Research News

Cleveland Clinic Lerner College of Medicine student Michelle Fang set out to develop an artificial intelligence‑based tool to identify patients with cancer that would benefit from cardioprotective care. She didn’t expect to like her first-year research project so much that she would continue past the summer. She also didn’t expect to become a co‑first author on a Journal of the American Heart Association paper before she even started her second year. 

Fang first joined the project during a structured research period early in her CCLCM training. CCLCM students are encouraged to engage with scientific discovery from the start of medical school. Fang’s background in computer science made her a natural fit for a cardio‑oncology machine‑learning team led by Feixiong Cheng, PhD, director of the Cleveland Clinic Genome Center.  

Despite modern advances, most chemo and radiation therapies still cause collateral damage to healthy cells. That’s why the side effects can be so severe. Most of the time, these side effects don’t affect the heart. Sometimes, cancer survivors face serious issues during or after treatment. Doctors have to weigh the benefits of chemotherapy against these risks and take cardioprotective measures as needed. 

“Cancer survivors deserve treatment plans that protect their hearts as well as their health,” says cardio‑oncologist Patrick Collier, MD, PhD, part of the research team. “Tools like this help us understand who is truly at risk, and are essential to giving patients the safest care possible.” 

Fang’s project is part of a larger, cross‑institutional network of cardio‑oncology experts. These experts’ work, including ongoing projects from collaborators in Cleveland Clinic Florida, helped lay the foundation for the greater team.  

“Our cardio‑oncology research succeeds when we combine all of our expertise,” Dr. Cheng says. “Michelle worked on a team of biologists, computational scientists and clinicians. She also worked closely with her co‑first author, Sherry‑Ann Brown, MD, PhD. That teamwork, across specialties and institutions, is what drives the cardio‑oncology and cardioprotection fields forward.” 

What is cardioprotection? 

Cardioprotection is an umbrella term that describes all treatment strategies aimed at reducing someone’s risk of heart attack, stroke, heart disease or death related to heart damage. There are many forms of cardioprotection including: 

• General cardioprotection: Lifestyle steps that help everyone, such as exercise. Cardio‑oncologists may recommend these especially for cancer survivors with excess weight.
• Medication-based cardioprotection: Drugs like statins to lower overall cardiovascular risk. Cardio-oncologists may prescribe drugs to cancer survivors whose cholesterol or blood pressure is high.
• Indirect cardioprotection: Adjusting cancer treatment plans, for example choosing a less aggressive therapy for a less aggressive cancer, to lower the risk of heart damage. 

Every cancer patient needs their own unique combination of these three cardioprotective treatments, tailored to the patient’s individual risk factors. Deciding the most appropriate combination of treatment options is a complicated, time-consuming process for each patient. That’s where the team’s prediction tool can help. 

What does the cardioprotection AI model predict? 

Fang and Dr. Brown's model flags cancer patients most at-risk for heart problems and helps physicians determine the best course of action. They worked hard to build a tool that was easy for clinicians to understand, so it could be used in the real world.  

“This project has reinforced my desire to integrate research into my future clinical career,” Fang says. “There’s an abundance of clinical data with the potential to help patients, but only if we can analyze it and make it interpretable.”  

Even after Fang left the lab to return to her medical studies, the team will continue refining the AI model. The project was supported by a Cleveland Clinic Catalyst Grant, and is now being expanded into a large-scale project with external funding. 

“What Michelle accomplished as a medical student is truly remarkable. Her work helped move this project forward and may one day help improve care for cancer survivors worldwide,” Dr. Cheng says.