JAHA: Tell us
about the key findings from your recent article in JAHA.
Dr. Tomaselli: This is a prospective observational study of patients who
were candidates for ICD implantation for primary prevention of sudden death.
These are generally stable heart failure or post-MI patients. As this is a
description of the cohort the major findings are to follow. Some of the key
features of this cohort are a much larger representation of non-white mostly
African-American patients, a rich biorepository with all patients having blood
drawn and stored at baseline and follow-up visits in addition to digital ECGs.
JAHA: What are the major implications of
this work?
Dr. Tomaselli: The major implications are the development of a well
phenotyped cohort to explore the utility of non-traditional biomarkers of risk
such as genotype, mRNA and microRNA expression, metabolites, dynamic ECG
metrics and in a subset of patients cMRI and CT imaging. We will also have a rather long followup for
this group allowing us to determine the short and long-term benefits of the ICD
in this cohort.
JAHA: How did you get the idea to do this
study?
Dr. Tomaselli: A well know shortcoming of primary ICD deployment are the
limitations in our ability to identify patients with primary prevention
indications at risk mostly likely to benefit from this invasive and expensive
treatment.
JAHA: What was your biggest obstacle in
completing this study?
Dr. Tomaselli: The recent rates of use of primary prevention ICDs has
slowed some either by patient or physician preference. It raises the
possibility that the group enrolled may have changed over the enrollment
period.
JAHA: What was
your most unexpected finding?
Dr. Tomaselli: Perhaps, not totally unexpected, the preliminary data
demonstrate that the overall mortality rate is greater than the appropriate
shock rate by the ICD. It reinforces the concept that there are competing risks
for death in this group that are not prevented by the ICD.
JAHA: What do you
plan to do next, based on these current findings?
Dr. Tomaselli: We will be doing a comprehensive analysis of mortality, ICD
therapy and risk once enough events are accrued. We have genotype the entire
cohort and done RNA, protein, metabolic and ECG studies on the group.
JAHA: What do you
like to do in your free time?
Dr. Tomaselli: Free time is in short supply, when there is any spending
time with family, helping coach recreation council basketball and baseball
JAHA: What is
your favorite sports team or musical group?
Dr. Tomaselli: I know you do not want to hear this: New York Yankees
Eclectic musical taste Classical to Vintage rock e.g.
Clapton
Profile originally published March 19, 2013
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