PET Guided Randomized CENTURY Trial and Interventions in Complex CAD

On this episode of Inside the Texas Heart Studio, Dr. Stephanie Coulter sits down with Dr. Lance Gould to discuss the “PET Guided Randomized CENTURY Trial and Interventions in Complex CAD." Dr. Gould is a pioneer in the field of coronary physiology and will discuss his groundbreaking work on PET guided interventions for complex coronary artery disease (CAD).

Key points that Dr. Gould will discuss:

• He reflects on his illustrious career and the evolution of coronary physiology over the past four decades.
• He emphasizes the importance of translating complex physiological data into routine clinical practice through automation and software development.
• Dr. Gould highlights the current need for young investigators to focus on making this knowledge readily available for everyday use, paving the way for the future of cardiology.

For more information on CAD visit texasheart.org/heart-health/heart-information-center/topics/coronary-artery-disease/

🔗Watch the Studio Interview on Texas Heart TV

🔗 Watch Dr. Gould’s Grand Rounds 

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Chapters

• 1:00 Dr. Lance Gould's Background and Work in Coronary Physiology
• 3:34 Automation and Future
• 7:51 Funding and Strategy
• 11:34 Collaboration and the Future

Transcript

hi I'm Stephanie Coulter and we're

inside the studio at the Texas Heart

Institute and today we have the esteemed

pleasure to welcome Dr Lance GH to our

grand rounds portfolio today and um I'm

super happy to have you here and I'm

want to remind our listeners that we are

happy to have you because you really are

the Godfather of coronary physiology and

you know your esteemed career um looking

at the physiology of coronary flow flow

Reserve coronary flow capacity and how

that relates to how we actually

intervene on people has changed

substantially over the last 40 years um

and in a building that was built by

surgical revascularization techniques so

much has changed um one I'd like to

thank you for coming and two I'd like to

thank you for your esteemed career and

for all that you've given to science and

I'm actually wondering throughout all

this huge amount of data that you've put

into um the development of products that

we we our group uses your technology on

a daily

basis how I'm a educator and I'm

thinking how do we get people to follow

a career path like you did where you

went and followed like I love your slide

where you said this is the slide in 1975

that changed my life and I and you

followed your passion how were you able

to do that well thank you for the honor

it has nothing to do with me really it

has to do with the heart and how it

works and so that passion came from

trying to figure out how the heart works

and then relating it to clinical

medicine and I think that there's a lot

to do there's a lot more to understand

and if people can understand a little

bit of it it and then catch the interest

and the passion for finishing up that

physiology so that it becomes routine

and automated then that's the lesson

that we need to get it's not so much my

personal life it's the story about the

heart oh I okay I love your humility

about that but I have to tell it's real

that's that's that's the way the heart

works well the heart does but humans

follow because we get distracted and but

you stayed focused on the things that

were interesting and entertaining to you

instead of you know being distracted by

you

know positions or administrative jobs

you know what I'm saying this way I

don't know what else to do so I'm a

little bit limited I'm no good at

Administration I'm a pretty good

clinician but in order to be a clinici

they need to understand it so any way

it's an honor but I think the honor

should be focused on the heart and what

other people can discover and then the

complexed problem of where does science

go when it knows the truth but that

truth is so complicated to apply that it

takes um in the modern world a kind of

software uh a technological

automation that carries all that over

into daily life that normal people not

going to spend 50 years trying to figure

it out so the the problem in the future

is not only how you educate but how you

translate this complexity into everyday

normal living now that's a real

challenge every AI person can do that

every teenager that goes up with a

computer can do that you know when I

grew up we had the most thing we had was

a radio and a circular cell phone that's

changed and I think think the modern

world needs to look at it as a

compression of all this data into

automation that's where it's going

that's my current passion but there's

going to have to be some younger people

that take that over are do you think

we're training young people to do this I

mean you have a very robust um operation

with funding and with interesting people

you can't have 25 people in the big

endowment to make this work it needs to

be automated to the extent that two

people a doc and a technologist and

maybe a nurse can make it work and it's

all programs that if you do the right

procedure in the pet skin then the

invasive guys know what he's got he

knows how to fix it so it's a matter of

compressing knowledge and a huge team

into a small package that can be real

that's a real fundamental challenge in

all of medicine and the hearts is you

know a great place to start from a young

investigator

wants to do that that's a major deal

that's a major way of making a career

and if one has an interest in this kind

of uh research that's where the research

needs to go not to ReDiscover coronary

flow Reserve but discover how to

translate it into uh daily practice Yeah

that's the magic of where the SE

research needs to go now but it feels

like you were I mean it may feel to I

don't know I don't want to presume to

say it feels to you

but from my impression of what you were

able to achieve you were able to prove

the physiology and then you've lifted

that physiology up into a place that it

it seems like it's usable data now in

certain in certain in you know instances

it's usable data a lot of people using

it it needs to be better done and

automated automated but understand how

that happened it has something to do

with me but it also has something to do

do with the historical evolution of

science in my generation remember I'm

the postwar Generation midw War

generation there not many

people there are very few people in

academics very few people so there was

this

enormous golf of no people and no uh

knowledge and so in a sense you know we

go in the lab you do something hey

that's pretty cool let's get a paper on

it that all kind of happened because of

when I was born what happened in the war

what happened in the whole idea of

research and how it evolved and so the

current circumstances are similar in a

different way there are now different

tools a different social organization

around medicine a different scientific

base but the opportunity there the

question there

is equally

compelling and there are not too many

people in the modern

Cardiology that can actually bring this

off so that if a young researcher wants

to translate this into clinical

practice the audience is there the

software would be welcome there's

commercial support for doing it and it

will fly and become a daily practice

that then gu

dominates the future of Cardiology

because Cardiology is basically

physiology and if we can compress that

into modern terms of software and

Technology then it'll survive otherwise

all those papers are going to sit in the

library and turn yellow nobody ever

reads it that's life that's the way it

works that's why we got to keep going

forward so what would you what would you

advise for you know how we allocate

funding for kinds of programs like this

this because we we we collectively we

waste a lot of

resources trying to make people better

but not in a very you know

technically cut the knife to the right

spot well approach it is

um when I started one experiment could

tell you where to

go now the proof of this working has to

be done at a societal larger level so

large groups that do this kind of C care

they can make an enormous difference in

practice if there are protocols that

they follow or they try it they learn

they see what's going on will will there

ever be a randomized trial right now

there's not enough groups that actually

do this right that you can do a

multicenter trial so what's happening is

that people are trying it in practice

some of it is in academics a lot of it's

not in academics and they're proving

that it works maybe there will

eventually be a trial but think about

that for a moment the classical

randomized trial are you going to take

somebody with a pet skin that turns

blue and randomize them to no surgery

when you know what's going to

happen so the trick

is the question it's a question can

precise measured physi

ology take the place of the randomized

trial that can never be

done possibly if you had enough big data

for outcomes if you did it could be and

then there could be a special kind of

randomized trial that does what we did

in a centry trial but on a bigger basis

in other words it's not just do you do

pet and no pet and see what happens if

you do pet and you don't and you do the

prevention then you have to make sure

that the BR arm is really well treated

in the es schic arm the adherence to

prevent the treatment was rotten 3% yeah

so in other words you can't test the

procedure you can't test an Imaging

modality as a

strategy unless you know that both the

procedure and the medical treatment are

absolutely optimal and what that means

is in the future will it be diet and and

Statin

or will it be diet and exercise and pck

ks9 that changes the whole ball game and

it changes a threshold at which the

physiologic severity tells you what you

should do but the fundamental tools the

physiologic measurement the refinement

of the strategy that you can't just test

a drug you can't just test a procedure

you can't just test a technology Imaging

you have to put them together in an

integrated strategy that way you do the

strategy and then you don't do the

strategy that would be a trial that

would be feasible because then you're

not assigning somebody that's blue to a

sentence of possible death but if you

include it at a strategy where if

they're bad enough you fix it but then

you do the medical part an expanded

Century trial and multi- Center done

intensely with

pcc9 that's the future and if somebody

has an interest in science and academics

that's what they need to learn how to do

and get involved with but it will be a

team effort the Lone Wolf doing a

procedure and doing an experiment in the

animal lab that's gone it's over it has

to be in society with patients organized

and strategically addressing all the

components of care not just one

piece I think that it's you you you you

bear it down into a more simplified

definition of what the problem is and

then you have to figure out what are the

you know recipes that are available to

help manage that problem and it's going

to take a lot of Society resources and

like you said Co um you know cooperation

between multiple team members to this

thing but it starts with having a

definition so I'm going to thank you

again for helping us to define the

problems that we've been working on

we've made tremendous strides in the

prevention and the treatment of arterial

diseases in the last 30 years I mean oh

absolutely it's huge so for all we've

been able to accomplish with the medical

therapy with surgical techniques with

stenting techniques um we've made a

tremendous impact um on the anthropology

really of coronary disease

that's true you know and um I just want

to thank you for coming and for sharing

your knowledge and your insights with us

today and um I'm proud to call you a

houstonian now oh yes inde yeah indeed

yeah okay well thank you very much my

pleasure thank you so much for coming

great questions thanks very much being

here appreciate it thank

you