Detailed History The history of the Cardiology Division at the University of Rochester School of Medicine is the history of individuals, and the history of their many contributions to high-quality patient care, pioneering medical education, and outstanding cardiovascular research programs. The Early Years: 1920 - 1950 Early members of the University of Rochester faculty in both Internal Medicine and Physiology had strong research interests in cardiac and pulmonary physiology and disease. Collaborating in heart-lung physiological research, they studied patients with both respiratory and cardiac disease, defined the components of lung volumes, and measured the effects of exercise on cardiopulmonary function. They conducted early studies of ECG changes in patients with disorders of the heart and lungs. Robert Bruce, pediatrician Howard Joos, Frank Lovejoy, Nolan Kaltreider, Robert Nye, Raymond Pearson, Herman Rahn, and the two department chairs – Wallace Fenn in Physiology and William McCann in Medicine – were involved in these basic and clinical studies, and in the teaching of medical students and residents. Growth of the Cardio-Pulmonary Unit: 1950-1960 The University of Rochester's Cardiology Unit grew exponentially after the National Institutes of Health (NIH) were established and NIH funds were awarded to successful researchers. Development of the Cardiology Unit was dramatically enhanced after Paul Yu was appointed to the faculty in the late 1940s: he visited Nobel laureate Andre Cournand’s laboratory in New York City to learn from Cournand and Dickinson Richards the techniques of cardiac catheterization. With the unit’s extensive base of patients with rheumatic and congenital heart disease, it became possible to apply catheterization to studies of the pulmonary circulation and ventricular function in patients. These physiological studies accompanied clinical studies in this cohort of patients – descriptive studies of clinical presentation and differential diagnosis, and clinical and pharmacological management of the wide variety of clinical presentations the patients exhibited. A host of publications resulted, including Paul Yu’s book “Pulmonary Blood Volume in Health and Disease.” Cardiology research and training expanded during the 1960s. A post-residency cardiology fellowship program was established and grew, initially funded from institutional and clinical income; then in 1962 the unit received an NIH Training Grant to support the fellowship. New full-time faculty were added and participated in the catheter-based studies, including Bernard Schreiner and Gerald Murphy. Arthur Moss joined the full-time faculty upon completion of his fellowship in cardiology at Rochester, began studies of myocardial oxygen tension, and clinical studies of patients with ischemic heart disease and then patients with the Long QT Syndrome. Jules Cohen, after two years at NIH and a year of cardiology training at the Hammersmith Hospital in London, joined the faculty in 1963, with NIH funding to expand the laboratory research program and develop a biochemistry laboratory to study pathogenesis of cardiac hypertrophy, cardiomyopathy and effects of endocrine factors on heart muscle, especially thyroid hormone. Pravin Shah, who also had a period of training at Hammersmith, then came to Rochester, and with Raymond Gramiak in Radiology began studies of cardiac ultrasound, eventually leading to their seminal finding of systolic anterior motion of the mitral valve in patients with obstructive hypertrophic cardiomyopathy. Separation of the Cardiology and Pulmonary Units: 1960-1970 After Lawrence E. Young was appointed Dewey Professor and chair of Medicine, succeeding William McCann, he made two decisions that had a major impact on cardiology unit activities and its place nationally. First, he appointed Paul Yu as head of the joint Cardiopulmonary Unit. Then in 1968 he decided to create a separate Pulmonary Medicine Unit. Yu remained head of the Cardiology Unit and, under his leadership and influential role in the American HHeart Association, the unit flourished. Major NIH Awards: Creation of the Myocardial Infarction Research Unit During the late 1960s, the impact of prevention and treatment of rheumatic fever began to be felt nationwide, and the numbers of patients with rheumatic heart disease declined. Simultaneously, there was a rising tide, nation-wide, of interest in ischemic heart disease, spurred in part by a major increase in federal funding for related research from the National Heart, Cancer and Stroke initiative. The Cardiology Unit at the University of Rochester was one of a select few to receive a five year, $5 million grant from NIH to establish a Myocardial Infarction Research Unit. This led to a series of wide-ranging studies of acute myocardial infarction (heart attacks), including: studies of the pre-hospital phase of myocardial infarction in which Arthur Moss collaborated with Dr. William A Greene of the Medical-Psychiatric Liaison Unit to investigate factors important in the precipitation and early course of infarction, including psychosocial factors; catheter-based invasive study of hemodynamic changes in acute myocardial infarction, led by Bernard Schreiner, Morrison Hodges and Herbert Marx, in a newly constructed specialized facility within the coronary care unit; study of hemodynamic changes and clinical course in animals undergoing experimental infarction, led by Jules Cohen; and development of new technology for monitoring electrocardiographic and physiological changes in patients, led by Bromley Clarke. The Focus of Attention Shifts to Coronary Artery Disease Large numbers of patients with ischemic coronary heart disease began to be referred to the cardiology faculty and to cardiac surgery for coronary bypass procedures at the University of Rochester Medical Center. The surgical efforts were initially led by James DeWeese and Scott Stewart, and beginning in the 1980s by George (Jeff) L. Hicks Jr. icks. Activity in the cardiac catheterization laboratory shifted to coronary angiography and angioplasty-based treatment of obstructive coronary disease, to complement the developments in surgery. To support these activities, several individuals were recruited to the cardiac catheterization team, including: Robert Rothbard, Patricia Fitzpatrick, Michael Cunningham, Robert Capone, Don Cutlip; and then Richard Pomerantz and Fred Ling, and next Chris Cove, James Doling, John Gassler, and Craig Narins. Electrocardiology The unit’s long standing support of the Heart Station and its exercise laboratory continued. Gerald Murphy was appointed head of the Heart Station and, with the addition of Toshio Akiyama in the mid 1970s, expanded interest in electrocardiography, electrophysiology and arrhythmia study and management flourished. Dr. William Hood and the Rise of the Expert Subspecialists: 1980-1990 Dr. Paul Yu stepped down as unit head in 1981, and then fully retired in the late 1980s. Based on a national search, Dr. William B. Hood was recruited from Boston to succeed Dr. Yu and began his appointment as Cardiology Unit head in July 1982. The Hood years, paralleling national trends, saw creation and growth of several specialized areas of cardiology. Heart Failure: Dr. Chang-seng Liang accompanied Dr. Hood from Boston to Rochester, and the two of them developed an extensive program of study of congestive heart failure – its pathophysiology and pharmacological treatment. Nuclear Imaging: An active nuclear cardiology section was developed and flourished under the leadership of Ronald Schwartz. Cardiac Ultrasound Imaging: The cardiac echo program’s activity were enriched by the appointment of first Navin Nanda in 1973, then Richard Meltzer in 1986 to succeed Nanda who had left for Alabama, and then Jerry Miller who ultimately left for private practice. The echo program was greatly strengthened by the appointment of Karl Schwarz as its director in the early 1990s. Preventive Cardiology: Phillip Greenland spearheaded a program in Preventive Cardiology before leaving to head up the Department of Community and Preventive Medicine at Northwestern University. Electrophysiology: First steps were taken to expand the clinical electrophysiology program in 1981 with the appointment of Thomas Rahilley, but after he was tragically killed in a motor vehicle accident in 1982, Toshio Akiyama went to Chicago for training in basic cardiac electrophysiology with Harry Fozzard, then returned and served in the electrophysiology leadership role. Dr. James Daubert was appointed director of Electrophysiology in 1992. Following Daubert’s appointment there was a dramatic expansion in the activities of this section, which has continued with the appointment of David Huang to direct the program after Daubert left in 2008 to direct Duke University’s program, with support from Spencer Rosero, David Huang and Mehmet Aktas. The Berk-Taubman Era: 1990-2010 After Dr. Hood retired in the late 1990s, two individuals were then recruited who transformed the cardiovascular research program at the University of Rochester Medical Center. First, Bradford C. Berk, M.D., Ph.D., a University of Rochester Medical School graduate, was recruited from the University of Washington where he had been professor of Medicine and director of the NIH Institutional Cardiovascular Research Training Program. He was appointed Paul Yu Chair of Cardiology in 1998. Berk moved up to become chair of Medicine and Dewey Professor in 1999, and Richard Pomerantz served in an interim capacity as unit head. Dr. Berk soon recruited Mark Taubman to come from Mt. Sinai in New York City, where Taubman had been director of cardiovascular research as well as director of the Cardiovascular Fellowship Program and the school’s M.D.-Ph.D. program. Berk and Taubman had trained together in cardiology under Eugene Braunwald at Peter Bent Brigham Hospital in Boston and knew one another well. Taubman was appointed head of Cardiology at Rochester in 2003 as well as director of the Center for Cellular and Molecular Cardiology, and two years later as director of Rochester’s Cardiovascular Research Institute. Under Dr. Berk and Dr. Taubman, the cardiology clinical services flourished. Highly specialized services expanded: advanced defibrillators with resynchronization therapy were offered by Electrophysiology, drug-eluting stents were implanted by Interventional Cardiac Catheterization team, the Women's Heart Program offered therapies specifically tailored towards women, and the Heart Failure service offered ventricular assist devices and cardiac transplantation by cardiac surgeon Todd Massey. Joseph Delehanty, John Bisognano, J. Franklin Richeson, Leway Chen, David Huang, James Eichelberger, Hanna Mieszczanska and Gladys Velarde have played prominent roles in providing these clinical services. Dr. Berk and Dr. Taubman dramatically increased research in basic cardiovascular biology – studies of thromboembolism, laminar flow and shear-stress, novel genetic factors, atherosclerosis, and cardiomyopathy. Berk and Taubman recruited a large team of co-investigators and their efforts have resulted in more than 200 publications in the seven to 10 years they have been in Rochester: articles describing original research, reviews and book chapters. Dr. Berk and Dr. Taubman in partnership with Rick Aab developed the Aab Cardiovascular Research Institute (CVRI). One of the most successful cardiovascular institutes in the country, the Aab CVRI is a separate building containing more than 80,000 square feet of laboratory space. More than 25 research faculty work at the CVRI, studying the basic science of cardiovascular diseases. The combined forces of all scientists have raised more than $8 million each year from the NIH to explore new pathways of disease and to invent novel therapies. During this era, Dr. Arthur Moss, working with Dr. Wojciech Zareba, led groundbreaking clinical research into sudden cardiac death. Dr. Moss conducted a series of clinical trials which showed that implantable defibrillators could save the lives of hundreds of thousands of patients across the world. These landmark studies have changed the way that doctors practice medicine. The Next Era: 2010 Dr. Berk was promoted to senior vice president and CEO of the Medical Center. Dr. Taubman - after serving for three years as chair of Medicine - was appointed dean of the Medical School. After his promotion to chair of Medicine, Dr. Taubman recruited Dr. Lowenstein from The Johns Hopkins University School of Medicine to lead the Cardiology Division. In contrast to the early years of the Cardiology Division, when faculty consisted of only a half -dozen individuals, there are now 35 full-time tenure-track cardiologists in the Cardiology Division, and 25 with clinical faculty appointments, as well. The Cardiology Division and the Medical School and the University Rochester Medical Center feel fortunate indeed to have attracted Lowenstein to come from Johns Hopkins and feel confident that he will now carry the Cardiology Division forward to its next stage of excellence and accomplishment.