardioVol technology with 3-D echocardiography and is now in discussions with pacemaker manufacturers for future clinical studies.

Looking to the Future

The physicians at UT Medicine Cardiology are also pioneering discoveries in the area of kidney disease as it correlates with vascular disease. In April of this year, Dr. Prasad and his colleagues hosted the inaugural “Cardio Renal Connections” conference. Primary care providers, cardiologists, nephrologists and vascular experts gathered to explore issues that impact the kidneys in patients with peripheral atrial disease and heart failure, as well as patients undergoing such procedures as transcatheter aortic valve replacement (TAVR).

Anand Prasad, MD, FACC, UT Medicine cardiologist, Associate Clinical Professor of Cardiology

As Dr. Prasad explains, the well-known trends of an aging population and an increase in diabetes contribute to a rise in both peripheral vascular disease and chronic kidney disease.

“The two are inseparable and the real complications are inevitable in patients with advanced kidney disease,” Dr. Prasad says. “You’re going to see more and more patients with advanced kidney disease and PVD, whether you’re a primary care provider or an interventional cardiologist. The question is, are they two completely separate issues?”

In his opinion, the answer is no. Worsening renal function corresponds with decreased vascular function, which leads to increased calcification and an increased risk of amputation. Treating patients, whether with surgery or endovascular intervention, involves contrast dye and the manipulation of catheters, both of which can also impact renal function. The interaction between the diseases bears more scrutiny. To that end, this June Dr. Prasad and his colleagues published the results of a survey in the journal Catheterization and Cardiovascular Intervention. The paper reports that roughly 40 percent of respondents to the survey did not follow evidence-based guidelines for preventing risk to the kidneys when performing invasive angiography in a catheterization laboratory setting. These practices included determining patients’ risk of kidney injury, assessing kidney function, calculating contrast thresholds and seeking a consultation with a nephrologist for patients at risk of kidney injury.

“It’s become a tricky situation and one where we need more information and data,” Dr. Prasad says.

An Eye on the Local Region

As the new Program Director of the Cardiovascular Fellowship at the School of Medicine, Dr. Prasad is focused on community engagement. One such project is geared toward reducing diabetes in San Antonio and South Texas. According to the South Texas Diabetes Initiative, roughly 76,000 residents of the Rio Grande Valley live with the condition.

As Dr. Prasad explains, the majority of research to date has concentrated on diabetes in Caucasian adults, leaving a scarcity of information on a key, local population: Mexican-Americans. The Cardiovascular Fellowship program recently received a grant to investigate the link between diabetes, ethnicity and peripheral vascular disease (PVD) in that community.

“This region of South Texas and the Rio Grande Valley has one of the highest rates of diabetes in the country, with one out of three people in the community affected,” Dr. Prasad says. “Patients in this region also have a very high risk of amputation. As such, we’re actually studying the prevalence of vascular disease in Mexican-Americans, trying to understand the novel and emerging risk factors for PVD.”

Taking the research one step further, the team will also be analyzing the frequency and geographic distribution of amputation within Texas, specifically attempting to pinpoint temporal trends.

Luckily for patients in the San Antonio area, the UT Medicine Cardiology practice is looking at a comprehensive, long-term strategy for cardiac and vascular care.

To refer a patient to UT Medicine Cardiology, call 210-450-6330.