(Circulation. 1998;97:715.)
© 1998 American Heart Association, Inc.
Richard Gorlin, MD
The Passing of a Legend and a Mentor
Valentin Fuster, MD, PhD, New York, NY
Dr Richard
Gorlin, one of the preeminent cardiologists of the
latter half of the 20th century, died on October 16, 1997, at age 71
years, of pancreatic cancer. Until the last days of his illness, Dr
Gorlin continued to work as a physician, to serve as Medical Director
of the Mount Sinai Health System, and to inspire those around him.
Dr Gorlin's contributions to
cardiovascular medicine are legendary and have
immensely influenced the clinical care of patients with
valvular heart disease, coronary artery disease, and
congestive heart failure. He earned an international reputation when,
in collaboration with his father, a mechanical engineer who designed
hydraulic systems for gasoline engines at the beginning of the century,
he developed a formula to calculate the area of stenotic
cardiac valves and congenital heart chamber defects. The "Gorlin
formula," still considered the "gold standard" for diagnosis of
critical heart valve obstruction, was crucial to the evolution of
cardiac surgery because it allowed proper case selection and
contributed greatly to the design of artificial valves.
Dr Gorlin conducted pioneering studies of coronary
blood flow and myocardial metabolism in ischemic
and hypertrophic heart disease and demonstrated that some areas of the
myocardium that appear mechanically quiescent can, when
stimulated, exhibit contractile activity. This observation foreshadowed
by a decade the concept of "hibernating myocardium." Dr
Gorlin was among the first to describe what is now widely recognized as
"microvascular angina" in a group of patients without
coronary obstruction. He also described "myocardial
asynergy" related to coronary artery disease, defined as
localized areas of reduced myocardial contraction. Carrying this
observation a step further, he showed that myocardial contraction and
ejection fraction are related and importantly determine the prognosis
of patients with advanced heart disease. He was also the first to
define the idiopathic high-cardiac-output state known as
"hyperkinetic heart syndrome," and more recently, he played a
dominant role in the largest trial to evaluate digitalis in patients
with chronic congestive heart failure (the DIG Study).
As a teacher, Dr Gorlin inspired and guided a legion
of prominent cardiologists. He was highly respected by medical students
and residents for bringing sensibility and sensitivity to clinical
teaching. His principles and personal attributes have been carried
forth into fellowship training programs throughout the world, where
they have had powerful influence on the careers of a generation of
cardiologists. Specifically, when Dr Gorlin was at Harvard Medical
School and Peter Bent Brigham Hospital between 1956 and 1974, his
laboratory trained more than 90 fellows. The majority went on to become
heads of cardiology divisions across the nation and
abroad; several became heads of departments of medicine, and still
others became leaders in cardiology in their
communities.
On the surface, Dr Gorlin displayed a tough
personality, generating respect by his very presence. Indeed, one of
his pupils, now head of cardiology of a major
university, remarked, "Whenever I see Dr Gorlin, I shake." Those
who worked more closely with him, however, realized that beneath this
strong exterior was a shy and sensitive man who was always ready to
advise or help. This was, no doubt, the key to his success as an
educator and as a physician caring for patients. Perhaps the most
fitting summary of Richard Gorlin's character came from his own
mother, who described him as "a clear thinker with a creative mind,
anxious to help and to be part of what is going on. ... A marvelous
son."
For myself, I will forever be grateful to Dr Gorlin for his
wisdom and guidance over many years. He recruited me to the position of
Chief of Cardiology at The Mount Sinai Medical Center,
where he served 18 years as Chairman of the Department of Medicine and
contributed enormously to the strengthening of our faculty and medical
school. He was the mentor who gave me the best opportunity of my life
and the support to develop an academic career. Just 2 weeks before his
death, I had the enormous privilege and gratification of receiving a
most distinguished honor: installation in the professorial chair in
cardiology that bears his name. I will try, to the best
of my abilities, to hold high the torch of excellence as a mentor that
symbolizes Dr Richard Gorlin.
