Clinical and Industry News

Clinical & Industry News

vProtect™ Luminal Shield Stabilizes Plaque

Healthy Vessel Seen in 6-Month Follow-up Exam on First Patient to Receive Preventive Treatment for Vulnerable Plaque The first patient receiving focal preventive treatment for vulnerable plaque recently underwent a 6-month follow-up examination that revealed successful stabilization of the target plaque. The interventional cardiology team, led by Professor Patrick W. Serruys, MD, PhD, of Erasmus University, placed a vProtect™ Luminal Shield in the left anterior descending (LAD) coronary artery of the patient at Erasmus Medical Center in Rotterdam in June of 2008. The 64-year-old man is enrolled in SECRITT I, a pilot study designed to evaluate the vProtect Luminal Shield as a treatment for vulnerable plaques. To date, the treated artery demonstrated excellent blood flow and healing. As part of the healing process, the Shield is now covered by a thin layer of tissue, incorporating it into the arterial wall. This is a hallmark of a successful implant and demonstrated that the Shield performed much better than would be expected for traditional bare metal stents and comparable to the first generation of drug-eluting stents. Patients enrolled in SECRITT I have been referred to the cath lab for treatment of clinically significant coronary lesions, which are treated according to current standards of care. Using a combination of ultrasound and optical imaging techniques, the SECRITT I investigators examine the coronary arteries for signs of additional, non-flow-limiting vulnerable plaques, for which patients would not generally receive treatment. Patients with vulnerable plaques undergo follow-up diagnostic catheterizations 6 months post-treatment, at which time investigators determine the Shield’s impact. According to Professor Serruys, the vProtect Luminal Shield represents a logical extension of modern cardiac medicine: “We are very good at opening arteries that are blocked, but we have not succeeded in preventing heart attacks related to plaque rupture. The vProtect Luminal Shield has demonstrated that it can be safely placed over a vulnerable lesion without rupturing the plaque, and the results at six months are extremely promising. The Shield performed exactly as intended, allowing us to prevent plaque rupture and an acute event, rather than trying to repair the damage after the fact.” _____________________________

Invatec Launches First Drug-Eluting Balloon Designed to Treat Atherosclerosis Below the Knee

Invatec announced the European launch of a new peripheral balloon, the IN.PACT™ Amphirion paclitaxel-eluting PTA balloon catheter. This is the first drug-eluting catheter designed specifically to treat atherosclerosis in arteries located below the knee (BtK). IN.PACT features FreePac™, a proprietary coating that frees and separates paclitaxel molecules and facilitates their absorption into the wall of the artery. The FreePac coating was developed in close collaboration with the researchers who pioneered drug-eluting balloon therapy, Ulrich Speck, PhD, Department of Radiology at Charite Mitte, Berlin, Germany and Bruno Scheller, MD, University Hospital, Department of Internal Medicine, Homburg/Saar, Germany. Invatec plans to launch a randomized trial, the IN.PACT DEEP study, in the first half of 2009, to provide additional data about the effectiveness of this new treatment concept. “After years of research we are pleased to see this technology available for clinical applications,” commented Prof. Speck and Prof. Scheller. “The drug-eluting balloon concept has the potential to reduce re-intervention rates for patients with atherosclerosis. Invatec’s balloon technology is an ideal platform for the FreePac coating and will allow for the development of specific solutions for additional endovascular applications including the superficial femoral artery (SFA).” According to data published in Wounds, 40 percent of patients require amputation within 12 months of a critical limb ischemia episode, and there is an annual mortality rate of more than 20 percent. _____________________________

Vascular Solutions Launches D-Stat® Dry Wrap Hemostatic Bandage

Vascular Solutions, Inc. announced the launch of its D-Stat Dry Wrap hemostatic bandage. A convenient pre-cut version of the D-Stat Dry hemostat, D-Stat Dry Wrap is designed specifically for the control of bleeding around indwelling lines. D-Stat Dry Wrap is the latest addition to Vascular Solutions’ line of D-Stat hemostasis products, which use thrombin to control bleeding. A component of the clotting cascade, thrombin cleaves fibrinogen to fibrin, enhancing the body’s own mechanism to produce a clot. D-Stat Dry Wrap contains the same thrombin activity level as the original D-Stat Dry, and comes complete with a clear adhesive bandage for continuous site monitoring after hemostasis is achieved. D-Stat Dry Wrap is currently available in the United States. _____________________________

Study Finds Failure to Include Nurses in Process of Admitting Errors to Patients, Families

Need for team approach to disclosing medical mistakes shown Even though nurses routinely disclose nursing errors to their patients, a new study published in the January 2009 issue of The Joint Commission Journal on Quality and Patient Safety shows that nurses often are not included when physicians tell patients about more serious mistakes. Nurses play such a hands-on role at the bedside of their patients that the study’s authors conclude that the absence of nurses from discussions to plan for or disclose errors can diminish the quality of the disclosure experienced by the patient or their family. For example, when nurses are not involved in the planning for disclosure, they may seem evasive in answering patients’ questions or stall by encouraging families to write down their questions or set up a meeting with doctors. The study, “Disclosing Errors to Patients: Perspectives of Registered Nurses,” systematically explores nurses’ attitudes toward and experiences with error disclosure to patients. “Improving the quality of error disclosure to patients is a top priority in health care,” says Sarah E. Shannon, PhD, RN, vice associate dean for academic services in the University of Washington School of Nursing, associate professor of behavioral nursing and health systems at the University of Washington, and lead author of the study. “Error disclosure needs to be a team sport. This means quickly sharing information among the team about the error: what happened, why it occurred, what is being done to mitigate potential harm and prevent future errors, and what the patient has been told, will be told, and when.” The study of nearly 100 nurses reports that nurses say they talk with patients about errors that are within their control, such as late or missed medications or treatments. But nurses in the study said they hesitate to independently disclose errors that involved serious harm or actions of other members of the healthcare team. In these situations, the nurses said the responsibility fell to the patient’s attending physician. The nurses said, however, that they would like a role in the disclosure process as a way to both communicate directly with the patient about nursing’s role in the event and to avoid being blamed for the event. The study also found low awareness of institutional disclosure policies. The study’s authors — three nurses and one physician — conclude that a team disclosure process is best and recommend that health care organizations establish policies that permit nurses and other caregivers to participate in and raise concerns about the disclosure process. The authors point out that a lack of collaboration and communication in the disclosure process may lead to moral distress, increased job dissatisfaction and job turnover among nurses. In addition, the authors suggest that nurse managers should receive training on how to tell patients and families that a mistake has occurred. _____________________________

First Patient Enrolled in Carotid Wallstent® Endoprosthesis Registry

Boston Scientific Corporation announced enrollment of the first patient in the CABANA post-market approval study of the Company’s Carotid Wallstent® Monorail® Endoprosthesis used in conjunction with its FilterWire EZ™ Embolic Protection System. The first patient was enrolled in the CABANA Study by Rajesh M. Dave, MD, Chairman, Endovascular Medicine, Pinnacle Health Heart and Vascular Institute, Harrisburg Hospital, Harrisburg, PA. The CABANA Study is a multi-center, U.S. surveillance registry designed to enroll a minimum of 1,000 patients at up to 150 sites. The objective of the study is to compile early clinical outcomes data for the Carotid Wallstent Monorail Endoprosthesis and FilterWire EZ Embolic Protection System in routine clinical practice. The U.S. Food and Drug Administration (FDA) approved the Carotid Wallstent on October 23, 2008. The FilterWire EZ Embolic Protection System received FDA clearance for use in carotid artery stenting procedures on December 14, 2006. Christopher J. White, MD, Chairman, Department of Cardiovascular Diseases, Ochsner Clinic Foundation, New Orleans, and Principal Investigator of the study, noted “We expect that the user-friendly design and ease of use will contribute to improved outcomes in patients with carotid artery stenosis who are at increased risk for carotid surgery.” The Carotid Wallstent Monorail Endoprosthesis is a self-expanding stent with a closed-cell design to promote increased scaffolding for lesion coverage and a smooth inner lumen. It features a highly flexible, low-profile stent delivery system for tracking through difficult anatomy. The FilterWire EZ Embolic Protection System is designed to capture plaque debris that may be released during a procedure. The Carotid Wallstent Endoprosthesis and Filter Wire EZ System is the only carotid artery stent system indicated in the United States for the treatment of certain patients at high risk for surgery with either ipsilateral or bilateral carotid artery disease. The BEACH Trial, a prospective, non-randomized, single-arm clinical trial with 480 patients, demonstrated the safety and efficacy of the Carotid Wallstent Monorail Endoprosthesis and FilterWire EZ Embolic Protection System. These patients were considered high risk for carotid endarterectomy (CEA) because they had either anatomical issues or co-morbidity. The primary endpoint in the BEACH trial was one-year morbidity and mortality defined as the cumulative incidence of non Q-wave myocardial infarction within 24 hours of the index procedure, peri-procedural (Medtronic Announces Clinical Trial of Stent for Peripheral Arterial Disease Medtronic, Inc. announced the first enrollment in the company’s FDA-approved clinical trial of its self-expanding (SE) Complete SE stent for the treatment of peripheral arterial disease (PAD) in the superficial femoral artery (SFA). Approved by the FDA under an investigational device exemption (IDE), the SFA study is a prospective, multi-center, single-arm trial planned to enroll 178 subjects at up to 30 sites globally. Enrolling patients with symptomatic PAD in the SFA, the study has primary endpoints of major adverse events (MAEs) and patency of the stent at 12 months. Enrollment in two other PAD studies to evaluate the treatment of iliac artery lesions with Medtronic stents also began in 2008: • The Complete SE stent is currently being evaluated in an IDE-approved clinical trial for use in the treatment of iliac artery lesions in subjects with symptomatic and asymptomatic PAD. The Complete SE Iliac Registry is a non-randomized, prospective study designed to enroll 60 subjects. The primary study endpoints are MAEs at 30 days and nine months. With 12 U.S. sites participating, enrollment is nearly complete. • Similarly, the balloon-expandable Assurant Cobalt stent is currently being evaluated in an IDE-approved clinical trial as a treatment for iliac artery lesions in subjects with symptomatic PAD. Initiated in October 2008, the study is a non-randomized, prospective, single-arm trial with an enrollment target of 123 subjects at 20 U.S. sites. The primary endpoint of the study is MAEs at nine months. _____________________________

FAME Study Published in New England Journal of Medicine

Routine measurement of fractional flow reserve reduces the risk of death or heart attack by 35 percent after stent placement in patients with multi-vessel disease St. Jude Medical, Inc. announced the publication of results from the landmark FAME (Fractional flow reserve (FFR) vs. Angiography in Multivessel Evaluation) study that demonstrate a statistically significant 30 percent difference in Major Adverse Cardiac Events (MACE) such as death, myocardial infarction and repeat revascularization. The randomized, prospective, multi-center trial looked at 1,005 patients with multi-vessel coronary artery disease 12 months after receiving a stent and compared outcomes for patients whose treatment was guided by FFR to those whose treatment was guided only by angiography. Published in the Jan. 15 issue of the New England Journal of Medicine, the FAME study results show superior clinical and cost-effectiveness outcomes for the FFR-guided patient group for which investigators used a pressure sensor mounted on a guidewire, PressureWire® Certus, developed and marketed by Radi Medical Systems, which was acquired in December 2008 by St. Jude Medical. In the study, the risk of a patient dying or having a heart attack was reduced by approximately 35 percent when FFR measurement was performed (11.1 percent for the angiography-guided group compared to 7.3 percent for the FFR-guided group, p = 0.04). The 12-month overall MACE rate was 18.4 percent, compared to 13.2 percent for the FFR-guided group (p = 0.02). This means that the likelihood of a patient having to return for further treatment (repeat stent placement or coronary artery bypass graft surgery) was significantly lower for the FFR-guided group. In addition to the significant difference in MACE, the quality of life (freedom from angina and chest pain) for patients whose treatment was guided by FFR was equal to, and in some cases better than, that of patients whose treatment was based solely on angiography. "Treatment decisions today should not be just about which stent you pick, they should be about where you put a stent," said the FAME study’s co-principal investigator, Professor Nico Pijls, MD, PhD, of Catharina Hospital in Eindhoven, the Netherlands. "We know that stenting ischemia-producing stenoses improves symptoms and outcomes, and that stenting non-ischemic stenoses has no benefit compared to medical treatment only. FFR is a simple measurement that can be performed quickly in the cath lab and makes it possible to treat culprit lesions only, while avoiding time, damage and expense from placing stents which do not benefit the patient.” The FAME study is the first large-scale, randomized, prospective, multi-center clinical trial that compares stenting guided by FFR to stenting guided by angiography alone in patients with two or more diseased coronary arteries. The goal of the FAME study is to explore whether routine use of FFR can guide physicians to place stents optimally when assessing patients with multi-vessel disease. The FAME study was conducted in 20 centers in Europe and the United States and included 1,005 patients. The FAME study also shows that FFR measurement is cost-saving and does not add time to the procedure. The average procedural costs were $5,332 for the FFR-guided group compared to $6,007 for the angiography-guided group (p Merit Medical Announces Year-End Developments Merit Medical Systems, Inc., a manufacturer and marketer of proprietary disposable devices used primarily in cardiology and radiology procedures, announced four developments regarding products and approvals. The Company has acquired the rights for a radial artery compression device for an undisclosed amount. The device is used to maintain a given pressure following a cardiac procedure which allows early ambulation. “Merit’s Prelude™ radial sheath product has been one of our most exciting products this year,” said Fred P. Lampropoulos, Merit's Chairman and Chief Executive Officer. “The addition of this compression device technology goes hand in hand with what the Company believes is an accelerating trend in radial artery procedures. This new product has several proprietary features and should be available for sale during 2009, following further development and regulatory approvals.” Merit also announced the acquisition of a device used for the removal of cuffed catheters, such as hemodialysis catheters, and other products, such as ports. The product has patents pending, 510(k) clearance from the Food and Drug Administration, and is sold as a stand-alone product as well as part of a kit. The Company did not disclose the purchase price. Merit also announced that it has received 510(k) clearance from the FDA for Merit's Miser™ contrast management system. The product has patents pending and will be released during the first quarter of 2009. “With the rising cost of health care, this product allows clinicians to more efficiently manage contrast media, which is a costly part of a diagnostic or interventional procedure,” Lampropoulos said. Finally, Merit announced that it has received ISO 13485 certification of its facility in Richmond, Virginia, from BSI, Merit’s European Notified Body. “This approval will allow Merit to better balance our facility load and, more importantly, to build products in our Richmond plant which may be sold in countries requiring the CE mark in the future, namely, the European Union,” Lampropoulos said. _____________________________

Abbott Begins U.S. Study of Xience V™ Drug-Eluting Stent Designed for Small Vessels

Abbott announced the start of SPIRIT Small Vessel, a clinical trial evaluating a 2.25 mm size of the Xience V™ Everolimus Eluting Coronary Stent System. The 2.25 mm stent system would offer physicians an option for treating coronary artery disease in narrower vessels. In July 2008, Xience V was launched in the United States. The addition of a 2.25 mm size would complement the broad range of Xience V lengths and diameters. Upon U.S. Food and Drug Administration (FDA) approval of the 2.25 mm stent system, the device will be called Xience Nano™ in the United States. The Xience V 2.25 mm stent system received CE Mark (Conformité Européene) approval and was launched in various countries in Europe, Asia and Latin America in March 2008. “Treatment of lesions in small coronary vessels is often complex and associated with higher rates of complications. Being able to deliver a stent accurately to the diseased area of the vessel is crucial for successful treatment,” said Marco Costa, MD, PhD, director of Invasive Services, and director of the Center for Research and Innovation, Harrington-McLaughlin Heart and Vascular Institute, University Hospitals, Case Western Reserve University, and principal investigator of the SPIRIT Small Vessel trial. The SPIRIT Small Vessel trial is designed to study 250 patients at approximately 50 centers in the United States. The primary endpoint is a composite measure of cardiac death, target vessel myocardial infarction and target lesion revascularization at one year. Abbott supplies a private-labeled XIENCE V to Boston Scientific called the Promus™ Everolimus-Eluting Coronary Stent System. Promus is manufactured by Abbott and supplied to Boston Scientific as part of a distribution agreement between the two companies. _____________________________

ESC Statement on Gender Differences in Medical Care and Survival After Myocardial Infarction

A paper published online by the journal Circulation concluded that, while men and women have a similar in-hospital death rate following acute myocardial infarction (AMI), women with ST-elevation myocardial infarction (STEMI) had an adjusted mortality rate almost twice as high as men (10.2% versus 5.5%). These differences were associated with a lower likelihood of reperfusion therapy in women. The paper was widely reported in the press, with suggestions of disparity in care and outcome after AMI. This study is one of many undertaken in the past 20 years on gender differences in the management of acute coronary events. Many, like this latest study, have found that women are treated less intensively in the acute phase. However, after adjustment for age, co-morbidity and severity of disease, some of these disparities have been found to disappear. Similarly, many studies have found gender differences in short-term survival rates after AMI, but such differences have not always persisted in the long term. In Europe, results from a Swedish cohort study of 53,781 subjects (of whom 37% were women) also showed that overall women were less intensively treated than men, but, in cases of non-STEMI, had a better long-term prognosis than men. Commenting for the ESC on the STEMI results in the Circulation paper, Professor Eva Swahn (University Hospital, Linköping, Sweden), who has conducted gender studies in acute coronary syndrome patients, said, “We are not surprised. We found similar results in our Swedish cohort study.” Although the incidence of AMI is low in both sexes, especially in premenopausal women, the view persists — mistakenly — that women don’t have the same coronary symptoms as men. “This is a myth,” says Professor Swahn. “The classical symptoms of AMI are the same for women as for men.” However, this mistaken belief may explain why reperfusion therapy is not started as quickly in women as in men — because women interpret their symptoms differently from men and may not summon help soon enough. While there are some recurring patterns in the studies — less intensive treatment in women, lower survival rates in female STEMI patients — much of the explanation for the disparities remains unknown. Definite answers about medication, invasive or non-invasive treatment, and survival will only be derived from studies powered to draw significant conclusions in both men and women in the same prospective cohort. And the optimal treatment recommendations for men and women respectively will only be resolved by inclusion of sufficient numbers of both women and men in future clinical trials. Reference Jneid H, Fonarow GC, Cannon CP, et al. Sex differences in medical care and early death after acute myocardial infarction. Circulation 2008 Dec 16;118(25):2803-2810. _____________________________

Stanley InnerSpace Launches New Internet Presence

Website Delivers Enhanced Product Information and Presents New Company Identity Stanley InnerSpace announced the launch of an all-new company website ( featuring an array of new features as well as the company’s most up-to-date product information and configuration options. InnerSpace provides supply/procedure carts, cabinets and casework, open storage and inventory management/RFID systems to healthcare facilities around the world. What separates the new InnerSpace site from those of its competitors, notes Jill Wheeler, Director of Marketing for Stanley Engineered Storage Solutions, is its streamlined presentation of a large amount of product information. “The new site is extremely user-friendly, and site visitors can easily pinpoint any specific product or product lines via their hospital department or by the product benefits they are looking for. Whether you are already familiar with InnerSpace products or if the website is your introduction to Stanley InnerSpace, you will be equally at ease finding exactly what you need.” Additional site features include a literature library housing downloadable information on all InnerSpace products, image and video galleries highlighting InnerSpace product installations, and detailed case studies from healthcare facilities across the country using InnerSpace storage systems. _____________________________

MIT Model Predicts How to Build a Better Stent

Work Could Help Reduce Blood Clot Risk in Stent Recipients Researchers have been puzzled in recent years by observations that drug-eluting stents can increase the likelihood of blood clots and heart attacks. Now, a mathematical model developed by MIT engineers can predict whether particular types of stents are likely to cause life-threatening side effects. The model “helps explain why some stents are better than others, and could predict which stents are predisposed to cause clotting,” said Elazer Edelman, the Thomas D. and Virginia W. Cabot Professor of Health Science and Technology (HST) and senior author of a paper on the work, appearing as the cover story of the Jan. 5 issue of the Journal of Controlled Release. Edelman and HST postdoctoral associates Vijaya Kolachalama and Abraham Tzafriri designed the model to predict how the size and shape of a stent affects blood flow and drug distribution. Drug-releasing stents have been proven a “double-edged sword,” Edelman said. The drugs successfully block tissue growth that could impede blood flow, but can have the unforeseen side effect of increasing the risk of blood clots and heart attacks. This paper explains why: Stents affect the fluid dynamics of blood flowing past them and cause drugs to accumulate in certain areas. Too much drug buildup promotes clot formation. The MIT model shows that the dynamics of blood flowing around a stent is similar to whitewater rapids, said Edelman. When water in a river flows over a boulder, some of the water strikes the base of the boulder, flies up in the air and comes back down, instead of flowing over the rock. This water continuously recirculates in the same area. The same thing happens when blood flows across a stent: Drugs tend to accumulate and spin around in the recirculation zone. This is most likely to happen with stents that protrude further into the artery. “Until now, the degree to which recirculation zones impact the distribution of drugs was not appreciated,” said Edelman. This is the first time that a mathematical model has successfully predicted stent performance based on changes in arterial blood flow and design, and the researchers hope the model and concepts it establishes could aid efforts to design stents that allow drugs to be more evenly distributed throughout the area. The model could also help the FDA in its approval processes, by helping regulators figure out which stents are most likely to be safe or harmful, based on their size and shape, which controls how they will affect blood flow. This research was funded by the National Institutes of Health. _____________________________

St. Jude Medical Acquires Radi Medical Systems

St. Jude Medical, Inc. and Radi Medical AB announced today the completion of St. Jude Medical’s acquisition of Radi Medical Systems AB for $250 million in cash. Radi Medical Systems is the world leader in two segments of the market for cardiovascular medical devices in which St. Jude Medical does not currently participate. For 2008, Radi Medical Systems is expected to generate approximately $80 million in sales, a 19 percent increase over 2007. Radi Medical Systems’ pressure measurement guidewire, PressureWire® Certus, comprises approximately a 70 percent share of the global market for physiological assessment of coronary lesions. The product is supported by a large and growing body of clinical evidence, including the FAME (“Fractional Flow Reserve vs. Angiography for Multivessel Evaluation”) study. The results of the FAME study were presented at the Transcatheter Cardiovascular Therapeutics conference in October 2008, and can be viewed at The market for physiological assessment of coronary lesions totaled over $60 million in 2008 and is projected to continue growing at a strong double-digit rate. Radi Medical Systems’ FemoStop® and RadiStop® product lines comprise approximately a 60 percent share of the global market for manual compression-assist products for vascular closure. This market totaled approximately $45 million in 2008 and is projected to continue to grow at least at a mid single-digit rate. The FemoStop and RadiStop product lines, together with St. Jude Medical’s world-leading Angio-Seal™ line of active vascular closure products, will be part of an expanded program by St. Jude Medical to fully develop the potential of a global vascular closure device market that is only about 27 percent penetrated. With this transaction, Radi Medical Systems will become part of the St. Jude Medical Cardiovascular Division. The transaction is expected to be neutral to St. Jude Medical’s consolidated earnings per share in 2009 and is expected to be positive to consolidated earnings per share beginning in 2010. _____________________________

Boston Scientific Acquires Labcoat Limited

Boston Scientific Corporation announced that it has acquired Labcoat Limited, a privately held, development-stage drug-eluting stent technology company located in Galway, Ireland. Terms of the acquisition were not disclosed. Labcoat has developed a novel technology for coating drug-eluting stents that uses precisely metered droplets of a biodegradable polymer and drug formulation to create a thin (Associations are Important in a Recession Peggy McElgunn, Esq., Executive Director, Alliance of Cardiovascular Professionals, Midlothian, Virginia Cardiovascular professionals and the organizations for which they work can be under tremendous pressure during recessions. Although risk management is ever-present, it is even more critical during tough economic times than it is during times of expansion. No doubt, we are all troubled by what we see and read every day about the economy, layoffs and failing businesses. More disturbing, perhaps, are reports that many individuals are dropping some of their memberships, possibly as a reaction to the economic downturn. It is as if all the bad news is affecting good judgment. A recent Kiplinger Letter (a newsletter offering forecasts for management decision-making) indicates that many individuals and companies are considering not renewing their memberships in associations in an effort to save money. But this is a false economy of the worse kind. In good times or bad, membership in associations is one of the best investments you can make. Membership in is an investment in your career and your organization’s bottom line. Think of all the ways you benefit from membership with a professional organization. The skills and contacts with other professionals you have gained through participation in conferences, seminars, industry groups and programs alone more than pay the price of your membership. Then there are the publications, the networking and the information you receive. With organizations like the Alliance of Cardiovascular Professionals, there is also the ability to survey membership, receive online CEUs and create your own benefit package. It is all up to you and what you need and access. Your membership puts you in touch with a network of professionals and experts across the country and around the world. Help is literally no further than a telephone call away. Associations provide the latest information on events and techniques affecting your field and your business. For you, this means staying on top of the cardiovascular arena, negotiating skills, management skills, clinical advances and much more. It means sharing ideas with the top experts in your field. And, it means contributing your own thoughts and expertise to help someone else or to improve the profession. During the 26th through the 28th of March, we will all have an opportunity to meet in Orlando for the 2009 Leadership Conference. It is always a sound business decision to invest in improving your performance. “Putting Magic into Leadership” is one way to do that successfully. Visit to download a program, learn about membership and take advantage of the opportunities accessed by 3000+ professionals. The result will be improved performance for your organization.