Intermountain Heart Institute Research Update. Brent Muhlestein, MD Co-Director of Cardiology Research Intermountain Heart Institute

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1 Intermountain Heart Institute Research Update Brent Muhlestein, MD Co-Director of Cardiology Research Intermountain Heart Institute

2 Disclosures I will not discuss off label use or investigation use in my presentation I have no financial relationships to disclose

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8 Highlights of Intermountain Heart Institute Program Development 2016 Recruitment and hiring of Kirk Ute Knowlton, MD as director of cardiology research BS in Chemistry from Brigham Young University MD from University of Utah Internal medicine residency at Duke University Cardiology Fellowship at University of California San Diego Highly published basic scientist studying myocarditis Clinical expert in pulmonary hypertension and pulmonary thromboembolic disease Chief of Cardiology at UCSD for over 10 years. Was acting Chairman of Internal Medicine at UCSD upon recruitment

9 Highlights of Intermountain Heart Institute Program Development continued Expansion of our research team to handle more investigator initiated studies. Development of an enhanced and formalized quality and compliance organization. Expanded interaction with industry in regards to collaborative investigator initiated studies Bristol Myers Squibb Corporation Medicure Corporation Medicines Company Enhanced Interaction with Philanthropy Dell Loy Hansen Cardiovascular Research Foundation - $1,000,000 Oakland Family Foundation Bingham Family Foundation

10 Three Published Research Studies from this Past Year Highlighted

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12 Standard 12 Lead ECG Machine

13 Smart Phone 12 Lead ECG Machine

14 Standard 12 Lead ECG

15 Smart Phone 12 Lead ECG

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17 ST LEUIS Multicenter Trial Aim: Can STEMI be diagnosed as accurately with a smart phone ECG machine as with a standard 12 lead ECG machine Plan to enroll 300 patients more than half already enrolled 200 chest pain patients 100 STEMI activation patients Multiple Sites participating Supervised by Intermountain Heart Institute Intermountain Heart Institute, Salt Lake City, UT Duke University, Durham, NC Mayo Clinic, Rochester, MN Integris Heart Hospital, Oklahoma City, OK Erlanger Institute for Clinical Research, Chattanooga, TN Argentina Heart Institute, Buenos Aires, Argentina

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19 Survival by Quartile Group of Endogenous Testosterone Concentrations (1 is lowest, 4 is highest)

20 Low testosterone in men increases their risk of death.

21 So Having Low Testosterone is Bad. Does Replacing it Help?

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24 May 4, 2015 FDA Announcement

25 Can the Intermountain Heart Institute Contribute Valuable Information to Help Address this Question?

26 Methods 4,736 males with initially low testosterone (T) levels and available follow-up T levels were included and followed for more than 3 years. The primary outcome was a composite of death (D), nonfatal myocardial infarction and stroke (MACE). Multivariable adjusted hazard ratios (HRs) obtained between three groups: Persistent low T (<212 ng/dl, n=801) Normal T ( ng/dl, n=2,241) High T (>742 ng/dl, n=1,694)

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29 Conclusions In a large general healthcare population, TRT in men with low T was associated with reduced MACE and D over 3 years compared to no or ineffective TRT. However, absence of a clear benefit for CVspecific MACE and a nominal increase in stroke with high follow-up T suggest a conservative approach to TRT for cardiovascular protection. We are pursuing more research into this important topic.

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34 Conclusion Elevated fine particulate matter air pollution exposures contribute to triggering acute coronary events, especially ST segment elevation myocardial infarction.

35 Summary Thanks to all the support from many persons within Intermountain Healthcare, cardiovascular research at the Intermountain Heart Institute is well and thriving. Research performed here has a significant impact far beyond our own borders. I believe this research contributes significantly to the extraordinary cardiovascular care provided by the Intermountain Heart Institute.

36 Thank you!