Dan Sorescu, MD

Associate Professor of Medicine

Emory University School of Medicine

Biography

Dan Sorescu received his medical degree from Carol Davila University of Medicine and Pharmacy in Bucharest (Romania). He completed a residency in Internal Medicine at Beth Israel Hospital (Albert Einstein College of Medicine in New York) and his clinical cardiology fellowship at Emory University School of Medicine. While at Emory he trained for three years as research fellow in basic science with Dr. Kathy K. Griendling in her vascular biology laboratory studying the role of oxidative stress and NADPH oxidases in human coronary artery disease. In 2001, he became an Instructor in Medicine at Emory University and since July 2003 he is Assistant Professor of Medicine in the Division of Cardiology. Dr. Sorescu is currently studying the interaction of oxidative stress with the renin-angiotensin II-aldosterone system and transforming growth factor beta in the development and progression of cardiac hypertrophy, fibrosis and heart failure. Dr Sorescu has received several grants from the American Heart Association. His clinical interest is in heart failure and tissue Doppler echocardiography as modality to assess severity of heart failure and mechanical cardiac dyssynchrony.

Dr. Sorescu is currently studying the interaction of oxidative stress with the renin-angiotensin II-aldosterone system and transforming growth factor beta in the development and progression of cardiac hypertrophy, fibrosis and heart failure. In vivo, cytokines such as angiotensin II, aldosterone and transforming growth factor beta (TGF) have been shown to cause cardiac hypertrophy and fibrosis via the activation of cardiac NADPH oxidases. Oxidative stress, TGF and cardiac fibrosis have been all implicated in heart failure associated with aging (diastolic dysfunction). We have recently demonstrated that one isoform of NADPH oxidases, Nox4 is strongly upregulated in human cardiac fibroblasts and mediates the cardiac fibrosis in response to TGF, the most pro-fibrotic cytokine to date. We are currently examining novel mechanisms by which Nox4 or other NADPH oxidases may mediate in vivo and in vitro cardiac hypertrophy, fibrosis and senescence.

We have also developed a translational project in collaboration with Cardiac Electrophysiology at Crawford Long Hospital (Dr. Angel Leon) and Cardiothoracic Research Laboratory (Dr Jakob-Vinten Johansen) through generous sponsorship from Carlyle Fraser Heart Center in which we propose to identify novel molecular and echocardiographic markers of mechanical dyssynchrony in patients with heart failure. Cardiac resynchronyzation therapy (CRT) has recently revolutionized the treatment of patients with advanced heart failure who have evidence of electrical dyssynchrony as evidenced by a wide complex QRS. However, it is estimated that at least 30-50% of patients with heart failure and "narrow" QRS (QRS<120 miliseconds) may have mechanical dyssynchrony as identified by other modalities such as echocardiogram or cardiac MRI. It is currently unknown what are the best echocardiographic parameters which predict mechanical dyssynchrony and therefore benefit from CRT in patients with heart failure and narrow QRS. In order to identify these parameters and ultimately expand the number of patients which may benefit from CRT, we have developed a large animal model of heart failure with dyssynchrony and we are examining the development of dyssynchrony by using 2D, M mode, tissue Doppler, 2D strain echocardiography and quantifying various molecular markers of heart failure.

Dr. Sorescu manages very complex patients with advanced heart failure. Due to an outstanding cardiac electrophysiology program (lead by Dr. Angel Leon and Dr. David Delurgio) and staff in Arrhythmia clinic, our patients can take advantage of novel mechanical technologies and therapeutic approaches to aid in the management of heart failure. State of the art tools available for assessment of volume status of heart failure patient include: Opti-vol (measures thoracic impedance which correlates with overall volume status and specifically total water content of lungs) and Chronicle (estimates diastolic pulmonary artery pressures, part of current clinical trial Chronicle-ICD). Device tools available for the management of patients with heart failure rely on biventricular pacemakers and their A-V and V-V optimization of biventricular pacemakers using echocardiography or more novel acustic cardiography (Audicor). On the inpatient side therapeutic tools include intravenous diuretics, vasodilators, inotropes and ultrafiltration (Aquadex).

Dr. Sorescu attends the inpatient cardiology service (4-5 rotations a year) at Emory University Hospital Midtown. He also provides inpatient consultative heart failure service at Emory University Hospital Midtown, especially to patients which undergo high risk open-heart surgery by working very closely with cardiothoracic surgery teams lead by Robert Guyton, Omar Lattouf and Vinod Thourani.

Supervision of cardiology fellows in reading and performing transthoracic and transesophageal echocardiograms.

In outpatient heart failure clinic at Emory University Hospital, Dr. Sorescu trains fellows how to use biventricular pacemakers to optimize management of complex patients with heart failure. State of the art tools available for assessment of volume status of heart failure patient include: Opti-vol (measures thoracic impedance which correlates with overall volume status and specifically total water content of lungs) and Chronicle (estimates diastolic pulmonary artery pressures, part of current clinical trial Chronicle-ICD). Device tools available for the management of patients with heart failure include A-V and V-V optimization of biventricular pacemakers using echocardiography or more novel acustic cardiography (Audicor).

Attends the inpatient cardiology service (4-5 rotations a year) at Emory University Hospital Midtown. This is a busy inpatient cardiology service (20-30 patients daily) during which Dr. Sorescu supervises and trains 1-2 students, 2-3 residents in internal medicine and 2 cardiology fellows. Dr. Sorescu also gives approximately 8 lectures a year on acute and chronic heart failure management and 12 lectures a year on echocardiography as part of curriculum for cardiology fellows at Emory University and Emory University Hospital Midtown.