Clinical Programs
Cardiomyopathy - Inherited Cardiovascular Disease Program
This unique program, a collaboration between Yale and University College London (UCL) Heart Hospital faculty, provides Yale patients access to the highest levels of international expertise. Directed by William McKenna , MD, Professor of Medicine at UCL and Adjunct Professor at Yale, and co-directed by Dr. Dan Jacoby, Assistant Professor of Medicine, the Program offers provides comprehensive evaluation of patients and families with inherited cardiomyopathies including dilated and hypertrophic, and arrhythmogenic. Program services include state of the art imaging and genetic testing, including exome sequencing, a full spectrum of treatment options as well as genetic counseling.
Echocardiography
The Yale Echo Laboratory is comprised of 9 board-certified cardiologists and over 17 registered cardiac sonographers performing transthoracic, stress, and transesophageal echocardiography using state-of-the-art equipment capable of 2D and 3D imaging, intracavitary contrast, and strain imaging. The lab actively supports rapidly growing programs within the section, including percutaneous aortic valve insertions, atrial fibrillation ablation, and left ventricular assist devices. The lab has been digital for over a decade and has image management software that enables database search and off-line processing of 3D and strain images.
Electrophysiology
Under the leadership of Academic Director Dr. Joseph Akar, Associate Professor of Medicine and Clinical Director, Dr. Mark Marieb, Associate Professor of Medicine, the electrophysiology program provides a full spectrum of rhythm management services. These include a Complex Ablation Program (Dr. Akar, Director) focused on atrial fibrillation and ventricular tachycardia that offers epicardial ablation approaches, and a high volume Lead Management Program (Dr. Jude Clancy, Director) that provides laser-based device lead extraction, as well as a comprehensive menu of other EP services. The EP lab also provides national physician education courses on the use of intracardiac echocardiography (ICE). Current clinical trials in the EP laboratories include first-in-man clinical evaluation of 3D ICE, a registry for MRI safety with ICD patients, an NIH-sponsored study examining the effects of mental stress on arrhythmogenesis, the MADIT-CRT post-approval study, and studies examining the use of remote monitoring of ICD's, among others.
Genetics Program
Directed by Arya Mani, MD, PhD, Associate Professor of Medicine and Genetics, the CV genetics program offers thorough evaluation for patients with inherited cardiovascular illnesses. This program provides clinical diagnosis, genetic testing and analysis as well genetic counseling for diverse cardiovascular disorders ranging from cardiac arrhythmias to metabolic and vascular diseases. The program has established the first clinical center using exome analysis for identification of known as well as novel disease genes. The investigative genetics focuses on genetic evaluation of premature atherosclerosis, metabolic syndrome, and adult congenital disorders, particularly bicuspid aortic valve and patent ductus arteriosus.
Heart Failure And Transplantation
Directed by Daniel Dries, MD, , Associate Professor of Medicine in collaboration with Abeel Mangi, MD, Assistant Professor of Surgery, the Advanced Heart Failure program provides a comprehensive, multi-disciplinary approach to patients with advanced heart failure. This includes optimization of advanced heart failure medical management, use of cardiopulmonary exercise testing to determine prognosis, and evaluation for advanced therapies such as short-term and long-term mechanical support platforms and cardiac transplantation. The Center also offers a destination LVAD Program that provides long-term mechanical circulatory support to patients otherwise ineligible for heart transplant. Yale is the only center in New England participating in the ROADMAP Study that is examining the use of mechanical circulatory support earlier in the disease process in patients otherwise ineligible for heart transplant. The Syncardia Total Artificial Heart as a mechanical circulatory support platform is also available to appropriate individuals. In 2011 Yale performed 16 transplants and 19 LVAD implantations and our heart transplant survival and post LVAD rates are among the best in the region.
Imaging
The CV imaging program is directed by Dr. A Sinusas, Professor of Medicine and Radiology and includes nuclear cardiology, echocardiography and cardiac CT imaging. Yale nuclear cardiology laboratories offer state of the art SPECT, PET and SPECT-CT facilities and a faculty with a long history of ground breaking research in CV nuclear imaging. Echocardiography laboratories provide a comprehensive array of 2-D and 3-D transthoracic and transesophageal imaging options as well as intracardiac echo imaging (ICE), in collaboration with the EP faculty.
Inpatient
Inpatient cardiovascular services encompass CCU and the step down unit, the Goodyer service (general inpatient cardiology) and the consult service. The CCU/step-down service, directed by Joseph Brennan, MD, Associate Professor of Medicine, provides full time management for patients with acute coronary syndromes. The Goodyer service, directed by Lynda Rosenfeld, MD, Associate Professor of Medicine, is dedicated to inpatient management of patients with a wide spectrum of cardiovascular illnesses spectrum of cardiovascular illnesses and their safe transition to outpatient care while the consult service makes Yale cardiology expertise available to all physicians and patients in the Yale New Haven Hospital.
Interventional
Led by Craig Thompson, MD, MS, Associate Professor of Medicine, Director of Interventional Cardiology and Michael Cleman, Professor of Medicine and Director of cardiac catheterization laboratories, Interventional Cardiology service provides state of the art facilities for a full spectrum of coronary, structural heart disease and peripheral interventions and invasive diagnostic studies. Areas of interest include comprehensive percutaneous revascularization including chronic total occlusions (CTO) management , structural heart disease including percutaneous aortic valve replacement (TAVI) program, one of the very few in the US to offer two different stent-valves, and a large volume peripheral interventions programs with a particular interest in carotid and renal interventions. The interventional cardiology faculty are involved in a wide range of trails including Mitral Clip, coronary bifurcation stenting (TRITON), carotid stenting registries and CTO trials among others.
Neurobehavioral
Research has shown that the expression of negative emotions in response to a real or perceived provocation seems to consistently correlate with acute cardiac events. A biomedical model incorporating simultaneous Heart-Brain endpoints with behavior which is manifested and shaped by latent cultural and social determinants is our challenge.
Nuclear & Stress Testing Service
The Nuclear Cardiac Imaging program at Yale is a high-volume lab (more than 4000 SPECT, PET and gated blood pool studies per year) that employs state-of-the-art technology to provide critical diagnostic and prognostic information. Our lab performs both inpatient and outpatient stress testing, optimizing the stress protocol and imaging protocol for each patient. In addition, we perform gated blood pool imaging, which we employ in the monitoring of left ventricular function in patients receiving potentially cardiotoxicity chemotherapy and in the evaluation of patients for ICD implantation.
Oncology Program
One of the very few of its kind, the cardio-oncology program, directed by Raymond Russell, MD, PhD and Kerry Russell, MD, PhD, Associate Professors of Medicine, provides dedicated expertise in evaluation and management of cardiac dysfunction in patients receiving a variety anti-tumor therapies and also provides pre-therapy cardiac risk assessment and comprehensive cardiac care for cancer patients with coexisting heart disease. The program is integrated into activities of the Smilow Cancer Hospital to make access easier for patients.
Outpatient
Outpatient cardiology services, directed by Michael Remetz, MD, Associate Professor of Medicine, provide easily accessible and patient-friendly facilities located on the Yale campus (Yale Physicians Building) and in Branford and Guilford facilities. Each facility is staffed by the full-time Yale faculty and provides comprehensive non-invasive diagnostic testing.
Peripheral Vascular
Yale has a long tradition of being at the forefront of interventional innovation, currently we are heavily involved in different clinical trials including iliac and SFA stent intervention, drug – eluting angioplasty balloons, carotid stenting, and renal denervation therapy. Our advanced vascular medicine and endovascular interventional training pathway provides comprehensive training for physicians to pursue an independently funded academic career in vascular medicine. The overall intent of the program is to train the next generation of leaders in the emerging field of vascular medicine.
