Research Efforts
The long-term area of focus is in the relationship between stress and arrhythmogenesis, which boils down to the relationship between substrate, trigger, and event.
- “Why did he die on a Tuesday and not on a Monday?”
- Douglas Zipes
In the 50 years since the advent of the coronary care unit (Lown and Selzer 1968), our ability to prevent arrhythmogenesis has not made a significant difference in clinical outcomes (with a stable 1 out of 5 deaths being secondary to arrhythmia (Hayashi, Shimizu, and Albert 2015; Lown, Verrier, and Rabinowitz 1977). This topic fascinates me, and has led me to continue to explore this path, with a mixed focus between atrial and ventricular arrhythmias.
Current projects
This serves as a summary of current/active research projects and relevant updates on progress.
- Weekly T32/F32 research-in-progress updates along with T32/F32 mentorship meetings agends
- Weekly K23 research-in-progress updates along with K23 mentorship meetings agends
| MSIMI and CV Mortality | A large prospective cohort study measuring myocardial ischemia in response to mental stress, with extensive follow-up. Analytical skills included the development of recurrent event models (AG, PWP, MSM, marginal, conditional). Recurrent event software in R was developed. Middle-author Publication in JAMA | 2019-2020 |
| HRV and Myocardial Perfusion | Evaluated circadian patterns in autonomic function using 24-hour Holter data, generating HRV with a focus on spectral density analyses. Compared these patterns with CFR on quantitate PET, finding a relationship with CFR and early morning low HRV. First-author publication in IJC | 2017-2020 |
| GEH and Diabetes | Using the CARRS cohort, evaluated ECG-based patterns of GEH and diabetes, finding a strong relationship with cardiac fibrosis and widening of specific GEH parameters. WIP | 2018-2019 |
| HRV and Psychosocial Factors | Evaluated changes in HRV from baseline to several years later in the ARIC Study. Found that psychosomatic stress (in the form of vital exhaustion) led to a persistent decrease in high frequency HRV, a surrogate of vagal tone. First-author Publication in JAHA | 2016-2020 |
| AFL and Family History | Statistical analysis of relationship between early onset AFL and family history, which notably yields different phenotypes in Whites and Blacks. WIP | 2022 |
| Disturbances of Neurocardiac Axis | TL1 and F32 grant focused on evaluating of myocardial ischemia and changes in autonomic function using HRV. Pilot study with completed recruitment. Publication of Thesis and WIP | 2019-now |
| Vagolysis and Arrhythmogenesis | Measurement of vagolysis in arrhythmogenesis in the electrophysiology lab and using clinical and epidemiological data. Currently working on the development/progress towards a K23 award, including pilot data collection. | 2022-now |
GEH = global electrical heterogeneity; HRV = heart rate variability; CV = cardiovascular; SCD = sudden cardiac death; AFL = family history; MSIMI = mental stress induced myocardial ischemia; PET = positron emission tomography
Research skills
Technical research skills:
- epidemiology and biostatistics
- study design (IRB, informed consent, subjection enrollment)
- digital signal processing (HRV, ECG)
- programming in R, MATLAB
- harmonic regression
- advanced survival models with recurrent events
Previous work
Stress and Cardiovascular Epidemiology
Physiological and psychological stress and cardiovascular mortality, from a neurocardiac perspective
- Effect of autonomic reactivity and resting vagal tone in cardiovascular mortality
- Depression and dysregulation of the autonomic nervous system, published in JAHA
- Circadian variability in autonomic function and microvascular coronary disease, published in IJC
- Atrial fibrillation recurrence after catheter ablation
- Family history and genetic basis of atrial flutter
- Cardiovascular biorepository for computational assessment of trajectories/history
Stress and Arrhythmognesis
Mechanisms behind stress and arrhythmia generation (or degeneration) in a pre-clinical and clinical electrophysiology context
- Murine models of vagolysis leading to triggered arrhythmias, which was initially proposed as an AHA IPA, but then withdrawn
Computational Neurocardiology and Biostatistics
Programming-based approaches in signal processing and biostatistics
- Measuring circadian patterns and disturbances using a cosinor regression method
Clinical Projects
Work being done as a cardiology fellow at UIC/JBVA
- Atrial fibrillation and efficacy of cardioversion
- Pulmonary embolism management with a coordinated response team (PERT)
- Endocarditis lesion characteristics in a gain-independent manner using pixel density changes
- Arrhythmia and device management in setting of endocarditis