Our echocardiography projects have included investigation into the effectiveness of simulator training in learning basic transthoracic imaging. We have also used more advanced echocardiographic measures of cardiac mechanics to describe the effects of cardiac surgery on heart function, and to predict patient outcomes. Ongoing projects involve the clinical applications of 3D imaging, 3D and conventional strain imaging, and perioperative diastolic function assessment in a variety of perioperative procedural settings.
Effect of lung transplantation on right ventricular performance
UCLA is a nationally recognized center for lung transplantation. Many patients presenting for lung transplants have elevated pulmonary artery pressures and impaired right ventricular function. Previous studies have demonstrated variable improvements in function following transplantation. We are studying whether right ventricular function before surgery predicts improvement in heart function and overall outcomes after surgery. The cardiac response to lung transplantation has yet to be fully elucidated, and our goal is for this study to add valuable prognostic information to guide clinical care for this critically ill patient population.
Our division is actively involved in translational research seeking to predict how and why cardiac surgery is often followed by the onset of atrial fibrillation. Postoperative atrial fibrillation is a significant cause of morbidity and mortality. To improve prediction and treatment of this devastating complication, our clinical faculty anesthesiologists are collaborating with basic science researchers in the Division of Molecular Medicine. Their work investigates epigenomic mechanisms of cardiovascular disease with the goal of finding DNA methylation biomarkers to predict postoperative atrial fibrillation. This novel research seeks to minimize adverse patient outcomes by predicting them prior to surgery and enabling clinicians to personalize patient care.
The Human Genome Project was expected to usher in a new renaissance in science and medicine. It has now been 14 years since the completion of this project, and while advances in science have been made, the translation to clinical medicine has been slow. Initial obstacles to this growth included the high cost of sequencing and the painstaking task of integration with clinical data. Now, with advances in technology and the use of electronic medical records, we have the tools to capitalize on the accomplishments of the Human Genome Project.
The UCLA health system recently announced the launch of its Institute of Precision Medicine, tasked with integrating genomic information into the diagnostic and therapeutic management of patient care. Our division will be at the forefront of this initiative. Our job will be developing one of the core components of the institute: perioperative genomics. As perioperative physicians, we face new challenges to patient care in an era of increasing surgeries, constrained resources, patients with complex and critical illnesses, and an aging population. Genomics has the potential to provide us with the tools necessary to overcome these challenges and continue to provide a high level of care to our patients.
If we can understand the contribution of genetics to the outcomes of our patients, we may be able to anticipate how each individual patient will respond to the numerous stresses and pharmacological exposures of the perioperative period. Phenotypes that will be specifically addressed include responses to therapeutic techniques such as spinal cord stimulation. Different phenotypes affect reactions to common drugs used in the perioperative arena such as pain medications, anesthetics, anticoagulants, and drugs used to augment the cardiovascular system. Other areas of interest include assessing the perioperative risk for complications such as stroke, myocardial infarction, acute kidney injury, bleeding, arrhythmias, cognitive decline, and sepsis. The UCLA Division of Cardiothoracic Anesthesia is proud to play a pivotal role in the Institute of Precision Medicine as we acknowledge the tremendous impact of genomics on the future of medicine.