Cardiovascular Medicine Fellowship Advanced Training

The BIDMC Advanced Non-invasive Cardiac Imaging Fellowship is intended to provide Level III training in CMR and echocardiography to future leaders in non-invasive imaging. The program is rigorous in training and research expectation. The fellowship was established in 1998 to accommodate the educational needs of recent graduates of a cardiovascular disease fellowship program who desired additional training in advanced non-invasive cardiac imaging.

Facilities

Echocardiography: The BIDMC Echocardiography laboratory is a state-of-the-art fully digital laboratory that includes 10 high end systems (GE Vivid e95 echocardiographs with full 2D and 3D capabilities), four portable systems (GE Vivid s70 echocardiographs), and 3 hand held echocardiographs (GE V scan; Butterfly IQ). In addition, there are three 3D and one pediatric TEE probes. The laboratory performs over 20,000 echocardiographic studies annually, including ~16,000 TTEs, 1000 TEEs, and 1800 stress echoes. All studies are interpreted by attendings who have passed the American Board of Echocardiography special competency examination in echocardiography.

Cardiovascular magnetic resonance: The BIDMC Cardiac MR Center was established in 1995 as the second such dedicated CMR center in the United States. A joint effort with the Department of Radiology, the Center includes a state-of-the-art 3T dedicated CMR system [Siemens Vida] located on the EAST campus. The center performs over 1500 CMR studies annually, of which -50% are clinical studies (ventricular function, viability, cardiomyopathy, pericardial disease, valvular disease, and coronary anatomy). Daily clinical readout occurs with both cardiology and radiology attending and fellowship staff.

Curriculum

A dedicated 12-24 months advanced cardiac imaging program is offered in which the individual will focus on one or more aspects of advanced cardiac imaging. Active participation in the CMR/Echo Center research and clinical activities is expected with advancement to Level III training.

In the first 12 months, the fellow will complete training in cardiovascular magnetic resonance consisting of:

• A minimum of 50 hours of didactic lectures to include CMR related issues of physics, studies of biologic effects, instrumentation, contrast agent mechanisms, cardiovascular anatomy, cardiovascular physiology and pathophysiology, magnetic resonance techniques and pulse sequences, understanding the indications, methods for interpretation, use of stress agents, and quality control.
• Supervised interpretation of at least 300 CMR (original and case review) studies representing the range of abnormalities observed in clinical practice – including but not limited to assessment of valvular heart disease, coronary artery disease, cardiomyopathy, pericardial disease, and aortic disease and to include substantial proportions (>25%) of both cardiac and vascular studies. For at least 100 studies, the trainee will be present at the time of the scan and the trainee will perform the analysis and make the initial interpretation.
• Attendance and active participation in weekly cardiology grand rounds, weekly cardiology clinical conference, weekly non-invasive cardiac imaging research conference, weekly advanced cardiac imaging conference, weekly CMR research conference, bimonthly case based cardiac imaging conference, and annual Society for Cardiovascular Magnetic Resonance.
• Active participation in an imaging research program.

The second 12 months the fellow will complete training on Echocardiography consisting of:

• A minimum of 10 hours of didactic lectures to include principles of stress echo and transesophageal echocardiography including instrumentation, echocardiography techniques, understanding the indications, methods for interpretation, use of stress agents, and quality control.
• Supervised interpretation of at least 300 transthoracic resting echocardiograms, 100 stress echocardiograms and 100 transesophageal echocardiograms representing the range of abnormalities observed in clinical practice. For all transthoracic studies, the trainee will make the initial interpretation. For at least 30 stress studies, the trainee will be present at the time of the stress echo. For at least 100 stress echocardiograms, the trainee will perform the initial interpretation. For all TEE studies, the trainee will perform the scan, the analysis and make the initial interpretation.
• Attendance and active participation in weekly cardiology grand rounds, weekly cardiology clinical conference, weekly non-invasive cardiac imaging research conference, weekly advanced cardiac imaging conference, and biweekly case based cardiac imaging conference.
• Active participation in imaging research program.

Leadership

Warren Manning, MD
Director of the Advanced Cardiac Imaging
Fellowship Program

The Structural Heart Disease Fellowship at Beth Israel Deaconess Medical Center is a one-year non-ACGME accredited program designed to provide training in structural heart disease procedures for fellows with prior cardiac catheterization and interventional cardiology experience. Candidates for the Structural Heart Disease Fellowship program should be highly qualified physicians with a minimum of 12 months’ experience in cardiac catheterization and coronary interventional procedures.

The training program will enable fellows to independently evaluate and manage simple and complex structural heart disease conditions. This includes clinical evaluation, advanced image analysis, understanding treatment alternatives, and acquiring all the skills needed for therapeutic intervention in a truly multidisciplinary approach. By the end of their training, Structural fellows will be proficient in all non-coronary cardiac interventional procedures including:

• Transeptal left heart catheterization
• Percutaneous PFO, ASD, VSD, and PDA closures
• Percutaneous aortic, mitral, and pulmonic balloon valvuloplasty
• Alcohol septal ablation and vein of Marshall ablation
• Balloon pericardiotomy
• Percutaneous closure of paravalvular leaks
• Balloon atrial septostomy
• Intracardiac echocardiography imaging
• Transcatheter aortic valve replacement (TAVR)
• Percutaneous repair (TEER) and replacement for mitral regurgitation
• Percutaneous tricuspid repair and replacement
• Percutaneous left atrial appendage closure
• Percutaneous cardiopulmonary support
• Foreign body retrieval

The fellowship program includes formal didactic sessions, a weekly structural case review and planning conference, a combined Cardiology-Surgery Multidisciplinary clinic, a weekly imaging conference and catheterization conference. The fellows are given ample opportunity to become meaningful participants in clinical research and trials on new devices and techniques and are encouraged to have a longitudinal research project throughout their training. The structural fellows review all available clinical data and imaging including advanced image analysis for aortic, mitral, tricuspid, and left atrial appendage interventions.

Leadership

Roger Laham, MD
Director of the Structural Heart Disease
Fellowship Program

The BIDMC Cardio-Oncology Program brings together cardiologists and oncologists to minimize cardiovascular toxicity from traditional and novel cancer therapies. Our team sees patients in the outpatient and inpatient setting. Our faculty are also leaders in basic, translational, and clinical research in cardio-oncology.

The Cardio-Oncology Fellowship provides an opportunity for clinical and research training in cardiovascular care of the cancer patient. The fellowship is designed to address the acute and chronic needs of the growing population of patients diagnosed and treated for cancer, many of whom have underlying cardiovascular comorbidities.

Traditional chemotherapies, novel targeted cancer therapies, and immunotherapies have all been associated with severe and often fatal cardiovascular toxicities. Fellows learn to optimize high-risk patients before and during cancer therapy, diagnose and treat cardiovascular toxicities arising from cancer treatment, and follow patients for long-term cardiovascular complications, such as those arising from chest radiation and chemotherapy.

Fellows also rotate with faculty in the BIDMC Cardiac Imaging program to gain expertise in the use of routine (echocardiography, nuclear medicine) and advanced (cardiovascular MRI) imaging modalities and methods (e.g., strain, CMR native Tl, extracellular volume fraction) to specifically evaluate cardiovascular toxicity from cancer therapies. Finally, fellows are expected to pursue a discrete scholarly project within cardio-oncology.

Learn More

• Learn more about cardio-oncology research at BIDMC
• Application process for the cardio-oncology fellowship

Leadership

Aarti Asnani, MD
Director of the Cardio-Oncology
Fellowship Program

The Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service at BIDMC is the oldest and largest program of its kind in the region. Staff were among the pioneers of modern cardiac electrophysiology, and continue cutting-edge research. Attracting patients nationally and worldwide, with about 7,000 visits annually in the arrhythmia and pacemaker/device clinics, the service offers advanced diagnosis and treatment modalities, including catheter-based ablation to control or cure a variety of arrhythmias with standard and investigational mapping systems.

The ambulatory electrocardiography laboratory provides 24-hour surveillance for arrhythmia diagnosis and management. In addition to implantation of standard and investigational pacemakers and defibrillators, pacemaker and ICD lead explantation are performed. Patients benefit from education and support groups. The Clinical EP services conducts daily teaching conferences and participates actively in the general clinical cardiology conference program.

The EP service is involved in multiple research studies, the majority of which are initiated by investigators at BIDMC. Currently active areas of investigation include noninvasive high resolution ECG analyses to detect persons at risk for ventricular tachyarrhythmias, study of investigational mapping systems, investigation of both noninvasive and invasive methods to identify persons likely to benefit from ICD therapy, and evaluation of mechanisms of atrial an ventricular arrhythmia. Clinical research is supplemented by an active preclinical (animal) research program that includes state-of-the-art mapping and imaging systems.

Learn More

• Learn how we're pioneering treatments for heart rhythm disorders
• Application process for the electrophysiology cardiology fellowship

Leadership

Patricia Tung, MD
Director of the Clinical Electrophysiology
Fellowship Program

BIDMC offers state-of-the-art catheter-based treatment for patients with coronary artery, peripheral vascular, and structural heart diseases. Full-time and affiliated faculty perform more than 4,300 procedures annually in cardiac procedural suites that include five catheterization laboratories and three hybrid operating rooms. In addition, BIDMC staff members play a major role in the pre-clinical and clinical development and evaluation of leading-edge technologies for the treatment of complex cardiovascular disorders, including clinical trials that provide access to investigational treatments. Interventional Cardiology faculty authored more than 100 original manuscripts over the past two years.

The BIDMC Interventional Cardiology Fellowship is an ACGME-certified program for comprehensive training in Interventional Cardiology techniques and patient care. The fellowship is an intensive combined clinical and research program focused on all aspects related to percutaneous coronary intervention (PCI) procedures. In addition, fellows will obtain experience in high-risk and chronic total occlusion (CTO) PCI and peripheral angiography and interventions. Fellows will also become proficient at large bore access and learn how to insert, manage and percutaneously decannulate different mechanical circulatory support devices. Fellows will also obtain experience in structural heart disease interventions including transcatheter aortic and mitral valve replacement, percutaneous mitral valve repair, PFO and ASD closure, LAA occlusion and PVL closure. The program also provides fellows with opportunities to participate in clinical trials of new interventional devices and treatment strategies. At completion, each fellow will have performed approximately 300 interventional procedures and will be eligible to take the certification examination in Interventional Cardiology given by the American Board of Internal Medicine.

Learn More

• Learn more about interventional cardiology at BIDMC
• Application process for the interventional cardiology fellowship

Leadership

The Vascular Medicine Fellowship at BIDMC offers a well-rounded and multidisciplinary approach to common and uncommon vascular disorders, striving to train the future academic leaders in Vascular Medicine. Our fellowship promotes clinical excellence; trainees will develop the necessary foundational knowledge, grow to integrate the wide range of clinical diagnostic data, and formulate optimal treatment plans for complex vascular patients. The fellows work in a collegial environment rotating with other services that also treat vascular disease and attend lectures and conferences throughout the program. Additionally, our clinical training program is complemented by robust basic and clinical research opportunities. Below is the basic fellowship program structure.

Outpatient Clinics

• Thrombosis
• Aortic Center
• Fellow continuity
• Lymphedema
• Vascular intervention clinic
• Vascular surgery clinic

Inpatient Service

• 20 weeks of inpatient vascular medicine consult coverage Monday-Friday
• 4 weeks with vascular surgery and vascular intervention

Vascular Lab Reading

• 12 weeks of hands on scanning, reading studies, and didactic conferences

Research

• 8 weeks of dedicated research along with a longitudinal research project throughout the year at the Smith Center for Outcomes Research in Cardiology. Learn more about vascular medicine research.

Learn More

• Learn more about vascular medicine at BIDMC
• Application process for the vascular medicine fellowship

Leadership

Brett Carroll, MD
Director of the Vascular Medicine
Fellowship Program