More than a year after his passing, Arthur Moss' research continues to fuel discoveries related to the treatment of heart disease, and his dedication to teaching and mentoring carries on in the training of a new generation of researchers.
Moss, M.D., founding director of URMC's Heart Research Follow-up Program who passed away in February 2018, made some of the most significant discoveries in sudden-cardiac-death prevention and treatment. His research improved the standard of care for people with heart disease and helped them to live longer, better lives.
"Arthur's mission was to identify people at risk of sudden cardiac death and to find a way to prevent it," said Charles J. Lowenstein, M.D., chief of Cardiology. "His mission led to landmark clinical trials and the groundbreaking discovery that implantable defibrillators save lives. Hundreds of thousands of lives worldwide were saved by Arthur's research."
The Multicenter Automatic Defibrillator Implantation Trial (MADIT) series of clinical trials in the 1990s showed that the implantable cardioverter defibrillator--a device that detects arrhythmias and shocks the heart back into a normal rhythm--significantly improves survival in patients with a high risk of sudden death. These findings directly led to new medical guidelines in the U.S. and around the world.
Moss' legacy endures in the ongoing work of URMC's team of cardiologists and electrophysiologists, through the expansion of the MADIT trials, a formal research training program, and broader collaboration and teamwork.
Expanding clinical trials
Building on the Heart Research Follow-up Program, URMC established the Clinical Cardiovascular Research Center (CCRC) to consolidate all clinical cardiology research into one team. The world's leading research group for clinical trials of sudden death, the CCRC team is led by center director Ilan Goldenberg, M.D., and includes faculty Wojciech Zareba, M.D., Ph.D., professor of Cardiology, Valentina Kutyifa, M.D., Ph.D., associate professor of Cardiology Heart Research, and Jean-Philippe Couderc, Ph.D., M.B.A., associate professor of Cardiology.
According to Goldenberg, center researchers are now looking to identify the patients in the more general population who are at risk of sudden cardiac death and to help them live longer using device and implantable monitor therapy. "Our initial series of MADIT trials focused on the sickest patients with more advanced cardiac dysfunction," Goldenberg said. "We are planning the next series of MADIT studies to expand and explore sudden cardiac death among a more general population."
One new study led by Kutyifa will analyze sex-specific outcomes in patients with non-ischemic cardiomyopathy treated with cardiac defibrillator device therapy. With a particular emphasis on women, the BIO-LIBRA study will explore whether women respond to defibrillator therapy differently than men. The target group is 1,000 patients in 50 sites in the U.S., with a goal of at least 40 percent female enrollment.
Goldenberg was recently awarded the highly prestigious American Heart Association grant on arrhythmia and sudden cardiac death, in collaboration with the University of Washington and Johns Hopkins. This project will focus on how to prevent sudden cardiac death using genomics and innovative digital technology, particularly among such underrepresented populations as women and children.
Continuing Moss' legacy of National Institutes of Health-funded research, Zareba obtained NIH grants to conduct multicenter studies on: 1) the risk stratification in nonischemic cardiomyopathy to test ECG and cardiac magnetic resonance parameters in predicting ventricular arrhythmias; and 2) new therapy in the arrhythmogenic right ventricular cardiomyopathy.
In addition to continuing international clinical trials on sudden cardiac death, center researchers are expanding trials into other areas, including novel technologies for heart failure, ventricular tachycardia and thrombosis. Examples range from telemedicine and the next generation of defibrillators, to new pacemakers and new monitoring devices. Couderc conducts NIH-funded studies with new monitoring technologies including video cameras and CardioMat to monitor heart rate and ECG.
A passion for teaching and mentoring
Besides conducting research, Moss' other passion was advancing the careers of his students. He trained one or two fellows per year in his clinical research methods. Today, his enthusiasm for teaching and mentoring lives on in a structured training program led by Goldenberg and Kutyifa that involves all URMC Cardiology fellows.
Fellows receive hands-on training, and they are assigned an individual research project. The CCRC team also is offering clinical research training to other URMC divisions, such as Pulmonary and Critical Care and the Wilmot Cancer Institute.
A center for collaboration
CCRC researchers are furthering Moss' commitment to teamwork by fostering greater collaboration among university faculty as well as among other centers around the globe. Faculty members are working together to prepare for the next phase of clinical trials, and the worldwide research network is expanding to other centers in the U.S. and Europe.
"Arthur Moss helped build our heart research program into a worldwide hub of international studies on medical interventions for sudden death, cardiac arrhythmias, heart attack and heart failure," Lowenstein added. "Today, Ilan Goldenberg and his team--all of whom worked with and were inspired by Arthur--are taking cardiovascular research to the next level, building on his legacy."