AI Can Translate Polygenic Risk For Coronary Artery Disease Into Clinically Actionable Information
A polygenic score (PGS) measures a person’s inherited risk for coronary artery disease (CAD). Causal AI algorithm can translate PGS for CAD into clinically useful information by quantifying how much each person must lower their LDL or SBP to overcome their inherited polygenic risk for CAD. The polygenic risk for CAD was overcome with small lifetime reductions in LDL and SBP.
Cardiac Team Must Have a Trained Interventional Echocardiographer (IE)
IE is an integral part of the multidisciplinary cardiac team including a cardiac surgeon, interventional & HF cardiologist. The imager must have specific knowledge and technical skills in all aspects of structural heart disease. In a study, it was seen that after mitral valve surgery or interventions, the RR of mortality was 61% lower for patients in the heart team compared to no heart team.
Imaging techniques in Transcatheter Therapies
Interventional echocardiography (IE) has an integral role in a plethora of heart interventions such as in heart valves including transcatheter mitral valve replacement, transcatheter tricuspid valve-in-valve (ViV), electrophysiology assessment, LAO ablation, TAVR, etc. Imaging techniques have also evolved in parallel, such as Live 30 MPR, 4D intra-cardiac echo, and Live T fusion.
Statin Prescribing In Patients With Atherosclerotic Cardiovascular Disease
High-intensity statin (HIS) use is low in patients with atherosclerotic cardiovascular disease despite guideline recommendations. A trial showed that baseline HIS/statin use at intervention and usual-care sites was 52.6% / 81% and 55.6% / 82.2%, respectively. Algorithm identified statin-associated side effects in 23% patients; individualized reminders on 5156 patients have been delivered to date.
Efficacy And Safety Of Macitentan-Tadalafil FDC In Pulmonary Arterial Hypertension
187 PAH pts were randomized to fixed dose combination of macitentan 10 mg + tadalafil 40 mg (MT FDC), macitentan or tadalafil. Pulmonary vascular resistance reduction with MT FDC was significantly greater vs macitentan (29%) and vs tadalafil (28%). MT FDC significantly improved hemodynamics vs monotherapies, with a safety and tolerability profile consistent with that of the loose combination.
Pulsed Field Ablation (PFA): A Novel Technology for AF Ablation
PFA is a very novel cardiac ablation technology which utilizes electrical pulses to cause irreversible electroporation and induce nonthermal cardiac cell death. Pre-clinical studies show that PFA can selectively ablate cardiac tissue effectively and rapidly while avoiding damage to structures surrounding the pulmonary veins (esophagus, phrenic nerve). This should enhance safety.
The Benefits Of Microcor (μCor™) In Ambulatory Decompensated Heart Failure (BMAD) Trial
In BMAD trial, subjects were asked to wear μCor system for 90 days and were assigned to a control group with investigators were blinded to thoracic fluid index (TFI) and a treatment group using TFI to guide HF therapy. There were 42 treatment subjects with a HF event compared to 63 control subjects. HF management using TFI results in a 36% reduction in HF ER visits, hospitalizations or death.
Mitral and Tricuspid TEE: Guideline-Based Screening for Structural Heart Disease (SHD)
Carpentier classification divides mitral valve regurgitation as: Type I: normal leaflet motion, Type II: excessive leaflet motion, and Type III: restricted leaflet motion. Finding the intended gripping zones by locating the tricuspid regurgitation (TR) on color Doppler and imaging the leaflets during systole and diastole to determine length and gaps are the screening's objectives.
Usefulness of H2FPEF Score for Predicting New Atrial Fibrillation
H2FPEF score consists of six factors: heavy, hypertension, atrial fibrillation (AF), pulmonary hypertension, elder, and high filling pressure. These factors are known to be associated with left ventricular diastolic dysfunction. A recent study showed that H2FPEF score can predict new AF development in patients without clinically significant cardiac disease.
Novel Wrist-Worn Transdermal Troponin-I-Sensor Assessment for Acute Myocardial Infarction
Wrist-worn transdermal infrared spectrophotometric sensor (ISS) model predicted elevated Trop-I with the area under the receiver operator characteristics of 0.89 and 0.92 for internal and external validation cohorts, respectively. In addition, a prediction of elevated Trop-I was associated with regional wall motion abnormalities and significant coronary stenosis.
Sotatercept With Background Therapy for the Treatment of Pulmonary Arterial Hypertension
STELLAR is a Phase III trial of Sotatercept in adults with Pulmonary Arterial Hypertension. Sotatercept provided broad therapeutic benefit across a range of effectiveness endpoints and significantly increased exercise capacity as measured by the 6MWD. The findings demonstrate the efficacy of Sotatercept as a novel mechanistic PAH treatment when used in conjunction with current PAH medications.
CVD Prevention in Asia- A Status Update and Future Directions
CVD mortality rate is increasing in Asia. It showed marked geographic differences due to the combined effects of age and other determinants including SES. Ischemic heart disease is the dominant type for CVD deaths in Central, Western and Southern Asia, stroke is common in Eastern Asia. Social aging, obesity and high salt intake become triple threats of CVD control in Asia, forming a vicious cycle.
Atrial Pacing for Heart Failure With Preserved Ejection Fraction
A study provides strong evidence that implantation of a cardiac pacemaker to increase exercise HR is not effective to improve submaximal or peak exercise capacity or functional status in patients with HFpEF and chronotropic incompetence. These results suggest that a lower than expected peak HR is a consequence of premature exercise cessation rather than a cause of exercise limitation.
Building Electronic Tools to Enhance and Reinforce Cardiovascular Recommendations for Heart Failure
68,000 preventable deaths occur yearly due to shortfalls in prescribing of therapies for HFrEF, particularly mineralocorticoid receptor antagonists (MRA). BETTER CARE-HF compared the effectiveness of an alert vs. message to improve MRA prescribing. The findings can be rapidly disseminated with the potential to improve morbidity and mortality for patients with HFrEF.
Should Leads be Extracted Before Tricuspid Valve Replacement - Con Jailing is Safer Than Extraction
ELECTRa study showed a higher risk of major complications or death in TR patients with TLE. Another study showed that TTVR in the setting of trans-TV pacemaker leads without lead extraction or re-replacement can be performed safely with a low risk for complications, offering an alternative to surgical TV replacement. The risk of CIED-related infection in jailing is 4.7 per 1000 person-years.
Management Of Atrial Fibrillation After Patent Foramen Ovale (PFO) Closure
Recent trials showed a benefit of PFO closure vs. medical therapy to prevent recurrent CVA in patients ≤ 60 years. Conditional recommendations for PFO closure: In patients > 60 years with a prior PFO-associated stroke; In persons with platypnea-orthodeoxia syndrome (POS) and without a prior PFO-associated stroke; In persons with systemic embolism and without a prior PFO-associated stroke.
Step by Step Initiation of HFrEF Quad Therapy for Optimization of Medical Management
Sequential HFrEF quad therapy initiation allows for personalization based on patient characteristics, medication factors and allows for shared-decision making. It is critical to identify improvement strategies i.e., GDMT titration clinics, HER interventions, telehealth, multidisciplinary HF management programs, electronically administered patient awareness tools.
Rapid Simultaneous Initiation of HFrEF Quad Therapy for Optimization of Medical Management
In patients with HFrEF, Quadruple GDMT i.e, ARNI, beta-blockers, MRA and SGLT2i are recommended. In patients with symptomatic HFrEF, SGLT2i are recommended to HHF and CV mortality, irrespective of presence of T2DM. In JAMA 2021 study, Dapagliflozin showed clinical benefit with significant reduction in risk of primary efficacy outcome of HHF and CV death or worsening HF by 4 weeks.
What is Needed in 2023 to Ensure Equitable Care for Patients with HF?
Patients at risk of HF (Stage A) with T2D/CVD risk, SGLT2i should be used to prevent HF hospitalizations. In Stage B patients with LVEF ≤ 40%, ACEi should be used. SGLT2i and ARNi are added in HFrEF stage C. In patients with stage D HF refractory to GDMT and device therapy awaiting MCS or cardiac transplantation, continuous intravenous inotropic support is reasonable as bridge therapy.
From Heresy to Necessity: Same Day Discharge for TAVR
The nationwide readmission database of SDD patients after transcatheter aortic valve replacement (TAVR) from 2015 to 2019 found that the SDD patients showed higher rate of readmissions as compared to non-SDD patients. The key points to be considered for the same day discharge (SDD) of patients are:- Patient and environmental factors- Procedural factors- Complications
