Fellowship
"Our program has been fashioned to equip its participants with the expertise, experience, intellectual foundation, and scientific insights needed for optimal performance as superb clinicians."
Burton E. Sobel, MD
Director of Cardiovascular Research Institute
Fellows can pursue training in Cardiovascular Disease at the University of Vermont/ Fletcher Allen Health Care in one of two tracks, the clinical track or the research track. The clinical track is designed to train fellows in general cardiology as well as to allow each fellow to pursue subspecialty training during the final year of this three year program. The research track is a four year program designed to train fellows in general cardiology as well as to provide them with training necessary to pursue an academic career in laboratory investigation.
How to Apply for Fellowship: http://www.fahc.org/gme/apply.html
Overview of the Cardiovascular Training Program
Clinical Track
Years 1 and 2 are devoted to general cardiology training. Thus, each fellow will be exposed to all aspects of general cardiology. Rotations will include inpatient cardiology (including consults) electrophysiology (exposure to electrophysiological testing as well as inpatient and consultative electrophysiology), stress testing, cardiac catheterization (training in diagnostic cardiac catheterization), and cardiac imaging (which includes radionuclide imaging, echocardiography, CT angiography and cardiac magnetic resonance imaging). In addition, the fellows play an integral role in an outpatient continuity clinic. After completion of the first two years, the fellow will have achieved level II training in stress testing with radionuclide imaging, cardiac catheterization, and echocardiography consistent with the guidelines presented in COCATS (J Am Coll Cardiol. 2002;39:1242-6.).
Year 3 in the clinical track is an elective year. We anticipate that each fellow will choose an area of cardiology for sub-specialization. The goals of this sub-speciality training will be to achieve COCATS level III training in one of three areas: electrophysiology, cardiac catheterization, or cardiac imaging. Other special training interest can also be accommodated in the 3rd year. Training in interventional cardiology and electrophysiology will require a fourth year of training. A comprehensive two year training program in the sub-speciality of cardiac imaging is being formalized.
Research Track
Those fellows pursuing research track training will spend two years under the direct supervision of a research mentor. A primary goal is to provide fundamental research training (usually in a bench research laboratory), providing the foundation for an independent research career in the Cardiovascular Sciences. The first two years of the research track are protected for research and so there is no call or inpatient clinical responsibilities. Following the two years of research training, the fellow will be trained in clinical cardiology indentical to that described above for the clinical track years 1 and 2. If desired, additional clinical training may be available in a third year of clinical training to obtain level III training in a cardiology subspecialty.
The Facility
Fletcher Allen Health Care is a tertiary care medical center and the teaching hospital of the University of Vermont, College of Medicine. This facility provides state-of-the-art health care to the nearly 1,000,000 residents of Vermont and Upstate New York. This population base is supported by an active cardiovascular service with approximately 5,100 patients admitted to the inpatient cardiology services, and 9,400 ambulatory patient visits yearly. Approximately, 5,200 diagnostic cardiac catheterization with 1,500 percutaneous interventions (e.g. angioplasty) performed annually. In addition, over 7,000 echocardiograms and approximately 3,600 nuclear stress tests are performed each year. The cardiac arrhythmia service implants approximately 400 devices (pacemakers and defibrillators) and performs 200 ablation procedures.
The Faculty
The Cardiology faculty at the University of Vermont is comprised of 25 highly trained clinician-scientists (including 5 PhD researchers). In addition to their busy clinical responsibilities, the faculty has active and productive research careers. For example, in the academic year 2005, 61 articles and 13 chapters/reviews were published. Funding for research comes from industry support as well as federal funding. Seven of the faculty are NIH sponsored principal investigators.
The Location
Burlington Vermont, located on the shores of Lake Champlain, is a vibrant college community of approximately 60,000 residents. There are 2 four year colleges in addition to the University of Vermont. Burlington is routinely rated as one of the most desirable places to live within the United States. The four seasons provide ample opportunities to enjoy oneself in the outdoors. Most notable is the easy access to world class skiing in the winter, while in the summer Vermonters enjoy hiking, cycling, boating, and several festivals.
A More In-depth Look at the Fellowship Training Program
Training in cardiovascular disease is enhanced through several modalities. A formal curriculum is distributed to each fellow upon matriculation. Independent reading is expected, and suggested reading is included in the curriculum. The cardiology library has copies of most major cardiovascular textbooks and journals. Online access to numerous journals is readily available. A weekly lecture series constitutes the didactic teaching of the training program. Cardiology fellows participate in didactic teaching through conferences. Finally, a substantial component of "hands on" training occurs during clinical rotations where there is a high degree of contact with the Cardiology Faculty.
Lecture Series
A daily lecture series includes Core Lectures (a basic curriculum designed to introduce basic concepts in cardiology), Morbidity and Mortality Conference, CCU Conference (selected cases are discussed weekly), Subspecialty Conference (focused conferences in cardiac catheterization, electrophysiology, and cardiac imaging), Journal Club, ECG Conference, and Fellow Didactic Lectures (fellow lectures on a fundamental area of the cardiovascular sciences).
WEEKLY LECTURES
Core Lectures
A comprehensive lecture series designed to cover all major aspects of cardiology and which prepares fellows for board certification in Cardiovascular Diseases. This curriculum is extensive and takes two years to complete.
Morbidity and Mortality
Once each month fellows rotating on the inpatient service present selected cases. A brief discussion and literature review is provided.
Subspecialty
A rotating weekly conference in which fellows on the electrophysiology, echocardiography and nuclear cardiology services review and discuss with the faculty selected cases highlighting a specific educational focus.
Journal Club
An alternating week conference in which fellows and faculty review recent articles.
ECG and EP Conference
Every other week electrophysiologists review ECG and intracardiac tracings with the fellows.
CCU Conference
A weekly conference where interesting cases are discussed amongst the faculty and fellows. Lively discussions usually entail.
Fellow Didactic Conference
Each fellow presents at least one didactic conference each year in an area of interest to the fellow.
Catheterization Conference
A weekly conference focusing on catheterization laboratory quality assurance, case reviews and didactic presentations, with joint presentations from the Cardiac Surgery faculty.
Cardiovascular Research Institute Research Seminar Series
A once monthly seminar in which clinical and translational research at the University of Vermont/Fletcher Allen Health Care is presented.
Nuclear Physics Course
An elective course in nuclear physics offered every other year which upon completion makes one eligible for NRC licensure, a requirement for establishing an independent nuclear cardiology laboratory.
Electrophysiology Service
At the end of two years of general clinical training each fellow will be able to accurately diagnose brady and tachy arrhythmias, will understand the use of diagnostic testing to determine the presence and type of arrhythmia, and will understand the role of pharmacologic and non-pharmacologic treatment in the management of arrhythmias. Fellows will be exposed to the following procedures; electrophysiologic testing, catheter ablation procedures, 24 hour ambulatory and event monitoring, signal averaged ECG, tilt table testing, pacemaker and AICD evaluation. Fellows will participate in the full range of catheter ablation (e.g. paroxysmal and chronic AF, VT and atrial arrhythmias following surgical repair of congenital heart disease). Fellows will be facile with electrogram recording systems, 3-D electro anatomic mapping systems and use of irrigated ablation.
Cardiac Catheterization & Interventional Cardiology
Cardiac catheterization and interventional cardiology are an essential and expanding part of modern clinical cardiology practice. All trainees in cardiology will complete an extensive core curriculum in cardiac catheterization and interventional cardiology. Trainees who plan to perform independent catheterization and angiography will require more extensive training during the third year of their fellowship. A fourth year of training can be dedicated to interventional cardiology. The requirements for training are met using three state-of-theart cardiac digital catheterization laboratories in which over 5,000 diagnostic and interventional procedures are performed per year. Full-time University faculty are involved directly in the training and supervision of cardiology fellows in the catheterization laboratory. The faculty brings a range of expertise in all aspects of cardiovascular hemodynamics, cardiac catheterization and intervention cardiology. The cardiac catheterization laboratory coordinates patient care with the cardiovascular surgery program.
Cardiac Rehabilitation
After two years of training, each fellow will be familiar with the foundations of cardiac rehabilitation and secondary prevention. The fellow will understand the principles of patient management, program operation and structure. The fellow will be capable of supervising a cardiac rehabilitation program as well as designing an exercise and secondary prevention component for clinical cardiology practice. Day to day management includes the performance and interpretation of cardiopulmonary stress tests and lipid management according to the NCEP (National Cholesterol Education Panel) goals.
The Adult with Congenital Heart Disease and Pulmonary Hypertension Program
After two years of clinical training each cardiology fellow will understand the basics of congenital heart disease and pulmonary hypertension as it pertains to the adult patient. More extensive congenital heart disease education (both pediatric and adult) is available in the third year of training.
Echocardiography
At the end of two years of general clinical training, each cardiology fellow will understand the basic principles of ultrasonic imaging and Doppler ultrasound, cardiac anatomy, standard two dimensional and transesophageal echocardiography. All fellows will be expected to perform and interpret a minimum of 300 two-dimensional Doppler echocardiography studies. Those fellows desiring Level III certification including stress echocardiography, transesophageal echocardiography and complex congenital heart disease will complete an additional 12 month training period during their 3rd year.
Exercise Stress Testing
After a two year training period, each cardiology fellow will be capable of safely and effectively supervising electrocardiographic exercise stress tests. Fellows will also be trained to accurately interpret and summarize results of electrocardiographic stress tests. Most important, fellows will be familiar with contraindications to exercise stress testing and indications for termination of an individual test. Interpretation will include knowledge of the concepts of sensitivity, specificity and predictive accuracy of stress tests as they relate to the prevalence of disease in selected subsets of patients.
Nuclear Cardiology
At the completion of general clinical training each cardiology fellow will be qualified to perform, analyze, and interpret nuclear cardiology procedures and will meet level II criteria for specialized training in nuclear cardiology. A nuclear medicine course is also offered which allows the fellow to be licensed in Nuclear Medicine by the Nuclear Regulatory Commission. Level III training in nuclear cardiology is available in the third year of clinical training. With this training, fellows will be board eligible in Nuclear Cardiology. A particular strength of our training program is the dual interpretation of all studies by both cardiologists and radiologists.
Cardiac Imaging
Cardiac Imaging with a 3 Tesla MRI is interpreted by Cardiology Faculty. In addition, Cardiology faculty participate in the interpretation CT angiography performed with both 40 and 64 slice scanners. A formalized training program in all modalities of Cardiac Imaging is being formalized.
Combining Clinical Care, Research, and Education
The cardiologists at University Cardiology Associates are academic faculty of the University of Vermont and dedicated to improving prevention, diagnosis, and treatment of cardiac diseases by focusing on direct patient care, cutting-edge research and educating the next generation of cardiac specialists. These nationally recognized professionals have chosen to work in an academic setting rather than private practice because a university affiliated tertiary care hospital provides the greatest opportunities for investigative work combined with clinical experience. The convergence of research, teaching and clinical experience creates cross-functional collaborations that directly translate into improved patient care. To learn more abut the research interests of individual faculty please visit their biography at Faculty/Physicians.
Fellow Publications
Publications of Fellows in Cardiology
Hayes KL, Tracy PB.The platelet high affinity binding site for thrombin mimics hirudin, modulates thrombin-induced platelet activation, and is distinct from the glycoprotein Ib-IX-V complex. J Biol Chem. 1999 274:972-80
Noori A, Lindenfeld J, Wolfel E, Ferguson D, Bristow MR, Lowes BD. Beta-blockade in adriamycin-induced cardiomyopathy. J Card Fail. 2000 6:115-9.
Holmes, MB, Kabbani, S, Watkins, MW, Battle, RW, Schneider, DJ: Abciximab-associated pseudothrombocytopenia. Circulation 101:938-9, 2000
Bluhm WF, Kranias EG, Dillmann WH, Meyer M. Phospholamban determines frequency response and postrest potentiation of cardiac muscle. Am J Physiol, 278:H249-H255, 2000
Chen Y, Billadello JJ, Schneider DJ: Identification and localization of a fatty acid response region in human plasminogen activator inhibitor-1 gene. Arterioscler Thrombos Vasc Biol, 20:2696-701, 2000
Schneider, DJ, Baumann, PQ, Holmes, MB, Taatjes, DJ, Sobel, BE: Time and dose dependent augmentation of inhibitory effects of abciximab by aspirin. Thromb Haemost 85:309-13, 2
Aggarwal A: Prevention of sudden death in patients with coronary artery disease (Correspondence). N Engl J Med 2000;342(17):1291
Holmes, MB, Schneider, DJ, Hayes, M, Sobel, BE, Mann KG: A novel bedside, tissue factor-dependent clotting assay permitting improved assessment of both antithrombotic and antiplatelet therapy. Circulation, 102:2051-7, 2000
Aggarwal A, Brown KA, and LeWinter MM: Diastolic Dysfunction: Pathophysiology, clinical features and diagnosis using radionuclide methods. J Nucl Cardiol 2001;8:98-106
Holmes, MB, Kabbani, SS, Terrien, CM, Watkins, MW, Sobel, BE, Schneider, DJ: Quantification by flow cytometry of the efficacy fo and inter-individual variation of platelet inhibition induced by treatment with tirofiban and abciximab. Coron Artery Dis 12:245-53, 2001.
Kabbani, SS, Watkins, MW, Ashikaga, T, Terrien, EF, Holoch, PA, Sobel, BE, Schneider, DJ: Platelet reactivity characterized prospectively: a determinant of outcome 90 days after percutaneous coronary intervention. Circulation, 104:181-6, 2001.
Aggarwal A, Ades PA: Exercise rehabilitation in elderly patients with cardiac disease. Cardiology Clinics 2001;19:525-536
Meyer M, Trost SU, Blum WF, Knot HJ, Swanson E, Dillmann WH: Impaired Sarcoplasmic Reticulum Function Leads to Contractile Dysfunction and Cardiac Hypertrophy. Am J Physiol, 280:H2046-2052, 2001
Aggarwal A, Ades PA: Interactions of herbal remedies with prescription cardiovascular medications. Coronary Artery Disease 2001;12:1-4
Trost SU, Belke D, Bluhm WF, Meyer M, Swanson E, Dillmann WH: Rescue of contractility in the diabetic myocardium by overexpression of Serca2a. Diabetes, 1166-1171, 2001
Jaffery J, Aggarwal A, Ades PA, Weise WJ: A long sweet sleep with sour consequences (Case report). Lancet 2001;358:1236
Kabbani SS Watkins, MW, Terrien, EF, Holoch, PA, Sobel, BE, Schneider, DJ: Platelet reactivity in coronary ostial blood: a reflection of the thrombotic state accompanying plaque rupture and of the adequacy of anti-thrombotic therapy. J Thrombos and Thrombolys, 12:171-6, 2001
Kabbani SS, Aggarwal A, Terrien ET, DiBattiste PM, Sobel BE, Schneider DJ: Suboptimal early inhibition of platelets by treatment with tirofiban: Implications for coronary interventions. American Journal of Cardiology 2002;89:547-600
Aggarwal A, Battle RW: Congenital absence of the left pericardium (Clinical picture). Lancet 2002;360:2038
Chen, Y, Schneider, DJ: The independence of signaling pathways mediating increased expression of plasminogen activator inhibitor type 1 in HepG2 cells exposed to free fatty acids or triglycerides. Int J Exp Diabetes Res, 3:109-19, 2002
Chen, Y, Sobel, BE, Schneider, DJ: Effect of fatty acid chain length and thioesterification on the augmentation of expression of plasminogen activator inhibitor-1. Nutrition, Metabol Cardiovasc Dis, 12:325-30, 2002
Aggarwal A, Klein JS, Battle RW: A 59-year-old asymptomatic man with systolic murmur and mediastinal mass (Roentgenogram of the month). Chest 2003;123:1289-1292
Aggarwal, A, Leavitt, BJ: Giant Lambl’s Excrescence (Images in Clinical Medicine). New England Journal of Medicine (In press)
Aggarwal, A, Kabbani, SS, Rimmer, JM, Gennari, JF, Taatjes, DJ, Sobel, BE, Schneider, DJ: Biphasic effects of hemodialysis on platelet reactivity in patients with end-stage renal disease, a potential contributor to cardiovascular risk. American Journal of Kidney Disease 2002;40(2):315-22
Schneider, DJ, Lakkis, N, Aguirre, F, Aggarwal, A, Kabbani, SS, DiBattiste, PM, Herrmann, HC: Enhanced early inhibition of platelet aggregation with an increased bolus of tirofiban. American Journal of Cardiology 2002;90(12):1421-23
Aggarwal, A, Sobel, BE, Schneider, DJ: Decreased platelet reactivity in blood anticoagulated with bivalirudin or enoxaparin compared with unfractionated heparin: Implications for coronary intervention. Journal of Thrombosis and Thrombolysis 2002;13(3);161-165
Tischler, MD, Aggarwal, A: Management of mitral regurgitation due to mitral prolapse. Current treatment Options in Cardiovascular Medicine 2002;4:521-527
Aggarwal, A, Terrien, EF, Terrien, CM: Treatment of totally occluded saphenous vein grafts using self-expanding stents. Coronary Artery Disease 2002;13(7):373-6
Schneider, DJ, Herrmann, HC, Lakkis, N, Aguirre, F, Lo, M, Aggarwal, A, Kabbani, SS, DiBattiste, PM: Increased concentrations of tirofiban and their correlation with the inhibition of platelet aggregation with greater bolus doses of tirofiban. American Journal of Cardiology 2003;91:334-6
Meyer, M, Hopkins, WE, Kaminsky DA: Cardiovascular Collapse in a 77-Year-Old-Woman with an Asthma Exacerbation following Bronchodilator Treatment Chest, 124:1160-1164, 2003
Aggarwal, A, Schneider, DJ, Terrien, EF, Terrien, CM, Sobel, BE, Dauerman, HL: Comparison of effects of abciximab versus eptifibatide on C-reactive protein, interlukin-6, and interleukin- receptor antagonist after coronary arterial stenting. American J Cardiology 2003 Jun 1;91(11):1346-9.
Taylor, MS, Bonev, AD, Gross, TP, Eckman, DM, Brayden, JE, Bond, CT, Adelman, JP, Nelson, MT: Altered expression of small-conductance Ca2+-activated K+ (SK3) channels modulates arterial tone and blood pressure. Circ Res. 2003 93:124-31
Aggarwal, A, Schneider, DJ, Sobel, BE, Dauerman, HL: Comparison of inflammatory markers in patients with diabetes mellitus versus those without before and after coronary arterial stenting. Am J of Cardiology 2003;92:924-929
Aggarwal, A, Schneider, DJ, Terrien, EF, Sobel, BE, Dauerman, HL: Increased coronary arterial release of interleukin-1 receptor antagonist and soluble CD 40 ligand indicative of inflammation associated with culprit coronary atherosclerotic plaques. Am J Cardiol 93:6-9, 2004.
Aggarwal, A: Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction (Correspondence). N Engl J Med 2003;349:88
Noori, A, Kabbani, S: Endothelins and coronary vascular biology. Coron Artery Dis. 2003 14:491-4.
Aggarwal, A, Schneider, DJ, Terrien, EF, Gilbert, K, Dauerman, HL: Increase in interleukin-6 in the first hour after coronary stenting: an early marker of the inflammatory response. Journal of Thrombosis and Thrombolysis 15:25-31, 2003.
Keating, FK, Sobel, BE, Schneider, DJ: Effects of increased concentrations of glucose on platelet reactivity in healthy subjects and in patients with and without diabetes mellitus. Am J Cardiol, 92:1362-1365, 2003.
Aggarwal, A, Whitaker, DA, Rimmer, JM, Solomon, RJ, Gennari, FJ, Sobel, BE, Schneider, DJ: Attenuation of platelet reactivity by enoxaparin compared with unfractionated heparin in patients undergoing hemodialysis. Nephrol. Dial. Transplant. 19:1559-1563, 2004.
Gutierrez, MJ, Aggarwal, A, Gilbert, K, Sobel, BE, Dauerman, HL: Use of femoral closure devices as part of a pharmacoinvasive reperfusion strategy. J. Inv. Cardiol, submitted.
Aggarwal, A., Schneider, D.J., Sobel, B.E., Dauerman, H.L.: Comparison of inflammatory markers in patients with diabetes mellitus versus those without before and after coronary stenting. Am J Cardiol, 92:924-9, 2003
Keating, F.K., Sobel, B.E., Schneider, D.J.: Effects of increased concentrations of glucose on platelet reactivity in healthy subjects and in patients with and without diabetes. Am J Cardiol, 92:1362-5, 2003
Aggarwal, A., Schneider, D.J., Terrien, E.F.,Dauerman, H.L.: Increased coronary arterial release of interleukin-1 receptor antagonist and soluble cd40 ligand indicative of inflammation associated with culprit coronary plaques. Am J Cardiol, 93:6-9, 2004
Chen, Y., Kelm, R.J., Budd, R.C., Sobel, B.E., Schneider, D.J.: Inhibition of apoptosis and caspase-3 in vascular smooth muscle cells by plasminogen activator inhibitor type-1. J Cell Biochem, 92:178-88, 2004
Aggarwal A., Whitaker D.A., Rimmer, J.M., Solomon, R.J., Gennari, F.J., Sobel, B.E., Schneider, D.J.: Attenuation of platelet reactivity by enoxaparin compared with unfractionated heparin in patients undergoing hemodialysis. Nephrol Dial Tranplant, 19:1559-63, 2004
Keating, F.K., Sobel, B.E., Whitaker D.A., Schneider, D.J.: Augmentation of Inhibitory Effects of Glycoprotein IIb-IIIa Antagonists in Patients with Diabetes. Thrombos Res, 113:27-34, 2004
Schneider, D.J., Hayes, M., Taatjes, H., Wadsworth, M., Rincon, M., Taatjes, D.J., Sobel, B.E.: Attenuation of neointimal vascular smooth muscle cellularity in atheroma by plasminogen activator inhibitor type-1 (PAI-1). J Histochem Cytochem, 52:1091-99, 2004
Keating, F.K., Whitaker D.A., Kabbani, S.S., Ricci M.A., Sobel, B.E., Schneider, D.J.: Relation of augmented platelet reactivity to the magnitude of distribution of atherosclerosis. Am J Cardiol, in press
Chen Y, Kelm RJ, Budd RC, Sobel BE, Schneider DJ. Augmentation of Proliferation of Vascular Smooth Muscle Cells by Plasminogen Activator Inhibitor Type 1. Arterioscler Thrombos Vasc Biol, in press.
Markus Meyer MD, Harold L. Dauerman MD, Stephen P. Bell BA, Martin M. LeWinter MD, Daniel L. Lustgarten MD PhD. Coronary Venous Capture of Contrast During Angiography. Am J Cardiol. Pending review.
Gogo PB Jr, Schneider DJ, Terrien EF, Watkins MW, Sobel BE, Dauerman HL. Relation of leukocytosis to C-reactive protein and interleukin-6 among patients undergoing percutaneous coronary intervention. Am J Cardiol. 2005 Aug 15;96(4):538-42.
Gogo P, Schneider D, Watkins M, Terrien E, Sobel B, Dauerman H. Systemic Inflammation After Drug-Eluting Stent Placement. J Thromb Thrombolysis 2005 Apr;19(2):87-92.
Keating FK, Dauerman HL, Whitaker DA, Sobel BE, Schneider DJ. Increased expression of platelet P-selectin and formation of platelet-leukocyte aggregates in blood from patients treated with unfractionated heparin plus eptifibatide compared with bivalirudin. Thromb Res 2005 August 31.
Guigaori P, Dauerman HL. A novel use of a distal embolic protection device: stent retrieval. J Inv Cardiol 2005; 17:183-184.
Guttierez MJ, Aggarwal A, Gilbert K, Sobel BE, Dauerman HL. Use of femoral closure devices as part of a pharmacoinvasive reperfusion strategy. J Thromb Thrombolysis 2005; 18: 187-192.
Gogo PB, Terrien EF, Watkins MW, Schneider DJ, Sobel BE, Dauerman HL. Systemic inflammation after drug eluting stent placement. J Thromb Thrombolysis 2005, 19: 87-92.
Blum A, Yeganeh S, Peleg A, Vigder F, Kryuger K, Khatib A, Khazim K, Dauerman HL. Endothelial function in patients with sickle cell anemia during and after sickle cell crises. J Thromb Thrombolysis 2005; 19:83-86.
