“In the field of heart failure, there is a brain hormone called arginine vasopressin that is secreted from the back of the brain in response to fluid overload in the body. We’ve done several studies using special compounds that block that hormone’s effect in the body and have shown that it can prevent fluid over-accumulation both right after and for months after a heart attack. That same hormone, when released in excess by the brain, causes the sodium level in the blood to go down, which further complicates heart failure, so we’re studying a related compound that can block the effect of that in the body.”

Did you get that? That’s Dr. Frank A. McGrew III talking. He’s director of clinical research at Memphis’ Stern Cardiovascular Center. He was polite enough to dumb the concept down a little — well, a lot — for me, but let me assure you: Dr. McGrew gets it in ways that make him elite in the already rarefied air of heart medicine. Dr. McGrew and his colleagues are shaping the future of cardiovascular medicine every day at Stern.

McGrew has been at Stern since 1976. Educated at Johns Hopkins University, with an M.D. from Case Western Reserve University, the West Virginia native wound up in Memphis at the encouragement of the late Dr. Thomas N. Stern, then head of the center. At Stern, McGrew continued research he had been doing at Duke University. For 33 years now and counting, McGrew has been studying the heart and pushing the boundaries of knowledge and medicine in relation to the vital organ. “We’ve had some sort of clinical trials going on here for decades,” McGrew says.

Stern Cardiovascular Center was founded in 1920 by Dr. Neuton S. Stern. (Dr. Thomas Stern was his son.) “The research started here in the 1920s when the group was founded,” McGrew says. “Stern had trained in Europe with Sir Thomas Lewis, who many people think was the first real cardiologist. Neuton Stern had the first EKG machine between New Orleans and Chicago. He really was a pioneer in all aspects of cardiology.”

That precedence of groundbreaking medicine is sustained today through the research and practice of the full complement of medical staff at the clinic. “It’s one aspect of our group that keeps things on the cutting edge,” McGrew says. “So much of cardiology is constantly in evolution. We have good treatments for many things; we have total cures for a few. So we’re constantly looking for new ways of improving things.”
Medical science is a lantern held aloft in the dark cave of human mortality. That light shines a bit brighter because of the efforts of Stern and physicians like McGrew, and each day’s discoveries are a small step forward down that blind path.

There are many ongoing trials in various stages of development at Stern Cardiovascular Center, and the amount of time they’ll be in study can vary widely. “At one end of the spectrum was a three-lead pacemaker defibrillator trial,” McGrew says. “The results were so dramatic, the study was stopped early, the FDA acted on it rapidly, and the device was approved for use within just a few months.

“With others, it can take longer trying to refine exactly how it can be used,” he continues. “There are still a lot of dead-ends. Sometimes the road to clinical trial success is a straight shot and sometimes it’s long and curvy.”

Even the idea of what success is isn’t a monolithic concept. “By the very nature of cardiology, most progress is incremental and takes large numbers of patients to prove a point,” McGrew says. “If we have a drug that improves heart attacks, it usually won’t cut the death rate in half, it will reduce it 20 percent. So in order to prove that [drug] effective, we have to have hundreds of patients. We’re usually part of multicenter studies, some of which are designed by pharmaceutical companies and some by the National Institutes of Health.”

Stem cells too are playing a role in cardiovascular research. In one area of stem-cell study, there are about 20 participating centers in the U.S. — most of them from major academic centers. “There are a few private practice clinics doing that, and we’re one of them,” McGrew says.

Still more studies originate from Stern itself. Talking about a study that investigates pacemakers in the elderly, McGrew says, “I don’t think anyone else in the world has really published data like we have, as a single center looking at the success rate in elderly people.”

Another example highlights the benefit Stern patients receive being on the leading wave of medicine. McGrew says there are six different medicines that are required to treat weak heart muscle. “We’ve participated in clinical trials and shown the effectiveness on every one of them. So, patients here got those medicines several years before they were FDA-approved and part of standard therapy.”

The patient-physician benefit travels in both directions, McGrew says. “We owe much of what we’ve done to the patients who participate in clinical trials.”

McGrew has just been named to the list of the Top Doctors in America by Castle Connolly. (See the July issue of Memphis magazine for a complete listing of physicians.)

“Being a cardiologist is like being a detective,” McGrew says. “Every time you walk into a room, you have to think, what’s wrong? And there are so many false leads to what’s wrong with patients.”

When it came to his area of expertise, McGrew chose the heart and, to an extent, the heart chose him. “When I was relatively young, my dad had serious heart disease,” he recalls. “And, in medical school, in the course of physical diagnosis, there was no question that heart disease occupied most of the knowledge in that area. Even the physical exam was very entertaining, enlightening, and interesting. Listening to murmurs, palpitating the heart, palpitating the pulses, and being able to treat those was a specialty that was unrivaled.”

McGrew adds, digging even further back into his personal history, that “I became interested in clinical research going back to high school doing science fair projects – I was in the Westinghouse Science Talent Search when I was 13.”

In a letter to colleagues announcing new trials, McGrew writes, “Very few cardiovascular conditions are truly cured by modern therapy and, thus, most conditions need continued research for better therapy to improve both morbidity and mortality.” His letter concludes, “The entire spectrum of cardiovascular disease still provides major health and economic problems. Participation in clinical trials provides your patient with their best therapeutic options. In all cases, these therapies are additional to conventionally approved medical therapy, the standardization of which is one of the major benefits of participation in a clinical trial.”

In this context, the work being done at Stern comes into sharper focus: It saves lives all over the world. As McGrew rattles off trials that are in progress and those still on the drawing board — he discusses each of them at length, in depth, and without having to refer to notes — the other impression one soon draws is that Stern isn’t pushing a few balls forward but a multivariate legion of them, widespread in scope and multidisciplinary.

There’s the study that takes back muscle and wraps it around the heart and electrically transforms it into heart muscle, and there are the studies that test medications to make heart muscle relax better and reduce fluid pressure.

There’s the stem-cell research where a muscle biopsy is taken from the leg, grown in a special solution, and non-invasively injected into scarred heart tissue. It’s not to be confused with the process of taking stem cells from bone marrow and giving them to the patient intravenously, where they travel through the blood and attach themselves to the heart.

McGrew says, “There really is not too much in terms of clinical trials in the field of heart failure that we’re not doing here. Most of the drugs that are being studied, we’ve studied here very early in their clinical development.”

And the ancient organ isn’t as immutable as it seems. “The heart surprises me every day,. It’s a constant challenge, and it’s a lot of fun because it’s constantly in evolution. The understanding of electrobiology — we’re just beginning to explore that. And the breaking of the genetic code, although that’s been pretty successful, has not yet translated much into bedside clinical care, but it will.”

For a glimpse into the future, take the really neat-sounding Nitinol (a nickel titanium alloy) stent inserted through a small incision in the chest and placed over the epicardium (the outer layer of heart tissue). The stent has viscoelastic properties that will prevent the heart from enlarging too much, and, as the heart fills during its rest phase, has the physical capability to store energy and release it during the heart’s next beat.

Science or science fiction? Star Trek’s Dr. McCoy can eat his heart out