¾ÅÉ«ÊÓƵ

During his first few years on faculty at Duke University Medical Center, Dr. Manesh Patel noticed something odd.

When he performed a cardiac catheterization on patients with chest pain whose stress test indicated a blocked artery, about half didn’t have one.

So, he wondered, how common was this – not just at his hospital, but across the United States?

Tapping into a decade of national data, Patel found about 500,000 people who’d never had a heart attack but had chest pain and a stress test indicating a likely blocked artery. It turned out that 60% ended up not having a blockage.

Patel suspected he’d revealed a flaw in treating this common situation. Although he’d never published a research paper in the New England Journal of Medicine, he submitted one with the understanding it was a long shot.

“A week later, the editor calls and asks, ‘Hey, can you verify these numbers?’” Patel said. “So, we verify them. And it gets published.”

That led Patel and a mentor, Pam Douglas, to launch a five-year randomized trial comparing thousands of routine stress tests to CT scans. The imaging proved as effective or better than the stress tests, eventually changing the way medicine is practiced. Now, heart CT scans are often the first test for chest pain.

This anecdote captures Patel’s hallmarks.

Start with his insatiable curiosity. Many doctors share this trait, but few have excelled in as many complex areas of cardiology as Patel.

Add his relentless drive. Plenty of standouts share that, too, yet Patel consistently uses it to stretch what he’s capable of doing.

What sets him apart is how he combines those traits, channeling his eagerness and energy to ask challenging questions, working with teams to pursue answers then pushing to deliver them to patients.

In recent years, Patel has been devoted to that last piece – shrinking the delay in getting proven solutions to the people who need them most. It’s called “science’s last-mile problem,” and he believes artificial intelligence can help close the gap.

Starting July 1, he’ll have a bigger platform to address it.

Patel is becoming president of the ¾ÅÉ«ÊÓƵ, taking on the organization’s top role for a science volunteer. He’ll be the first South Asian president in the Association’s 102-year history.

“We always aim to meet the moment, and Manesh is the perfect person to lead our science at this pivotal time when AI is expanding what’s possible while also carrying challenges,” Association CEO Nancy Brown said. “Having witnessed the critical, creative thinking he’s brought to so many roles in our organization, I’m eager to see what the future holds.”

***

The direction that changed everything

As an intern in the Duke coronary care unit in 1997, Patel hung on every word from his clinician mentors.

The faculty included many esteemed doctors on their way to even grander roles, such as Dr. Robert Califf, the founding director of the Duke Clinical Research Institute. He would later serve two stints as commissioner of the U.S. Food and Drug Administration.

“Every time you present to me, I want you to tell me what you’re doing and what the evidence behind it is,” Califf told Patel.

This guidance and drive for evidence-based medicine became a foundational part of Patel’s career.

He clung to it as he scratched all his cognitive itches – becoming a clinician, researcher, interventionalist and even a cardiac MRI reader.

He’s used it over the last several years as chief of cardiology and vice president of Duke’s Heart and Vascular service line and in many roles with the Association.

He even seems to have channeled that simple, direct power for this line he wrote for the Association’s 2028 Impact Goal: “The greatest discoveries in health must reach people where they are.”

But to best understand Patel’s career, it helps to understand everything that led up to it.

To do so, the scene shifts from the Duke campus to the west coast of India, in the state of Gujarat, and the neighboring farming villages that were home for both sides of his family.

That is, until the tale jumps to Kampala, the capital city of Uganda.

***

From Gujarat to Tybee Island

Manesh’s maternal grandfather, his “Bapuji,” was a school principal. India was under British rule at the time, as was Uganda. A job transfer sent the family from Gujarat to Kampala.

A decade later, while still in Kampala, Bapuji arranged for Indu, his oldest daughter of seven children, to marry a man from back home, Raman Patel. Raman moved to Kampala and became a storekeeper, running various businesses with Indu.

In January 1971, the couple already had a 6-year-old son and Indu was pregnant with Manesh when Idi Amin led a bloody coup in Uganda. In August 1972, Manesh was still in diapers when Amin gave all South Asians 90 days to evacuate the country.

“Although it was a crisis, in some ways it became a blessing to our family,” Manesh said.

One of Indu’s brothers sponsored the family’s migration to Toronto. Indu went to a trade school then did accounting for a company that made staples. Raman did anything and everything. The family still laughs about the unimposing 5-foot-7, 130-pound Raman’s gig as a night security guard.

Friends lured Raman to spend a summer working at a hotel in Statesboro, Georgia, a town of 15,000 best known as home to Georgia Southern University. He returned to Toronto with news that he’d made a down payment on a motel in Statesboro.

This was the early 1980s. The Patels were the only Indian family in Statesboro and perhaps the only household that didn’t eat meat. Indu and Raman made it work. While she cared for the boys and helped at the motel, he joined the Kiwanis Club and did enough schmoozing to make their place the default for sports teams and other GSU visitors.

“My dad is a jokester and a crazy-good people person,” Manesh said. “You have to, to be able to make friends and live socially and to understand and overcome whatever biases they faced.”

Raman did so well that he sold the 30-room, single-floor motel and bought a 60-room, two-story hotel on the beach of Tybee Island, Georgia, which is close enough to Savannah that the family settled there.

By then, Manesh was in high school – old enough for real jobs, not just chores like loading the vending machine. Now that he was dealing with customers and employees, he watched more closely how his dad navigated situations.

For college, Manesh chose Vanderbilt in Nashville, Tennessee, because it was a great school and it was a full day’s drive from his parents, making drop-in visits unlikely. (He quickly discovered otherwise.)

His freshman-year grades were OK, but not enough to justify the private-school tuition. He spent the ensuing summer working at the hotel. The job became a daily reminder of the life that awaited him if he didn’t get serious about his education.

“Just to be very clear, in 1989 and 1990, my parents cut me slack that I don't know I would give my kids,” Manesh said. “Part of why I'm so grateful for my career is that I don't think I’ll ever work as hard as they did.”

As a sophomore, Manesh took classes in molecular biology and human physiology. Both forced him to stretch his mind in new ways.

These new ways of thinking – and the challenge and confidence of mastering complicated material at the speed of his peers – sparked something.

***

Learning how to learn

Manesh soon made another important discovery. The more ways he tackled material – reading, writing, discussing – the better he processed it.

His grades climbed. He advanced to Emory University School of Medicine in Atlanta, continuing to sponge up information.

“And then we hit the wards,” Manesh said, smiling. “That's when I really came to love medicine even more.”

A people person like his dad, Manesh savored getting to know every patient. He also became fascinated by the puzzle of turning a physical exam into a diagnosis and a treatment plan.

This spark led to another.

While touring Duke as a residency candidate, Manesh observed typical conversations about care and treatment plans for each patient.

Except in these conversations, residents cited evidence for everything. There was even talk of them generating evidence.

“I realized,” Manesh said, “I was only scratching the surface of what I could do.”

***

The Duke era, 1997-present

Manesh arrived in Durham, North Carolina, determined to be “the best intern he could be.” His metric was writing the most patient assessment plans. He did.

A fellowship at Duke followed. He paused it after one year to serve as chief resident. Upon resuming his fellowship, he began training in the cardiac catheterization lab, learning to perform diagnostic exams (peeking inside hearts).

Manesh was captivated. Improving became an obsession. He’d wake up at night thinking about it and get out of bed to practice, using a take-home manifold and visualizing where he would make every twist and turn.

“I had to learn how to manipulate the catheter,” he said. “There was something about the physicality of it.”

Even though he had no intention of becoming an interventionalist (the specialists who insert stents), Manesh challenged himself to get good enough to perform a “cath” without help from an attending physician – for an entire month. He also wanted to set the record for the most diagnostic caths.

He did.

“I’m just competitive,” he said, laughing.

Next came learning how to do cardiac MRIs.

Duke had just hired Raymond Kim, who discovered how to do cardiac MRIs using a contrast agent, a technique that helps diagnoses. Over the next month, Manesh did all the MRIs he could – not to set a record but because “I was enthralled by it, it was a new way to see the heart muscle.”

Manesh was so keen on it that when he started two years of working at the Duke Clinical Research Institute, he told his new mentor, Dr. Bob Harrington: “I’m going to do everything you want me to do. But I also want to go over there and do some MRIs too.”

Manesh found a way to combine the two. He hustled and recruited enough patients for scans that he wrote one of the early, key papers about cardiac sarcoidosis, clusters of inflammatory cells that can not only affect the lungs but can silently be in the heart muscle and lead to fatal heart rhythms.

Once it was time for Manesh to launch his career, Duke had a job for him as a clinician-researcher.

Instead, he chose to spend the next year becoming an interventionalist.

Several of Duke’s top leaders tried to talk him out of it. This included Harrington, who asked the obvious question: Why?

“There’s just something about being in the lab that I love,” Manesh said.

Harrington smiled and said, “OK, that’s all I needed to hear.”

A year later, a budget crunch left no openings at Duke.

While a disappointed Manesh pursued jobs elsewhere, his advocates at Duke cobbled together a job only he could pull off: working in the cath lab in Raleigh, doing some research at the institute and helping read cardiac MRIs. When the vascular clinician left for another job, Manesh did that, too, and ended up helping build Duke’s vascular practice.

By the 2010s, Manesh remained excited about all the ways he could help patients. He had started to conduct clinical trials and see the therapies that could benefit patients.

But as he looked around the emergency room, he saw the same problems he’d seen in medical school.

“Overall, the trajectory of human health hasn’t changed fast enough,” he said. “Changing behavior is the hardest part. To get something to happen, you must activate three things: the patient, the doctor and the system.”

Ah, yes – the system.

In Manesh’s pursuit of learning clinical research through collaborative teams and working to improve care, the system was one piece of the equation he had yet to take on.

That was more the domain of organizations like the ¾ÅÉ«ÊÓƵ.

***

Helping everyone, everywhere

Up to now, Manesh’s involvement with the Association had been typical of an up-and-coming scientist. Abstract presentations at Scientific Sessions; a junior faculty award; writing a scientific statement as part of a catheterization committee.

In 2011, his mentor Harrington became vice chair of the Committee for Scientific Sessions Programs, planners of the annual event. Manesh joined the committee for Harrington’s two years as vice chair and two years as chairman. When Harrington moved on, so did Manesh.

Five years later, Harrington was becoming president of the Association and Manesh was a few years into his tenure as Duke’s chief of cardiology. The timing was right for him to come back to the committee, working as vice chair to Donald Lloyd-Jones, another future Association president.

Soon, Manesh felt another spark.

Planning Scientific Sessions was only part of it. Committee leaders also attend high-level science meetings during gatherings of the Association’s national board. There, Manesh better understood the Association’s depth and breadth.

“You realize, this is a machine – a billion-dollar behemoth – that can have an enormous impact on people’s lives,” he said. “The Association may be the most powerful organization to support science and get people the health they need.”

After two years as the committee’s vice chair and two years as chair, Manesh joined the national board. He was asked to help write the 2028 Impact Goal. The assignment weighed on him. He kept thinking about its relevance for the organization’s 30,000 professional members and 35 million supporters globally.

His effort led to him being considered for president. He again pondered the implications. Was he ready? He consulted a patient who’d become a trusted friend and mentor.

Mike Krzyzewski.

Coach K, as he’s widely known, led Duke’s men’s basketball team to five national titles. He retired with the most wins in major-college history. He also guided Team USA to gold medals at the 2008, ’12 and ’16 Olympics.

When Manesh told Krzyzewski about possibly becoming Association president, the coach said: “This is your USA Basketball moment.”

“You’ve got to make the most of it,” Krzyzewski said.

***

Optimistic about AI’s potential – with human help

Association presidents come from all areas of science. During their year in charge, it’s understood they’ll spotlight their favorite domain.

Seeing as Manesh has so many interests, it could be a tough choice.

It’s not.

Manesh is among the many organization leaders who are bullish on AI’s potential to dramatically help with discovery, and improve and expand the delivery of proven cardiovascular care.

“We can close some gaps with the technology,” he said. “But it can't just be technology. Humans must be in the loop, too.”

For instance, he sees enormous potential for emerging tools that eliminate grunt work, allowing clinicians to spend more time with patients, making diagnoses and recommending treatments.

Over his career, Manesh has been in the right place at the right time. He became an interventionalist as that field was taking off. Ditto for cardiac MRIs. Now it’s happening again with AI – and, this time, he could be among those shaping the future.

“We have to get it right and it needs to be done with a trusted source,” he said. “I can't think of a source more trusted than the ¾ÅÉ«ÊÓƵ.”

***

Family life in North Carolina

Manesh was finishing his first year of residency at Duke when one of his fellow interns introduced him to a former crew teammate at Yale.

Sallie Johnson had since graduated from Johns Hopkins University School of Medicine and was doing her residency in family medicine at the University of North Carolina in nearby Chapel Hill.

They married during his fellowship. A son, Sanju, arrived during Manesh’s interventional fellowship year, and 18 months later, they had their daughter, Maya.

Sanju is headed into his senior year at the University of Chicago. He’s majoring in biology and economics. This past year, he earned Division III All-America honors as a cross-country runner. Maya is spending her summer in Spain, then going into her sophomore year at Emory. She’s interested in pre-law and social justice.

Sallie has been practicing at Piedmont Health in a Federally Qualified Community Health Center in Burlington, North Carolina, for more than 20 years – long enough that she’s cared for multiple generations within families. She’s also been a steady sounding board for Manesh and a supporter of his professional quests.

Fifteen years ago, Indu and Raman moved to Durham to help the kids when they were young. These days, Manesh and Sallie see them regularly as they help with the family Labradoodle, Bosco.

***

‘The craziness of life’

As Sanju and Maya were going through grade school and middle school, Manesh was busy building his career. Family and work left little time for anything else.

Among the things he neglected was his own health.

One day, Manesh was admiring how a heart attack patient he had stented and supported had transformed himself from a guy carrying excess weight to having a buff physique. The man described how he’d done it, then asked: “Doc, what are you going to do?”

Manesh already had a high-tech stationary bicycle but wasn’t using it much. This conversation was the spark he needed.

He lost over 50 pounds, nearly reaching his ideal weight. He’s maintained it by riding for at least a half-hour early every morning, even while traveling. If he doesn’t have access to a bike, he’ll use an elliptical or treadmill.

Manesh is on a streak of daily workouts that began March 30, 2025. He’s challenging himself to keep it going past his birthday in August and into Scientific Sessions in November.

Many would consider this the worst time to set such a goal. To Manesh, it’s the perfect time.

“It’s the craziness of life,” he said. “It's the joy of it.”