TCT Career Achievement Award Goes to CV Pathologist Renu Virmani, MD

MIAMI BEACH, FLA.—Renu Virmani, MD, was presented with the Cardiovascular Research Foundation’s Career Achievement Award on Thursday in recognition of her accomplishments in vascular pathology, work that has contributed significantly to the current understanding of coronary thrombosis, atherosclerosis, and vulnerable plaque.

The founder and president of CVPath Institute, a research service of the International Registry of Pathology in Gaithersburg, Md., Virmani is directing much of her current efforts toward understanding chronic total occlusion and its role in sudden cardiac death. “We have made so much progress in MI and treatment of CHD, but we have not changed the course of sudden cardiac death,” she told TCT Daily.

“I am still trying to understand thrombosis and why many people who present with sudden death have one artery totally occluded but have never been symptomatic. Eventually we will be able to recognize the disease before it manifests and will be able to change its course in patients.

“My goal is to learn what has gone wrong and what can go wrong. You can’t improve if you don’t know that, and to do that you need the autopsy,” she said.

In presenting the award, TCT Course Director Martin B. Leon, MD, of Columbia University Medical Center, New York, N.Y., said, “Renu has overcome great obstacles to achieve great professional goals. She’s proven that a woman and a pathologist can have enormous impact on mainstream clinical medicine. She has the courage to question, and the conviction to challenge, accepted norms in the interests always of patient safety. She is our conscience. Over the course of 20 years, she’s been a voice steering us in the right direction. Based on her iconoclastic spirit and good science, Renu is remarkably deserving to be our 2012 career achievement award winner.”

Distinguished career in research

Virmani earned her medical degree at Lady Hardinge Medical College at Delhi University in New Delhi, India. After marrying Chester Finn, who was an assistant to Daniel Patrick Moynihan when Moynihan served as the U.S. ambassador to India, she moved to the United States and worked with William C. Roberts, MD, a cardiac pathologist who became her mentor and role model.

“Bill is an absolutely driven human being and he was very influential in shaping my way of working. He offered me a job without pay when I first came here, and that was one of the best things I ever did. I wrote two papers in the 9 months I was with him before I went into residency.”

After Virmani completed a 2-year residency at George Washington University Medical Center, she rejoined Roberts for a fellowship in the pathology branch at the National Heart, Lung, and Blood Institute. She then served as a staff pathologist and was chair of the department of CV pathology at the Armed Forces Institute of Pathology until 2004 — a stint that required joining the army as well as serving a few years in the reserves.

In the 1980s, Virmani was also an associate professor and director of the autopsy service at Vanderbilt University and was director of autopsy services at the Veterans Administration Medical Center in Nashville, Tenn. She is currently clinical professor in the department of pathology at Georgetown University and George Washington University in Washington, D.C.; the University of Maryland-Baltimore; and Vanderbilt University.

The private nonprofit CVPath Institute, which she founded in 2005, has yielded important research on vulnerable plaque, physiological responses to stents, and pathological findings of transplanted transaortic valves. The institute performs philanthropic work with medical examiners, she said. “My goal is to have a place where we are able to learn what goes wrong with cardiovascular disease and treatment. I have fellows from all over the world who want to dive into these registries and learn more.

“I am also teaching clinicians how to recognize plaque progression. If clinicians understand that we have tools now where we can recognize these various phases of plaque progression, then I think we can really make a difference by invasive and noninvasive means.”

Research advances

Recognized for her astute research and her observations about the implications of developments in interventional cardiology, Virmani has often been one of the first to question the potential outcome of the latest trends in therapy. She warned interventional cardiologists about the potential problems with brachytherapy. “Everybody said that brachytherapy would work, and I said, ‘You are going to have a problem. Right now it works, but in 2 years you will start seeing problems.’ And I was right.”

She also issued an early warning about problems associated with DES when compared with bare metal stents, including the potential for late stent thrombosis, poor endothelialization, and development of in-stent neoatherosclerosis.

Throughout her career she has kept her mind open to new possibilities, she said. “When Marty Leon came to me and said they were thinking of putting a stent in the aortic valve, I said to him that this could never occur. Of course, I was wrong. They came to my lab, and we did it in a pig’s heart. That experience taught me never be dogmatic and to keep an open mind.”

A prolific researcher, Virmani has delivered more than 800 presentations around the world, authored or co-authored more than 600 publications in peer-reviewed journals, and has edited 7 books and written more than 100 book chapters.