Description of Research Expertise

My clinical research has been focused in three areas. My development as a clinical investigator initiated with my Masters’ program study project – a comprehensive evaluation of the clinical implications of left ventricular hypertrophy and geometry in African Americans. Ventricular hypertrophy is a risk factor for significant cardiovascular morbidity in all racial groups, but risk criteria have been derived exclusively from whites. To fund this endeavor, I successfully competed for a CAP award (M01) from the NIH General Clinical Research Center from 1998–2003. During that time, I single-handedly screened 2,000 patients at HUP, PMC and PVAMC, enrolling 167 subjects. In the subsequent years, I have continued to collect abundant clinical, electrocardiographic and echocardiographic data on this cohort, and am currently assembling the accumulated data for analysis and publication. This will serve not only as my Master’s Thesis, but the foundation for future studies of LV hypertrophy in African Americans.

My interest in hypertrophic ventricular remodeling integrated well with a new research initiative from the NIDDK – the Chronic Renal Insufficiency Cohort (CRIC) study. This multi-center, prospective study is the first large-scale effort examining risk factors for cardiovascular morbidity in patients with renal insufficiency. A critical component of the cardiac evaluation includes echocardiography for complete assessment of heart size, structure and function. I have played a prominent and integral role since inception – designing the echocardiographic protocol and coordinating the implementation of the echocardiographic core lab for this 3,000-patient study. I have also participated as a key cardiovascular representative on the Scientific Data Coordinating Committee. Translating sophisticated cardiovascular and imaging concepts to a group consisting primarily of nephrology experts has been a tremendously valuable experience for me. As co-director of the CRIC echo core lab for the past 4 years, I have played a crucial role in the efficient processing of 2,650 echocardiograms from 7 clinical sites. This includes supervision of all clinical echo interpretations, research quantitation and accurate transmission of data to the central CRIC database. I look forward to playing an integral role in the final analysis of the baseline data in the next year, and to ongoing participation in the collection and analysis of follow-up echocardiographic data on LV remodeling over the next several years.

A third major research interest for me has been aortic valve and proximal aortic pathology. This grew from my early collaboration with Dr. Joseph Bavaria and the Complex Aortic Surgery research group. I’ve had a particular interest in the bicuspid aortic valve. It has been recognized only recently that the tissue pathology underlying the bicuspid valve extends into the aortic root and proximal ascending aorta. My examination of proximal aortic size in the setting of varying levels of bicuspid aortic valve disease was a landmark demonstration that excess aortic dilatation is independent of the severity of underlying valve disease. Published in Circulation, this suggests that intrinsic tissue abnormalities of the root may account for dilation. I have subsequently established accelerated growth rates of the aortic root in the presence of the bicuspid aortic valve, with a manuscript currently under revision for publication in Annals of Thoracic Surgery. My ongoing projects aim to identify the optimal timing and degree of surgical intervention on the bicuspid aortic valve root, and to assess histologic abnormalities in tissue obtained from surgical samples. I look forward to fruitful collaboration with my surgical colleagues in the years to come.

Description of Other Expertise

A fundamental mission of academic medicine is the education of medical students, residents and advanced subspecialty fellows. I have made educational activities my foremost priority since the beginning of my career as a Clinician Educator, and am proud of my accomplishments in this area. My involvement in medical student education started with Curriculum 2000 cardiovascular block lectures and workshops, but subsequently expanded to groups at all levels within the School of Medicine. I teach in numerous advanced courses and seminars in the Departments of Medicine, Biostatistics, Epidemiology and Pharmacology. The ability to pass on my knowledge to future generations of medical scholars is tremendously rewarding. Constant exposure to the questions of young, inquisitive minds challenges me and propels my own intellectual growth. My efforts have been rewarded with uniform acclaim from students and a Merck Teaching Award. My appointment as Associate Scholar in the Center for Clinical Epidemiology and Biostatistics also recognizes my significant educational contributions.

I have also played an integral role in the educational activities of the Cardiovascular Division itself – including presentations at Grand Rounds, participation in CV/CT conferences and weekly Journal Club. I am particularly proud of my weekly noninvasive imaging conference, presented for the benefit of cardiovascular fellows, residents, medical students and sonographers. I established this conference as a senior fellow, and continue to organize it annually. The first six months include a comprehensive introduction to cardiovascular imaging, affectionately known as “Echo Boot Camp.” I designed this lecture series, compiling and editing it with the assistance of my colleagues. It has been a pleasure watching this educational program mature over the years, and it has recently become the backbone of the American Society of Echocardiography online introductory echo course. I have served as primary research mentor to numerous medical students, residents and fellows, resulting in four peer-reviewed publications and ten abstracts presented at national meetings. It is gratifying to me that several of my trainees have gone on to successful academic careers of their own.

Description of Itmat Expertise

Dr. Keane's primary research focus is on cardiovascular epidemiology with a focus on non-invasive cardiovascular imaging. Areas of particular interest include aortic valvular and root disease, cardiac disease in chronic renal insufficiency, hypertensive heart disease/LVH and establishing echo phenotype-genotype relationships in the area of structural and valvular heart disease.