Pauley Research Roundup - Spring 2025
A roundup of research published by Pauley faculty from February through May 2025
July 29, 2025
February
All Implantable Cardioverter Defibrillators Are Not Programmed Equal: A Case Report of Pseudomalfunction
Pauley researchers: Gautham Kalahasty, MD; Mark Nelson, MD
Journal: Anesthesia & Analgesia Practice
Publication date: February 1, 2025
During some types of surgery, implantable cardiac defibrillators (ICDs) need to be disabled for patient safety; the devices are typically disabled by placing a magnet around the ICD. If a patient enters an abnormal heart rhythm during surgery, the magnet can be removed to allow the ICD to deliver a shock. This case report describes a situation during heart valve surgery in which a patient’s ICD didn’t respond as expected following magnet removal. The authors stress that not all ICDs work in the same way and suggest that advanced cardiovascular life support protocols (e.g. external defibrillator) may be a better therapy for unstable heart rhythms.
Src inhibition potentiates MCL-1 antagonist activity in acute myeloid leukemia
Pauley researchers: Fadi Salloum, PhD; L. Ashley Cowart, PhD
Journal: Signal Transduction and Targeted Therapy
Publication date: February 10, 2025
MCL-1 is a protein that helps cancer cells in acute myeloid leukemia (AML) survive. Drugs that block MCL-1 can kill these cells, but the cells often fight back by making more MCL-1. This limits how well the drugs work. In addition, some of the drugs that block MCL-1 can also damage the heart.
This study found that using a second drug that blocks a protein called Src can stop this MCL-1 rebound. When both drugs are used together, they work better than either alone. They cause more cancer cells to die by:
- Preventing the cancer cells from making more MCL-1
- Helping the cell break down MCL-1 faster
- Shutting down survival signals inside the cell
- Activating proteins that trigger cell death
This combo treatment worked well in lab-grown AML cells, in patient samples, and in mouse models. It killed cancer cells but did not harm healthy blood or heart cells. This suggests that combining Src inhibitors with MCL-1 blockers could be a better, and less cardiotoxic, way to treat AML.
Characteristics and Outcomes of Patients With Cardiogenic Shock and Clinically Significant Valvular Heart Disease: From the Critical Care Cardiology Trials Network
Pauley researchers: Michael Kontos, MD
Journal: Journal of Cardiac Failure
Publication date: February 17, 2025
This study looked at patients in cardiac intensive care units (CICUs) who had cardiogenic shock (CS)—a life-threatening condition in which the heart can't pump enough blood—and whether they also had serious valve disease in the heart.
Out of over 5,200 patients with CS:
- About 4% had CS caused by valve disease.
- Another 19% had valve disease that wasn’t the main cause of CS.
- The rest had no severe valve disease.
The most common valve problems were mitral regurgitation and aortic stenosis. Patients whose CS was caused by valve disease were more likely to have normal heart pumping strength and had higher death rates in the hospital (40%) compared to the other groups.
The study shows that while valve disease is a less common cause of CS, it’s linked to worse outcomes.
Epidemiology and Prognostic Significance of Acute Noncardiac Organ Dysfunction Across Cardiogenic Shock Subtypes
Pauley researchers: Michael Kontos, MD
Journal: Journal of Cardiac Failure
Publication date: February 25, 2025
This study looked at how non-cardiac organ problems (like kidney, lung, liver, or brain issues) affect patients with cardiogenic shock (CS)—a condition in which the heart suddenly can’t pump enough blood.
Researchers studied over 3,900 patients and grouped them by the cause of their CS:
- Heart attack-related (AMI-CS)
- Worsening chronic heart failure (AoC HF-CS)
- New heart failure (de novo HF-CS)
They found that kidney problems were the most impactful factor in developing CS and that having more than one failing organ while experiencing CS greatly increased the risk of death in the hospital. Patients with AoC HF-CS had fewer organ problems overall, but any organ failure was linked to worse outcomes across all groups.
A call for transparency, improved reporting, and interpretation of trials using surrogate end points in cardiac electrophysiology
Pauley researchers: Jose Huizar, MD; Kenneth Ellenbogen, MD
Journal: Heart Rhythm
Publication date: February 26, 2025
This article urges researchers in cardiac electrophysiology to improve how they report clinical trials that use surrogate end points—indirect markers or measurements that substitute for stronger direct measurements (like mortality, or quality of life) of how well trial treatment works.
The authors recommend two recent tools: SPIRIT-Surrogate and CONSORT-Surrogate, both of which provide best practice and reporting guidelines to researchers using surrogate end points in their clinical trials. The article also provides examples of the “surrogate end point paradox,” in which a treatment has a positive effect on the surrogate marker but a negative effect on the actual clinical outcome. The authors use this paradox to underscore the ethical need guidelines and transparency around clinical trial end points.
March
Conduction system pacing associated with reduced heart failure hospitalizations and all-cause mortality compared with traditional right ventricular pacing in the Medicare population
Pauley researchers: Kenneth Ellenbogen, MD; Jordana Kron, MD
Journal: Heart Rhythm
Publication date: March 1, 2025
This study looked at two types of pacing techniques used in older adults: traditional right ventricular (RV) pacing and a newer method called conduction system pacing (CSP). Using data from 20,000+ Medicare patients, researchers found that CSP led to fewer hospital visits for heart failure and lower death rates within six months of pacemaker implantation compared to RV pacing.
CSP works by sending electrical signals in a way that follows the heart’s natural rhythm more closely than is possible with RV. One type of CSP, called left bundle branch area pacing (LBBAP), also had lower rates of complications than another type of CSP know as His bundle pacing (HBP).
High-dose metformin treatment to inhibit complex I during early reperfusion protects the aged mouse heart via decreased mitochondrial permeability transition pore opening
Pauley researchers: Qun Chen, PhD; Edward Lesnefsky, MD
Journal: The Journal of Pharmacology and Experimental Therapeutics
Publication date: March 1, 2025
When blood flow returns to the heart after a cardiac injury (a process called reperfusion), it can cause damage—especially in older hearts. This study tested whether a high dose of metformin, a common diabetes drug, could protect the heart during reperfusion.
Researchers found that giving metformin early during reperfusion helped reduce heart damage in aged mice. Specifically, metformin inhibited several mitochondrial enzymes and sites that may play a role in cellular injury and death during reperfusion. The results suggest that metformin might be useful for protecting older hearts during heart attacks.
Partnering With Schools for Community-Based Health Interventions: How Educating Children Improves Hypertension Awareness
Pauley researchers: Sangeeta Shah, MD, FACC, FASE; W. Greg Hundley, MD; Kristine Olson, PhD; Cherylann Rocha, BSW; Amy Ladd, PhD
Journal: Ochsner Journal
Publication date: March 1, 2025
High blood pressure, also known as hypertension, is a major cause of heart disease, especially among Black and low-income adults in Virginia. A school-based program called Teach BP was created by the Pauley Heart Center to help children learn about hypertension early.
In this study, 52 elementary students from a majority Black, majority low-income school took part in the program. They learned:
- What blood pressure and hypertension are
- How hypertension affects the body
- Healthy habits to keep blood pressure normal
- How to use a blood pressure monitor
After the program, students were much better at recognizing and understanding hypertension. They also learned how to check blood pressure correctly. This was measured by an eightq uestion assessment taken before and after the program; outcomes showed an overall increase in understanding hypertension.
Reflections on a Dobutamine Shortage in an Academic Health System: A Roadmap for Risk Reduction
Pauley researchers: Michael Kontos, MD
Journal: The Joint Commission Journal on Quality and Patient Safety
Publication date: March 1, 2025
This article describes how VCU Health responded to a nationwide shortage of dobutamine, a drug used to support heart function. The team used a coordinated strategy that included using technology to track and manage supply; reducing waste and increasing conservation of dobutamine; and centralizing control of the drug. These steps helped ensure that patients who needed dobutamine the most were able to receive it. The authors suggest their approach could serve as a model for other hospitals during future drug shortages.
Beyond Cholesterol: Unraveling Residual Lipidomic Risk in Cardiovascular Health
Pauley researchers: Anurag Mehta, MD
Journal: Current Atherosclerosis Reports
Publication date: March 17, 2025
This review looks at how lipidomics—the detailed study of fats in the blood—can help doctors better predict heart disease risk.
Key points:
- Special fat patterns (called lipidomic signatures) can identify people at risk for heart disease, even if their cholesterol level appears normal.
- Certain fat molecules, like ceramides and phospholipids, are linked to a higher chance of heart attacks or death in people with known heart disease.
- New risk scores based on these fats can improve predictions, but they’re not widely used yet because measuring the level of these fats in the body requires special equipment.
- Right now, there are no treatments that target these specific fat patterns—only general lifestyle and risk factor changes.
April
Cardiac testing choices by physician specialty in the CMR-IMPACT trial
Pauley researchers: W. Greg Hundley, MD
Journal: The American Journal of Emergency Medicine
Publication date: April 1, 2025
This is a secondary analysis of a randomized controlled trial called the CMR-IMPACT trial. The original trial compares the effectiveness of two testing strategies for patients presenting with chest pain and elevated troponin levels (a marker of possible heart damage):
- Invasive strategy: heart catheterization
- Noninvasive strategy: cardiac MRI
By randomly assigning patients to each of these groups, the study found that the noninvasive strategy and the invasive strategy had no major difference in long-term patient outcome.
In this analysis, researchers used data from CMR-IMPACT to determine how the specialty of a doctor admitting a patient with chest pain affects which strategy the patient receives. Specifically, they compared tests ordered by interventional cardiologists (ICs) involved in the trial with other all other admitting doctors involved.
Patients admitted by ICs were more likely to receive the invasive strategy, and ICs were more likely to follow a patient’s randomly assigned testing strategy when the strategy was invasive. For patients assigned to non-invasive imaging, both groups of doctors followed the protocol at similar rates.
Intermuscular Fat and Physical Activity Levels Relative to Exercise Capacity Change During Breast Cancer Treatment
Pauley researchers: Lauren Daniel, BS (Pauley Summer Undergraduate Research Fellow); Moriah Bellissimo, PhD; Kristine Olson, PhD; Amy Ladd, PhD W. Greg Hundley, MD;
Journal: JACC: CardioOncology
Publication date: April 1, 2025
This study looked at how physical activity and intermuscular fat (IMF) affect exercise capacity in women undergoing chemotherapy for breast cancer. Researchers measured how far patients could walk in six minutes before and after three months of treatment.
Key findings:
- Breast cancer patients had more IMF than people without cancer.
- Patients who were physically active during breast cancer treatment and had low IMF maintained better walking ability.
- Those who were less active or had high IMF saw a drop in exercise capacity during breast cancer treatment, even if their muscle quality was good.
- The type of chemotherapy drug the patient was taking also influenced how much their walking ability declined.
The study suggests that staying active and reducing IMF may help patients maintain their functional abilities during breast cancer treatment.
Ovarian cancer and the heart: pathophysiology, chemotherapy-induced cardiotoxicity, and new therapeutic strategies
Pauley researchers: Rakesh Kukreja, PhD; Anindita Das, PhD, FAHA; Arun Samidurai, PhD
Journal: Journal of Ovarian Research
Publication date: April 5, 2025
Ovarian cancer (OC) is the deadliest cancer of the female reproductive system. It’s driven by genetic changes and influenced by molecules called non-coding RNAs, which help the cancer grow, spread, and resist treatment.
Treatment usually includes surgery and chemotherapy. However, some chemotherapy drugs—especially doxorubicin—can damage the heart, sometimes leading to heart failure.
To reduce this risk, researchers are exploring:
- Safer drug versions (like liposomal doxorubicin);
- Heart-protective medications (like ACE inhibitors and beta-blockers);
- New therapies (like immunotherapy, PARP inhibitors, and nanoparticles); and
- PDE5 inhibitors, which may protect the heart and help kill cancer cells.
More research is needed to find treatments that are both effective against cancer and safe for the heart.
High-Density Mapping and Fasciculoventricular Pathways
Pauley researchers: Kenneth Ellenbogen, MD
Journal: JACC: Clinical Electrophysiology
Publication date: April 9, 2025
This report describes three patients who had a rare type of electrical connection in the heart called a fasciculoventricular (FV) pathway, which can cause abnormal heart rhythms. Using high-density mapping, doctors were able to precisely locate where these pathways connected to the heart muscle.
In all three cases, the FV pathways were found very close (within 1 cm) to a key part of the heart’s electrical system called the His bundle. This detailed mapping helps doctors better understand these unusual pathways and may improve treatment for certain heart rhythm problems.
Left bundle branch area pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with left ventricular ejection fraction ≤50%: Results from the International Collaborative LBBAP Study (I-CLAS)
Pauley researchers: Kenneth Ellenbogen, MD
Journal: Heart Rhythm
Publication date: April 25, 2025
Cardiac resynchronization therapy (CRT) is a type of treatment for heart failure in which a pacemaker is used to help the lower heart chambers pump blood more efficiently. This study compared two methods of CRT in patients with weakened hearts the standard biventricular pacing (BVP) method and a newer method called left bundle branch area pacing (LBBAP).
Among 2,500+ patients, those who received LBBAP had better electrical coordination in the heart, fewer hospitalizations for heart failure, and fewer complications during the procedure. Death rates were similar between the two groups.
These findings suggest LBBAP may be a better option than BVP for many patients needing CRT, though more research is needed to confirm long-term benefits.
Hierarchical physiologic pacing to enhance clinical outcomes in conduction system pacing
Pauley researchers: Kenneth Ellenbogen, MD; Ajay Pillai, MD
Journal: Heart Rhythm
Publication date: April 26, 2025
This study looked at how the exact placement of a pacing lead in the heart affects outcomes in patients receiving left bundle branch area pacing (LBBAP). Of the two types of placements examined in this study—left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP)—LBBP is thought to be more effective.
Using CT scans, researchers measured how close the pacing lead was to two key areas: the His bundle (part of the heart’s electrical system) and the inner wall of the left ventricle. They found that leads placed closer to these areas led to greater improvement in heart function, especially in patients with already weakened hearts.
This suggests that more precise lead placement can improve the benefits of LBBAP.
HRS Call to Action: Improved MRI Access for Patients with Cardiovascular Implantable Electronic Devices
Pauley researchers: Jayanthi Koneru, MD
Journal: Heart Rhythm
Publication date: April 26, 2025
In the past, patients with cardiovascular implantable electronic devices (CIEDs), such as pacemakers or defibrillators, were unable to undergo MRI scans; the powerful magnetic field of the MRI machine could cause dangerous interference with these devices. However, newer types of CIEDs have been designed to be safe for MRI, and meanwhile research indicates that 1.5T MRI machines are indeed safe for patients with all types of CIEDs. However, many of these patients still have limited access to MRI, for a variety of reasons.
This statement from the Heart Rhythm Society (HRS) explains the barriers to MRI for these patients, such as hospital policies, device manufacturer restrictions, and lack of clear guidelines. The statement also highlights the extra work placed on heart specialists by inefficient workloads and the need for fair payment for MRI-related care.
As they note steps a hospital system can take to make sure all patients with CIEDs can have improved access to the MRIs they may need, the HRS also urges better cooperation among doctors, hospitals, companies, and regulators to improve reimbursement and inefficiencies among heart specialists.
Heart Rate Lowering with Ivabradine and Burden of Symptoms in Patients with Postural Orthostatic Tachycardia Syndrome
Pauley researchers: Deepak P Thomas, MD; Roshanak Markley, MD; Justin Canada, PhD, RCEP; Antonio Abbate, MD, PhD
Journal: Journal of Cardiovascular Pharmacology
Publication date: April 28, 2025
Postural Orthostatic Tachycardia Syndrome (POTS) causes a fast heart rate when standing, leading to symptoms like dizziness, fatigue, and chest pain. It’s unclear whether the fast heart rate is a helpful response or part of the problem.
This study tested ivabradine, a drug that slows the heart rate, in people with POTS. After treatment:
- The increase in heart rate when standing dropped from about 40 to 15 beats per minute.
- Symptoms improved significantly, as measured by a symptom score (Malmö score), which dropped from 86 to 39.
- The more the heart rate improved, the more symptoms improved.
Slowing the heart rate with ivabradine helped reduce symptoms in POTS patients. This suggests that the fast heart rate may be causing symptoms, not just compensating for other problems.
May
Pathologist interrater reliability and clinical implications of elevated donor-derived cell-free DNA beyond heart transplant rejection, on behalf of the GRAfT investigators
Pauley researchers: Keyur Shah, MD; Inna Tchoukina, MD
Journal: The Journal of Heart and Lung Transplantation
Publication date: May 1, 2025
After a heart transplant, doctors check for signs of organ rejection using tissue samples from biopsies and a blood test called donor-derived cell-free DNA (dd-cfDNA). This study looked at how reliable biopsy readings are between different pathologists and how useful dd-cfDNA is in predicting patient outcomes.
Key findings:
- Pathologists often disagreed on biopsy results, especially for a type of rejection called antibody-mediated rejection.
- In some patients, dd-cfDNA levels were high even when biopsies didn’t show rejection. These patients still had a high risk (59%) of serious problems like rejection, heart dysfunction, or death within a year of the transplant.
- In contrast, patients with biopsy-proven rejection but normal dd-cfDNA had fewer problems (20%).
- dd-cfDNA was better at predicting long-term outcomes than detecting rejection at one point in time.
Percutaneous Coronary Intervention During the Shortage of Iodinated Contrast
Pauley researchers: Zachary Gertz, MD; Michael Kontos, MD; Mohammed Quader, MD
Journal: Journal of Invasive Cardiology
Publication date: May 1, 2025
A global shortage of iodinated contrast dye—used to enhance the visibility of cardiovascular structures during imaging—led doctors to use less of it during percutaneous coronary interventions (PCI). PCI is a minimally invasive procedure used to open blocked or narrowed coronary arteries, which supply blood to the heart. Historically, iodinated contrast dye has been used to visualize coronary arteries in real-time via fluoroscopy (x-ray) while the procedure is performed. Iodinated contrast is essential for PCI but is also known to pose a risk for contrast-induced acute kidney injury (AKI), especially in patients with pre-existing kidney issues.
Comparing data from before and during the shortage, researchers found that doctors used less contrast per procedure, but patient outcomes stayed the same. Even in patients at higher risk for kidney problems, there was no change in AKI complications, suggesting patient-specific factors—rather than amount of contrast used in PCI— factor more heavily in a patient’s chance of AKI occurrence.
Psychological Distress and Cardiovascular Health in Pregnancy: Findings From the U.S. National Health Interview Survey
Pauley researchers: Anurag Mehta, MD
Journal: JACC: Advances
Publication date: May 1, 2025
This study looked at how mental health affects heart health during pregnancy. Using national survey data, researchers found that pregnant individuals with moderate or severe psychological distress had worse cardiovascular health compared to those with little or no distress.
The more severe the mental distress, the worse the heart health score. This shows a clear link between mental well-being and physical heart health during pregnancy, suggesting that both should be monitored and managed together.
Pulsed Field Ablation for Persistent Atrial Fibrillation: 1-Year Results of ADVANTAGE AF
Pauley researchers: Kenneth Ellenbogen, MD; Jayanthi Koneru, MD
Journal: Journal of the American College of Cardiology
Publication date: May 6, 2025
This study examines a new way to treat a heart rhythm problem called persistent atrial fibrillation (PerAF). PerAF causes the upper chambers of the heart to beat irregularly for long periods, which can lead to issues like stroke and heart failure.
The treatment itself is called pulsed field ablation (PFA). This treatment uses electrical pulses to destroy small areas of heart tissue that are causing irregular rhythm—all without damaging nearby organs like the esophagus.
The study’s researchers treated 260 patients with PFA to isolate pulmonary veins (PVI), a common source of the problem, and treat the back wall of the atrium (PWA), an area involved in persistent cases. Patients were followed for one year to gauge PFA efficacy.
The study finds that PFA is effective—64% of patients had no major recurrence of abnormal heart rhythms after a year. 85% of patients had no symptoms or need for further treatment. Only 2.3% of patients had serious side effects. There were no strokes, heart punctures, or esophagus injuries—big concerns with older methods.
Complications Leading to Death in Patients Supported by the Impella 5.5: Analysis From the FDA MAUDE Database
Pauley researchers: Pengyang Li, MD, MS; Charlotte Roberts, ACNP; Inna Tchoukina, MD; Melissa Smallfield, MD, Josh Chery, MD; Z. A. Hashmi, MD, FACC; Michael Kontos, MD; K. Keyur Shah, MD
Journal: Catheterization & Cardiovascular Interventions
Publication date: May 11, 2025
This study reviewed reports of deaths linked to the Impella 5.5, a short-term heart pump used in patients with cardiogenic shock or some forms of heart failure. Using data from the FDA’s MAUDE database, researchers analyzed 43 cases where the device may have contributed to a patient’s death.
Key findings:
- Most deaths (93%) were linked to procedural or device-related problems.
- The most common issue was cardiac perforation (37%), often caused by incorrect placement or movement of the device.
- Other problems with the Impella 5.5 included bleeding, valve damage, device malfunction, and blood clots or stroke.
The study highlights the need for improved procedural techniques, enhanced clinical management, and standardized safety protocols for device usage.
The Pleiotropic Role of the MicroRNA-17-92 Cluster in Cardiovascular Diseases and Cancer
Pauley researchers: Arun Samidurai, PhD; Anindita Das, PhD, FAHA
Journal: Reviews in Cardiovascular Medicine
Publication date: May 27, 2025
MicroRNAs are tiny molecules that help control how genes work. One group, called the miRNA-17-92 cluster, plays a big role in both heart disease and cancer.
This cluster can affect many important processes in the body, like how heart cells grow, repair, and age. When the levels of these microRNAs are not balanced, they can either help protect the heart or make heart disease worse. In cancer, the same miRNA-17-92 cluster can influence how tumors start, grow, and spread. Thus, the cluster might be useful for diagnosing or predicting cancer or heart disease, and possibly for developing new treatments for both. This review looks at how this group of microRNAs works in both heart disease and cancer and how targeting it might lead to better therapies in the future.
Treatment With Phosphodiesterase 5 Inhibitors and Long-Term Outcomes in Patients Undergoing Coronary Angiography and Cardiac Catheterization
Pauley researchers: Ion Jovin, MD, ScD; Fadi Salloum, PhD, FAHA
Journal: Catheterization & Cardiovascular Interventions
Publication date: May 27, 2025
This study looked at whether taking phosphodiesterase 5 (PDE5) inhibitors—medications often used for erectile dysfunction—affects heart outcomes in patients who undergo heart procedures while already on the medication.
Among over 4,500 patients, those who were already taking PDE5 inhibitors did not have a higher risk of serious heart problems (like heart attacks, heart failure, or death) within one year of their procedure. After adjusting for other factors, there was no significant difference in outcomes following invasive heart procedures between those who took the medication and those who didn’t.
Why, how and in whom should we measure levels of lipoprotein(a): A review of the latest evidence and clinical implications
Pauley researchers: Anurag Mehta, MD
Journal: Diabetes, Obesity, and Metabolism
Publication date: May 28, 2025
Lipoprotein(a), or Lp(a), is a type of cholesterol. Research has shown that high levels of Lp(a) in the blood can increase the risk of heart disease and problems with heart valves. Doctors don’t often test Lp(a) levels because it’s hard to measure, and there are few available treatments to lower Lp(a).
This review explains how Lp(a) causes heart problems by promoting plaque buildup, blood clots, and inflammation. A person’s Lp(a) levels are determined by their genetic makeup, and don’t change much over the course of a person’s life, so one Lp(a) test is usually enough. Testing is especially important for people with early-onset heart disease, a family history of heart problems, or those of African or South Asian background.
While there aren’t many treatments that directly lower Lp(a), some medicines and healthy habits can help reduce overall heart disease risk. New drugs that target Lp(a) directly are being tested and show promise. Testing more people for Lp(a) could help prevent heart disease in the future.
