Columbia Cardiology: A Living Tradition
“Now then in the last place we may bring our opinion, concerning the circulation of blood, and propound it to all men. Seeing it is confirm’d by reasons and ocular experiments, that the blood does pass through the lungs and heart by the pulse of the ventricles, and is driven in and sent into the whole body...It must be of necessity concluded that the blood is driven into a round by a circular motion in creatures, and that it moves perpetually; and hence does arise the action and function of the heart, which by pulsation it performs; and lastly, that the motion and pulsation of the heart is the only cause.”
William Harvey, Exercitatio Anatomica De Motu Cordis Et Sanguinis In Animalibus (1628)
The esteemed history of Columbia Cardiology dates back to 1931, when Andre Cournand and Dickinson F. Richards opened the cardiopulmonary (C6) lab of the First Division (Columbia) of Bellevue Hospital under the Chairmanship of the legendary Robert Loeb. The first lab of its kind pioneered the conceptual merger of the heart and lung into a single organ.
In 1929, a continent away, the German physician Werner O.T. Forssmann tested the first prototype for cardiac catheterization by threading a catheter from his own cubital vein to the right atrium. Although this event was dismissed by many as invasive and hazardous, Cournand and Richards were prescient, realizing this was “the key in the lock”. In 1941, after manipulating and refining this technique, they reported the first cases of cardiac catheterization in humans in their manuscript “Catheterization of the Right Auricle in Man”.
Cournand and Richards went on to use cardiac catheterization as a practical tool to describe the hemodynamics of traumatic shock during World War II, diagnose various forms of congenital heart disease, and describe the physiology of heart failure, action of cardiac drugs, various forms of dysfunction in chronic cardiac and pulmonary diseases, and their treatment.
In 1956, the Royal Karolinska Institute of Stockholm recognized Cournand, Richards, and Forssman as the fathers of cardiac catheterization, and awarded them the Nobel Prize in Physiology and Medicine. At the Nobel presentation, Professor G. Liljestrand, the secretary of the committee, proclaimed that the prize was awarded “for your discoveries concerning cardiac catheterization and pathologic changes in the circulatory system…Professor Cournand and Professor Richards. The practical value of cardiac catheterization has been definitely proved by you and your co-workers. This method, combined with those already available before, has in your hands led to may important new observations, to diagnostic as well as therapeutic advances.”
Cournand and Richards not only validated the observations and hypotheses of William Harvey in his seminal work “De Motu Cordis”, but had also established a paradigm shift in cardiology and provided the impetus for the development of interventional cardiology, clinical electrophysiology, and open-heart surgery.
The work of the two giants at the First Division of Bellevue quickly thrust the C6 lab on to the international stage, and attracted the best and brightest aspiring physicians and scientists. These included Eugene Braunwald, William Briscoe, Homer Smith, Domingo Gomez, Charles Ragan, Dudley Rochester, Jaques Durand, Jack Parker, Robert Darling, Richard Riley and Alfred Fishman.
Irene Ferrer was the first woman chief resident at Columbia’s Bellevue Hospital. While working in the cardiopulmonary laboratory, she used cardiac catheterization to define the mechanism of action of many cardiac medications, including digitalis. She subsequently spent 33 years as the director of Presbyterian Hospital’s EKG lab, and collaborated with IBM to develop the first software for computer EKG interpretation. Her career has served as a model for the academic advancement of women in medicine.
In the 1960s, members of the laboratory developed additional techniques, including the use of radioisotopes and fiberoptics, to examine detailed aspects of cardiac function. They also extended Cournand and Richards’ observations about the pulmonary circulation to consider the impact of respiratory acidosis on the pulmonary vasculature. As Cournand and Richards headed towards retirement, Charles Ragan replaced Richards in 1961 as Chief of the First Medical Service, and Harry Fritts replaced Cournand in 1964 as head of the cardiopulmonary laboratory.
Concomitant with the advancement of cardiac hemodynamics and circulatory physiology through catheterization, pioneering work was being performed at Columbia in electrophysiology. Brian Hoffman and Paul Cranefield (Rockefeller University and Adjunct Professor at Columbia) published the classic work “Electrophysiology of the Heart” in 1960. Dr. Hoffman gained international repute for his work on normal cardiac impulse initiation and conduction, mechanisms of arrhythmogenesis and anti-arrhythmic drugs, and bridging the gap between basic and clinical electrophysiology. Over 70 of the world’s leading electrophysiologists have either trained or worked closely with Dr. Hoffman. In 1963, Dr. Hoffman was named Chairman of the Department of Pharmacology at Columbia University. He held the David Hosack chair in that department from 1964 until his retirement in 1999. Among other numerous awards and recognition, Dr. Hoffman received the Medal of the New York Academy of Medicine in 1988 along with Dr. Cranefield for “work that ushered in a ‘new era in cardiac physiology and pharmacology.’”
Albert Waldo entered Columbia as one of Dr. Hoffman’s post-doctoral fellows in 1966 and joined the faculty of the department of pharmacology until 1972. In 1966, Dr. Waldo became the first person to perform electrophysiologic mapping during open heart surgery. He has gone on to a highly distinguished career, establishing himself as the father of entrainment and a leading expert on tachyarrhythmias. Dr. Waldo is currently the Walter H. Pritchard Professor of Cardiology, Professor of Medicine and Professor of Bioengineering at Case Western Reserve University.
Amid the escalating Vietnam War and the upheaval of student unrest at Columbia over the war, the late 1960s ushered in an important era in Columbia medical history. In 1968, the First Medical Service at Bellevue was phased out and Rejane Harvey, Yale Enson, and Dudley Rochester were charged with inaugurating the Columbia Medical Service at Harlem Hospital. Rejane Harvey, another member of the cardiopulmonary laboratory, joined the Columbia College of Physicians & Surgeons staff in 1946 and went on to develop an international reputation in the treatment of cardiopulmonary disorders. She served as chief of Cardiology at Harlem Hospital and was president of the New York Heart Association from 1975-1977. Dr. Harvey eventually became the Dickinson W. Richards Professor of Medicine.
Yale Enson was the last fellow to train under Cournand, and he went on to make significant contributions to the fields of hypertension and pulmonary circulatory diseases. Dr. Enson helped create both the CCU and cardiac catheterization laboratories at Harlem Hospital. As Professor Emeritus of Clinical Medicine, he has also become an eminent Columbia historian.
1968 was also the year in which Dr. Stan Bradley divided the Department of Medicine into specialty divisions. Harry Fritts became the first Chief of the Cardiopulmonary Division. While in the cardiopulmonary laboratory, Dr. Fritts had worked on the mechanism of hypoxic vasoconstriction. He extended this groundbreaking work to eventually identify acetylcholine as a uniquely specific pulmonary vasodilator. Dr. Fritts' research went on to focus on systemic and pulmonary circulatory physiology. The major thrust of his mature work involved the innovative simultaneous use of multiple indicators (dye substances, gases, radioisotopes) in the solution of complex circulatory problems in the lungs. These studies involved elegant mathematical treatments of multi-compartment systems
When Dr. Fritts left Columbia in 1973 to assume the founding Chair of Medicine at SUNY Stonybrook, J. Thomas Bigger was tapped as the first chief of the division of cardiology. Dr. Bigger’s work has had an indelible impact on the current practice of cardiology. Dr. Bigger’s research runs the gamut through both basic and clinical electrophysiology. He investigated the pharmacology of antiarrhythmic drugs and their effects on ventricular arrhythmias, demonstrated that paroxysmal atrial tachycardia (PAT) was due to AV nodal reentry, and has become an internationally recognized expert in sudden cardiac death. Dr. Bigger’s interests have included risk stratification after myocardial infarction, the diagnostic and prognostic utility of autonomic tone, heart rate variability, t-wave alternans studies in patients with cardiac disease, and the role of implantable cardiac defibrillators in the current landscape of ischemic and non-ischemic cardiomyopathy. Dr. Bigger was a principal investigator in the Cardiac Arrhythmia Suppression Trial (CAST) and CABG-PATCH trials. He served as chief of cardiology until 1984. Dr. Bigger is a recipient of the ACC Career Achievement Award. He remains active in the Division; currently, he is the Principal Investigator on a major NIH clinical trial examining cardiovascular risk in diabetic patients (ACCORD trial).
Dr. Bigger’s tenure was followed by that of Paul J. Cannon. Dr. Cannon became known for his work on the pharmacology of loop diuretics, the elucidation of the rennin-angiotensin-aldosterone neurohormonal axis, early myocardial perfusion imaging, and the vascular biology of prostanoid and eicosanoid inflammatory mediators. Later, he made significant contributions towards elucidating the role of nitric oxide in multiple models of vascular injury, including atherosclerosis and transplant vasculopathy.
Perhaps Dr. Cannon’s most important contribution to Columbia Cardiology was the institution of a philosophy and framework for the division that has persevered to this day. Dr. Cannon’s vision for the Cardiology division rested on two major tenets: 1) A multidisciplinary approach and collaborative effort between departments such as Medicine, Pharmacology, Physiology and Cellular Biophysics, and Molecular Cardiology to enhance and realize all potential opportunities for faculty and fellows, and 2) delegation and autonomy for the various sub-divisions of cardiology to construct paradigms of clinical practice, create a comprehensive curriculum for the fellows, and pursue academic innovation.
Under Dr. Cannon’s leadership and the chairmanship of Myron Weisfeldt, Columbia rose to preeminence in heart failure and transplantation, and bolstered its position at the forefront of cardiovascular research. On June 9, 1984, James Preston “JP” Lovette of Denver became the beneficiary of the world’s first successful pediatric heart transplant. The surgical team was led by Dr. Eric Rose, and included Dr. Keith Reetsma.
Soon after, the heart failure and transplantation program at Columbia-Presbyterian hospital blossomed. In the early 1990’s Milton Packer was recruited as the Dickinson W. Richards Professor of Medicine, Chief of Circulatory Physiology and Director of the Heart Failure Service. While at Columbia, Dr. Packer pioneered heart failure treatments, most notably the use of beta-blockers, and was a principal investigator for numerous trials including COPERNICUS, OVERTURE, ATLAS, and PRECISE.
Over the past 25 years, researchers such as Alan Tall, Henry Ginsberg, Ira Tabas, Ira Goldberg, Robert Kass, Andrew Wit and Michael Rosen have established themselves as leaders in the fields of vascular biology, lipid metabolism, and basic electrophysiology. David Pinsky rose to prominence for his work on cardiomyocyte apoptosis and mechanisms of heart failure. Henry Levin (the inaugural chief of the Center for Device Research), Eric Rose and Mehmet Oz helped coordinate the REMATCH trial, and continue to perform pioneering work on cardiac assist devices.
In 1997, Andrew R. Marks joined the Columbia faculty as the inaugural Director of the Center for Molecular Cardiology in the Division of Cardiology. He went on to become the Chair of the Department of Physiology & Cellular Biophysics in 2003. Dr. Marks is the Clyde and Helen Wu Professor of Medicine and Pharmacology and is currently the Editor-In-Chief of the Journal of Clinical Investigation, Dr. Marks is uniformly recognized as one of the world’s finest scientists and cardiologists. His research has contributed important insights into the molecular mechanisms regulating contraction of normal and failing cardiac muscle and coronary artery re-stenosis following stent placement. He has contributed to the development of drug eluting stents and his current work shows promising insight into the possibility of novel therapies.
Columbia was also fortunate enough to recruit Dr. Steven Marx, who was a co-collaborator with Dr. Marks in the discovery of the anti-proliferative and anti-migratory effects of rapamycin on vascular smooth muscle cells and has made significant contributions in basic electrophysiology and ion channel biology. Dr. Geoffrey Pitt is another key member of the research faculty who also studies the structure and function of ion channels. Specifically, those proteins that control electrical activity and the diseases resulting from ion channel dysfunction, such as cardiac arrhythmias and epilepsy. Dr. Pitt was the first recipient of the Lewis Katz Cardiovascular Research Prize for a Young Investigator in 2006.
In 1999 our current chief, Dr. Allan Schwartz, the Seymour Milstein and Harold Ames Hatch Professor of Clinical Medicine, brought his leadership and insight to the division. Dr. Schwartz is a renowned clinical cardiologist whose primary interest lies in valvular pathology. He is active in clinical research concerning acute coronary syndromes and percutaneous interventions for mitral disease. Under Dr. Schwartz’s leadership, the fellowship program is now partially supported by a competitively awarded NIH training grant.
Since the turn of this century, Dr. Schwartz has ushered in a renaissance for Columbia Cardiology. Shunichi Homma, the Associate Chief of the division and the Margret Milliken Hatch Professor of Medicine, heads the Cardiovascular Ultrasound lab and has made significant contributions to clinical and translational cardiovascular research. Dr. Lynne Johnson was recently recruited to direct the Nuclear Cardiology lab. She is interested in targeted imaging and was one of the first investigators to use radiolabeled antibodies as probes to image biological targets. Joseph Tenenbaum, the Edgar M. Leifer Professor of Clinical Medicine, widely recognized as an outstanding clinical cardiologist and clinician-educator, has been appointed as Chair of Medicine at Columbia’s Allen Pavilion.
Donna Mancini has assumed the mantle of leadership for the heart failure and transplant program, along with Yoshifuma Naka, her surgical counterpart. Columbia is now the largest heart transplant center in the world. The recruitment of the Center for Interventional Vascular Therapy and Cardiac Research Foundation, led by Dr. Martin Leon and Dr. Jeffrey Moses, has made Columbia an international epicenter for interventional cardiology. Dr. Hasan Garan, one of the fathers of modern clinical electrophysiology, continues to move the field forward and keep Columbia on the cutting edge. Conventional and advanced cardiac imaging has been significantly strengthened by new recruits and technological advances. Close ties have been cemented between cardiology and cardiac surgery, enhancing the profile of both disciplines. The division continues to be enriched by the breadth and depth of basic and clinical cardiovascular research.
Columbia University Medical Center has just broken ground on the Vivian and Seymour Milstein Family Heart Center, a 115,000 square foot building that will revolutionize cardiac care by uniting some of the world’s finest cardiovascular physicians, scientists, and nurses in cutting edge laboratories and facilities. The hope is to integrate basic and applied research to speed the process of discovery into clinical practice.
With the appointment of Dr. Lee Goldman as the Dean of Columbia University Medical Center, there is now an opportunity to advance Columbia’s international reputation as a center for cardiovascular excellence. It is our mission now to train the academic leaders of this century who will pioneer the paradigm shift in modern diagnostic and therapeutic cardiology.
“Now, what of the future? Perhaps the only incontestable prophecy that can be made is that advances in methodology and advances in understanding will go hand in hand... As progress is made, more results will pour in. Let us, then, beware of the danger of seeking security for our concept in the accumulation of facts. As the poet has said:
‘Knowledge is proud that it has learned much,
Wisdom is humble that it knows no more’”
(Andre Cournand, 1956, Nobel Banquet speech)