Since arriving at MGH in 1999 I have had the privilege of training in internal medicine and cardiology, teaching as a chief resident and as a cardiology attending, providing clinical care to patients with a broad range of cardiovascular diseases, and conducting research. I current serve as Section Head of Heart Failure, Medical Director of the Heart Transplant Program, and Director of the Cardiopulmonary Exercise Testing Laboratory.
As an investigator at MGH I have published over 100 manuscripts in fields ranging from the evaluation of novel therapies for heart failure to mechanisms of exercise intolerance in cardiovascular disease and metabolic response patterns to exercise. I am particularly interested in the role of the lung circulation and other extra-cardiac organs in mediating exercise intolerance in patients with heart failure. Through metabolic profiling of human plasma at rest and during exercise, in collaboration with the Broad Institute, our group has established metabolic signatures of cardiovascular disease states that may help to refine current phenotyping approaches.
Our cardiopulmonary exercise laboratory focuses on clinical evaluation of patients with shortness of breath of unclear etiology through comprehensive evaluations of each organ system's contribution to reduced functional capacity. Our laboratory also focuses on risk stratification in heart failure patients and serial assessments of exercise performance before and after medical interventions.
As Medical Director of the MGH Heart Transplant Program it has been an honor to work in close collaboration with my medical and surgical colleagues and the Transplant Center to help bring innovative approaches to heart transplantation with a particular focus on organ pool expansion.
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Mass General Heart Center
55 Fruit St.
Boston, MA 02114
Phone: 866-644-8910
Medical Education
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My background is in biochemistry and cardiopulmonary physiology, and I have formal training in trial design, clinical investigation and mass spectrometry-based metabolic profiling. An objective of my research is to understand mechanisms of exercise intolerance in patients with heart failure and to define physiologic and biochemical signatures of heart failure subphenotypes.
One area of focus has been on defining physiologic and metabolomic signatures of right ventricular-pulmonary vascular (RV-PV) interactions during exercise in heart failure. Through a unique exercise protocol that integrates hemodynamic measurements, ventriculography, gas exchange measurement and plasma sampling, we found that periodic breathing and kinetics of oxygen uptake and efficiency of ventilation provide complementary gas exchange signatures of RV-PV dysfunction during exercise. This physiologic data is complemented by measurements of circulating small molecules that serve as metabolomic signatures of RV-PV dysfunction. Taken together, these parameters promote recognition of impaired RV-PV function in HF and may also may inform targeted interventions for RV-PV dysfunction.
Another area of focus is the periphery in heart failure, which constitutes the vasculature and skeletal muscle systems. These systems outside of the heart play a critical role in determining functional capacity in patients with heart failure. My group recently reported that peripheral oxygen extraction is abnormal in patients with heart failure. To improve peripheral oxygen utilization, we are investigating iron homeostasis in heart failure and whether or not oral iron repletion improves exercise capacity in heart failure through an NIH-sponsored multicenter trial (IRONOUT-HF, PI=Lewis).
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