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<h2 id="toc-title">On this page</h2>
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<li><a href="#current-projects" id="toc-current-projects" class="nav-link active" data-scroll-target="#current-projects">Current projects</a></li>
<li><a href="#research-skills" id="toc-research-skills" class="nav-link" data-scroll-target="#research-skills">Research skills</a></li>
<li><a href="#previous-work" id="toc-previous-work" class="nav-link" data-scroll-target="#previous-work">Previous work</a>
<ul class="collapse">
<li><a href="#stress-and-cardiovascular-epidemiology" id="toc-stress-and-cardiovascular-epidemiology" class="nav-link" data-scroll-target="#stress-and-cardiovascular-epidemiology">Stress and Cardiovascular Epidemiology</a></li>
<li><a href="#stress-and-arrhythmognesis" id="toc-stress-and-arrhythmognesis" class="nav-link" data-scroll-target="#stress-and-arrhythmognesis">Stress and Arrhythmognesis</a></li>
<li><a href="#computational-neurocardiology-and-biostatistics" id="toc-computational-neurocardiology-and-biostatistics" class="nav-link" data-scroll-target="#computational-neurocardiology-and-biostatistics">Computational Neurocardiology and Biostatistics</a></li>
<li><a href="#clinical-projects" id="toc-clinical-projects" class="nav-link" data-scroll-target="#clinical-projects">Clinical Projects</a></li>
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<h1 class="title">Research Efforts</h1>
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<p>The long-term area of focus is in the relationship between stress and arrhythmogenesis, which boils down to the relationship between <em>substrate</em>, <em>trigger</em>, and <em>event</em>.</p>
<blockquote class="blockquote">
<dl>
<dt>“Why did he die on a Tuesday and not on a Monday?”</dt>
<dd>
Douglas Zipes
</dd>
</dl>
</blockquote>
<p>In the 50 years since the advent of the coronary care unit <span class="citation" data-cites="Lown1968">(<a href="#ref-Lown1968" role="doc-biblioref">Lown and Selzer 1968</a>)</span>, our ability to prevent arrhythmogenesis has not made a significant difference in clinical outcomes (with a stable 1 out of 5 deaths being secondary to arrhythmia <span class="citation" data-cites="Hayashi2015 Lown1977">(<a href="#ref-Hayashi2015" role="doc-biblioref">Hayashi, Shimizu, and Albert 2015</a>; <a href="#ref-Lown1977" role="doc-biblioref">Lown, Verrier, and Rabinowitz 1977</a>)</span>. This topic fascinates me, and has led me to continue to explore this path, with a mixed focus between atrial and ventricular arrhythmias.</p>
<section id="current-projects" class="level1">
<h1>Current projects</h1>
<p>This serves as a summary of current/active research projects and relevant updates on progress.</p>
<ol type="1">
<li>Weekly <a href="https://shah-in-boots.github.io/research/t32/rip.html">T32/F32 research-in-progress</a> updates along with <a href="https://shah-in-boots.github.io/research/t32/mentors.html">T32/F32 mentorship meetings</a> agends</li>
<li>Weekly <a href="https://shah-in-boots.github.io/research/k23/rip.html">K23 research-in-progress</a> updates along with <a href="https://shah-in-boots.github.io/research/k23/mentors.html">K23 mentorship meetings</a> agends</li>
</ol>
<table class="table">
<tbody>
<tr class="odd">
<td>MSIMI and CV Mortality</td>
<td>A large prospective cohort study measuring myocardial ischemia in response to mental stress, with extensive follow-up. Analytical skills included the development of recurrent event models (AG, PWP, MSM, marginal, conditional). Recurrent event software in R was developed. Middle-author Publication in JAMA</td>
<td>2019-2020</td>
</tr>
<tr class="even">
<td>HRV and Myocardial Perfusion</td>
<td>Evaluated circadian patterns in autonomic function using 24-hour Holter data, generating HRV with a focus on spectral density analyses. Compared these patterns with CFR on quantitate PET, finding a relationship with CFR and early morning low HRV. First-author publication in IJC</td>
<td>2017-2020</td>
</tr>
<tr class="odd">
<td>GEH and Diabetes</td>
<td>Using the CARRS cohort, evaluated ECG-based patterns of GEH and diabetes, finding a strong relationship with cardiac fibrosis and widening of specific GEH parameters. WIP</td>
<td>2018-2019</td>
</tr>
<tr class="even">
<td>HRV and Psychosocial Factors</td>
<td>Evaluated changes in HRV from baseline to several years later in the ARIC Study. Found that psychosomatic stress (in the form of vital exhaustion) led to a persistent decrease in high frequency HRV, a surrogate of vagal tone. First-author Publication in JAHA</td>
<td>2016-2020</td>
</tr>
<tr class="odd">
<td>AFL and Family History</td>
<td>Statistical analysis of relationship between early onset AFL and family history, which notably yields different phenotypes in Whites and Blacks. <a href="https://shah-in-boots.github.io/aflubber">WIP</a></td>
<td>2022</td>
</tr>
<tr class="even">
<td>Disturbances of Neurocardiac Axis</td>
<td>TL1 and F32 grant focused on evaluating of myocardial ischemia and changes in autonomic function using HRV. Pilot study with completed recruitment. Publication of Thesis and WIP</td>
<td>2019-now</td>
</tr>
<tr class="odd">
<td>Vagolysis and Arrhythmogenesis</td>
<td>Measurement of vagolysis in arrhythmogenesis in the electrophysiology lab and using clinical and epidemiological data. Currently working on the development/progress <a href="https://shah-in-boots.github.io/research/k23/planning.html">towards a K23 award</a>, including pilot data collection.</td>
<td>2022-now</td>
</tr>
</tbody>
</table>
<p><em>GEH = global electrical heterogeneity; HRV = heart rate variability; CV = cardiovascular; SCD = sudden cardiac death; AFL = family history; MSIMI = mental stress induced myocardial ischemia; PET = positron emission tomography</em></p>
</section>
<section id="research-skills" class="level1">
<h1>Research skills</h1>
<p>Technical research skills:</p>
<ul>
<li>epidemiology and biostatistics</li>
<li>study design (IRB, informed consent, subjection enrollment)</li>
<li>digital signal processing (HRV, ECG)</li>
<li>programming in R, MATLAB</li>
<li>harmonic regression</li>
<li>advanced survival models with recurrent events</li>
</ul>
</section>
<section id="previous-work" class="level1">
<h1>Previous work</h1>
<section id="stress-and-cardiovascular-epidemiology" class="level2">
<h2 class="anchored" data-anchor-id="stress-and-cardiovascular-epidemiology">Stress and Cardiovascular Epidemiology</h2>
<p><em>Physiological and psychological stress and cardiovascular mortality, from a neurocardiac perspective</em></p>
<ul>
<li>Effect of autonomic reactivity and resting vagal tone in cardiovascular mortality</li>
<li>Depression and dysregulation of the autonomic nervous system, published in <a href="https://doi.org/10.1161/JAHA.120.017172">JAHA</a></li>
<li>Circadian variability in autonomic function and microvascular coronary disease, published in <a href="https://doi.org/10.1016/j.ijcard.2020.01.069">IJC</a></li>
<li>Atrial fibrillation recurrence after catheter ablation</li>
<li>Family history and genetic basis of <a href="https://shah-in-boots.github.io/aflubber">atrial flutter</a></li>
<li>Cardiovascular biorepository for computational assessment of trajectories/history</li>
</ul>
</section>
<section id="stress-and-arrhythmognesis" class="level2">
<h2 class="anchored" data-anchor-id="stress-and-arrhythmognesis">Stress and Arrhythmognesis</h2>
<p><em>Mechanisms behind stress and arrhythmia generation (or degeneration) in a pre-clinical and clinical electrophysiology context</em></p>
<ul>
<li>Murine models of vagolysis leading to triggered arrhythmias, which was initially proposed as an <a href="https://shah-in-boots.github.io/research/grants/aha_innovative_project_2022.html">AHA IPA</a>, but then withdrawn</li>
</ul>
</section>
<section id="computational-neurocardiology-and-biostatistics" class="level2">
<h2 class="anchored" data-anchor-id="computational-neurocardiology-and-biostatistics">Computational Neurocardiology and Biostatistics</h2>
<p><em>Programming-based approaches in signal processing and biostatistics</em></p>
<ul>
<li>Measuring circadian patterns and disturbances using a <a href="https://shah-in-boots.github.io/card">cosinor regression method</a></li>
</ul>
</section>
<section id="clinical-projects" class="level2">
<h2 class="anchored" data-anchor-id="clinical-projects">Clinical Projects</h2>
<p><em>Work being done as a cardiology fellow at UIC/JBVA</em></p>
<ul>
<li>Atrial fibrillation and efficacy of cardioversion</li>
<li>Pulmonary embolism management with a coordinated response team (PERT)</li>
<li>Endocarditis lesion characteristics in a gain-independent manner using pixel density changes</li>
<li>Arrhythmia and device management in setting of endocarditis</li>
</ul>
</section>
</section>
<div id="quarto-appendix" class="default"><section class="quarto-appendix-contents" role="doc-bibliography" id="quarto-bibliography"><h2 class="anchored quarto-appendix-heading">References</h2><div id="refs" class="references csl-bib-body hanging-indent" data-entry-spacing="0" role="list">
<div id="ref-Hayashi2015" class="csl-entry" role="listitem">
Hayashi, Meiso, Wataru Shimizu, and Christine M. Albert. 2015. <span>“The <span>Spectrum</span> of <span>Epidemiology Underlying Sudden Cardiac Death</span>.”</span> <em>Circulation Research</em> 116 (12): 1887–1906. <a href="https://doi.org/10.1161/CIRCRESAHA.116.304521">https://doi.org/10.1161/CIRCRESAHA.116.304521</a>.
</div>
<div id="ref-Lown1968" class="csl-entry" role="listitem">
Lown, Bernard, and Arthur Selzer. 1968. <span>“The Coronary Care Unit.”</span> <em>The American Journal of Cardiology</em> 22 (4): 597–602. <a href="https://doi.org/10.1016/0002-9149(68)90167-7">https://doi.org/10.1016/0002-9149(68)90167-7</a>.
</div>
<div id="ref-Lown1977" class="csl-entry" role="listitem">
Lown, Bernard, Richard L. Verrier, and Stephen H. Rabinowitz. 1977. <span>“Neural and Psychologic Mechanisms and the Problem of Sudden Cardiac Death.”</span> <em>The American Journal of Cardiology</em> 39 (6): 890–902. <a href="https://doi.org/10.1016/S0002-9149(77)80044-1">https://doi.org/10.1016/S0002-9149(77)80044-1</a>.
</div>
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clipboard.on('success', function(e) {
// button target
const button = e.trigger;
// don't keep focus
button.blur();
// flash "checked"
button.classList.add('code-copy-button-checked');
var currentTitle = button.getAttribute("title");
button.setAttribute("title", "Copied!");
let tooltip;
if (window.bootstrap) {
button.setAttribute("data-bs-toggle", "tooltip");
button.setAttribute("data-bs-placement", "left");
button.setAttribute("data-bs-title", "Copied!");
tooltip = new bootstrap.Tooltip(button,
{ trigger: "manual",
customClass: "code-copy-button-tooltip",
offset: [0, -8]});
tooltip.show();
}
setTimeout(function() {
if (tooltip) {
tooltip.hide();
button.removeAttribute("data-bs-title");
button.removeAttribute("data-bs-toggle");
button.removeAttribute("data-bs-placement");
}
button.setAttribute("title", currentTitle);
button.classList.remove('code-copy-button-checked');
}, 1000);
// clear code selection
e.clearSelection();
});
var localhostRegex = new RegExp(/^(?:http|https):\/\/localhost\:?[0-9]*\//);
var mailtoRegex = new RegExp(/^mailto:/);
var filterRegex = new RegExp('/' + window.location.host + '/');
var isInternal = (href) => {
return filterRegex.test(href) || localhostRegex.test(href) || mailtoRegex.test(href);
}
// Inspect non-navigation links and adorn them if external
var links = window.document.querySelectorAll('a[href]:not(.nav-link):not(.navbar-brand):not(.toc-action):not(.sidebar-link):not(.sidebar-item-toggle):not(.pagination-link):not(.no-external):not([aria-hidden]):not(.dropdown-item):not(.quarto-navigation-tool)');
for (var i=0; i<links.length; i++) {
const link = links[i];
if (!isInternal(link.href)) {
// undo the damage that might have been done by quarto-nav.js in the case of
// links that we want to consider external
if (link.dataset.originalHref !== undefined) {
link.href = link.dataset.originalHref;
}
}
}
function tippyHover(el, contentFn, onTriggerFn, onUntriggerFn) {
const config = {
allowHTML: true,
maxWidth: 500,
delay: 100,
arrow: false,
appendTo: function(el) {
return el.parentElement;
},
interactive: true,
interactiveBorder: 10,
theme: 'quarto',
placement: 'bottom-start',
};
if (contentFn) {
config.content = contentFn;
}
if (onTriggerFn) {
config.onTrigger = onTriggerFn;
}
if (onUntriggerFn) {
config.onUntrigger = onUntriggerFn;
}
window.tippy(el, config);
}
const noterefs = window.document.querySelectorAll('a[role="doc-noteref"]');
for (var i=0; i<noterefs.length; i++) {
const ref = noterefs[i];
tippyHover(ref, function() {
// use id or data attribute instead here
let href = ref.getAttribute('data-footnote-href') || ref.getAttribute('href');
try { href = new URL(href).hash; } catch {}
const id = href.replace(/^#\/?/, "");
const note = window.document.getElementById(id);
if (note) {
return note.innerHTML;
} else {
return "";
}
});
}
const xrefs = window.document.querySelectorAll('a.quarto-xref');
const processXRef = (id, note) => {
// Strip column container classes
const stripColumnClz = (el) => {
el.classList.remove("page-full", "page-columns");
if (el.children) {
for (const child of el.children) {
stripColumnClz(child);
}
}
}
stripColumnClz(note)
if (id === null || id.startsWith('sec-')) {
// Special case sections, only their first couple elements
const container = document.createElement("div");
if (note.children && note.children.length > 2) {
container.appendChild(note.children[0].cloneNode(true));
for (let i = 1; i < note.children.length; i++) {
const child = note.children[i];
if (child.tagName === "P" && child.innerText === "") {
continue;
} else {
container.appendChild(child.cloneNode(true));
break;
}
}
if (window.Quarto?.typesetMath) {
window.Quarto.typesetMath(container);
}
return container.innerHTML
} else {
if (window.Quarto?.typesetMath) {
window.Quarto.typesetMath(note);
}
return note.innerHTML;
}
} else {
// Remove any anchor links if they are present
const anchorLink = note.querySelector('a.anchorjs-link');
if (anchorLink) {
anchorLink.remove();
}
if (window.Quarto?.typesetMath) {
window.Quarto.typesetMath(note);
}
// TODO in 1.5, we should make sure this works without a callout special case
if (note.classList.contains("callout")) {
return note.outerHTML;
} else {
return note.innerHTML;
}
}
}
for (var i=0; i<xrefs.length; i++) {
const xref = xrefs[i];
tippyHover(xref, undefined, function(instance) {
instance.disable();
let url = xref.getAttribute('href');
let hash = undefined;
if (url.startsWith('#')) {
hash = url;
} else {
try { hash = new URL(url).hash; } catch {}
}
if (hash) {
const id = hash.replace(/^#\/?/, "");
const note = window.document.getElementById(id);
if (note !== null) {
try {
const html = processXRef(id, note.cloneNode(true));
instance.setContent(html);
} finally {
instance.enable();
instance.show();
}
} else {
// See if we can fetch this
fetch(url.split('#')[0])
.then(res => res.text())
.then(html => {
const parser = new DOMParser();
const htmlDoc = parser.parseFromString(html, "text/html");
const note = htmlDoc.getElementById(id);
if (note !== null) {
const html = processXRef(id, note);
instance.setContent(html);
}
}).finally(() => {
instance.enable();
instance.show();
});
}
} else {
// See if we can fetch a full url (with no hash to target)
// This is a special case and we should probably do some content thinning / targeting
fetch(url)
.then(res => res.text())
.then(html => {
const parser = new DOMParser();
const htmlDoc = parser.parseFromString(html, "text/html");
const note = htmlDoc.querySelector('main.content');
if (note !== null) {
// This should only happen for chapter cross references
// (since there is no id in the URL)
// remove the first header
if (note.children.length > 0 && note.children[0].tagName === "HEADER") {
note.children[0].remove();
}
const html = processXRef(null, note);
instance.setContent(html);
}
}).finally(() => {
instance.enable();
instance.show();
});
}
}, function(instance) {
});
}
let selectedAnnoteEl;
const selectorForAnnotation = ( cell, annotation) => {
let cellAttr = 'data-code-cell="' + cell + '"';
let lineAttr = 'data-code-annotation="' + annotation + '"';
const selector = 'span[' + cellAttr + '][' + lineAttr + ']';
return selector;
}
const selectCodeLines = (annoteEl) => {
const doc = window.document;
const targetCell = annoteEl.getAttribute("data-target-cell");
const targetAnnotation = annoteEl.getAttribute("data-target-annotation");
const annoteSpan = window.document.querySelector(selectorForAnnotation(targetCell, targetAnnotation));
const lines = annoteSpan.getAttribute("data-code-lines").split(",");
const lineIds = lines.map((line) => {
return targetCell + "-" + line;
})
let top = null;
let height = null;
let parent = null;
if (lineIds.length > 0) {
//compute the position of the single el (top and bottom and make a div)
const el = window.document.getElementById(lineIds[0]);
top = el.offsetTop;
height = el.offsetHeight;
parent = el.parentElement.parentElement;
if (lineIds.length > 1) {
const lastEl = window.document.getElementById(lineIds[lineIds.length - 1]);
const bottom = lastEl.offsetTop + lastEl.offsetHeight;
height = bottom - top;
}
if (top !== null && height !== null && parent !== null) {
// cook up a div (if necessary) and position it
let div = window.document.getElementById("code-annotation-line-highlight");
if (div === null) {
div = window.document.createElement("div");
div.setAttribute("id", "code-annotation-line-highlight");
div.style.position = 'absolute';
parent.appendChild(div);
}
div.style.top = top - 2 + "px";
div.style.height = height + 4 + "px";
div.style.left = 0;
let gutterDiv = window.document.getElementById("code-annotation-line-highlight-gutter");
if (gutterDiv === null) {
gutterDiv = window.document.createElement("div");
gutterDiv.setAttribute("id", "code-annotation-line-highlight-gutter");
gutterDiv.style.position = 'absolute';
const codeCell = window.document.getElementById(targetCell);
const gutter = codeCell.querySelector('.code-annotation-gutter');
gutter.appendChild(gutterDiv);
}
gutterDiv.style.top = top - 2 + "px";
gutterDiv.style.height = height + 4 + "px";
}
selectedAnnoteEl = annoteEl;
}
};
const unselectCodeLines = () => {
const elementsIds = ["code-annotation-line-highlight", "code-annotation-line-highlight-gutter"];
elementsIds.forEach((elId) => {
const div = window.document.getElementById(elId);
if (div) {
div.remove();
}
});
selectedAnnoteEl = undefined;
};
// Handle positioning of the toggle
window.addEventListener(
"resize",
throttle(() => {
elRect = undefined;
if (selectedAnnoteEl) {
selectCodeLines(selectedAnnoteEl);
}
}, 10)
);
function throttle(fn, ms) {
let throttle = false;
let timer;
return (...args) => {
if(!throttle) { // first call gets through
fn.apply(this, args);
throttle = true;
} else { // all the others get throttled
if(timer) clearTimeout(timer); // cancel #2
timer = setTimeout(() => {
fn.apply(this, args);
timer = throttle = false;
}, ms);
}
};
}
// Attach click handler to the DT
const annoteDls = window.document.querySelectorAll('dt[data-target-cell]');
for (const annoteDlNode of annoteDls) {
annoteDlNode.addEventListener('click', (event) => {
const clickedEl = event.target;
if (clickedEl !== selectedAnnoteEl) {
unselectCodeLines();
const activeEl = window.document.querySelector('dt[data-target-cell].code-annotation-active');
if (activeEl) {
activeEl.classList.remove('code-annotation-active');
}
selectCodeLines(clickedEl);
clickedEl.classList.add('code-annotation-active');
} else {
// Unselect the line
unselectCodeLines();
clickedEl.classList.remove('code-annotation-active');
}
});
}
const findCites = (el) => {
const parentEl = el.parentElement;
if (parentEl) {
const cites = parentEl.dataset.cites;
if (cites) {
return {
el,
cites: cites.split(' ')
};
} else {
return findCites(el.parentElement)
}
} else {
return undefined;
}
};
var bibliorefs = window.document.querySelectorAll('a[role="doc-biblioref"]');
for (var i=0; i<bibliorefs.length; i++) {
const ref = bibliorefs[i];
const citeInfo = findCites(ref);
if (citeInfo) {
tippyHover(citeInfo.el, function() {
var popup = window.document.createElement('div');
citeInfo.cites.forEach(function(cite) {
var citeDiv = window.document.createElement('div');
citeDiv.classList.add('hanging-indent');
citeDiv.classList.add('csl-entry');
var biblioDiv = window.document.getElementById('ref-' + cite);
if (biblioDiv) {
citeDiv.innerHTML = biblioDiv.innerHTML;
}
popup.appendChild(citeDiv);
});
return popup.innerHTML;
});
}
}
});
</script>
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