Faculty Spotlight: Jackie DesJardin, MD

The Best of All Worlds

“Cardiology is a great field, because you get to be the best part of every type of doctor,” said Jacqueline (Jackie) DesJardin, MD. “Like an internal medicine doctor, you get to use your diagnostic skills. Like a surgeon, you get to do procedures. Like a radiologist, you get to read echo and imaging studies. Like an ICU doctor, you get to do hands-on critical care. And like a primary care doctor, you get to see patients in clinic and manage chronic diseases. I love the diversity in cardiology, and getting to focus on the heart as a specialist while getting to do different types of medicine.”

The daughter of two chemists, Dr. DesJardin grew up in Sunnyvale, Calif., and developed a love of science. She earned her bachelor’s degree in neurobiology from Georgetown University, then came to UCSF, where she completed her medical degree, internal medicine residency, masters in advanced studies in clinical research, as well as fellowships in general cardiology and advanced heart failure and transplantation.

During residency, she cared for a number of patients with severe cardiovascular disease as a consequence of methamphetamine use. Many of these patients developed pulmonary hypertension, a condition characterized by high blood pressure in the lungs. “That got me really interested in how we could help this patient population,” said Dr. DesJardin. “I wanted to better understand how illicit substances can cause cardiovascular toxicity, and how we can treat both the addiction and the resulting toxicity to the heart.”

During her UCSF training years, one of her main mentors was Teresa De Marco, MD, R.H. and Jane G. Logan Endowed Chair in Cardiology, a renowned expert in both advanced heart failure and pulmonary hypertension. “Dr. De Marco helped me get involved in big pulmonary hypertension registries, sponsored me on committees, and gave me research opportunities in pulmonary hypertension,” said Dr. DesJardin. “She has been very impactful on my career trajectory, and in many ways I’ve followed in her footsteps by becoming an advanced heart failure cardiologist who sees pulmonary hypertension patients.”

“Dr. DesJardin is a force of nature,” said Dr. De Marco. “She is an outstanding clinician, talented educator, and a researcher par excellence. Most importantly she is a warm, empathetic physician who cares deeply for patients in her charge. She is a phenomenal asset to our division, department and institution.”

After completing her advanced heart failure and transplantation fellowship, Dr. DesJardin joined the UCSF Division of Cardiology faculty in 2024.

Just like cardiology brings together some of the best parts of medicine, Dr. DesJardin appreciates how advanced heart failure brings together the best parts of being a cardiologist. “I’m a subspecialist, but I also get to be a generalist in some ways,” she said. “We manage the whole patient, especially when caring for transplant patients, because they’re so complex. That involves not only cardiology, but a lot of internal medicine, infectious diseases, and managing them in the post-operative setting as well as their immunosuppression.”

She enjoys the team-based model in heart failure. “We work really closely with pharmacists, nurse practitioners, social workers and others,” said Dr. DesJardin. “We also have beautiful longitudinal relationships with our patients, because we see them before, during and after transplant, which can be challenging for patients to go through. We also see their recovery, and get to follow them for many years afterwards.”

Gleaning Insights from a Rare Disease

Dr. DesJardin also appreciates the vibrant research environment at UCSF. “UCSF is one of the biggest research institutions in the country, and there’s a lot of opportunity to partner with basic science labs and do translational studies in pulmonary hypertension,” she said.

As a third-year general cardiology fellow, she worked with Marc Simon, MD, MS, director of the UCSF Pulmonary Hypertension Comprehensive Care Center, to establish a pulmonary hypertension biobank. It includes blood samples from patients with pulmonary hypertension, as well as some tissue samples from patients who went on to receive lung transplants because of their condition.

She is now working with a basic science lab led by Akiko Hata, PhD, associate director of the UCSF Cardiovascular Research Institute (CVRI), to develop biomarkers that could help with earlier diagnosis of certain subtypes of pulmonary hypertension. “It’s been really exciting to partner with a basic science lab, even though that’s not my historical training,” said Dr. DesJardin. “I’ve learned so much from Akiko and her lab.”

Dr. Hata’s lab investigates pulmonary veno-occlusive disease (PVOD), a rare and severe form of pulmonary hypertension in which fewer than 30 percent of patients survive beyond five years. In healthy patients, the blood flows smoothly through the heart, lungs and the rest of the body – like a highway system with cars moving easily at the speed limit. However, heart failure or pulmonary hypertension can develop if there is the equivalent of a “traffic jam” – something that impedes the smooth flow of blood. The traffic jam can occur at many different points in the heart or lungs. Pinpointing the exact location, underlying cause, and resulting backup is key to diagnosing and effectively treating patients.

More than a dozen therapeutics have been approved by the U.S. Food and Drug Administration to treat pulmonary arterial hypertension, also known as Group 1 pulmonary hypertension. This occurs when the pulmonary arteries – which carry blood from the right side of the heart to the lungs to release carbon dioxide and pick up oxygen – become narrowed, thickened or stiff.

However, so far there are no medications to treat Group 2 pulmonary hypertension. While several issues can contribute to this problem – including problems with how the heart squeezes or relaxes, or with valves in the left side of the heart – another contributing factor may be something called pulmonary venous remodeling. This occurs when the pulmonary veins, which carry freshly oxygenated blood from the lungs back to the left side of the heart, undergo unhealthy changes.

PVOD causes an extreme form of pulmonary hypertension which results in pulmonary venous remodeling, although similar changes in the vasculature occur in patients with Group 2 pulmonary hypertension. “We’re using PVOD, which is rare, as a way of understanding how the pulmonary veins remodel under stress, such as in more common forms of heart failure,” said Dr. DesJardin. “It’s our hypothesis that in Group 2 pulmonary hypertension and heart failure, the same pathways are activated, and the same biomarkers can be detected when pulmonary venous remodeling is happening.”

Dr. Hata’s lab has already developed animal models of PVOD to better understand the underlying mechanisms of this disease. By partnering with Drs. DesJardin and Simon to study biospecimens from patients with pulmonary hypertension, they are hoping to identify biomarkers that could make it easier to diagnose pulmonary venous remodeling.

Advancing Towards Better Diagnostics and Therapies 

This is clinically important, because arteries and veins are physiologically different. “Arteries have a much more muscular layer, while veins have thinner intimal layers,” said Dr. DesJardin. “We know from animal studies that different pathways cause venous and arterial remodeling.” Unfortunately, giving patients with pulmonary venous remodeling therapeutics designed to address pulmonary arterial remodeling can actually worsen their condition. And currently, it is very difficult to distinguish between patients with pulmonary arterial hypertension and PVOD.  

“For patients with severe pulmonary hypertension, often we don’t suspect PVOD because it’s quite rare,” said Dr. DesJardin. “If we start them on pulmonary arterial vasodilators, there’s a pretty high risk that they will develop pulmonary edema and these therapies will cause more harm than good.” That occurs because it’s like opening the floodgates of the pulmonary arteries, allowing increased blood flow to the pulmonary veins, which are already constricted and become overwhelmed with the additional volume of blood they are expected to carry. That fluid then backs up into the lungs, making it difficult to breathe. Only at this point are most patients with PVOD diagnosed.

Dr. DesJardin is working with Dr. Hata’s lab to develop a diagnostic test using patient blood samples which could more easily identify not only PVOD, but potentially other forms of pulmonary hypertension that have venous involvement. Even more exciting, Dr. Hata’s lab is investigating possible therapeutic agents that could block the pathway responsible for this venous remodeling.

“Most of the pulmonary hypertension community thinks that PVOD is a rare subtype of pulmonary hypertension, but my hypothesis is that many patients operate on a spectrum,” said Dr. DesJardin. “Perhaps some patients have all arterial remodeling, while others have all venous remodeling, but most patients might have some of both.” By better understanding the underlying cause of a specific patient’s pulmonary hypertension, it would help physicians tailor treatment.

“Jackie, working alongside Marc Simon, established the pulmonary hypertension biobank at UCSF, which has provided our team with invaluable human samples and clinical data,” said Dr. Hata. “Through analysis of these samples, we successfully identified a promising blood biomarker that can accurately distinguish PVOD from pulmonary arterial hypertension – a breakthrough that could revolutionize diagnosis. Currently, Jackie is expanding this research by testing the biomarker’s effectiveness across different types of pulmonary hypertension patients. She is also developing her skills in basic research techniques within our laboratory, strengthening the translational bridge between clinical samples and fundamental disease mechanisms.”

New Insights in Research and Medical Education

Dr. DesJardin has also contributed to other areas of pulmonary hypertension research. For example, although about 70 percent of the people who develop pulmonary hypertension are women, every disease registry indicates that men have higher mortality rates when they do have pulmonary hypertension. “Even though women are at higher risk of this disease, we wonder why men seem to die more frequently of this condition,” said Dr. DesJardin. “It’s been called a ‘sex paradox.’ There are a lot of theories in the literature about the possible effect of estrogen or hormonal therapies.”

However, in a recently published paper, Dr. DesJardin suggested another explanation called “collider stratification bias.” The idea is that there are different causal pathways that can lead to development of pulmonary hypertension. For example, women are more likely to develop connective tissue diseases such as lupus, scleroderma and rheumatoid arthritis, which in turn can harm blood vessels and contribute to pulmonary hypertension.

“However, it’s possible that men who develop pulmonary hypertension do so as a result of higher-risk causal pathways, such as severe HIV or intense methamphetamine exposure, which themselves are independently associated with mortality,” said Dr. DesJardin. “Although this is a hypothesis I can’t prove, I did epidemiologic modeling in this study to show that this theory is reasonable.”

Dr. DesJardin also helped test an improved echocardiography-based screening algorithm that helps determine whether a patient is a suitable candidate for liver transplantation.

A passionate medical educator, Dr. DesJardin helped lead research investigating gender disparities in how internal medicine residents are trained in critical care procedures. “We found that when internal medicine residents were in the ICU, men did more procedures compared with women,” she said. “We conducted a lot of focus groups to try to understand why. We learned that if the attending says, ‘There’s a procedure that needs to be done – who wants to do it?’ you’ll get more male than female volunteers. A lot of that has to do with identity formation – the process by which someone says, ‘I could become a cardiologist or a proceduralist.’ That sort of unstructured teaching environment selects for people who have historically looked like cardiologists or proceduralists.” By contrast, they found that when attendings created structured teaching environments where all residents take turns doing a certain procedure instead of relying on volunteers, there were no gender disparities.

Piloting a New Model of Care 

In addition to her research, Dr. DesJardin performs right heart catheterizations and endomyocardial biopsies in the Cardiac Catheterization Lab, cares for hospitalized patients on the Heart Failure Service, and has an outpatient clinic which includes general cardiology patients as well as those with advanced heart failure and pulmonary hypertension.

She is also launching a pilot clinic for patients with pulmonary arterial hypertension who are also active methamphetamine users. In partnership with Sienna Kurland, MD, MPH, a UCSF primary care and addiction medicine specialist, the two received a United Therapeutics Jenesis Innovative Research Award to test whether an intensive 12-week program can help these high-risk patients reduce their methamphetamine use and better control their pulmonary arterial hypertension.

As a cardiology fellow, Dr. DesJardin worked in the Heart Plus clinic at Zuckerberg San Francisco General Hospital (ZSFG). It’s a program started by heart failure specialist Jonathan Davis, MD, MPHS, to serve patients with heart failure who also use methamphetamines, which can contribute to both heart failure and pulmonary hypertension. Dr. Davis and Dr. Simon helped Dr. DesJardin and Dr. Kurland adapt the Heart Plus model to UCSF’s medical system and pilot this approach specifically in pulmonary hypertension patients. 

The program will start by taking an in-depth medical history, seeing how far patients can walk in six minutes to measure exercise tolerance, and will invite patients to contribute a baseline sample of their hair, which can be analyzed to estimate their average exposure to methamphetamine in the previous three months. Patients will then have weekly visits with Dr. DesJardin, Dr. Kurland, and other team members who will help them manage their pulmonary hypertension, explore reasons to reduce or stop using stimulant drugs, and support them in taking steps towards their health goals.

For every clinic visit and every negative drug test, patients get to draw tickets with the chance to win a small prize; the more clinic visits and negative drug tests they accumulate in a row, the more tickets they get to draw. “That provides incentives for desired behaviors, such as clinic attendance and negative toxicology screening,” said Dr. DesJardin. “It creates an incentive structure so they develop healthier patterns of behavior. At the same time, hopefully we’ll help them start to feel better as they get on the right medications for pulmonary hypertension and receive social work support, addiction counseling, and potentially pharmaceutical therapy to treat stimulant use disorders.”

At the end of 12 weeks, participants will repeat their initial six-minute walk test to measure any changes in exercise tolerance, as well as hair sample testing to estimate their methamphetamine use during the program. The program will also pilot a virtual version of the weekly visits and prize drawing. “Because our patient population at UCSF Health is a little more spread out than San Francisco General, where all patients live in San Francisco, we want to test different ways to make the clinic accessible to people who might have difficulties with making in-person visits to UCSF every week,” said Dr. DesJardin. “This is an underserved population which doesn’t have great outcomes, so hopefully we can improve those.”

“Jackie brings a passion for clinical care and research in pulmonary hypertension,” said Dr. Simon. “She has developed this multidisciplinary methamphetamine pulmonary hypertension pilot program with addiction medicine, which was recently funded by a very competitive United Therapeutics Jenesis Innovative Research Award. She is currently developing a K grant proposal. Expect to hear great things from her in the future!”

“Dr. DesJardin brings an exceptional blend of scientific rigor and compassionate clinical care to the UCSF Division of Cardiology,” said Liviu Klein, MD, MS, director of the UCSF Advanced Heart Failure Comprehensive Care Center, who is another one of Dr. DesJardin’s mentors. “Her research in pulmonary hypertension advances the field with innovative insights, while her dedication to patients elevates the quality of care we deliver.”

Mentoring the Next Generation

Dr. DesJardin is grateful for all the mentorship she has received at UCSF, and in turn now serves as an advocate and champion for current trainees. As a co-chief cardiology fellow, she started a fellowship boot camp, in which the incoming class of general cardiology fellows spend their first week visiting each of the different campuses where they will be working – UCSF Health, ZSFG, and the San Francisco Veterans Affairs Medical Center – to get oriented, meet faculty members, and get onboarded. “My own first day of cardiology fellowship was a weekend call, and it was a bit chaotic,” she said. “I thought, ‘We need a better orientation,’ and now they do this boot camp every year, so every fellow knows how to log into their pager and access the electronic medical record before starting their clinical rotations.”

As co-chief fellow, she also advocated for improved radiation safety for all trainees who work with radiation, including cardiology fellows in the Cardiac Catheterization Lab as well as trainees in urology, orthopedic surgery, vascular surgery, anesthesiology, and other fields. “I helped protect pregnant women and those of childbearing age from radiation exposure,” said Dr. DesJardin. “We got universal access to protective lead gear that fits different trainees well, as well as routine monitoring for radiation exposure.” In recognition of this effort, she was awarded a UCSF Graduate Medical Education Excellence and Innovation Award in 2022.

She recently became a fellowship coach, providing career mentorship to several general cardiology fellows and helping them navigate their fellowship experience. “I really enjoy working with trainees, seeing how different people learn and understand things, and how they develop their identity as physicians or cardiologists,” said Dr. DesJardin. “I especially enjoy mentoring people who have a different perspective, such as women in cardiology, and helping them understand their potential.”

She advises trainees to keep an open mind. “When I was an intern, I didn’t know what field of medicine I wanted to pursue, but I knew I definitely didn’t want to be a cardiologist,” Dr. DesJardin recalled with a wry smile. “By the second year of residency, obviously that had changed a lot. I encourage people to create opportunities for exposure and to not rule anything out too early, because what they’re interested in may change.”

In addition to medicine and research, Dr. DesJardin is a former collegiate and professional soccer player. She and her husband, Edward Hesselgren, who works in marketing, are raising two young children.

Dr. DesJardin is very happy to have joined the UCSF faculty. “The research opportunities are fantastic,” she said. “We get to see a lot of Medicaid patients, which isn’t always the population that gets in to see an advanced heart failure specialist. All my mentors are here. People say that UCSF stands for ‘U Can Stay Forever.’ I love it here.”

 

- Elizabeth Chur