Resident Research Grants

Every year the Department of Medicine provides funding in the form of Resident Research Grants. These are awarded to PGY-2s to support mentored resident research projects. This year there are 10 funded proposals on a variety of topics.

Outcomes of BRTO vs Cyanoacrylate in Gastric Variceal Bleeding

Resident: Daniel Stein, MD, MPH
Faculty Mentor: Stephen Caldwell, MD

Gastric varices are present in up to 25% of patients with cirrhosis, and form as a compensatory shunt to reduce blood flow through the portal vein. Bleeding is seen in around a third of patients in a 3-year period. My project is a retrospective review of all of the UVA experience with two methods for management of bleeding – cyanoacylate glue (superglue) injected directly into the vessel and an IR procedure call BRTO (balloon retrograde transvenous obliteration) involving embolization. We plan to compare both clinical outcomes and further delineate the rationale for choosing one procedure vs the other.

New-Onset Atrial Fibrillation in the Coronary Care Unit: An Irregularly Recognized Problem

Resident: Eric Holland, MD
Faculty Mentor: J. Randall Moorman, MD

The incidence and impact of atrial fibrillation (AF), particularly new-onset AF, remains poorly characterized in critically ill patients. We hypothesize that new-onset AF is a poorly recognized condition and is associated with worse outcomes in the coronary care unit (CCU). Patients will be grouped into four main categories: No AF, known AF, new-onset AF, and undiagnosed new-onset AF. Categorization will be based on 12-lead electrocardiogram (ECG) reports, continuous ECG data, and diagnosis code. We will implement a novel heart rhythm pattern recognition technique developed at UVA to further aid in detecting AF. Multivariable analysis will be performed to investigate if new-onset AF, both diagnosed and undiagnosed, has any impact on LOS and mortality compared to known AF. Multiple other risk factors, including age, post-operative status, heart failure, valvular heart disease, sepsis, and other co-morbidities will be explored as possible contributing factors to new-onset AF.

Combination Biomarkers of Interstitial Lung Disease in Hermansky-Pudlak Syndrome

Resident: Sean Fortier, MD
Faculty Mentor: Borna Mehrad, MD

Progression of interstitial lung disease (ILD) is unpredictable.  The ability to predict progression of disease and outcomes would help identify at-risk patients that may benefit from pre-emptive care.  As of yet, there exists no clinical biomarker(s) to make such predictions and guide management in ILD.  Hermansky-Pudlak Syndrome (HPS) is a rare autosomal recessive disease that manifests as a triad of albinism, platelet storage defects, and development of ILD in early adulthood.  As such, individuals with HPS represent a unique population to develop biomarkers for ILD that can be tested in other ILD populations. We hypothesize that subjects with HPS will display a combination of peripheral blood molecular biomarkers that correlate with the progression and outcome of ILD.  To test this hypothesis, we will utilize our existing database of 68 HPS patients followed longitudinally (with data including PFTs, chest CTs, lab tests, and serial exams) and process aliquots of frozen plasma from these patients for measurement of candidate biomarkers described in the literature as correlating with ILD and other fibrotic diseases. Candidate biomarkers will then be analyzed individually and in combination for correlation with decline in pulmonary function test parameters and death.

Renal Insufficiency and the Effect on Mortality Outcomes after Continuous-Flow Left Ventricular Assist Device Implantation

Resident: Bryan Lawlor, MD
Faculty Mentor: Sula Mazimba, MD, MPH

Renal insufficiency is common in patients with advanced heart failure and is a risk factor for higher morbidity and mortality. While left ventricular assist device (LVAD) implantation may provide hemodynamic support, LVAD recipients are at a high risk for post-operative renal insufficiency. Recent studies by Sandner et al. (2009) and Hasin et al. (2012) have demonstrated overall improvement in renal function with Sandner’s study showing an association with improved survival after continuous-flow LVAD implantation. Despite these encouraging results, both studies did demonstrate a trend that as patients were followed further out from LVAD implantation, their renal function began to worsen again.  It is currently unclear how this decline in renal function impacts mortality outcomes. To further characterize changes in renal function after LVAD implantation and the effect on mortality outcomes, a retrospective cohort study will be conducted reviewing all patients at the University of Virginia Health System who underwent continuous-flow LVAD implantation with the Heartmate II device. Multivariate analysis will be conducted to determine significant predictors of developing improved and worsened renal function after implantation, including patients who require renal replacement therapy. Mortality at 1, 3, and 6 months will also be reported and multivariate analysis will similarly be conducted to determine significant predictors with attention to mortality in patients with preimplantation renal insufficiency, patients without improvement in renal function after LVAD implantation, and patients without sustained improvement in renal function.