The proposed K23 Career Development Award will enable Dr. Philip Green to establish an independent career with expertise in conducting research in interventional geriatric cardiology. Dr. Green is a clinical interventional cardiologis whose long-term goal is to optimize outcomes in older adult patients who receive invasive procedures to treat heart disease. However, further research training is required to accomplish this goal. Dr. Green's prior work has led the way in demonstrating that frailty is an important ris factor that compliments traditional cardiovascular risk assessment and that frailty increases the risk for adverse events after valve replacement in older adults with aortic stenosis.1, 2 The primary objective of this K23 research training program is to identify mechanisms underlying frailty related risk in order to lay the groundwork for future studies designed to test interventios to target those mechanisms and reduce the risk of adverse outcomes in older adults with aortic stenosis. We hypothesize that decreased physiologic reserve manifested in the operating room during valve replacement and during recovery after valve replacement mediates frailty related risk of adverse outcomes. To test this hypothesis this proposal outlines two separate but related studies. Study 1 will analyze continuously recorded physiologic data collected during the valve replacement procedure to evaluate the impact of impaired physiologic reserve during the procedure on complications immediately after valve replacement. Study 2 will use accelerometers to measure activity before and for 6 months after valve replacement to analyze the dynamics of physical activity recovery as a mediator of frailty related decreased quality of life after valve replacement. To conduct this research training, Dr. Green has assembled a multidisciplinary team of mentors to provide training in: (1) geriatric cardiovascular research methods; (2) quantitative methods for evaluating high density repeated measures datasets; (3) biostatistical methods for evaluating complex constructs (mediation); and (4) ethical research conduct and research dissemination. He has also enrolled in and completed courses toward a Master's Degree in Biostatistics Clinical Research Methods program at the Columbia Mailman School of Public Health. This area of research addresses an unmet public health need in that it aims to identify a novel pathway to improve outcomes in older adults with aortic stenosis who receive valve replacement. Aortic stenosis is a common and growing problem among older adults and can only be cured with valve replacement. Advances in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement have made valve replacement available to high risk and frail older adults.3 Therefore efforts to improve outcomes in this population should be seen as a high priority. This K23 proposal will position Dr. Green to accomplish his goals of identifying novel targets for optimizing outcomes in the frail elderly with heart disease and facilitate his development into an independent investigator in the field of geriatric interventional cardiology.

Public Health Relevance

We will conduct observational studies to test the hypothesis that decreased physiologic reserve is a mechanism that explains adverse outcomes related to frailty. The prevalence of significant aortic stenosis in patients aged 70 to 80 years is estimated to be 2% and as the population ages, its prevalence will increase. Advances in endovascular treatments for valvular disease are addressing the marked undertreatment of aortic stenosis in the frail elderly. Accordingly, improving outcomes in the frail elderly who receive valve replacement or other cardiac interventions is a public health priority. This research will identify novel targets to improve outcomes in older adults who receive cardiac procedures.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Special Emphasis Panel (ZHL1)
Program Officer
Scott, Jane
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Columbia University (N.Y.)
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Christakopoulos, Georgios E; Christopoulos, Georgios; Karmpaliotis, Dimitri et al. (2017) Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry. Can J Cardiol 33:478-484
Dharmarajan, Kumar; Foster, Jill; Coylewright, Megan et al. (2017) The medically managed patient with severe symptomatic aortic stenosis in the TAVR era: Patient characteristics, reasons for medical management, and quality of shared decision making at heart valve treatment centers. PLoS One 12:e0175926
Song, Lei; Maehara, Akiko; Finn, Matthew T et al. (2017) Intravascular Ultrasound Analysis of Intraplaque Versus Subintimal Tracking in Percutaneous Intervention for Coronary Chronic Total Occlusions and Association With Procedural Outcomes. JACC Cardiovasc Interv 10:1011-1021
Christakopoulos, Georgios E; Karmpaliotis, Dimitri; Alaswad, Khaldoon et al. (2016) Contrast Utilization During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry. J Invasive Cardiol 28:288-94
Finn, Matthew T; Green, Philip; Nicholson, William et al. (2016) Mother-Daughter-Granddaughter Double GuideLiner Technique for Delivering Stents Past Multiple Extreme Angulations. Circ Cardiovasc Interv 9:
Karacsonyi, Judit; Karatasakis, Aris; Karmpaliotis, Dimitri et al. (2016) Effect of Previous Failure on Subsequent Procedural Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention (from a Contemporary Multicenter Registry). Am J Cardiol 117:1267-71
Finn, Matthew; Green, Philip (2015) The Application of Frailty to the Modern Cardiac Risk Assessment: a Case-Based Review. Curr Cardiovasc Risk Rep 9:
Matsumura, Mitsuaki; Mintz, Gary S; Green, Philip et al. (2015) Multivessel spontaneous coronary artery dissection with angiographic documentation before and after the acute event. Coron Artery Dis 26:361-3
Christopoulos, Georgios; Karmpaliotis, Dimitri; Alaswad, Khaldoon et al. (2015) Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry. Int J Cardiol 198:222-8
Arnold, Suzanne V; Spertus, John A; Vemulapalli, Sreekanth et al. (2015) Association of Patient-Reported Health Status With Long-Term Mortality After Transcatheter Aortic Valve Replacement: Report From the STS/ACC TVT Registry. Circ Cardiovasc Interv 8:e002875

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