2011 July - December - nuhcs

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Work &Experience at NUHCSDr. Eliana C. MartinezMD, PhDTime goes by very fast and in the blink ofan eye, five years have passed since I joinedthe National University of Singapore (NUS)and the National University Heart Centre,Singapore (NUHCS). A few passions of minewere combined through the opportunity tomove to Singapore: search for knowledge,exposure to multicultural environments, andpersonal development. Also, another reasonmotivated me to join the team that wouldstart-up a basic research laboratory underthe mentorship of A/Professor TheodorosKofidis at the NUHCS’ Department ofCardiothoracic and Vascular Surgery (CTVS).And this reason was my wish to take mycareer up to the next level.As a Colombian medical doctor, I hadaccomplished research post-doctoral trainings at StanfordUniversity (USA) and Hannover Medical School (Germany),moving to Singapore has been quite a fascinating and enrichingexperience. Besides, this has definitely been a good move formy scientific career as the country is a vibrant research hub inbiomedical sciences, with plenty of opportunities to acquirefunding and interact with other scientists and clinicians fromvarious disciplines and institutions. I have also been fortunate toalways count on the support from my boss, Professor Lee ChuenNeng, Head of Dept of CTVS, who has provided me with the trust,and independence I needed as a young researcher. Thanks to thissupport, I also had the exceptional opportunity to pursue a PhDdegree at NUS concomitantly to my work as a Research Fellow.Starting-up a new lab was not easy, but the learning experiencewas invaluable. A/Prof Kofidis’ Myocardial Restoration Lab wasup and running by mid-2007, and soon after, I got the chance toobtain my own funds through an NMRC/New Investigator GrantAward in 2008. This provided me a great foundation to furtherdevelop independent scientific reasoning.In the past five years, my research has been focused on thedevelopment of pre-clinical projects with translational potentialaiming at enhancing the angiogenic potential of tissue-engineeredgrafts towards improvement of cardiac performance followingmyocardial ischemia. Since <strong>July</strong> <strong>2011</strong>,I have been fortunate to have a jointappointment with the CardiovascularResearch Institute (CVRI) under thedirection of Professor Mark Richards.The NUHCS/CVRI is constituted by a multidisciplinary researchteam aimed at pursuing translational cardiovascular research,and offers me the possibility to work in an environment thatfacilitates the development of my full potential as a scientist.My future research goals within NUHCS/CTVS-CVRI involvethe development of novel therapies for heart failure throughpost-ischemic acellular regenerative strategies that will involvemodulation of paracrine signaling to promote angiogenesis andattenuate fibrosis after myocardial injury. I am interested inapproaches with realistic clinical application that can be deliveredto the patient with least morbidity and surgical complications.Furthermore, I am expanding my research scope at CVRI bygetting involved in projects aimed at a better understanding ofneuroendocrine pathways and their possible modulation throughnovel therapeutic compounds.It definitely requires dedication to perform as a young scientistabroad. Yet, my professional growth thus far would have not beenpossible without the infrastructure and opportunities provided byNUHCS, and the support from my mentors, colleagues, studentsand collaborators. I am very much looking forward to my upcomingyears in NUHCS, in the hope that all our combined efforts willproduce science with high clinical impact.NUHCS PULSE | 8
What isOptical CoherenceTomography?A/Prof Ronald LeeSince its inception 25 years ago,percutaneous coronary intervention (PCI)has gained widespread acceptance, andcoronary stent implantation has become thestandard revascularization therapy for mostpatients with obstructive coronary arterydisease. Yet, instent restenosis and stentthrombosis are two major complicationslimiting the benefits of PCI. Although the emergence of drug-elutingstents has remarkably reduced the occurrence of instent restenosis,stent thrombosis—which is associated with high incidences of fataland non-fatal myocardial infarction—remains an unsolved problem.In fact, late stent thrombosis occurs more frequently following drugelutingstent than bare metal stent implantation. Moreover, the useof drug-eluting stents in increasingly complex lesions and multivesselcoronary artery disease implies that these complications are likely topersist and effective preventive strategy is warranted.Stand-alone X-ray angiography is the traditional imaging methodguiding PCI, and is still used in majority of the procedures nowadays.Coronary angiography depicts vessel images that are relatively simpleto comprehend, making PCI procedures easy to perform. However,stand-alone angiographic guidance has some inherent inadequacies andlimitations, which, if one fails to recognize, may result in suboptimalprocedural outcomes, as well as acute and long-term complications.Among others, angiography merely produces a planar silhouette ofthe contrast-filled lumen. The severity of the lesion can vary widelywith different X-ray projection angles. In fact, visual interpretationof angiography exhibits significant inter-observer variability andcorrelates poorly with post-mortem examination. In addition, coronaryangiography is essentially a luminography, which provides no insightto the amount, tissue composition, distribution of coronary plaque, aswell as coronary remodeling pattern. After coronary stent implantation,angiography has limited ability to assess the adequacy of stent expansionand stent strut apposition. Therefore, intravascular imaging technologyhas been widely accepted as an essential tool in complex PCI.Until recently, intravascular ultrasound (IVUS) is the onlyintravascular imaging technology available. There are severalpotential utilizations of IVUS when a coronary stenosis is detectedby angiography. As a baseline evaluation tool, IVUS providesquantitative measurement on the extent of artery lumen obstruction,enabling the operator to determine if the patient would benefitfrom revascularization therapy. Once committed for PCI, IVUSalso assists in procedural strategy and device selection. In a singlecenter study, the original revascularization strategy planned waschanged after preintervention IVUSimaging of the target lesions. Followingstent implantation, IVUS plays a crucialrole in optimizing the procedural outcomes,which in turn determines the risk of futurecomplications. IVUS optimizes outcomesthrough assessment on adequacy of stentexpansion, completeness of stent strutapposition and presence of unrecognized dissection or residual stenosis.Optical Coherence Tomography (OCT) has emerged as theintravascular imaging technology. OCT is an imaging modality thatis analogous to ultrasound imaging, but uses light instead of sound.Cross-sectional images are generated by measuring the echo timedelay and intensity of light that is reflected or back-scattered frominternal structures in tissue. Preliminary experiences with OCT imagesacquisition show the technique to be safe. OCT imaging techniquehas gained considerable adoption in many centres across Europe andJapan, and various centres have presented large series of patients imagedby OCT without major complications. Compared with conventionalIVUS, OCT offers several advantages. The resolution of OCT (10 μm)is 10 times better than that of IVUS (100-150 μm). This enables thedetection of procedural complications such as stent edge dissectionwith higher accuracy. In addition, tissue coverage of the drug-elutingstent struts, which has been proposed as a parameter predicting latestent thrombosis, can be assessed reliably by OCT. Acquisition of theimages by OCT is much faster than that of IVUS (20 seconds versus2-3 minutes). Last but not least, OCT is the only technology whichcan accurately measure coronary plaque fibrous cap thickness, whichis one of the most important characteristics underlying a vulnerableplaque. With all these advancements, OCT is perceived to the overtakeIVUS as the predominant intravascular imaging technology in moderncardiac catheterization laboratory.In order for the interventional cardiology team to acquire thenecessary skills and knowledge in this new technology, we weregranted the Academic Medicine Development Award (AMDA) forshort-term training in 2 overseas centers. I have spent four weeksat the Massachusetts General Hospital, Harvard Medical Schoolunder Professor IK Jang. Mr. Anand Kalesam and Miss JY Lee(medical technologists) have each spent 2 weeks at the Thoraxcenter,The Netherlands under Dr. Everlyn Regar. Our OCT program hasstarted since 4 months ago and a few cases of OCT imaging procedureshave been performed. It is anticipated that OCT will becomethe intravascular imaging technology of choice in our catheterizationlaboratory.NUHCS PULSE | 9
Page 2 and 3: in this issue02 (Clinical Vignettes
Page 5 and 6: Fortunately modern and available tr
Page 7: The “Hybrid” operating theatre
Page 11 and 12: We had the pleasure and privilege o
Page 13 and 14: and handsome men from among our col
Page 15 and 16: Bioabsorbable Stent:A/Prof Tan Huay
Page 17 and 18: ESC 2011Dr YeoTee JooI recently att
Page 19 and 20: The new P2Y12 - inhibiiting drugs,
Page 21 and 22: happeningsMO dinner 24 Oct 2012Card
Page 23 and 24: publications1. Annals of Vascular D
Page 25 and 26: 38. Am J Med. 2011 Nov;124(11):1051
Page 27 and 28: Western Vascular Society 26th Annua

2011 July - December - nuhcs

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