Cardiology; Cardiovascular Disease; Internal Medicine
As director of the Division of Cardiology at the Buffalo VA Medical Center (Buffalo VAMC), I oversee cardiac care, education and research. My division is one of the most efficient across similar VA facilities: it provides the full spectrum of cardiovascular diagnostic and therapeutic services while maintaining outcomes that meet or exceed all nationally mandated standards. I see outpatients in my own clinic, and I see inpatients as well, including those admitted to the Intensive Care Unit (ICU). My practice focuses on coronary artery disease (CAD), congestive heart failure, atrial fibrillation and valvular abnormalities. I approach my patients by practicing both the art and science of medicine and spend ample time getting to know my patients and the social structures that surround them. I believe that the care of a patient is much more effective when the patient is treated as a person rather than a diagnosis. I truly enjoy my clinical sessions at the Buffalo VAMC where I meet new and returning veterans who share their stories with me. It is a privilege to care for each of these amazing individuals. The abundance of complex cases at the Buffalo VAMC, along with extensive longitudinal electronic health data, allows us to conduct clinical research to improve patient care. We physician-scientists at the Buffalo VAMC are increasing our focus on clinical research to complement the bench research performed at UB. My current research is studying the role of post-traumatic stress disorder (PTSD) in heart disease. While longitudinal studies indicate a role of PTSD on CAD prevalence and outcomes, its causative mechanism has been debated. My colleagues and I are looking at mental stress-induced myocardial ischemia (MSIMI) and how this differs in patients with PTSD. I am passionate about teaching and feel a strong responsibility to mentor the next generation of physicians. I trained as a Royal College of Physicians educator in order to become a better medical educator. To me, mentorship involves more than just teaching the facts of medicine. I emphasize interpersonal and communication skills with the fellows I train, in addition to traditional bedside teaching, because these patient-centered abilities are essential to being a good physician. I also help trainees navigate increasingly complex hospital and health care environments. The knowledge I share with them about the systems that are part of modern health care is also key to providing the best care to patients.
Cardiology; Clinical Cardiac Electrophysiology
I am a clinical cardiac electrophysiologist, and my focus and passion are in evaluating and managing cardiac arrhythmias and their associated symptoms such as palpitations and syncope. I treat patients with bradycardia, heart block, supraventricular tachycardia (SVT) including atrial tachycardia, atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT), atrial fibrillation (AF) and ventricular tachycardia. My main clinical responsibilities include diagnostic and therapeutic procedures for arrhythmias such as electrophysiologic studies, and ablation of arrhythmias such as atrial flutter, AF, SVT and ventricular tachycardia. I perform implantation and extraction of cardiac implantable electronic devices (CIEDs) such as pacemakers, implantable cardioverter defibrillators (ICDs) and biventricular pacemakers and ICDs for the treatment of certain patients with heart failure. I also perform laser lead extraction in patients with malfunctioning or infected pacemaker and ICD leads. I believe in extensive pre- and post-procedural care and provide in-depth consultation and close communication with my patients, referring physicians and staff. I monitor closely my post-implant patients through the use of remote monitoring systems, and I am a strong advocate for appropriate reprogramming to accommodate the needs of patients with CIEDs. I evaluate and treat inpatients with cardiovascular disease and other cardiac disorders at Buffalo General Medical Center (BGMC) as part of the Cardiac Critical Care Unit and the cardiology consult service and at the Buffalo VA Medical Center (Buffalo VAMC). I also see outpatients at various sites, including the BGMC Heart and Lung Center, UBMD Internal Medicine Electrophysiology Clinic and the Buffalo VAMC Electrophysiology Clinic. I am involved in the RE-CIRCUIT clinical trial. It evaluates treatment using the drug Pradaxa in patients with paroxysmal or persistent nonvalvular atrial fibrillation (NVAF) who are scheduled to undergo a first ablation procedure. I also have a research interest in using imaging techniques to delineate patients with infection who might require extraction of CIEDs. By the innovative use of PET scan techniques, physicians can differentiate pacemaker lead infection versus fibrosis. The goal of this research is to help physicians decide whether patients really need laser lead extraction or if the procedure could be avoided. I enjoy teaching. I lecture on arrhythmias in various forums, including continuing medical education classes, and to a variety of trainees, including medical students, residents and fellows as well as other health professionals in internal medicine and emergency medicine. I supervise cardiology fellows during their clinics, inpatient consultation and electrophysiology rotations at BGMC and the Buffalo VAMC.
Cardiology; Cardiovascular Disease
I am a noninvasive cardiologist at the Buffalo VA Medical Center (VAMC). I care for patients with various cardiovascular diseases, including acute and stable coronary artery disease, congestive heart failure, cardiomyopathies, valvular heart disease and arrhythmias. My responsibilities are diverse and include attending on the cardiology consult service, covering medicine inpatient service, performing and teaching transesophageal echocardiograms (TEEs), interpreting echocardiograms and electrocardiograms (EKGs) in addition to electrical cardioversions, stress testing and Holter/event monitors interpretation. My clinical specialties are valvular heart disease, atrial arrhythmias and acute cardiac and coronary artery diseases. I continue to care for patients after they are discharged from the hospital, both in my clinic at the VAMC and via the telehealth clinic in the VAMC to various areas in Western New York. I am currently involved in research projects both as a site principal investigator (PI) and as a subprincipal investigator in collaboration with colleagues at the VAMC. One project is focused on the role of new anticoagulants (NOACs) in the management of myocardial injury after noncardiac surgery (MINS). The other project is comparing double vs. triple therapy, i.e., antiplatelet drugs and Coumadin vs. NOAC after coronary percutaneous intervention in patients with atrial fibrillation. I also serve as a member of the VAMC’s institutional review board (IRB), which reviews the ethical and scientific aspects of research projects. I am passionate about teaching and enjoy working closely with medical students and medicine residents during their rotations on both cardiology and medical consult services. I supervise and work with cardiology fellows during their clinics, inpatient consultation and noninvasive/echocardiogram rotations at the VAMC.
Cardiology; Cardiovascular Disease; Clinical Cardiac Electrophysiology; Internal Medicine
An internationally recognized cardiovascular physician-scientist, Dr. Cain is a specialist in abnormal heart rhythms. He is board-certified in internal medicine, cardiovascular diseases and clinical cardiac electrophysiology and pacing. He is a fellow of the American College of Cardiology, the American Heart Association and the Heart Rhythm Society. A former associate editor of Circulation, Cain is a member of the editorial boards of the American Journal of Cardiology, the Journal of Cardiovascular Electrophysiology, Nature Clinical Practice Cardiovascular Medicine and Heart Rhythm. His NIH-supported research has focused on determining the mechanisms of life-threatening heart rhythm abnormalities that occur in heart attacks and other conditions that damage heart muscle cells. This information is being used to better characterize and more accurately localize the abnormal heart tissue responsible for these abnormal heart rhythms and to improve the identification of patients at increased risk for sudden cardiac death.
Cardiology; Cardiovascular Disease; Apoptosis and cell death; Cardiac pharmacology; Gene therapy; Genomics and proteomics; Molecular Basis of Disease; Stem Cells
As chief of the Division of Cardiovascular Medicine at UB, I am responsible for the clinical, teaching and research programs related to adult patients with heart disease. I care for patients at the UBMD Internal Medicine practice group in Amherst, the Gates Vascular Institute (GVI) of Buffalo General Medical Center (BGMC) and the Buffalo VA Medical Center (VAMC). My clinical areas of expertise are in diagnosing and caring for patients with coronary artery disease and heart failure. My research group conducts translational studies directed at advancing our mechanistic understanding of cardiac pathophysiology as well as developing new diagnostic and therapeutic approaches for the management of patients with chronic ischemic heart disease. Our ongoing areas of preclinical investigation apply proteomic approaches to identify intrinsic adaptive responses of the heart to ischemia and studies examining the ability of intracoronary stem cell therapies to stimulate endogenous cardiomyocyte proliferation and improve heart function. We also conduct basic and patient-oriented research to understand how reversible ischemia modifies the cellular composition and sympathetic innervation of the heart to help develop new approaches to identify patients at risk of sudden cardiac arrest from ventricular fibrillation. In addition to my laboratory investigation, I serve as the deputy director of the UB Clinical and Translational Research Center (CTRC) and the director of the UB Translational Imaging Center. The Translational Imaging Center offers researchers opportunities to perform multimodality research imaging using PET molecular imaging, high-field magnetic resonance imaging (MRI) and X-ray computed tomography (CT). Our overall goal is to use advanced cardiac imaging to translate new applications between the bench and bedside in order to identify new imaging biomarkers of pathophysiological processes such as chronic myocardial ischemia and cardiac arrhythmogenesis. I am engaged in the cardiology profession at national and international levels, including as former president of the Association of Professors of Cardiology.
Cardiology; Critical Care Medicine; Internal Medicine
I practice noninvasive clinical cardiology, which includes diagnosing and treating patients across the spectrum of cardiovascular disease. In the UBMD Amherst clinic, I care for patients with rhythm disturbances, cardiomyopathies, valvular heart disease, congestive heart failure, acute and chronic coronary artery disease and vascular disease. Preventive cardiology services are also an important part of my practice. I diagnose and treat patients with conditions that may put them at risk for heart disease—conditions such as hypertension, lipid disorders and nicotine addiction. I also assess the heart health of my patients by performing and interpreting electrocardiograms (EKGs), stress tests, Holter monitors and transthoracic echocardiography. I evaluate my patients for peripheral vascular disease, including measurements of their ankle-brachial index. I care as well for patients admitted to the Cardiac Care units (CCU) and the Cardiology Telemetry floors in Buffalo General Medical Center (BGMC) and at Millard Fillmore Suburban Hospital. As medical director for outpatient cardiology for UBMD, I ensure a patient-centered practice that provides the most advanced and innovative cardiac care and strives to provide patients with the best diagnostics and treatments available—all with a focus on care that is affordable and accessible. I am also a vice chair for clinical operations and outreach for the Department of Medicine. As such, I am actively involved in the department’s growth by developing a strong network of primary care and specialty practices for UBMD Internal Medicine. This effort will lead the transformation of health care delivery systems in Western New York. My research interests include evaluating modalities of cardiac imaging in diagnosing coronary artery disease, evaluating methods of diagnosing arrhythmias and assessing individuals with noncardiac chest pain. Specifically, I am an investigator in research involving preventive cardiology and lipid management. I am also collaborating with residents, fellows and colleagues in behavioral medicine to investigate how behavioral analysis affects treatment of atrial fibrillation and patient care. Another research project involves working with medical students and cardiology fellows to leverage portable technology, such as smart phones, in evaluating symptomatic arrhythmias. I am working as well with medical residents on an epidemiologic study. We expect an outcome that would identify a possible etiology of a well-recognized cutaneous manifestation of cardiac disease, which will allow us to develop a reliable test to help screen for coronary artery disease. Teaching is an important part of my day. I teach physical diagnosis to first- and second-year medical students. I also mentor eight first-year and eight second-year medical students, helping them navigate through, and succeed in medical school. I teach third-year medical students as they rotate with me in my outpatient practice. Fourth-year medical students, interns, residents and a cardiology fellow accompany me when I attend on the cardiology consult and cardiology floor services at BGMC. I find satisfaction in sharing my knowledge and experience with those in the training phase of their careers: their questions help me stay current in my field and ultimately help me render the best care to my patients.
Cardiology; Critical Care Medicine
I care for patients with diagnoses across the spectrum of heart disease. I see my patients at the UBMD Internal Medicine practice group in Amherst and in the Cardiac Care Unit at Buffalo General Medical Center (BGMC). I conduct stress tests, interpret cardiac imaging studies, read electrocardiograms (EKGs) and perform evaluations for advanced heart failure therapies and cardiac transplantation. My specialty is the diagnosis and treatment of congestive heart failure: I integrate information from patient history, physical exam findings and diagnostic studies, and I coordinate treatment for my patients with interventional cardiologists, heart rhythm specialists and heart surgeons. My research is focused on new approaches to identifying patients at risk for heart attacks and strokes. I am involved in collaborative studies addressing the treatment of heart failure, and I participate in the clinical trials of new medications for congestive heart failure. I also study the role of hematopoietic stem cells and precursors in coronary artery disease and congestive heart failure. I am also an investigator in several multicenter clinical drug trials in patients with heart failure. I teach and supervise internal medicine residents and cardiology fellows in all facets of my clinical practice: during inpatient hospital care, while interpreting cardiac imaging studies and in my outpatient practice. I also teach second-year medical students in small-group settings for the Human Cardiovascular System course.
Cardiology; Cardiovascular Disease; Interventional Cardiology
I am an interventional and clinical cardiologist at the Buffalo VA Medical Center (Buffalo VAMC) after having been in private practice for over 25 years. The focus of my practice is the cardiac catheterization laboratory, though I also see outpatients in the cardiology clinic and perform inpatient clinical consultations in the hospital. I care for individuals with a spectrum of cardiovascular disease, including patients with stable coronary disease, acute coronary syndromes, valvular diseases and cardiomyopathies. I participated as a site investigator in over 100 multicenter clinical research trials. My particular research interests are in studies of lipid management and preventive cardiology, intravascular ultrasound and plaque regression, critical care pathway development and application and outcomes research in the treatment of acute coronary syndromes. My current research involvement includes studies on lipid therapy, novel congestive heart pharmacologic therapy and atrial fibrillation in cancer patients. I am also involved in a supportive role with a study of antibiotic therapy and the management of peripheral arterial disease. I enjoy teaching and have taught throughout my private practice career and continue at the VA. I teach cardiology fellows in the cardiac catheterization laboratory and in the cardiology clinic during initial cardiology consultations and follow-up outpatient care. I also teach fellows, medical residents and medical students during consultative rounds in the hospital.
Cardiology; Clinical Cardiac Electrophysiology
As a clinician actively involved in patient care, I see patients in my office at 1020 Youngs Road, suite 110 in suburban Amherst, as well as in the Conventus Medical Office Building on the downtown Buffalo Niagara Medical Campus. My specialty is clinical cardiac electrophysiology, which is the field of cardiology that deals with arrhythmias and implantable devices, such as pacemakers and defibrillators. We have assembled a team of cardiac electrophysiologists who work closely together, so that patients who are evaluated for cardiac arrhythmias in our practice have access to state-of-the-art procedures such as catheter ablation and implantable cardiac electrical devices. I was personally involved in the development of national guidelines for patient care in the treatment of atrial fibrillation from 2004 to 2011, and I am on the writing committee for the upcoming national guideline on ventricular arrhythmias and sudden cardiac death. As the chair of the Department of Medicine at the University at Buffalo, I am involved in the education of residents and fellows as well as clinical research, in addition to my administrative responsibilities. My research focus is electrophysiology and pacing, including implantable device therapy and clinical trials in atrial fibrillation. I am the principal investigator on a study of heart failure patients with atrioventricular block entitled the Block HF Trial, the results of which have recently been published in the New England Journal of Medicine. I have been involved in clinical trials for over 25 years which have led to close to 300 publications. I am a member of a number of prominent professional organizations, and I am the current President of the Association of University Cardiologists. On a national level, I have held numerous national leadership roles, including serving as president of the Heart Rhythm Society. I have also chaired the American College of Cardiology’s Clinical Electrophysiology Committee and the Food and Drug Administration’s Circulatory System Devices Panel. I currently serve as an associate editor of one of the key journals in the field of cardiology, the Journal of the American College of Cardiology.
Cardiology; Cardiovascular Disease; Regulation of metabolism
My clinical activities as a noninvasive cardiologist primarily take place at the Buffalo VA Medical Center (VAMC). My responsibilities include attending on the inpatient cardiology consultation service and interpreting echocardiograms, stress tests and electrocardiograms (EKGs). My research career initially focused on translational research using porcine models to investigate physiologic and metabolic adaptations that result from acute and chronic myocardial ischemia (chronically stunned and hibernating myocardium). These preclinical investigations have led to clinical research, including the recent completion of an NIH-sponsored clinical trial. This trial, on which I am the co-principal investigator with John M. Canty, Jr., MD, proved that the presence of sympathetically denervated myocardium quantified by positron emission tomography can predict the risk of sudden death in patients with ischemic cardiomyopathy. I am in the process of extending these findings to the clinical management of patients with implantable cardiac defibrillators. My work as a physician-scientist has included serving on numerous research-related oversight committees and as a peer reviewer for multiple national, regional and local committees. I have been funded by the National Institutes of Health (NIH), the Department of Veterans Affairs and the American Heart Association to conduct a variety of investigator-initiated research projects. Medical education is a critical component of my professional life. Nearly all of my clinical and research activities are performed in conjunction with the education of fellows in cardiovascular diseases, residents in internal medicine and medical students. I facilitate small group sessions for second-year medical students in Cardiovascular Physiology for which I have earned several commendations for teaching excellence; I am gratified to have participated in the education of hundreds of young physicians. I have also published dozens of abstracts and manuscripts with various levels of trainees, giving them the opportunity to grow as physician-scientists while at the same time advancing medical knowledge.
Cardiology; Cardiovascular Disease
My clinical practice focuses on all aspects of general cardiology. I work in areas from preventive cardiology, such as treatment of patients with resistant hypertension or high-risk complex dyslipidemia, to inpatient care of critically ill patients with acute coronary syndrome,congestive heart failure exacerbation or advanced valvular disorders. I have particular expertise in noninvasive imaging techniques and use multimodality cardiac imaging to aid the diagnosis and treatment of patients with complex cardiovascular diseases. I am involved in the structural heart program at the Gates Vascular Institute (GVI) and am well-versed in ultrasound-based imaging modality. This includes interpretation of basic transthoracic and transesophageal echocardiograms as well as “interventional echocardiography,” which provides intraprocedural transesophageal imaging support for transcatheter aortic valve replacement (TAVR), MitraClip valve repair and left atrial appendage occluder deployment. I also perform and interpret 12-lead electrocardiograms, 24-hour Holter monitors, event monitors, 24-hour ambulatory blood pressure monitors, cardiac nuclear stress testing, stress echocardiograms and cardiac computed tomography (CT) angiography. My expertise in the range of cardiac imaging modalities allows me to provide guidance to medical practitioners from different specialties in the appropriate use and application of each modality. My research focus spans both translational and clinical applications. Using a porcine model of ischemic heart disease, our team investigates cardiac autonomic regulation and remodeling, employing in-vitro protein analysis and whole animal PET imaging to identify sympathetic denervation and subsequent neuronal sprouting. This area of study has important implications in our understanding of the myocardial substrate that promotes vulnerability to electrical instability and sudden cardiac death. I am also conducting several clinical trials, including a Phase III PCSK9 inhibitor study to evaluate the clinical benefits of Evolucomab in high-risk populations (FOURIER trial, Amgen). I am also involved in a clinical trial using the repositionable Lotus valve system for transcatheter aortic valve replacement (REPRISE study, Boston Scientific). As a faculty member in the Division of Cardiovascular Medicine, I teach medical students, internal medicine residents and cardiology fellows. I facilitate small group discussions for second-year medical students as part of the cardiovascular physiology curriculum, and I serve as a clinic preceptor for third-year medical students in the outpatient cardiology clinic. I also conduct inpatient rounds with residents and fellows. In addition, I teach cardiology fellows in the performance and proper interpretation of cardiac imaging modalities such as echocardiograms and stress testing.
Cardiology; Cardiovascular Disease
I am a cardiologist with a subspecialty interest in heart failure and general cardiology. I am based at Buffalo General Medical Center (BGMC) and the Gates Vascular Institute (GVI), and I care for inpatients admitted to Cardiology Critical Care, Inpatient Cardiology and Inpatient Consultation. I have administrative duties that focus on the care of the cardiac patient at Kaleida Health: I help lead the collaborative efforts of over 50 cardiologists to improve the quality of patient care and patient outcomes. My research responsibility has included serving as a local principal investigator in multicenter clinical trials, and our site has contributed to a number of cardiology research programs over the past 25 years. Our current focus is in systolic and diastolic heart failure, as a collaborative effort with colleagues in internal medicine and cardiology. I am part of the teaching faculty in the Division of Cardiovascular Medicine, and I am the lead physician for the BGMC training site. In this role, I work with another attending cardiologist to provide oversight and guidance to a team of five cardiology fellows, residents and fourth-year medical students at the BGMC continuity clinic. I also help organize and lead annual continuing medical education conferences through the medical school’s Department of Medicine and through Kaleida Health.
Cardiology; Interventional Cardiology
I am an interventional cardiologist specializing in structural heart interventions. My clinical practice includes general cardiology, interventional cardiology and complex valvular heart diseases. I see patients at the UBMD cardiology offices--and at Buffalo General Medical Center (BGMC), where I direct the complex valve clinic. I also direct structural heart interventions at the Gates Vascular Institute (GVI) and BGMC, and in that capacity I perform transcatheter aortic valve replacements, mitral clip procedures, left atrial appendage occlusion, atrial and ventricular septal defect closure and percutaneous paravalvular leak closures. I also care for patients by performing routine diagnostic coronary angiograms and percutaneous coronary interventions (PCI)/angioplasty. I believe that in this era of technologically advanced, modern medicine it is the physician’s responsibility to educate patients in a straightforward and open manner about the different treatment modalities. I spend time with my patients to ensure that they are comfortable with the treatment options they choose and that they have a clear understanding of the alternatives, benefits and risks. My research interests are in new devices for aortic and mitral valve replacement, novel therapeutics in the form of stem cells and newer therapies for acute coronary syndromes. I also collaborate with the Toshiba Stroke Research Center to develop advanced imaging modalities in the cardiac catheterization laboratory. I am investigating the use of robotic PCI to improve precision in stent placement and reduce radiation dosage in the catheterization laboratory, and I serve as the local principal investigator for a number of multicenter clinical trials in these areas. For example, I am: evaluating the LOTUS transcatheter valve to CoreValve in high-risk patients (Reprise III, Boston Scientific); investigating the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with severe, symptomatic aortic stenosis (AS) at intermediate surgical risk by randomizing patients to either surgical aortic valve replacement (SAVR) or TAVI (SURTAVI, Medtronic); and determining the efficacy of cardiac stem cells in patients with recent myocardial infarction and ischemic cardiomyopathy (ALLSTAR, Capricor. I train residents and cardiology fellows through didactic and bedside teaching, and I mentor their research projects. I also oversee cardiology fellows in outpatient settings. Additionally, I collaborate with the departments of Anesthesiology and Pediatrics and the Division of Pulmonary, Critical Care and Sleep Medicine to train their residents and fellows.
Cardiology; Cardiovascular Disease; Cell growth, differentiation and development; Gene Expression; Molecular and Cellular Biology; Signal Transduction; Stem Cells
As a general cardiologist, I diagnose and treat a wide range of problems that affect the heart and blood vessels, including but not limited to coronary artery disease, valvular heart disease, heart failure, diseases of the myocardium and pericardium, cardiac arrhythmias, conduction disorders and syncope. I attend on the inpatient Coronary Care ICU (CCU), Cardiac Step-down Unit, and Cardiology Consult service at Buffalo General Medical Center as well as see patients in my outpatient clinic. In addition to treating pre-existing cardiac conditions, I also believe in strong preventive care and addressing modifiable risk factors for coronary disease. I take time to get to know my patients, and I talk with them about measures they can take to reduce their risk for cardiovascular disease and improve their health. As a clinician-scientist, I have a special interest in developing new stem cell based treatments for heart disease. My research is focused on understanding what stem cell secreted factors are responsible for improved heart function, what their targets are and how these can be modulated to develop new cell-free therapies that can help patients with a wide spectrum of coronary disease and heart failure. I welcome medical students, graduate students, residents and fellows to conduct research with me in my lab. As a native Buffalonian, I am honored to partner with the patients in our community to help improve their heart health and cardiac knowledge base. I am equally excited to be involved in shaping the next generation of physicians through the teaching I conduct at the medical student, resident and fellow level.
Research in my laboratory is focused on stem cell biology, engineering, and therapeutic applications with an emphasis on cardiovascular repair. We have explored the immunomodulatory property of bone marrow mesenchymal stem cells (MSCs) in our cell transplantation studies, and found that large quantities of human and porcine MSCs can be implanted in immunocompetent pigs, mice, and hamsters without inducing inflammatory immune responses in the host. Our research shows that MSCs improve cardiac function in the porcine myocardial ischemia and hamster heart failure models. Implanted MSCs promote tissue regeneration by recruiting bone marrow progenitor cells and activating local host stem cell niches. These processes are mediated by inter-tissue cross-talk mechanisms involving signaling molecules such as JAK/STAT3, integrins, VEGF receptors, and Wnt/b-catenin. Our long-term goal is to generate clinically relevant stem cell information that may be used to achieve robust therapeutic effects for a broad spectrum of human diseases and lower the cost of future stem cell therapy.
Cardiology; Cardiovascular Disease; Internal Medicine; Molecular Basis of Disease
I am a board-certified cardiologist trained in multimodality cardiovascular imaging. I have completed the most advanced training possible in all cardiovascular imaging modalities (Level III) - echocardiography, nuclear cardiology, cardiac computed tomography (CT), and adult and congenital cardiac magnetic resonance imaging (MRI). I supervise and interpret these studies at the Buffalo General Medical Center (BGMC) and the Gates Vascular Institute (GVI). As a clinical cardiologist, I care for patients in the BGMC coronary care unit and the cardiac step-down unit. I provide consultative services at BGMC as well. I also leverage my background in epidemiology and public health to advise appropriate utilization of imaging at BGMC and the GVI for patients with known or suspected ischemic heart disease. I use my training to educate providers about the best way to determine the likelihood of ischemic heart disease in their patients and how they can improve the application of these tests to diagnose patients, determine their prognoses and institute appropriate therapies. As a clinical investigator, my research is geared toward imaging arrhythmogenesis in patients with heart failure. The goal of my research is to use imaging-based approaches to guide cardiac device therapies in heart failure patients. This includes implantation of defibrillators and biventricular pacemakers. I use nuclear cardiology-based imaging approaches to assess dyssynchronous cardiac contraction and sympathetic denervation in patients with heart failure to guide whether a particular device should be implanted or not. Once a decision is made to implant a device, these imaging approaches can also guide how the device should be implanted. My research helps identify the patients who will benefit from devices as treatment modalities, since these devices are invasive and expensive. My research also helps identify patients who will not benefit, which protects patients from a needlessly invasive and costly procedure. As a faculty member in the Division of Cardiovascular Medicine, I teach my team of fellows, residents and students during and after rounds when I am on consult and inpatient services. I also supervise the fellows’ clinic at BGMC.
Cardiology; Cardiovascular Disease
I am a cardiologist with more than 30 years’ experience. The primary focus of my patient care is the diagnosis, treatment and prevention of coronary artery disease, arrhythmias, valvular heart disease, lipid abnormalities, heart failure and hypertension. My goal is to improve my patients’ quality of life. The UBMD cardiology practice allows me to provide my patients the full spectrum of cardiovascular services representing state-of-the-art therapy. In addition, I am able to take advantage of a wide range of clinical research studies conducted within UBMD Cardiology, which may prove to be unique options for my patients. Having these complete services and research studies available to me allows my patients to receive a level of care unparalleled in our community. I am intimately involved in educating the next generation of physicians through my teaching of medical students, residents and fellows. In 2015, the family medicine residents at Millard Fillmore Suburban Hospital recognized my commitment to medical education with an award for my specialty teaching.
Cardiology; Cardiovascular Disease
As a general cardiologist, I care for patients diagnosed with a spectrum of cardiovascular diseases, including acute and chronic manifestations of coronary artery disease, congestive heart failure, cardiomyopathies, valvular disorders, arrhythmias and aortic and pericardial diseases. I have expertise in the role of echocardiography and nuclear cardiac imaging for the evaluation of cardiac disorders, including transesophageal echocardiography (TEE), nuclear stress testing (myocardial perfusion imaging), viability imaging and multiple-gated acquisition scan (MUGA) studies for evaluation of cardiac function. I supervise and interpret these studies at both the Buffalo General Medical Center (BGMC) and Gates Vascular Institute (GVI) and in the outpatient setting. I also perform electrical cardioversions to manage arrhythmias and interpret electrocardiograms (EKGs) for BGMC, and I provide consultative services there as well. I care for inpatients in the critical care and cardiac monitoring units (telemetry) at BGMC and the GVI, and I continue to provide care for patients after they are discharged from the hospital. I care for individuals on an outpatient basis by managing those with chronic cardiac conditions and by providing preventative cardiology services for patients with hypertension and hyperlipidemia. I also evaluate patients with chest pain or shortness of breath. My research focus is on clinical cardiac imaging. I supervise resident projects involving the role of myocardial perfusion imaging and coronary computed tomography angiography (CTA) in patients with mildly elevated markers of cardiac injury (troponin). I also am the sponsor for a project aimed at improving congestive heart failure outcomes at BGMC, an effort that will improve cardiac care for patients in Western New York. As program director for the fellowship in cardiovascular disease, I organize the fellowship didactic curriculum and case discussions. I mentor the fellows and coordinate their training to achieve their specific career goals, including preparation for subspeciality training in interventional cardiology, electrophysiology, heart failure or advanced cardiac imaging. I also enjoy teaching medical students and residents. I teach in the second-year medical student cardiovascular curriculum and coordinate and lead small-group case discussions for third- and fourth-year medical students. I also provide lectures and board review to internal medicine residents.
Cardiology; Cardiovascular Disease; Internal Medicine; Radiology; Cardiopulmonary physiology; Autoimmunity; Cardiac pharmacology; Gene Expression; Immunology; Stem Cells
I am a cardiologist with specialized training in advanced cardiac imaging. I see outpatients at the Heart and Lung Center of Buffalo General Medicine Center (BGMC), and I care for inpatients through the cardiology consult and inpatient services at BGMC. As an advanced imaging cardiologist, I am responsible for developing and advancing the cardiac computed tomography (CT) and magnetic resonance imaging (MRI) programs at the Gates Vascular Institute (GVI) and providing these services to patients. These advanced, noninvasive imaging techniques allow physicians to perform in-depth, 3-D evaluation of the coronary tree, myocardium, heart valves, pericardium and great vessels. These imaging tools allow for the best possible diagnoses and care of patients. My research spans basic science, translational and clinical fields and combines the cross-discipline expertise on magnetic resonance (MR) technology with molecular biology. My overall goal is to study the consequences of ischemia-induced myocardial injury, with a focus on their therapeutic reversal. My research laboratory at UB’s Clinical and Translational Research Center (CTRC) is devoted to the development of novel time-and-tissue-targeted MRI methods for integrative understanding of cardiovascular pathophysiology in preclinical models. We have several interesting research projects, e.g., we have recently discovered that the presence of high-risk plaques in the carotid arteries predict future incidence of myocardial infarction and stroke. The results emphasize that the nature of atherosclerosis and the use of comprehensive non-invasive computed tomography angiography (CTA) will help identify patients who are at higher risk of developing ischemic stroke. These research results will help physicians employ early therapeutic strategies for these high-risk patients. I mentor medical students, residents and fellows both in clinical and research settings, and I precept cardiology fellows at the Heart and Lung Center at BGMC. In addition, I am deeply engaged in furthering the research and clinical education of our house staff. Our trainees have published their research in highly esteemed peer-reviewed journals, and many have routinely presented their work at national and international scientific conferences. I am committed to facilitating the career goals of my mentees while I continue to advance my own career as a clinician, researcher and mentor.
Cardiology; Cardiovascular Disease; Internal Medicine; Apoptosis and cell death; Cell Cycle; Cell growth, differentiation and development; Gene therapy; Stem Cells
I am a researcher with formal training and practice in both general and interventional cardiology. My research expertise is in coronary physiology and physiological studies in large animals with ischemic heart disease. Based on my background, my research is focused on therapeutic approaches to effect cardiac regeneration in large animals with acute and chronic ischemic heart disease. In my laboratory, I use a preclinical porcine model of hibernating myocardium with chronic left anterior descending (LAD) coronary artery occlusion and collateral-dependent myocardium or infarcted myocardium caused by coronary ischemia-reperfusion. I have addressed the problem with several different therapeutic approaches involved in gene therapy, pharmacological and stem cell therapies. We routinely perform physiological studies on these porcine models with quantitative analyses of myocardial morphometry and immune-histochemical analyses. The information we have collected in completed work demonstrates remarkable functional recovery and myocyte regeneration in the adult porcine heart. Intracoronary adenoviral gene transfer with fibroblast growth factor (FGF-5), the HMG-CoA inhibitor pravastatin and intracoronary mesenchymal stem cells (MSCs) all stimulate the proliferation of endogenous cardiac myocytes and, to some extent, generate new myocytes and vessels. Our current work is focused on understanding the regenerative capability of cardiosphere-derived cells (CDCs) originating from heart tissue in acute or chronic ischemic myocardium. The result of this work will play an important role in advancing the care of many patients with acute and chronic ischemic heart disease. In my laboratory, I mentor research fellows through their rotation. Fellows who work in my laboratory have the unique opportunity of being exposed to large animal experimentation and learning skills related to it--in physiology and coronary angiography, as well as computed tomography (CT) and magnetic resonance imaging (MRI) techniques. Under my supervision, fellows also may work on independent projects and learn about cell biology and molecular biology, with the chance to present at international meetings and to publish as an author in international journals.
Cardiology; Cardiovascular Disease; Stem Cells
My research program is focused on the investigation of mechanisms underlying functional and structural cardiac remodeling in heart disease, as well as novel therapeutic interventions to prevent or reverse left ventricular dysfunction caused by myocardial ischemia and hemodynamic overload. These studies generally utilize non-invasive advanced cardiovascular imaging techniques and invasive hemodynamic assessment to assess cardiac performance in vivo, along with ex vivo analysis of myocardial tissue to examine cellular and molecular mechanisms underlying observed changes in physiological function.
Cardiology; Cardiovascular Disease; Interventional Cardiology
As an interventional cardiologist, I perform a variety of invasive diagnostic and interventional cardiac catheterization procedures. My primary interests are in the diagnosis and treatment of acute coronary syndromes and interventional treatment of complex coronary lesions such as unprotected left main coronary artery interventions, bifurcating lesions and chronic total occlusions. Although my focus and passion have been interventional cardiology, I maintain an active interest and involvement in general cardiology and internal medicine and treat a variety of cardiovascular diseases, including congestive heart failure, valvular heart disease, arrhythmias and dyslipidemias. I practice at the Buffalo VA Medical Center (Buffalo VAMC) where I have been the chief of the cardiac catheterization laboratory since 1999. In addition to my responsibilities in the laboratory, my duties include attending on the cardiology consult service, covering the inpatient acute medicine service and interpreting a variety of non-invasive studies (e.g., stress tests, Holter and event monitor studies and EKGs). I enjoy teaching and working with medical students, residents and fellows as they progress through their hospital rotations on cardiology consults and weekend medicine service coverage. I also mentor, supervise and teach fellows in the cardiac catheterization laboratory and outpatient cardiology clinic.
Cardiology; Cardiovascular Disease; Interventional Cardiology; Endovascular Medicine; Vascular Medicine
I am an interventional cardiologist with UBMD Cardiovascular Medicine, with specialized training in echocardiography, nuclear cardiology and noninvasive vascular interpretation (RPVI). I see outpatients through the UBMD ambulatory practice at the Amherst Clinic, and I care for patients admitted to the Buffalo General Medical Center (BGMC) consultative service and BGMC’s Cardiac Care Unit (CCU). My interventional practice involves evaluating and caring for patients with coronary and structural heart diseases. I perform diagnostic coronary angiography, percutaneous coronary intervention (PCI), coronary atherectomy, percutaneous mechanical hemodynamic support, cardiac biopsy, patent foramen ovale (PFO)/atrial spetal defect (ASD) closure and transaortic valve replacement (TAVR). I also have a specialized focus on evaluating and managing patients with peripheral vascular disease, including noninvasive vascular testing and endovascular interventions. I see patients at the Gates Vascular Institute (GVI) where I perform diagnostic peripheral and carotid angiography and interventions for peripheral arterial diseases. These procedures include lower extremity arterial atherectomy, angioplasty and stenting, renal and mesenteric artery revascularization and subclavian intervention. I am active in research at the GVI by participating in a number clinical trials. One aims at protecting patients from renal damage during PCI (CARIN, Ischemix). Another involves an alternative procedure to perform TAVR for intermediate-risk patients with symptomatic aortic stenosis (SURTAVI, Medtronic). A third clinical trial addresses using intracoronary delivery of stem cells in patients postanterior myocardial infarction with ischemic left ventricular dysfunction (ALLSTAR, Capricor). As a faculty member at the University at Buffalo, I teach and mentor residents and fellows during their hospital rotations.