Medical Student Research Fellowship for Summer 2010

Mentor: Alice Y. Chang, MD, MSCS
Department: Internal Medicine
Room number: U9.134H
Mail Code: 8857
Phone number: 214-648-2564
E-mail: alice.chang@utsouthwestern.edu
Project title: Coronary Atherosclerosis and Cardiovascular Performance in Polycystic Ovarian Syndrome

Human subjects IRB approved project number (where applicable):
IRB #102007-007, IRB #082008-046

Animal subjects IRB approved project number (where applicable):

Project Type patient-based research

Brief Description of Project:

Project 1: Coronary Atherosclerosis and Cardiovascular Performance in Polycystic Ovarian Syndrome
The global objective of this study is to determine if women with Polycystic Ovarian Syndrome (PCOS) have a greater burden of coronary atherosclerosis than women without PCOS using magnetic resonance imaging (MRI). Polycystic Ovarian Syndrome (PCOS) is a common disorder that occurs in 6-8% of women in the United States. PCOS is characterized by irregular menses, hirsutism and/or elevated circulating concentrations of testosterone, and an increased prevalence of metabolic risk factors for cardiovascular (CV) disease, including obesity, insulin resistance and dyslipidemia. Although it is generally assumed that women with PCOS are at increased risk for CV events, the evidence supporting this premise is weak. The overarching goal of the PI's research is to study the coronary atherosclerosis and exercise capacity of PCOS women to determine if they are at increased risk for CV disease. The primary objective of this project is to compare coronary macrovascular and microvascular function in response to the cold pressor test and the vasodilator adenosine between women with and without PCOS who are all at higher risk for cardiovascular disease secondary to insulin resistance. Secondary goals include characterization of differences in cardiovascular performance during an exercise test and assessment of the influence of testosterone concentrations and insulin sensitivity measured by the frequently sampled intravenous glucose tolerance test. A second funded project will evaluate the effects of 6 months exercise training in a subgroup of women with PCOS.

In the summer of 2010, the student will analyze correlations of insulin sensitivity with exercise performance in the first 20 to 30 participants studied. The student will also learn how to analyze data on left ventricular mass from cardiac MRI and participate in recruitment and data collection for additional participants.

Project 2: The Effect of Exercise Training on Coronary Vascular Reactivity and Cardiovascular Performance in Women with Androgen Excess Disorders
The objective of this study is to determine if androgen excess is associated with greater improvements in fitness. In particular, this project will study women with Polycystic Ovarian Syndrome and women with Congenital Adrenal Hyperplasia to determine if higher androgens are associated with greater improvements in fitness and exercise performance during stress tests. The goals for the summer of 2010 will be to complete training and studies for the last 2 patients as well as prepare the initial cross-sectional data for publication.

Previous Research Activities or Publications with Medical Students:

Summer of 2009, Juhee Choi, MS0-1. UT Southwestern. Cardiovascular Performance in women with PCOS
Juhee Choi was selected for an oral presentation at the local UT Southwestern Medical Student Research Forum and a poster presentation at the Southern American Federation for Medical Research in New Orleans 2009.
Choi J, Snell P, Palmer MD, Levine BD, Chang AY. Stroke Volume during Exercise is associated with Insulin Sensitivity among Women with Polycystic Ovarian Syndrome. Poster presentation, Southern Regional Meeting, American Federation for Medical Research, February 2010.
Choi J, Snell P, Palmer MD, Levine BD, Chang AY. Stroke Volume during Exercise is associated with Insulin Sensivity among Women with Polycystic Ovarian Syndrome. Oral abstract presentation. Medical Student Research Symposium, UT Southwestern Medical Center at Dallas, January 2010.

2008-2009 Christopher Maroules, BS (MSIV). UT Southwestern. Measurement of Coronary Sinus Blood Flow using 3T MRI
Maroules, CD, Chang AY, Yadav H, Peshock RM. Measurement of Coronary Sinus Flow Reserve at 3-Tesla using Spiral Velocity-Encoded Cine MR Imaging in Response to Cold Pressor Stress: A Feasibility Study in At-Risk Women, in press, Acta Radiologica.
Maroules CD, Yadav H, Peshock RM, Chang AY. Measurement of Impaired Coronary Vascular Reactivity using 3T MRI in Asymptomatic Women with Type 2 Diabetes. Oral abstract presentation, Southern Regional Meeting, American Federation for Medical Research, February 2009.
Chang AY, Kotys M, Dimitrov I, Kontak A, Yadav H, Maroules, CD, Tillery T, Peshock RM.
Coronary Artery Flow Velocity Reserve during the Cold Pressor Test in Overweight, Healthy Women using Spiral Imaging at 3T. Oral abstract presentation, Society for Cardiovascular Magnetic Resonance, January 2009.
Maroules, CD, Chang AY, Kontak A, Yadav H, Peshock RM. Coronary Sinus Flow Reserve in Response to Cold Pressor Stress in Healthy Women Using Velocity-Encoded Cine Spiral 3T MRI. Medical Student Research Symposium, January 2009.

In the summer of 2007, Alicia Jones, MS1, collected preliminary data for Project 2. She presented a poster at the UT Southwestern Medical Student Research Forum and an oral presentation to the Southern American Federation for Medical Research in New Orleans 2008.
Jones, A, Chang, AY. Dyslipidemia in Women with Polycystic Ovarian Syndrome from a County Hospital. Southern Regional Meeting, American Federation for Medical Research, February 2008.
Dr. Chang's has worked with 2 medical residents on case reports, one was presented as a poster at the Endocrine Society and one was published in 2008:
Sukumar S, Chang, AY, Welch, BJ, Kovacs, WJ, Wyne, KL. The Use of Labetalol in the Setting of Thyrotoxicosis and Cocaine-Induced Myocardial Infarction. Endo Suppl 2006;147 (298):Abst P2-877.
Patel R, Peterson G, Rohatgi A, Ghayee HK, Keeley EC, Auchus RJ, Chang AY. Hyperthyroidism-associated Coronary Vasospasm with Myocardial Infarction and Subsequent Euthyroid Angina. Thyroid. 2008; 18(2): 273-276.