Man of heart

Kovács uses nature's language, math, to solve the body's mysteries
By Gwen Ericson

"Basically, I'm a misfit," says Sándor J. Kovács, M.D., Ph.D., professor of medicine in the Cardiovascular Division at the School of Medicine. Kovács isn't talking about being a Hungarian-born Brooklynite living in suburban St. Louis or being a scuba instructor far from the ocean.

Photo by Tim Parker

Sándor J. Kovács, M.D., Ph.D., teaches Leo Shmuylovich (left), an M.D./Ph.D. student, and Wei Zhang, a student in physics in Arts & Sciences, in his lab. "Sándor is a rare individual in cardiology," says David M. Kipnis, M.D, the Distinguished University Professor of Medicine and professor of developmental biology. "He sets up mathematical models and then verifies them using physiologic and diagnostic data from real patients."

No, Kovács is referring to his unconventional style of research, a result of being a cardiologist who first trained as a theoretical physicist. Unlike some in cardiovascular research, Kovács doesn't, for example, grow heart cells in a dish or genetically modify mouse hearts.

Instead, he builds models — the kind of models represented by cryptic-looking mathematical equations. Kovács' models describe how the heart pumps using concepts from fluid dynamics, three-dimensional geometry, nonlinear dynamics and kinematics.

"When I started as a cardiologist, I decided to look at the heart in a different way, through mathematics, and the solutions to some unsolved problems about heart function just fell into my lap — it's the kind of thing that makes you hit your forehead with your palm and say, 'Why didn't anyone see that before?'" Kovács says.

One of the times that gave Kovács an "I coulda had a V8" reaction was when he was able to prove mathematically that the heart's left ventricle isn't just a pump for pushing blood to the body; it also works as a suction pump. Like the rubber bulb on a bicycle horn, it springs back after contracting to draw blood in from the upper chamber and the lungs.

So heart health depends not only on how strongly the muscle can squeeze but also on how springy it is. Even today, Kovács says, many cardiologists don't fully appreciate that basic fact.

"Mathematics is the language of nature," Kovács says. "My colleagues and I are using this language to more carefully delineate and characterize what's happening in the heart."

Expanding his mathematical descriptions of the heart over the years, Kovács and collaborators at the School of Medicine have generated original insights about heart function that give cardiologists more objective ways to understand the heart.

"Sándor is driven by an innate need to figure out how things work," says longtime friend and colleague Samuel Wickline, M.D., professor of medicine in the Cardiovascular Division and of biomedical engineering. "He has developed new methods for understanding heart function that are directly applicable to clinical care of patients. In an era when there is a lot of talk about translational medicine, Sándor is really doing it."

From Hungary to St. Louis

Kovács was born in Budapest, Hungary, in 1947 and came to the United States with his parents and sister, Maria, when he was 12. His most vivid memories of Hungary are of scarcity and hardship during the communist era.

"I remember there were no refrigerators, just iceboxes," Kovács says. "And if you wanted chicken for dinner, you went to the market and brought home a live chicken, holding it by its feet."

The 1956 Hungarian Revolution forced the Kovács family to flee the country. They stayed in Austrian refugee camps until they were allowed, in 1959, to immigrate to the United States, where they settled in Brooklyn, N.Y.

After graduating from Brooklyn Technical High School, Kovács went to Cornell University and earned an undergraduate degree in engineering and then went to the California Institute of Technology, where he earned a doctorate in theoretical physics.

His doctoral thesis dealt with gravitational waves, a concept suggested by Einstein's relativity theory and now is being tested by an international network of observatories. During his graduate career, he worked with luminaries Richard Feynman, Ph.D., and Kip Thorne, Ph.D., who was his thesis advisor. He also was heavily influenced by physicist-turned-neurobiologist George Zweig, Ph.D., who was interested in the mechanics of hearing.

"George was the first to turn me on to the idea that the laws of physics are perfectly applicable to the life sciences," Kovács says.

After Caltech, Kovács enrolled in the Ph.D. to M.D. program at the University of Miami, an accelerated program that granted a medical degree after 22 months of concentrated study. At the suggestion of former WUSTL faculty member Eric Reiss, M.D., then at Miami, Kovács came to the School of Medicine for his internship — and stayed through residency and a fellowship in cardiology. And he has never left.

The physicist of the heart

When he first arrived at the School of Medicine in 1979, Kovács' plan was to become a neuro-ophthalmologist and to use physics to study how the retina works. But almost right away, he realized that his interests were better matched by the kinds of medical and physiological problems that cardiologists encounter.

Courtesy Photo

The Kovács family (from left): Son Sándor Ádám, a WUSTL graduate student in chemical engineering; daughter, Katherine Julianna, who will transfer to WUSTL in the fall; son Tamás Robert, a junior at Cornell University; father, Sándor; wife, Diane F. Merritt, M.D., professor of obstetrics and gynecology; Sándor J. Kovács, M.D., Ph.D.; family friend Carol Hart; and sister, Maria Kovács, Ph.D., professor of psychiatry at the University of Pittsburgh.

"Sándor came to me as an intern in neurology and asked to switch to internal medicine," says David M. Kipnis, M.D., who headed the Department of Medicine from 1972-1992. "I've made my reputation by being able to spot smart people, and I soon realized that he was one of the smartest people I've ever met."

While a resident and fellow, Kovács developed the suction pump model of the left ventricle, which has been validated and is now universally accepted. His further work has advanced the understanding of the integrated interactions of all four chambers of the heart and has provided new methods for measuring heart health. Kovács' approach has been highly influential and has helped catalyze a broad field of research into cardiac physiology and biophysics.

"Sándor is a rare individual in cardiology," says Kipnis, the Distinguished University Professor of Medicine and professor of developmental biology. "He sets up mathematical models and then verifies them using physiologic and diagnostic data from real patients."

Kovács spends about half his work time on clinical activities — he's an attending physician on Barnes-Jewish Hospital's cardiology service and performs cardiac catheterizations in the cardiac catheterization lab. There and as director of the Cardiovascular Biophysics Laboratory, Kovács obtains images from cardiac catheterization, echocardiography and MRI that help advance his research.

Kovács teaches students from the physics and biomedical engineering departments and from the Medical Scientist Training Program. He is known as an outstanding teacher and mentor, and, in 2005, he received a Faculty Mentor Award.

Sándor J. Kovács

Academic titles: professor of medicine and of cell biology and physiology; adjunct professor of physics and of biomedical engineering; and director of the Cardiovascular Biophysics Laboratory.

Hobbies: scuba diving, underwater photography and swimming.

Personal philosophy: : "I like to think of myself as an explorer. I like to go out into the wilderness and build my cabin where no one else has," he says.

Other:Kovács is the president of the Cardiovascular System Dynamics Society, an international society of cardiologists and physiologists, and will oversee its 18th International Conference in St. Louis in September.

In December 2007, Kovács was awarded the Swedish Society of Medicine's Sjöstrand Medal for his contributions to cardiovascular physiology.

"Sándor is extremely dedicated to teaching and to his students," Wickline says. "He encourages them to become curious, and he finds ways to sustain their curiosity."

Family and friends

Kovács met his wife, Diane F. Merritt, M.D., professor of obstetrics and gynecology, while he was a resident and she was chief resident in OBGYN at the School of Medicine. She is director of the Program in Pediatric and Adolescent Gynecology.

"We met in the cafeteria at Barnes," Kovács says. "We got married two years later, and, in April, we celebrated our 25th anniversary. She deserves a large share of the credit for everything I've accomplished."

Kovács and Merritt have three children: Sándor Ádám, 23, Tamás Robert, 21, and Katherine Julianna, 19, all in college. Kovács says raising children has been the most rewarding experience of his life. "You see your own DNA running around and then talking back to you," he says.

His family has always been a central part of his life, Kovács says. He credits his parents for his values. Although his mother, Julianna, died in 1993, his 94-year-old father, Sándor, lives in St. Louis. The extended family dines together every evening.

Last August, Thorne organized the "Sándor Fest" in honor of Kovács' 60th birthday. This kind of celebration is common in the physical sciences and is hosted by former students and colleagues of the guest of honor.

"It's a wonderful tradition," Kovács says. "I saw people I hadn't seen for decades — from MIT, Cornell, Caltech and beyond. We had a mini-symposium at Blueberry Hill and dinner at the Whittemore House with more than 100 guests. It was great to be with friends — interesting people doing interesting things."

Kovács isn't slowing down his own production of interesting things. Last year, he and his graduate students published 10 papers, far above the average for someone in his field. "We're just going like gangbusters," he says of his research team.

Kovács gratefully acknowledges Washington University's "no boundaries" environment for its influence on his success, both professional and personal.

"Being a professor at the University has been very rewarding and fulfilling, and I've made lifelong friends here," he says.