Interventional cardiologist at UBMD says heart disease is back as the No. 1 killer of men and women in the U.S. The cause? Poor diet, obesity, too much stress and high diabetes levels, among other factors. He talks about advances in heart disease treatments and new heart implants now available
By Chris Motola
Q: We spoke about seven years ago. We talked about uses for 3D printing in medical training.
A: We were using it for complex procedure training, yes.
Q: Have the applications evolved since then?
A: We’re mostly using it for the same things, for training purposes. We are also now using it for individual case planning for one-off cases that are unique, or if we’re planning to utilize a device for an off-label purpose and want to try to figure out how the device will behave. But a lot of the uses continue to be the same.
Q: I understand you’re utilizing a new implant for complicated heart failure cases. There was a story that ran recently in The Buffalo News about a patient who seems to be doing quite well with it.
A: There’s a large number of devices coming out for heart failure. It’s a large population of patients who sort of fall between having advanced heart failure but aren’t good candidates for other interventions or implants, that use cardiac contractility modulation therapy. A number of different devices have been trialed, so there’s a big market for these devices, and we’re involved in a bunch of those trials.
Q: What is CCM?
A: This is an FDA device similar to a pacemaker that goes into the septum that’s implanted by an electrophysiologist. It’s for advanced heart failure patients who continue to experience symptoms despite receiving medical therapy. The CCM device seems to improve cardiac contractility and symptoms. Whether it improves long-term survival is yet to be known, but it does seem to improve their symptoms in the short-term.
Q: How long have the devices been in use?
A: The device has been out for more than a year. We started implanting them over the last two or three months. It’s very early, but so far the initial success rates are looking pretty good. Implants have all gone without any complications. Patients have all left the hospital feeling better. We’ll have to wait and see about rehospitalization rates and long-term relief of symptoms. Time will tell.
Q: Are we seeing broader uses for devices for cardiology over time?
A: I think so. There are a number of devices being developed. There’s one being developed for the carotid artery that’s implanted in the neck. There are devices that are meant to restore ventricular size. So there is a large market of devices that are being tried and tested. It’s premature to say whether they’ll all be helpful or not, but what we do is make sure that patients are optimized medically and they get good follow-up. And, if they are good candidates for a transplant or an implanted device that they get them. Despite the best treatment there’s still often a gap, and mortality for these advanced heart failure patients still tends to be pretty high.
Q: What are the advantages of implants over surgery?
A: Oh, it depends on what you’re using it for. Some implants are temporary. Some implants are permanent. With surgery, it depends on what kind of surgery you’re talking about. Surgery for restoration of the ventricle over time has not been found to be very effective. Surgery is more invasive. It’s a good option for a small number of patients, but in general surgery in advanced heart failure patients tends to be more morbid and tends to be risky.
Q: Has your philosophy toward cardiac interventions changed at all since we last spoke seven years ago?
A: More and more we’re starting to realize that these devices are a very good alternative for a lot of patients. For a lot of these patients other therapies are out of reach; many of whom would have been subjected to surgery, are now getting these devices. The field has already grown in huge amounts and it’s still growing fast. It’s now the treatment of choice for the majority of patients with advanced coronary disease and valvular disease, and a lot of patients with advanced heart failure. So we have a lot more tools in the continuum of care to improve outcomes. And the tools are getting better every day.
Q: Heart disease is still the No. 1 killer overall.
A: I think COVID took over transiently, but we are back to heart disease being the No. 1 killer in both men and women.
Q: What’s keeping it at the top of the list despite all these advances?
A: Overall mortalities are declining, but a lot of other things have gotten worse. Our diets have gotten worse. The obesity epidemic continues to get worse, especially in third world countries. Diabetes has become a bigger problem. So despite some of the improvements we’ve seen in therapies, these factors are impacting patient health. And there are other issues. A lot of the patients who would have died from myocardial infarctions in the past are now alive, but instead of dying they’re in need of ongoing care. So there are consequences to our actions. But, yes, we’re making a lot of progress on the overall continuum but there’s a long way to go in eradicating heart disease.
Q: What role do interventional cardiologists play in prevention?
A: WThe way I think of it is that interventional cardiologist take care of acute problems, but these are systemic problems that can only be treated with lifestyle modification and prevention. Even after the intervention, that continuum of care has to continue. We still need to educate on diet and lifestyle and managing stress. What we do in the cath lab is one moment in time of that continuum.
Q: What effect does stress have on the heart?
A: There’s a fair amount of data that stress has a direct impact on blood pressure and is pro-inflammatory. People who manage their stress through mindfulness and meditation tend to see their blood pressure come down. Whether that changes long-term outcomes we don’t know; there are no randomly controlled trials. But we know patient wellness is generally better when they’re managing stress.
Q: If we speak again in another seven years, where do you want your field to be at that point?
A: The field is going to continue to evolve and get more precise, which will produce better outcomes. But it’s also going to integrate better into wholesome and holistic care. People think of interventional cardiology as a bunch of people sticking catheters into people and clearing blockages. I think we’re going to get more sophisticated, make sure we get to patients sooner and do better follow-up. And I think our treatments will continue to get less morbid and less invasive.
Name: Vijay S. Iyer, M.D.
Position: Division chief of cardiovascular medicine and interventional cardiologist with UBMD Internal Medicine and Jacobs School of Medicine and Biomedical Sciences
Hometown: Mumbai, India
Education: Grant Medical College, Maharashtra University of Health Sciences, Mumbai, India (medical doctor); Drexel University, Philadelphia, Ph.D., pharmacology; University of Minnesota, Minneapolis, fellowship in interventional cardiology; University at Buffalo Jacobs School of Medicine and Biomedical Sciences, fellowship in cardiovascular disease and postdoctoral fellowship in the division of cardiology
Affiliations: Buffalo General Hospital; Niagara Medical Center; Olean General Hospital
Organizations: American College of Cardiology; American Heart Association
Fmialy: Son, 19
Hobbies: Reading, traveling, watching movies, golf