Consultation with...Eduardo Marbán
The new chief of the division of cardiology talks about the changing art of treating the damaged heart and offers some predictions for the future.
What’s different in cardiology since you were in training 20 years ago?
It was still about lead pipes and plumbing then. I’d listen to a patient tell me he had trouble exercising, then hear fluid in his lungs and extra heart sounds. Those are the sounds of congestive heart failure, which afflicts tens of millions of people worldwide, but at the time we didn’t have a clue what was happening. A lot of interesting biology was beginning —— how the vascular wall reacts to cholesterol, how heart failure weakens the contractions of the heart, why instabilities of rhythm arise during heart attacks. But the models that were being used were very static. Today, we’re poised for a revolution.
Is that affecting treatment yet?
In one of the first applications of fundamental biology to a treatment, we’re beginning to use coated stents. Instead of focusing on the mechanics of opening up a clogged artery and putting in a spring. We’re coating these springs with biological factors, reducing the risk of re-stenosis.
Now, go back to congestive heart failure. How would you treat that today?
We know this disease occurs when the heart doesn’t beat strongly enough —— its muscle has grown weak, perhaps from coronary artery disease or high blood pressure. We have a host of medications now that prolong life —— beta blockers and ACE inhibitors. We also have amazing devices to help the problem.
The bi-ventricular pacemaker can resynchronize a damaged heart by sending an electrical current into the chambers on both sides. Automatic internal defibrillators, like the one that Dick Cheney wears, can keep people alive. And LVADs —— left ventricular assist devices —— which once were just bridges to keep people alive until they could have a transplant, today are taking the place of transplants.
Now, tell us what’s coming next.
The most exciting things are gene and stem-cell therapy. I actually believe that in two or three years we’re going to be able to put stem cells —— grown from bone marrow or even from heart tissue——back into damaged hearts to regrow myocardial tissue. I’d say the future prospects for battling heart disease look very bright indeed.