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American Heart Association Update “Highlights of the AHA” “Duke at the AHA” Cardiology Grand American Heart Association Update “Highlights of the AHA” “Duke at the AHA” Cardiology Grand Rounds November 23, 2010 John H. Alexander, MD Director, Heart Center SBR Co-Director, DCRI CV Research

John Alexander: Disclosures (2010) Research Support: Bristol Myers Squibb, CSL Behring, Medtronic Japan, Merck, John Alexander: Disclosures (2010) Research Support: Bristol Myers Squibb, CSL Behring, Medtronic Japan, Merck, NIH, Pfizer, Regado Biosciences Consulting: Astra Zeneca, Boeringer Ingelheim, Bristol Myers Squibb, CSL Behring, Medsphere, Novartis, Ortho-Mc. Neil. Jannsen, Otsuka Pharmaceuticals, Regado Biosciences Disclosures available: https: //dcri. org/about-us/conflict-of-interest All Rights Reserved, Duke Medicine 2008

Agenda • Hot Science • Duke at the AHA • Modern Communication “The grand Agenda • Hot Science • Duke at the AHA • Modern Communication “The grand rounds tomorrow is intended to generate discussion on how to incorporate the late-breaking science into our clinical practice. So please join us and prepare to discuss. ” (Tracy Wang, MD - 11/22/10) All Rights Reserved, Duke Medicine 2008

Hot Science • • ● ROCKET-AF EMPHISIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Hot Science • • ● ROCKET-AF EMPHISIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Rights Reserved, Duke Medicine 2008

Hot Science • • ● ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Hot Science • • ● ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Rights Reserved, Duke Medicine 2008 “It is Rocket Science!”

Risk Factors Study Design Atrial Fibrillation Rivaroxaban 20 mg daily 15 mg for Cr Risk Factors Study Design Atrial Fibrillation Rivaroxaban 20 mg daily 15 mg for Cr Cl 30 -49 ml/min Randomize Double Blind / Double Dummy (n ~ 14, 000) • CHF • Hypertension At least 2 or 3 required* • Age 75 • Diabetes OR • Stroke, TIA or Systemic embolus Warfarin INR target - 2. 5 (2. 0 -3. 0 inclusive) Monthly Monitoring Adherence to standard of care guidelines Primary Endpoint: Stroke or non-CNS Systemic Embolism * Enrollment of patients without prior Stroke, TIA or systemic embolism and only 2 factors capped at 10%

Primary Efficacy Outcome Stroke and non-CNS Embolism Cumulative event rate (%) Rivaroxaban Event Rate Primary Efficacy Outcome Stroke and non-CNS Embolism Cumulative event rate (%) Rivaroxaban Event Rate Warfarin 1. 71 2. 16 Warfarin Rivaroxaban HR (95% CI): 0. 79 (0. 66, 0. 96) P-value Non-Inferiority: <0. 001 Days from Randomization No. at risk: Rivaroxaban 6958 6211 5786 5468 4406 3407 2472 1496 634 Warfarin 7004 6327 5911 5542 4461 3478 2539 1538 655 Event Rates are per 100 patient-years Based on Protocol Compliant on Treatment Population

Primary Efficacy Outcome Stroke and non-CNS Embolism On Treatment Rivaroxaba Warfarin n Event HR Primary Efficacy Outcome Stroke and non-CNS Embolism On Treatment Rivaroxaba Warfarin n Event HR P-value Rate (95% CI) 1. 70 2. 15 0. 79 0. 015 (0. 65, 0. 95) 2. 42 0. 88 0. 117 (0. 74, 1. 03) N= 14, 143 ITT N= 14, 171 Rivaroxaban better 2. 12 Warfarin better Event Rates are per 100 patient-years Based on Safety on Treatment or Intention-to-Treat thru Site Notification populations

Key Secondary Efficacy Outcomes Rivaroxaban Warfarin Event Rate HR (95% CI) P-value 4. 51 Key Secondary Efficacy Outcomes Rivaroxaban Warfarin Event Rate HR (95% CI) P-value 4. 51 4. 81 0. 94 (0. 84, 1. 05) 0. 265 Stroke Type Hemorrhagic Ischemic Unknown Type 0. 26 1. 62 0. 15 0. 44 1. 64 0. 14 0. 58 (0. 38, 0. 89) 0. 99 (0. 82, 1. 20 1. 05 (0. 55, 2. 01) 0. 012 0. 916 0. 871 Non-CNS Embolism 0. 16 0. 21 0. 74 (0. 42, 1. 32 0. 308 Myocardial Infarction 1. 02 1. 11 0. 91 (0. 72, 1. 16) 0. 464 All Cause Mortality Vascular Non-vascular Unknown Cause 4. 52 2. 91 1. 15 0. 46 4. 91 3. 11 1. 22 0. 57 0. 92 (0. 82, 1. 03) 0. 94 (0. 81, 1. 08) 0. 94 (0. 75, 1. 18) 0. 80 (0. 57, 1. 12) 0. 152 0. 350 0. 611 0. 195 Vascular Death, Stroke, Embolism Event Rates are per 100 patient-years Based on Intention-to-Treat Population

Primary Safety Outcomes Rivaroxaban Warfarin Event Rate or N (Rate) HR (95% CI) P-value Primary Safety Outcomes Rivaroxaban Warfarin Event Rate or N (Rate) HR (95% CI) P-value 3. 60 2. 77 1. 65 0. 82 0. 24 3. 45 2. 26 1. 32 1. 18 0. 48 1. 04 (0. 90, 1. 20) 1. 22 (1. 03, 1. 44) 1. 25 (1. 01, 1. 55) 0. 69 (0. 53, 0. 91) 0. 50 (0. 31, 0. 79) 0. 576 0. 019 0. 044 0. 007 0. 003 Intracranial Hemorrhage 55 (0. 49) 84 (0. 74) 0. 67 (0. 47, 0. 94) 0. 019 Intraparenchymal 37 (0. 33) 56 (0. 49) 0. 67 (0. 44, 1. 02) 0. 060 Intraventricular 2 (0. 02) 4 (0. 04) Subdural 14 (0. 13) 27 (0. 27) 0. 53 (0. 28, 1. 00) 0. 051 Subarachnoid 4 (0. 04) 1 (0. 01) Major >2 g/d. L Hgb drop Transfusion (> 2 units) Critical organ bleeding Bleeding causing death Event Rates are per 100 patient-years Based on Safety on Treatment Population

Conclusions Efficacy: Rivaroxaban was non-inferior to warfarin for prevention of stroke and non-CNS embolism. Conclusions Efficacy: Rivaroxaban was non-inferior to warfarin for prevention of stroke and non-CNS embolism. Rivaroxaban was superior to warfarin while patients were taking study drug. By intention-to-treat, rivaroxaban was non-inferior to warfarin but did not achieve superiority. Safety: Similar rates of bleeding and adverse events. Less ICH and fatal bleeding with rivaroxaban. Conclusion: Rivaroxaban is a proven alternative to warfarin for moderate or high risk patients with AF.

Stroke or Systemic Embolism Non-inferiority Superiority p-value Dabigatran 110 vs. Warfarin <0. 001 0. Stroke or Systemic Embolism Non-inferiority Superiority p-value Dabigatran 110 vs. Warfarin <0. 001 0. 34 Dabigatran 150 vs. Warfarin <0. 001 Margin = 1. 46 0. 50 0. 75 1. 00 1. 25 HR (95% CI) 1. 50

0. 04 All Intracranial Bleeding # at Risk Year 0. 5 1. 0 1. 0. 04 All Intracranial Bleeding # at Risk Year 0. 5 1. 0 1. 5 2. 0 2. 5 5900 5771 4666 3006 1420 6076 5958 5817 4735 3080 1451 W 6022 5887 5759 4632 2933 1343 0. 02 0. 03 6015 D 150 0. 01 Warfarin Dabigatran 150 Dabigatran 110 0. 0 Cumulative Hazard Rates D 110 0 0. 5 1. 0 Years 1. 5 2. 0 2. 5

Hot Science • • ● ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Hot Science • • ● ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Rights Reserved, Duke Medicine 2008

EMPHASIS-HF: Major results Outcome Eplerenone (%) Placebo (%) Adjusted hazard ratio (95% CI) p EMPHASIS-HF: Major results Outcome Eplerenone (%) Placebo (%) Adjusted hazard ratio (95% CI) p Cardiovascular death/heart-failure hospitalization Cardiovascular death 18. 3 25. 9 0. 63 (0. 54– 0. 74) <0. 001 10. 8 13. 5 0. 76 (0. 61– 0. 94) 0. 01 Heart-failure hospitalization 12. 0 18. 4 0. 58 (0. 47– 0. 70) <0. 001 Hospitalization for hyperkalemia 0. 3 0. 2 1. 15 (0. 25– 5. 31) 0. 85 NYHA Class II HF (N=2737) LV EF < 30% Eplerenone 25 -50 mg QD vs. Placebo

Hot Science • • ● ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER “a small phase II Hot Science • • ● ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER “a small phase II trial in the eyes of REVEAL someone in the ACS world” DEFINE sdfjaliex All Rights Reserved, Duke Medicine 2008

Background § Acute heart failure is a major health problem responsible for several million Background § Acute heart failure is a major health problem responsible for several million hospitalizations worldwide each year. § Standard therapy has not changed since 1970 s and includes diuretics and variable use of vasodilators or inotropes. § In 2001, nesiritide was approved by the FDA to reduce PCWP and improve dyspnea, based on efficacy at 3 hrs. § However, in 2005 two meta-analyses raised concerns regarding the risks of mortality and renal injury. § Subsequently, an independent panel* was convened by Scios Inc and recommended that a clinical trial be conducted to definitively answer the question of nesiritide’s safety and efficacy.

Co-Primary objectives To assess whether nesiritide vs placebo, in addition to standard care provides: Co-Primary objectives To assess whether nesiritide vs placebo, in addition to standard care provides: • Significant improvement in self-assessed dyspnea at 6 or 24 hrs using 7 -point Likert scale 60 Markedly Better Moderately Better 40 % Subjects • Reduction in rate of HF rehospitalization or all-cause mortality through Day 30 20 0 Minimally Better No Change Minimally Worse Moderately Worse 20 40 Markedly Worse

Study design and drug procedures Nesiritide Acute HF < 24 hrs from IV RX Study design and drug procedures Nesiritide Acute HF < 24 hrs from IV RX 24– 168 hrs Rx Placebo Co-primary endpoint: Dyspnea relief at 6 and 24 hrs Co-primary endpoint: 30 -day death or HF rehosp All-cause mortality at 180 days § Double – blind placebo controlled § IV bolus (loading dose) of 2 µg/kg nesiritide or placebo • Investigator’s discretion for bolus • Followed by continuous IV infusion of nesiritide 0. 01 µg/kg/min or placebo for up to 7 days § Usual care per investigators including diuretics and/or otherapies as needed § Duration of treatment per investigator based on clinical improvement

Co-Primary outcome: 30 -day all-cause mortality or HF rehospitalization 12 10 P=0. 31 10. Co-Primary outcome: 30 -day all-cause mortality or HF rehospitalization 12 10 P=0. 31 10. 1 Hazard Ratio 0. 93 (95% CI: 0. 8, 1. 08) 9. 4 Placebo Nesiritide 8 % 6. 1 6 4. 0 4 6. 0 3. 6 2 0 30 -day Death/HF Rehospitalization Risk Diff (95 % CI) -0. 7 (-2. 1; 0. 7) 30 -day Death -0. 4 (-1. 3; 0. 5) HF Rehospitalization -0. 1 (-1. 2; 1. 0)

Co-Primary Endpoint: 6 and 24 hour dyspnea 6 Hours 24 Hours 70 70 P=0. Co-Primary Endpoint: 6 and 24 hour dyspnea 6 Hours 24 Hours 70 70 P=0. 030 60 % Subjects 40 30 42. 1% 44. 5% 50 13. 4 15. 0 40 20 10 60 28. 7 29. 5 0 34. 1 32. 8 50 60 30. 4 38. 6 37. 8 22. 1 21. 2 9. 5 8. 6 3398 Placebo 3371 Nesiritide 30 20 10 10 20 30 40 27. 5 0 10 20 % Subjects 50 66. 1% P=0. 007 68. 2% 30 21. 7 20. 3 3444 Placebo 40 3416 Nesiritide Markedly Better Moderately Better Minimally Worse Moderately Worse Markedly Worse No Change

Renal Safety >25% decrease e. GFR Placebo (n=3509) Nesiritide (n=3498) P-value 29. 5% Anytime Renal Safety >25% decrease e. GFR Placebo (n=3509) Nesiritide (n=3498) P-value 29. 5% Anytime Through Day 30 31. 4% 0. 11 End of Treatment Creatinine Nesiritide Discharge or 10 day Creatinine 1. 0 0. 9 0. 8 0. 7 Cum Dist 1. 0 Cum Dist Placebo 0. 6 0. 5 0. 4 0. 3 0. 2 0. 1 0 0 2 4 6 Creatinine (mg/d. L) 8

Hypotension Risk Difference (95% CI) Placebo (n=3509) Nesiritide (n=3498) Any hypotension (Through Day 10/discharge) Hypotension Risk Difference (95% CI) Placebo (n=3509) Nesiritide (n=3498) Any hypotension (Through Day 10/discharge) 15. 3% (538) 26. 6% (930) (9. 4 to 13. 1) Asymptomatic Hypotension 12. 4% (436) 21. 4% (748) 9. 0 <. 001 (7. 2 to 10. 7) Symptomatic Hypotension 4. 0% (141) 7. 1% (250) 3. 1 (2. 1 to 4. 2) 11. 3 P- value <. 001

Conclusions § Nesiritide did not reduce the rate of recurrent heart failure hospitalization or Conclusions § Nesiritide did not reduce the rate of recurrent heart failure hospitalization or death at 30 days. § Nesiritide reduced dyspnea to a modest degree, consistent with previous findings but did not meet prespecified protocol criteria for statistical significance at 6 and 24 hours. § Nesiritide did not affect 30 -day all cause mortality nor did it worsen renal function as had been suggested by prior meta-analyses of smaller studies.

Hot Science • • ● ROCKET-AF EMPHISIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Hot Science • • ● ROCKET-AF EMPHISIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Rights Reserved, Duke Medicine 2008

GRAVITAS Study Design Elective or Urgent PCI with DES* Verify. Now P 2 Y GRAVITAS Study Design Elective or Urgent PCI with DES* Verify. Now P 2 Y 12 Test 12 -24 hours post-PCI PRU ≥ 230 R High-Dose Clopidogrel† clopidogrel 600 -mg, then clopidogrel 150 -mg daily X 6 months Standard-Dose Clopidogrel† clopidogrel 75 -mg daily X 6 months Primary Efficacy Endpoint: CV Death, Non-Fatal MI, Stent Thrombosis at 6 mo Key Safety Endpoint: GUSTO Moderate or Severe Bleeding at 6 mo Pharmacodynamics: Repeat Verify. Now P 2 Y 12 at 1 and 6 months *Peri-PCI clopidogrel per protocol-mandated criteria to ensure steady-state at 12 -24 hrs †placebo-controlled All patients received aspirin (81 -162 mg daily)

GRAVITAS Patient Flow 5429 patients screened with Verify. Now P 2 Y 12 12 GRAVITAS Patient Flow 5429 patients screened with Verify. Now P 2 Y 12 12 -24 hours post-PCI 2214 (41%) with high residual platelet reactivity (PRU ≥ 230) Clopidogrel High Dose N=1109 Clopidogrel Standard Dose N=1105 3215 (59%) without high residual platelet reactivity (PRU < 230)

Pharmacodynamics: Effect of SD vs HD Clopidogrel Standard-Dose 500 P = 0. 98 High-Dose Pharmacodynamics: Effect of SD vs HD Clopidogrel Standard-Dose 500 P = 0. 98 High-Dose P < 0. 001 400 PRU value Persistently high reactivity @ 30 days: 62% vs 40%, p<0. 001 300 200 100 0 N=1105 N=1013 N=940 Post-PCI 30 d ITT population 6 mo N=1109 N=1012 N=944 Post-PCI 30 d 6 mo

Primary Endpoint: CV Death, MI, Stent Thrombosis Observed event rates are listed; P value Primary Endpoint: CV Death, MI, Stent Thrombosis Observed event rates are listed; P value by log rank test.

Bleeding Events: Safety Population Severe or life-threatening: Fatal bleeding, intracranial hemorrhage, or bleeding that Bleeding Events: Safety Population Severe or life-threatening: Fatal bleeding, intracranial hemorrhage, or bleeding that causes hemodynamic compromise requiring blood or fluid replacement, inotropic support, or surgical intervention Moderate: Bleeding that leads to transfusion but does not meet criteria for severe bleeding P by log rank test; observed event rates listed. HD, high-dose; SD, standard dose

GRAVITAS: Summary • Compared with standard-dose therapy, high-dose clopidogrel achieved a modest pharmacodynamic effect GRAVITAS: Summary • Compared with standard-dose therapy, high-dose clopidogrel achieved a modest pharmacodynamic effect in patients with high residual reactivity. • In patients with high residual reactivity measured after PCI, 6 -months of high-dose clopidogrel did not reduce the rate of cardiovascular death, nonfatal MI, or stent thrombosis and did not increase GUSTO severe or moderate bleeding.

Hot Science • • ● ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Hot Science • • ● ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Rights Reserved, Duke Medicine 2008

Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments – Emergency Response (RACE-ER) Project Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments – Emergency Response (RACE-ER) Project on behalf of RACE Coordinators, Nurses, Physicians, Paramedics, and Administrators

Objectives Regional approach to overcoming systematic barriers 1) Increase reperfusion rate 2) Increase speed Objectives Regional approach to overcoming systematic barriers 1) Increase reperfusion rate 2) Increase speed of reperfusion RACE Pilot RACE 65 hospitals 2003 2005 2006 RACE - ER 119 hospitals 2007 2008 2009

RACE Hospitals by PCI and Reperfusion Designation Primary PCI (21) Transfer for Primary PCI RACE Hospitals by PCI and Reperfusion Designation Primary PCI (21) Transfer for Primary PCI (52) Lytics (31) Mixed (15) (primary PCI if transport readily available

Reperfusion Strategy Overall population, Eligible Patients P = 0. 0003 for PCI group trend Reperfusion Strategy Overall population, Eligible Patients P = 0. 0003 for PCI group trend

Use of Pre-hospital 12 -lead ECG (Direct presenters via EMS to PCI Centers) Use of Pre-hospital 12 -lead ECG (Direct presenters via EMS to PCI Centers)

Transfer Patients: Time to lytic or to device by designation strategy Transfer Patients: Time to lytic or to device by designation strategy

Hot Science • • ● ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Hot Science • • ● ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Rights Reserved, Duke Medicine 2008

A Randomized, Double-blind, Placebo-controlled Trial of Intravenous Erythropoietin in Patients with ST-Segment Elevation Myocardial A Randomized, Double-blind, Placebo-controlled Trial of Intravenous Erythropoietin in Patients with ST-Segment Elevation Myocardial Infarction – Primary Results of the REVEAL Trial

STEMI n=110 Primary or rescue PCI TIMI 0 -1 flow in IRA Successful PCI STEMI n=110 Primary or rescue PCI TIMI 0 -1 flow in IRA Successful PCI - Randomize - Study drug within 4 hrs IV EPO Matching saline placebo Infarct size in IRA territory 2 -6 days by c. MRI

Results: Primary endpoint Mean (SE) infarct size at 2 -6 days after study drug Results: Primary endpoint Mean (SE) infarct size at 2 -6 days after study drug admin 25 Infarct Size (%LV) 20 15 10 5 0 EPO Placebo EPO vs. placebo 15. 8% vs. 15. 0%, P=NS P-value adjusted for age, infarct location, enrollment phase

Conclusions n These data, coupled with the lack of efficacy seen in other STEMI Conclusions n These data, coupled with the lack of efficacy seen in other STEMI trials involving EPO (REVIVAL-31, HEBE III 2), do not support the hypothesis that EPO favorably impacts outcome after reperfusion for STEMI n Whether earlier administration or alternate dosing provides a cardioprotective effect of EPO in humans remains to be determined 1 Ott I, et. al. Circ: CV Intv 2010 2 Voors AA, et. al. EHJ 2010

Hot Science • • ● ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Hot Science • • ● ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE sdfjaliex All Rights Reserved, Duke Medicine 2008

Background: CETP inhibition Cholesteryl ester transfer protein (CETP) is a plasma protein that catalyzes Background: CETP inhibition Cholesteryl ester transfer protein (CETP) is a plasma protein that catalyzes the transfer of CE from HDL to apo. B-containing lipoproteins (VLDL and LDL-C) in exchange for Trig. LDL-R CE SR-B 1 Liver FC X inhibition CETP CE LCAT Bile LDL / VLDL FC HDL Free Cholesterol (FC) in Extrahepatic tissues

Anacetrapib l Orally active, potent, selective CETP inhibitor l Robust lipid efficacy in Phase Anacetrapib l Orally active, potent, selective CETP inhibitor l Robust lipid efficacy in Phase I-II studies l No effects on blood pressure, electrolytes, and aldosterone in preclinical and Phase I-II clinical studies l In vitro HDL functional assays: HDL particles isolated from anacetrapib-treated patients demonstrate preserved (and possibly enhanced) cholesterol efflux properties l Dose of 100 mg selected based on PK/PD modeling: minimal dose to achieve maximal effects on HDL and LDL

Study Design Randomization 1: 1 Ratio • Age: 18 -80 years • LDL-C @ Study Design Randomization 1: 1 Ratio • Age: 18 -80 years • LDL-C @ NCEP ATPIII goal < 100 mg/d. L R • Statin ± other lipid modifying therapy Anacetrapib 100 mg n=750 Placebo n=750 Study drug stopped if LDL-C<25 mg/d. L during treatment 12 week follow-up Stable dose-regimen of lipid-modifying therapy Week -2 0 6 12 18 24 30 38 46 54 62 70 76 80 84 88 Visit 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 18 Placebo Screening Run-in Treatment Phase Reversibility Phase

Effects on LDL-C and HDL-C LDLC 100 120 100 HDL-C (mg/d. L) (SE) LDL-C Effects on LDL-C and HDL-C LDLC 100 120 100 HDL-C (mg/d. L) (SE) LDL-C (mg/d. L) (SE) 80 60 -39. 8% (p<0. 001) 40 20 0 Anacetrapib Placebo Baseline Wk 12 Wk 24 Wk 6 Wk 18 Wk 30 80 Wk 46 Wk 62 Wk 76 Anacetrapib n = 804 771 716 687 646 604 568 540 Placebo n = 803 759 741 743 735 711 691 666 +138. 1% (p<0. 001) 60 40 20 Study Week HDL-C 0 Anacetrapib Placebo Baseline Wk 12 Wk 24 Wk 6 Wk 18 Wk 30 Wk 46 Wk 62 Wk 76 Anacetrapib n =776 757 718 687 647 Anacetrapib n = 607 572 543 Placebo n =766 761 744 736 Placebo n = 711 691 666 Study Week

Lipid Parameters Parameter LS Mean Percent (95% CI) Placebo-Adjusted Change from Baseline Week 24 Lipid Parameters Parameter LS Mean Percent (95% CI) Placebo-Adjusted Change from Baseline Week 24 Week 76 Non-HDL-C -31. 7* (-33. 6, -29. 8) -29. 4* (-31. 6, -27. 3) Apo B -21. 0* (-22. 7, -19. 3) -18. 3* (-20. 2, -16. 4) Apo A-1 44. 7* (42. 8, 46. 5) 42. 3* (40. 5, 44. 1) TC 13. 7* (12. 0, 15. 3) 15. 6* (13. 8, 17. 3) TG -6. 8 (-9. 9, -3. 9) Lp(a) -36. 4 (-40. 7, -32. 3) Apo. E 29. 2* (24. 7, 33. 7) s for all variables except for triglycerides, lipoprotein(a), for which medians are shown -5. 3 -38. 8 35. 3* (-8. 9, -1. 7) (-44. 5, -33. 9) (30. 6, 40. 1)

Systolic blood pressure (mm. Hg) Anacetrapib had no effect on BP 220 200 180 Systolic blood pressure (mm. Hg) Anacetrapib had no effect on BP 220 200 180 16 0 SBP 140 120 10 0 80 60 40 A= A nac etrapib L B = Place bo 20 0 Diastolic blood pressure (mm. Hg) Baseline 6 12 18 24 140 30 Week 38 46 54 62 70 76 120 100 DBP 80 60 40 20 A= Anacetrapib L B= Plac eb o 0 Baseline 6 12 18 24 30 Week 38 46 54 62 70 76

l Anacetrapib treatment had robust effects on HDL-C, LDL-C, non HDL-C and Lp(a) with l Anacetrapib treatment had robust effects on HDL-C, LDL-C, non HDL-C and Lp(a) with sustained effects over 18 months. l Anacetrapib had an acceptable side-effect profile with no effects on blood pressure, electrolytes or aldosterone. l Within the power of the study, anacetrapib did not exhibit adverse cardiovascular effects seen with a prior CETP inhibitor l The long term safety and efficacy of anacetrapib will now be tested in a large clinical outcomes trial.

 • 30, 000 patients with occlusive arterial disease in North America, Europe and • 30, 000 patients with occlusive arterial disease in North America, Europe and Asia • Background LDL-lowering with atorvastatin • Randomized to anacetrapib 100 mg vs. placebo • Scheduled follow-up: 4 years • Primary outcome: Coronary death, myocardial infarction or coronary revascularization www. revealtrial. org

Hot Science • • ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE ● sdfjaliex All Hot Science • • ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITAS RACE-ER REVEAL DEFINE ● sdfjaliex All Rights Reserved, Duke Medicine 2008

PI 3 K Regulates 2 -Adrenergic Receptor Stimulated EGFR Transactivation Kevin M. Alexander, Supachoke PI 3 K Regulates 2 -Adrenergic Receptor Stimulated EGFR Transactivation Kevin M. Alexander, Supachoke Mangmool, Chetan B. Patel, Kunhong Xiao, and Howard A. Rockman Duke University Medical Center Durham, NC

β-AR Mediated EGFR Transactivation Noma et. al. (2007) J. Clin. Invest. and Engelhardt (2007) β-AR Mediated EGFR Transactivation Noma et. al. (2007) J. Clin. Invest. and Engelhardt (2007) J. Clin. Invest.

PI 3 K is Required for 2 AR Mediated EGFR Transactivation β 2 AR PI 3 K is Required for 2 AR Mediated EGFR Transactivation β 2 AR stable HEK-293 cells EGFR Phosphorylation Src Activity § Both the lipid and protein kinase activity of PI 3 K are necessary for 2 AR mediated EGFR transactivation. § PI 3 K protein kinase activity appears to lead to Src activation.

PI 3 K is Required for 2 AR-EGFR Complex Formation Fluorescence Resonance Energy Transfer PI 3 K is Required for 2 AR-EGFR Complex Formation Fluorescence Resonance Energy Transfer (FRET) PI 3 K Inhibition

Quantification of Src Phosphorylation Using Stable Isotope Labelling with Amino Acids in Cell Culture Quantification of Src Phosphorylation Using Stable Isotope Labelling with Amino Acids in Cell Culture (SILAC) Grow two populations of HEK-293 cells expressing HA-Src and β 2 AR “Light” medium “Heavy” medium L-Arg L-Lys HCl [13 C 6, 15 N 2 ]-L-Lys HCl (+8) [13 C 6, 15 N 4]-L-Arg (+10) LY + ISO Mix, IP, trypsin digest, and IMAC phosphopeptide enrichment pe Relative Abundance 100 pt id e pe A pt id pe e B pt id e pe C pt id pe e D pt id e pe E pt id e F Phosphopeptide analysis by LC-MS Extracted Ion Chromatogram (XIC) Light Heavy 0 Measure area under the curve

Sites of Src Phosphorylation by PI 3 K SH 3 SH 2 Sites of Src Phosphorylation by PI 3 K SH 3 SH 2

PI 3 K Regulates β 2 AR Stimulated EGFR Transactivation Function of PI 3 PI 3 K Regulates β 2 AR Stimulated EGFR Transactivation Function of PI 3 K in β 2 AR stimulated EGFR transactivation 1. Formation of PIP 3 2. Src phosphorylation

Agenda • Hot Science • Duke at the AHA • Modern Communication All Rights Agenda • Hot Science • Duke at the AHA • Modern Communication All Rights Reserved, Duke Medicine 2008

Duke At the AHA • • • An Award Presentations Fellow Presentations LBCT & Duke At the AHA • • • An Award Presentations Fellow Presentations LBCT & LBSS The Duke Reception All Rights Reserved, Duke Medicine 2008

Award • Dr. Victor Dzau receives the 2010 Research Achievement Award at the AHA Award • Dr. Victor Dzau receives the 2010 Research Achievement Award at the AHA Opening Sessions All Rights Reserved, Duke Medicine 2008

Duke Presentations All Rights Reserved, Duke Medicine 2008 Duke Presentations All Rights Reserved, Duke Medicine 2008

Duke Presentations • • • Saturday November 13 th Sunday November 14 th Monday Duke Presentations • • • Saturday November 13 th Sunday November 14 th Monday November 15 th Tuesday November 16 th Wednesday November 17 th Total All Rights Reserved, Duke Medicine 2008 5 23 57 52 18 155

Duke Fellow Presentations (5) Gerald Bloomfield Studying Non-Communicable Cardiovascular Diseases in sub-Saharan Africa: One Duke Fellow Presentations (5) Gerald Bloomfield Studying Non-Communicable Cardiovascular Diseases in sub-Saharan Africa: One Fellow's Journey Todd Kiefer, Lawrence Park, Christophe Tribouilloy, Claudia Cortes, Riccardo Utilli, Andrew Wang Heart Failure Complicating Infective Endocarditis: An Analysis of In-Hospital Mortality from the International Collaboration on Endocarditis Prospective Cohort Study Prediction of In-Hospital Major Bleeding Among Patients With Acute Myocardial Infarction: Results From 90, 273 Patients in the Acute Coronary Treatment Intervention Outcomes Network Registry® - Get With the Guidelines™ (AR-G) Are We Targeting the Right Economic Metric for Heart Failure? Association of Hospital 30 -Day Heart Failure Readmission Rates and Total Inpatient Days Is Bleeding Risk Augmented With Acute Therapies Across Increasing INR Levels Among NSTEMI Patients on Home Warfarin Therapy? Robin Mathews, Eric D. Peterson, Anita Y. Chen, Tracy Wang, Chee T. Chin, Gregg C. Fonarow, Christopher P. Cannon, Matthew T. Roe, Karen P. Alexander Robb D. Kociol, Li Liang, Adrian F. Hernandez, Lesley H. Curtis, Paul A. Heidenreich, Clyde W. Yancy, Gregg C. Fonarow, Eric D. Peterson Sumeet Subherwal, Eric D. Peterson, Anita Y. Chen, Richard G. Bach, Brian F. Gage, Deepak L. Bhatt, Stephen D. Wiviott, Jeffrey B. Washam, Matthew T. Roe, Karen P. Alexander, Tracy Y. Wang All Rights Reserved, Duke Medicine 2008 Early Career: Global Cardiovascular Research Training, Opportunities and Experiences Valvular Heart Disease: Diagnosis, Pathophysiology and Medical Management II Best of AHA Specialty Conferences Poster Session: QCOR 2010 Atrial Fibrillation/Arrhythmias: Epidemiology, Quality of Care and Outcomes

Duke Fellow Presentations (9) Chee Tang Chin, John C Messenger, Lisa A Kaltenbach, Michael Duke Fellow Presentations (9) Chee Tang Chin, John C Messenger, Lisa A Kaltenbach, Michael A Kutcher, H Vernon Anderson, Matthew T Roe, Tracy Y Wang Comparison of Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention for Previously Stented versus De Novo Culprit Lesions: Insights from the National Cardiovascular Data Registry Cath. PCI Registry Sergio Leonardi, Amanda Stebbins, 7118 - Pre-Treatment With Renato D Lopes, Yuliya Lokhnygina, Thienopyridines Reduces The Amount of Deepak L Bhatt, Gregg W Stone, Michael A Myonecrosis in Acute Coronary Lincoff, Harold L Dauerman, C. Michael Syndrome Patients Invasively Managed: Gibson, Harvey D White, Keyur Parick, Insights from the CHAMPION trials Luis Gruberg, Howard C Herrmann, Brent T Mc. Laurin, Shaun Goodman, Robert A Harrington, Kenneth W Mahaffey Kevin M Alexander, Supachoke 15645 - Phosphoinositde 3 -Kinase Mangmool, Chetan B Patel, Kunhong Xiao, Regulates β 2 -Adrenergic Receptor Howard A Rockman Stimulated Epidermal Growth Factor Receptor Transactivation Thomas T Tsai, John C Messenger, J 19884 - Contemporary Risk of Follow-up Matthew Brennan, Uptal D Patel, David Adverse Events in Older Patients with Dai, Robert Piana, Kevin J Anstrom, Eric L Chronic Kidney Disease and Dialysis Eisenstein, Rachel S Dokholyan, Eric D Undergoing Percutaneous Coronary Peterson, Pamela S Douglas Interventions: A Report from the Merged NCDR CMS Registry All Rights Reserved, Duke Medicine 2008 Acute Coronary Syndromes and Percutaneous Coronary Intervention: Quality of Care and Outcomes What's New in the Treatment of Patients with Acute Coronary Syndromes? Vascular Signaling The Role of Comorbidities in Cardiovascular Disease

Duke Fellow Presentations (14) Jonathan P Piccini, Bradley G. Hammill, Moritz F. Sinner, Paul Duke Fellow Presentations (14) Jonathan P Piccini, Bradley G. Hammill, Moritz F. Sinner, Paul N. Jensen, Adrian F. Hernandez, Susan R. Heckbert, Emelia J. Ben, Lesley H. Curtis Robin Mathews, Anita Y Chen, Chee T Chin, Tracy Y Wang, Kevin L Thomas, Matthew T Roe, Eric D Peterson Chee Tang Chin, Robert V Kelly, Mauricio G Cohen, Marc Cohen, J Richard Trout, Gregg W Stone, Jan T Christenson, Robert J Freedman Jr, Ramachandra C Reddy, Debra Joseph, E Magnus Ohman Sergio Leonardi, L. Kristin Newby, E. Magnus Ohman, Paul W Armstrong Zubin J Eapen, Shelby D Reed, Lesley H Curtis, Adrian F Hernandez, Eric D Peterson All Rights Reserved, Duke Medicine 2008 Incidence of Atrial Fibrillation and Associated Mortality among Medicare Beneficiaries from 1993 to 2007 Epidemiology and Outcomes in Atrial Fibrillation Short- and Long-term Outcomes Among Black vs. Diagnosis and Outcomes White Patients with Non-ST-segment Elevation Myocardial Infarction The Impact of Anticoagulation During Intra-Aortic Heart Failure: Pacing and Balloon Counterpulsation Pump Placement on In- Other Therapeutic Devices Hospital Outcomes in 18, 875 Patients Undergoing Cardiac Revascularization Lack of Implementation of ESC/ACC Definition of Myocardial Infarction in Contemporary Randomized Clinical Trials Do Heart Failure Disease Management Programs Make Financial Sense Under a Bundled Payment System? From Acute Thrombotic to Chronically Occluded Coronary Arteries Heart Failure: Disease Management, Quality of Care, Anemia

Duke Fellow Presentations (18) Rajendra H Mehta, Jonathan P Piccini, James T Tcheng, Martin Duke Fellow Presentations (18) Rajendra H Mehta, Jonathan P Piccini, James T Tcheng, Martin Fahy, Roxana Mehran, Gregg W Stone, On Behalf of HORIZONS-AMI Investigators Robin Mathews, Eric D. Peterson, Shuang Li, Matthew T. Roe, Stephen D. Wiviott, Jorge F. Saucedo, Elliott M. Antman, Tracy Y. Wang J. Matthew Brennan, Eric D Peterson, Yue Zhao, Sean O'Brien, Rachel Dokholyan, Pamela S Douglas, Fred H Edwards Jonathan P. Piccini, Jennifer A. White, Rajendra H. Mehta, Sana M. Al-Khatib, Pierluigi Tricoci, Charles V. Pollack Jr, Gilles Montalescot, Frans Van de Werf, C. Michael Gibson, Robert A. Harrington, L. Kristin Newby All Rights Reserved, Duke Medicine 2008 Prognostic Significance of Post-Procedural Sustained Ventricular Tachycardia or Fibrillation in Patients Undergoing Primary Percutaneous Coronary Intervention: Insights from the HORIZONS AMI Trial Under-utilization of Emergency Medical Service Transport Among Contemporary Patients with ST Elevation Myocardial Infarction: Findings from the National Cardiovascular Data Registry ACTION - Get With The Guidelines Predictors of Bioprosthetic Aortic Valve Failure: Results in 73, 616 Patients from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery National Database Sustained Ventricular Tachycardia and Ventricular Fibrillation are Infrequent Events but are Associated with Increased Arrhythmic and All-cause Death Following Non-STSegment Elevation Acute Coronary Syndromes From Acute Thrombotic to Chronically Occluded Coronary Arteries Cardiac Surgery: Valvular Heart Disease (Not Including Percutaneous Valves) IV Noninvasive Arrhythmia Testing/Risk Assessment

Duke LBCT & LBSS • Late Breaking Clinical Trials – ROCKET-AF – ASCEND-HF • Duke LBCT & LBSS • Late Breaking Clinical Trials – ROCKET-AF – ASCEND-HF • Late Breaking Sciences Sessions – RACE-ER – REVEAL All Rights Reserved, Duke Medicine 2008

“The Duke Reception” Sponsors Duke Heart Center Duke Division of Cardiology Duke Clinical Research “The Duke Reception” Sponsors Duke Heart Center Duke Division of Cardiology Duke Clinical Research Institute Networking Current Faculty & Fellows Heart Center, Division, DCRI Staff Former Fellows Academic & Industry Collaborators All Rights Reserved, Duke Medicine 2008 Interviews at the DCRI Reception

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Agenda • Hot Science • Duke at the AHA • Modern Communication All Rights Agenda • Hot Science • Duke at the AHA • Modern Communication All Rights Reserved, Duke Medicine 2008

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44 Shows Broadcast in Real Time Duke TV Temporarily Shut Down for “Internet Abuse” 44 Shows Broadcast in Real Time Duke TV Temporarily Shut Down for “Internet Abuse” Internet Abuse Shutdown Nov 15 13: 55 Hello Michael, Your server's switchport has been shutdown due to broad/multi casted traffic affecting multiple clients on our network and saturating their switchports. We request a response from you with an explanation for the large amount of traffic. If we do not receive a response in a timely manner we may need to terminate your account for violation of our acceptable use policy agreement. All Rights Reserved, Duke Medicine 2008

Dr. Hisao Ogawa reviews: ROCKET-AF and RELY, A Japanese Perspective in Japanese. Dr. Robert Dr. Hisao Ogawa reviews: ROCKET-AF and RELY, A Japanese Perspective in Japanese. Dr. Robert Harrington, Dr. Robert Califf, Dr. C. Michael Gibson present: AHA 2010 wrap-up. Dr. Robert Califf, Dr. Manesh Patel, Dr. Kenneth Mahaffey, and Dr. Keith Fox discuss: Stroke Prevention Using the Oral Direct Factor Xa Inhibitor Rivaroxaban Compared with Warfarin in Patients with Nonvalvular Atrial Fibrillation (ROCKET-AF). Dr. Matthew Price presents: Standard Versus High-Dose Clopidogrel According to Platelet Function Testing After PCI: Results of the GRAVITAS Trial. Dr. Robert Califf, Dr. Adrian Hernandez, Dr. Christopher O'Connor and Dr. Randy Starling discuss: Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Dr. Clyde Yancy presents ASCEND: Historical perspective, implications for patients Failure Trial (ASCEND-HF). Dr. Anthony Furlan and Dr. Duane Pinto discuss: CLOSURE I Trial: A Prospective, Multicenter, Randomized Controlled Trial to Evaluate the Safety and Efficacy of the STARFlex Septal Closure System Versus Best Medical Therapy in Patients with a Stroke or Transient Ischemic Attack due to Presumed Paradoxical Embolism through a Patent Foramen Ovale. All Rights Reserved, Duke Medicine 2008

Dr. Renato Lopes, Dr. Alexandre Quadros, Dr. Antonio Carlos Carvalho and Dr. Roberto Giraldez: Dr. Renato Lopes, Dr. Alexandre Quadros, Dr. Antonio Carlos Carvalho and Dr. Roberto Giraldez: AHA wrap-up in Portuguese. Dr. Hisao Ogawa and Dr. Yoshihiko Saito: An AHA 2010 wrap-up in Japanese. Professor Murray Esler and Dr. Duane Pinto discuss: Symplicity HTN-2: International, Multicenter, Prospective, Randomized, Controlled Trial Of Endovascular Selective Renal Sympathetic Denervation For The Treatment Of Hypertension. Dr. Jonathan Piccini and Dr. Duane Pinto discuss: Sustained Ventricular Tachycardia and Ventricular Fibrillation Are Infrequent Events but are Associated with Increased Arrhythmic and All-Cause Death Following Non-ST-Segment Elevation Acute Coronary Syndromes. Dr. Stephen Nicholls and Dr. Ravi Karra discuss the results of the ASSERT study, the first major clinical trial of an oral agent inducing Apo A 1 synthesis: A new approach to HDL raising and CV risk modification. Dr. Magnus Ohman and Dr. C. Michael Gibson discuss LVADs: Improving Outcomes. Dr. Matthew Brennan and Dr. C. Michael Gibson discuss: Anticoagulation Following Bioprosthetic Aortic Valve Replacement. All Rights Reserved, Duke Medicine 2008

Dr. Christopher Granger, Mayme Roettig, RN, MSN, and Dr. Ravi Karra discuss: Mission Lifeline Dr. Christopher Granger, Mayme Roettig, RN, MSN, and Dr. Ravi Karra discuss: Mission Lifeline Update 2010. Dr. Peter Kowey provides and expert opinion on ROCKET AF and RELY. Dr. Robert Harrington presents: Beyond 2010, The Future of Antithrombic Therapy - Old Agent Replacement, Combination Therapy, and the Impact of Generics. Dr. Kristin Newby and Dr. Duane Pinto discuss: An EARLY-ACS Update. Dr. Chistopher Cannon presents: Primary Results of the DEFINE trial: Determining the EFficacy and Tolerability of CETP INhibition with Anac. Etrapib. Dr. Peter Kowey discusses: Efficacy And Safety Of Prescription Omega-3 -Acid Ethyl Esters (P-OM 3) For The Prevention Of Recurrent Symptomatic Atrial Fibrillation (AF). Dr. Magnus Ohman reviews: TRILOGY: An Update. Dr. Karen Alexander and Dr. Duane Pinto describe: The Coming Tsunami: Cardiovascular Disease in the Elderly. All Rights Reserved, Duke Medicine 2008

Dr. Tracy Wang and Dr. Duane Pinto discuss: Under-Utilization of Emergency Medical Service Transport Dr. Tracy Wang and Dr. Duane Pinto discuss: Under-Utilization of Emergency Medical Service Transport Among Contemporary Patients with ST-Elevation Myocardial Infarction – Findings from the National Cardiovascular Data Registry ACTION, Get with the Guidelines. Dr. Sara Pasquali and Grendel Burrell discuss: The Impact of Intensive Care Unit Structure on Post-operative Outcomes Following Congenital Heart Surgery: Analysis of a Multiinstitutional Database. Dr. Jennifer Li, Dr. C. Michael Gibson, and Grendel Burrell discuss: Lessons from Pediatric Cardiovascular Drug Trials. Dr. Dominick Angiolillo presents: Commentary on GRAVITAS. Dr. Christopher Granger and Dr. Ravi Karra discuss: Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments - Emergency Response (RACE-ER) Project. Bradi Granger RN, Ph. D and Dr. Ravi Karra discuss: The Duke Translational Nursing Institute. Dr. Otavio Berwanger and Dr. Duane Pinto discuss: Acetylcystein for the Prevention of Contrast-Induced nephropa. Thy (ACT) Trial: a Pragmatic Multicenter Randomized Trial to Evaluate the Efficacy of Acetylcysteine for the Prevention of Renal Outcomes in Patients Undergoing Coronary and Vascular Angiography. All Rights Reserved, Duke Medicine 2008

Dr. Christoph Kaiser and Dr. Duane Pinto discuss: The BASKET PROspective Evaluation Examination (BASKET Dr. Christoph Kaiser and Dr. Duane Pinto discuss: The BASKET PROspective Evaluation Examination (BASKET PROVE): Late Cardiac Clinical Death and Myocardial Infarction Associated With Late Stent Thrombosis in Large Vessel Stenting After 1 st or 2 nd Generation Drug-eluting Compared to Bare-metal Stents. Dr. William Weintraub and Dr. Ravi Karra discuss: Top 100 Vocabulary Project. Dr. Richard Becker and Dr. Ravi Karra discuss: Pathways in Anticoagulation: What's Most Efficacious, Safest. Karen Pieper and Dr. Duane Pinto present: Insights from Plato: Proton Pump Inhibitor Use Is Likely a Marker for, Rather than a Cause of, a Higher Risk of Cardiovascular Events. Dr. Thomas Povsic and Dr. Duane Pinto discuss: A Prospective RADAR Pharmacokinetic and Pharmacodynamic. Substudy: Pegnivacogin (RB 006), a Direct Factor IXa Inhibitor, Results in Consistent and Near Complete Inhibition of Factor IX Activity in Patients with Acute Coronary Syndromes. Dr. Sunil Rao and Dr. Ravi Karra discuss: The Primary Results of the REVEAL Trial: A Randomized Placebo Controlled Trial of Intravenous Erythropoietin to Reduce Infarct Size After ST-Segement Elevation Myocardial Infarction. All Rights Reserved, Duke Medicine 2008

Dr. Kristin Newby and Dr. Duane Pinto discuss: MURDOCK Study Progress and Substudies. Dr. Dr. Kristin Newby and Dr. Duane Pinto discuss: MURDOCK Study Progress and Substudies. Dr. Keith Aaronson and Dr. Duane Pinto discuss: Evaluation of the Heartware HVAD Left Ventricular Assist Device System for the Treatment of Advanced Heart Failure: Results of the ADVANCE Bridge to Transplant Trial. Dr. James Daubert and Dr. Duane Pinto discuss: QTc Prolongation During Therapeutic Hypothermia: Does it Deserve Attention? Dr. David Cohen and Dr. Duane Pinto discuss: PARTNER Trial (Cohort B): Health-Related Quality of Life After Transcatheter Aortic Valve Implantation vs. Non-Surgical Therapy Among Inoperable Patients With Severe Aortic Stenosis. Dr. Karen Alexander discusses: Frail Older Adults at Risk for Loss of Independence Following MI. Dr. Kenneth Ellenbogen and Dr. Duane Pinto discuss: SMART AV: Comparison of AV Optimization Methods Used in Cardiac Resynchronization Therapy (CRT). Dr. Deepak Voora and Dr. Duane Pinto discuss: A Whole Blood RNA Signature Accurately Classifies Multiple Measures of Platelet Function on Aspirin in Healthy Volunteers and Highlights a Common Underlying Pathway. All Rights Reserved, Duke Medicine 2008

Dr. James Januzzi and Dr. Duane Pinto discuss: PROTECT: Use of NT-pro. BNP Testing Dr. James Januzzi and Dr. Duane Pinto discuss: PROTECT: Use of NT-pro. BNP Testing to Guide Heart Failure Therapy in the Outpatient Setting. Dr. Chris O'Connor, Dr. Randy Starling, and Dr. Clyde Yancy provide historical perspective and discuss the results/implications for ASCEND. Dr. Christopher O'Connor and Dr. Zubin Eapen discuss Duke's Presence at AHA, What's Happening, What to Expect. Dr. Rob Califf talks with Dr. Zubin Eapen about a Cardiology Fellow's Perspective from AHA 2010. All Rights Reserved, Duke Medicine 2008

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Daily Heart Line Memos From Chris & Marti All Rights Reserved, Duke Medicine 2008 Daily Heart Line Memos From Chris & Marti All Rights Reserved, Duke Medicine 2008

Post-Test Question: What was the most important advance by Duke Heart Center faculty or Post-Test Question: What was the most important advance by Duke Heart Center faculty or fellows from the AHA? Answer Options: • ROCKET-AF • ASCEND • RACE-ER • The Duke Cardiology Fellows Blog • DUKE-TV All Rights Reserved, Duke Medicine 2008

Post-Test Question: What was the most important advance by Duke Heart Center faculty or Post-Test Question: What was the most important advance by Duke Heart Center faculty or fellows from the AHA? Answer Options: • ROCKET-AF • ASCEND • RACE-ER • The Duke Cardiology Fellows Blog • DUKE-TV All Rights Reserved, Duke Medicine 2008

Thank You! Have a Happy Thanks Giving! Cardiology Grand Rounds November 23, 2010 John Thank You! Have a Happy Thanks Giving! Cardiology Grand Rounds November 23, 2010 John H. Alexander, MD Director, Heart Center SBR Co-Director, DCRI CV Research