Advancing Cardiovascular Medicine and Innovation
Dr. Joseph G. Rogers, Director of the Texas Heart Institute at Baylor College of Medicine, is a leading cardiologist and an internationally recognized expert in heart failure, heart transplantation, and mechanical circulatory support. In this exclusive interview, he discusses the latest challenges and breakthroughs in cardiovascular medicine, the future of heart transplantation, and the impact of artificial intelligence in cardiology.
Dr. Rogers, you have had a distinguished career in cardiology. Can you tell us about your journey and role at The Texas Heart Institute?
I have dedicated my career to the study and treatment of advanced heart failure, heart transplantation, and mechanical circulatory support. Before joining The Texas Heart Institute, I spent nearly two decades at Duke University and a decade at Washington University in St. Louis. For the past three and a half years, I have been leading The Texas Heart Institute, working to advance research, education, and clinical innovation in cardiovascular medicine.
In your opinion, what are the most pressing challenges in addressing heart disease today?
The biggest challenge is prevention. Ideally, we would prevent heart disease before it even occurs rather than just treating it after diagnosis. Cardiovascular disease is primarily driven by cardiometabolic conditions—high blood pressure, high cholesterol, diabetes, and obesity. These conditions are often linked to lifestyle factors such as poor diet, lack of exercise, and smoking.
We are seeing groundbreaking innovations, but one of the biggest concerns is accessibility. For example, the recent development of GLP-1 receptor agonists, such as semaglutide (Ozempic), is transforming the management of obesity and metabolic disease, but their cost limits access for many people worldwide. At the end of the day, the most effective solution is promoting healthy lifestyles—ensuring access to nutritious foods, encouraging physical activity, and eliminating smoking.
You mentioned lifestyle changes as a crucial factor in reducing heart disease. How can healthcare systems better support patients in making these changes?
Lifestyle changes are essential, but they require a multi-faceted approach. It’s not just about telling people to eat better or exercise more—it’s about ensuring they have the means to do so. I recall a patient I treated in North Carolina who struggled with severe obesity. She told me it was more affordable to feed her children at fast-food restaurants than to buy fresh ingredients and cook at home.
This highlights a deeper systemic issue. We need policies that improve access to affordable, healthy food and create environments where people can exercise safely. In Houston, for instance, I spoke with community members who said stray dogs in their neighborhoods prevented them from going outside for walks. These are real-life barriers that policymakers must address to make a significant impact on public health.
You are a leading expert in heart failure. What are some of the latest advancements in heart failure treatment?
There have been several major advancements in the management of heart failure, particularly in drug therapy. The standard of care now includes four key pillars of medication that can dramatically improve outcomes.
What’s critical is the urgency of initiating treatment. Historically, physicians would introduce one medication at a time over several months or even years. Now, we understand that getting patients on these therapies as soon as possible—within the first few months of diagnosis—significantly reduces hospitalizations and mortality.
One of the most exciting breakthroughs has been the use of SGLT2 inhibitors, which were originally developed to treat diabetes but have shown remarkable benefits in heart failure patients, even those without diabetes. What’s fascinating is that we still don’t fully understand their exact mechanism of action, but the clinical results are undeniable.
With heart transplantation limited by donor availability, what role do mechanical heart technologies play in the future of treatment?
Mechanical circulatory support has evolved tremendously over the years. The current leading device is a continuous-flow left ventricular assist device (LVAD), which has proven to be a life-saving bridge to transplant and even a long-term alternative for some patients.
At The Texas Heart Institute, we are at the forefront of artificial heart development. One of the most promising innovations is the BiVACOR Total Artificial Heart, which is based on magnetic levitation (maglev) technology. This device supports both the right and left sides of the heart and has the potential to be a durable alternative to transplantation.
The FDA recently approved early feasibility studies, and the initial results have been very encouraging. One patient in Australia has been supported on the device for over two months, which is an exciting step forward.
What are some of the latest innovations in heart transplantation?
Two key advancements are reshaping heart transplantation. The first is non-invasive rejection monitoring.
Traditionally, we’ve had to perform heart biopsies to check for rejection, but now, we can use a blood test that detects donor DNA fragments in the recipient’s bloodstream. This allows us to monitor rejection without invasive procedures, making post-transplant care safer and more effective. The second major development is in donor organ preservation and transportation.
We have moved away from simply placing donor hearts in ice and now use advanced preservation techniques that keep the heart warm and beating or maintain it in a controlled cold environment. These strategies improve organ viability and allow us to retrieve hearts from farther distances, increasing the available donor pool.
Artificial intelligence is rapidly advancing in healthcare. How is it being integrated into cardiology?
AI is already making a significant impact, particularly in diagnostics. For example, electrocardiograms (ECGs) have been interpreted using AI-based algorithms for years, and now, machine learning is being applied to echocardiograms to enhance the detection of abnormalities.
In the future, AI could play a crucial role in personalized medicine, integrating genetic and clinical data to tailor treatment plans for individual patients. We are just scratching the surface, but I believe AI will become a standard tool in cardiology within the next decade.
The Texas Heart Institute is known for groundbreaking research. What are some of the most exciting experimental therapies being developed?
We are involved in several pioneering projects, including:
- Stem Cell Therapy: Researchers have demonstrated that injecting stem cells into the heart reduces inflammation and lowers the risk of heart attacks and strokes.
- Gene Therapy: Scientists have identified a molecular pathway that stops heart muscle cells from regenerating. By turning off this “stop signal,” they have successfully regenerated heart tissue in animal models, with human trials set to begin soon.
- Heart Regeneration: Our researchers are working on creating bioengineered hearts by washing out cells from animal hearts and repopulating them with human stem cells. This could one day lead to lab-grown hearts for transplantation.
These are exciting developments that could completely transform cardiovascular medicine.
