Our academic heritage from CR Conti—A lifetime committed to education and excellence

When Dr. Wenger asked me to write about the professional contributions made by CRC, on reflection I realized that this need not be about his CV, but more about the fascinating life that he enjoyed building our program at the University of Florida (UF) as an internationally prominent cardiologist and educator and the exhilaration of practicing with others with whom he was privileged to be involved. I thought, perhaps I could shed some light on the standards of excellence involved in being a cardiovascular disease (CVD) expert and how CRC emulated them. At the time of his unexpected death, “Dick” was Emeritus Professor in Cardiovascular Medicine and an academician working at the UF in Gainesville. He had been involved during his working life evaluating and treating patients with known or suspect CVD and searching for evidence that one treatment is superior or at least not inferior to other approaches. I trust that this piece will be interesting for many people, not only for other cardiologists. I have tried to portray key aspects of his professional life as a cardiologist in this article, starting from his career at UF in 1974, to after his retirement in 2014, to his death in 2022. I explain in a sequential way how his life as a cardiologist developed in a specific direction in to an internationally recognized academic cardiologist.


| CORONARY VASOMOTOR DISORDERS
Related to his close relationship with the Italian academic cardiologist Attilio Maseri, Dick was keenly interested in coronary artery spasm (CAS). He encouraged us to intensely study CAS as a key mechanism for ischemia, with or without obstructive atherosclerotic CAD. 7 He encouraged us to follow such patients for their clinical outcomes. At one time, we had a registry that regularly followed over 500 patients with angiographically confirmed CAS. This included a series of studies in which we documented that spontaneous CAS and CAS provoked by intravenous ergonovine demonstrated by coronary angiography had essentially the same clinical and angiographic characteristics. 8 We also used intracoronary ergonovine in an attempt to minimize its systemic vascular effects which elevated myocardial oxygen demands and confounded the actual cause of ischemia among patients with co-existing obstructive CAD. Ergonovine was assessed in patients with mitral valve prolapse. 9 We also studied the coronary artery responses to inhalation of cold air in the angiographic lab. 10 We intensely investigated coronary angiographic responses to various medications. Nitroglycerin was studied intensively. 11 These results led us to argue against the "routine use of nitroglycerin prior to coronary angiography" since its use would remove the possibility of documenting spontaneous CAS. 8,[11][12][13][14][15][16][17] We studied most of the medications used for coronary spasm, often before they were approved for that indication. 18 This work helped to refine the understanding of these characteristics when observed in our patients. [23][24][25][26] We also examined the effects of various valvular lesions on the functional significance of coronary artery narrowings. 27

| CARDIOVASCULAR PHYSIOLOGY
When Dick moved to Florida, he also brought with him an R01 (HL 15576-01 CVB, "Velocity of Aortic Blood Flow In Myocardial Ischemia"), and a cardiovascular physiologist, Wilmer Nichols, PhD.
That program, Dr Nichols, and collaborations with Huntly Millar brought novel catheters with miniature micromanometers that provided high-fidelity aortic and LV pressure and ascending aortic blood flow velocity, as well as pulmonary artery pressure and blood flow velocity. 28 This work led to a series of publications about instantaneous force-velocity-length relations in the intact human heart and aortic input impedance as LV load. [28][29][30][31][32][33][34] His R01 provided the resources to study aortic and pulmonary blood flow in intact patients: Our ability to perform aortic and pulmonary artery blood flow velocity measurements led to a series of studies in patents with myocardial ischemia and other disorders. We evaluated aortic input impendence in heart failure [30][31][32][33][34] and also investigated pulmonary artery blood flow. 35

| CORONARY ANGIOPLASTY
As a former cardiac cath lab director at Johns Hopkins Hospital, he very interested in everything that we did in the lab and did cardiac catheterizations until the early 2000s. Dick was very interested in percutaneous coronary angioplasty after hearing Andreas Gruentzig present his animal studies and first patient. When I, as the UF cardiac cath lab director, traveled to Zurich to attend the mandatory demonstration course required by the catheter manufacturer, Dick accompanied me. He was fascinated that we could now work within the coronary arteries. This interest also led him to support George Abela, one of our prior fellows, to pioneer the study of Laser Angioplasty in occluded human atherosclerotic arteries and several animal models. [36][37][38][39][40][41][42][43] We also used novel sensors 28,44,45 and were among the early investigators to study the use of intracardiac echocardiography. 46

| MENTORSHIP
Since starting at the UF in 1974, I estimate that CR Conti mentored more than 150 fellows in training and junior faculty. Many of these served as, or continue to serve, the Division's faculty. As a past president of the ACC, he continued his teaching and mentoring through clinical practice.
His audio journal ACCEL features interviews with researchers on various cardiology topics. He has also served as chairman of the American College of Cardiology Extramural Program Committee. As chairman of the Self-Study Educational Programs Committee, he led the development of the initial ACC Self-Assessment Program.
With his down-to-earth nature and no-nonsense attitude, Dick was committed to excellence in patient care and education. During

| IN CLOSING
Dick Conti was incredible in his persistence for excellence in patient care and education, and these traits were also reflected in all other aspects of his work. He passed this trait on to those who worked with him.
Simply put, he made us all better cardiologists and better people.
The national and international cardiology community lost an important part of their history with Dick's passing.