Mandeep Singh, M.D.

The purpose of this study is to calculate biological age among 600 patients undergoing TAVI (≥65 years) over 2 years, through deficits estimation (presence or alterations in functional, psychosocial, and traditional cardiovascular deficits). Biological aging will be defined as deficit index (deficits present/deficits measured) and would be counted by simply adding them. We will then build and internally validate a composite predictor of biological aging that is simple, practical, and inexpensive.

The purpose of this study is to evaluate the contribution of clinical deficits, functional impairment, epigenetic biomarkers, and proteomic profiles to the estimation of biological age in patients undergoing PCI.

The purpose of this study is to identify correlates of healthcare-seeking behavior in patients with ACS and CHF and its association with psychosocial and health outcomes.

The purpose of this study is to test whether chronic metformin administration will improve longevity of the cell, improve its machinery by reducing aging-related biochemical parameters, and improve physical performance as measured by short physical performance battery test.

The primary aims of this study are to test the hypothesis that clopidogrel monotherapy is safe following successful PCI among 100 consecutive patients with HBR and meeting the inclusion criteria, and to determine the incidence of BARC 3 or 5 bleeding events among participants enrolled in Aims 1 and 2.

The purpose of this study is to address the unmet need of an effective pharmacologic intervention in patients with Heart Failure with Preserved Ejection Fraction (HFpEF) and leverage the favorable cellular underpinnings of rapamycin to improve multiorgan reserve capacity and physical function with reduction in inflammation and cellular senescence (biological aging).

The purpose of this study is to evaluate whether simple cardiac exercise interventions to improve physical performance before transcatheter aortic valve replacement (TAVR) surgery improves outcomes after TAVR.

The investigators will do the study in two phases. The first phase will be a pilot study on up to 18 participants [patients 60 years or older with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) or patients who are eligible to undergo and participate in cardiac rehabilitation (CR)]; up to 6 participants each will be given oral daily rapamycin (0.5, 1, and 2mg) dose for the duration of CR. Baseline and follow-up data will be collected for age-associated impairment (AAI): frailty (primary endpoint) and quality of life (QOL),senescent-associated secretory phenotype (SASP)and abdominal/thigh subcutaneous adipose biopsy for measurement of adipocyte mitochondrial DNA copy number and to quantitate the number of senescent preadipocytes. Safety of rapamycin will be assessed by periodic clinical follow-up, blood draws, and serum rapamycin levels. Following completion of the pilot phase, the data will be analyzed. If favorable changes are noted in the SASP or AAI, the investigators will start a phase 2 randomized trial.

Second phase: In a prospective, randomized, clinical trial design, patients 60 years or older will be randomized at the time of CR to a standardized exercise protocol, or exercise protocol with the addition of low-dose rapamycin to test the hypothesis whether low-dose rapamycin (demonstrated in the pilot trial to improve SASP/AAI) will improve measures of AAI, SASP, or findings on the fat biopsy as compared to exercise alone. The null hypotheses are that there is no improvement with rapamycin in measures of AAI or SASP.

We will identify the prevalence of hemodynamic abnormalities following percutaneous coronary interventions (PCI). Second, among patients with hemodynamic problems, we will be able to identify problems for which action needs to be taken. Third, pursuant to the results of our study, we can identify the clinical utility of such monitoring and will be able to target such monitoring to at-risk patients and will likely obviate the need for routine monitoring, propose cost-effectiveness measures, and propose same day discharge on low-risk patients.

The purpose of this study is to assess whether a daily, 15-minute stretching routine for one year reduces musculoskeletal pain and improves quality of life in personnel working in the radiology and cardiology departments ata Mayo Clinics and Mayo Clinic Health System sites.