Student Research Year Highlights: Bowen and DeAngelo

The Cleveland Clinic Lerner of College of Medicine of Case Western Reserve University (CCLCM) is a five-year program dedicated to developing the next generation of physician investigators. During their first year, students are assigned dedicated physician and research advisors to help ensure they reach their educational goals. In their fourth year, students work with a mentor to develop a master’s-level thesis in basic science, translational medicine, clinical medicine or health systems. When the students graduate, they each receive an MD with Special Qualification in Biomedical Research from Case Western Reserve University.

The research in which students are involved is critical, timely and often results in presentations at national conferences and publication in scholarly journals. The examples below briefly describe two students’ research projects, one that involves how patient characteristics and other factors affect access to liver transplantation in patients with acute-on-chronic liver failure, and another that involves sex differences in aortic regurgitation:

“For my research year, I investigated how sociodemographic factors influence access to liver transplantation in patients with acute-on-chronic liver failure (ACLF), a distinct manifestation of severe liver disease associated with multiple organ failures and markedly high short-term mortality, for which liver transplant remains the only curative treatment. I completed this work in the Cleveland Clinic's Department of Gastroenterology, Hepatology, and Nutrition under the mentorship of Christina Lindenmeyer, MD.

“The study included over 400 patients admitted to the Cleveland Clinic's Medical Intensive Liver Unit (MILU), a liver-specific ICU, with ACLF. Using deidentified patient data, we examined how patient characteristics and access-related factors impacted the likelihood of undergoing liver transplant evaluation, waitlisting and receipt. We found that private insurance was the most consistent predictor of access across all stages of the transplant process.

“We also identified gaps in healthcare access, with non-white patients significantly less likely to already be in transplant evaluation upon MILU admission. However, there were no significant differences in evaluation or transplant rates by race or sex once patients were admitted to the MILU, suggesting that structured, multidisciplinary transplant pathways within liver ICUs may help mitigate barriers to care.

“These findings highlight the need for more timely and consistent referral practices as well as expanded access to specialized care settings like the MILU to ensure equal access to transplantation.”

-Kelly Bowen (’26)

“For my thesis research, I worked with Deborah Kwon, MD, Director of Cardiac MRI and staff cardiologist in the Heart, Vascular & Thoracic Institute at Cleveland Clinic. This work was supported by the Society for Cardiovascular Magnetic Resonance (SCMR) Outcomes Grant and conducted in close collaboration with Christopher Nguyen, MD, Director of the Cardiovascular Innovation Research Center (CIRC) at Cleveland Clinic.

“Our project focused on sex differences in aortic regurgitation, a common form of valvular heart disease in which the aortic valve does not close properly and allows blood to leak backward into the heart. Although current national treatment guidelines are sex agnostic, emerging evidence suggests important differences in clinical outcomes and left ventricular remodeling between males and females. For the first aim of the thesis, we conducted a multicenter retrospective study across five U.S. institutions of patients with chronic aortic regurgitation who underwent cardiac MRI. We found that females presented with smaller heart size and lower regurgitant severity, yet experienced greater symptom burden and worse clinical outcomes, and they were referred for surgery less often than males. For the second aim of the thesis, we recruited 40 patients with chronic aortic regurgitation into a prospective study. Patients underwent cardiac MRI with novel imaging sequences to better characterize left ventricular structure and function. Through this work, I gained experience in study design, statistical analysis, grant writing and prospective clinical research recruitment.

“Our findings highlight the need for further research into sex differences in aortic regurgitation to inform more individualized risk assessment and treatment guidelines.”

-Lydia DeAngelo (’26)