Category Archives: Cardiology

Cardiology

New drugs, updated treatment strategies: 5 important trends in cardiology from an eventful 2023 – Cardiovascular Business

With the end of the year rapidly approaching, the American Heart Association (AHA) editorial staff has published a list of some of 2023s biggest breakthroughs in cardiovascular disease (CVD) research.

In 2023, investigators made important strides toward improving and extending the lives of people affected by these conditions, along with potentially lowering the burden of disease with therapies and strategies that hold promise for prevention, the AHA editors wrote. Particularly noteworthy were advances in technology to restore blood flow to blocked and narrowed arteries, potentially preventing death and disability for a wide range of patients, including those with severe illness.

The AHAs choices included:

A new investigational drug, zilebesiran, can decrease the production of angiotensinogen, a protein believed to contribute to a patient's risk of high blood pressure. Early data suggests taking zilebesiran for eight weeks is associated with reductions in key blood pressure measurements compared to a placebo; higher doses are linked to higher reductions.

Not only does the suppression of angiotensinogen hold promise for more effectively reducing hypertension for extended periods of time after injection, there is growing excitement over the possibility it also might be therapeutic for kidney and heart disease, AHAs editors wrote. The results are also highly significant because only a single dose was needed, which could improve access to care and adherence to long-term drug regimens.

The full analysis was published in The New England Journal of Medicine.[1]

The concept of using intravascular imaging to guide percutaneous coronary intervention (PCI) procedures gained significant momentum in 2023. (Cardiovascular Business wrote about this topic several times, including here, here and here.)

AHAs editors highlighted multiple studies that examined the potential impact of intravascular imaging. The ILUMIEN IV study, for example, found that PCI guided by optical coherence tomography (OCT) resulted in a larger minimum stent area than angiography-guided PCI. That analysis was published in full in The New England Journal of Medicine.[2]

The OCTIVUS trial, published in Circulation, showed that OCT-guided PCI and intravascular ultrasound were both safe and effective treatment options for patients with significant coronary artery lesions.[3]

Treating atrial fibrillation (AFib) patients with direct-acting oral anticoagulants (DOACs) after a stroke can reduce their risk of experiencing another strokebut the exact timing of prescribing those DOACs remains unclear.

Doing so too early could increase the risk of brain bleeds, while doing so later could raise the risk of having a second stroke, AHAs editors wrote.

Physicians typically recommend stroke patients wait a few days before they start taking DOACs, but new research published in The New England Journal of Medicine provided evidence that those patients could start treatment even sooner.[4]

Overall, the study found that starting DOAC treatment within 48 hours of a stroke was associated with outcomes comparable to starting treatment on day three or four after a strokeone key difference was that the risk of recurrent stroke appeared to decrease with early treatment.

The trial was not designed to test whether earlier treatment was better than later treatment, but to help health care providers estimate possible outcomes, the editors wrote.

Original post:

New drugs, updated treatment strategies: 5 important trends in cardiology from an eventful 2023 - Cardiovascular Business

Cardiology

Cardiologists’ Holiday Wish: Medicare Pay Cuts Roasting on an Open Fire – TCTMD

As in Decembers past, the cardiology community is once again calling on Congress to stave off cuts to the Medicare Physician Fee Schedules that go into effect in 2024.

Annually, the US Centers for Medicare & Medicaid Services (CMS) announces its Physician Fee Schedule (PFS), and for the past several years, cardiologists have protested cuts for the care or services they provide. Some have called for an overhaul of the whole system, which often results in advocacy groups scrambling for last-minute legislation to push off proposed cuts to reimbursement. This year is no different, with an impending 3.37% cut to the Medicare PFS next year.

We have once again arrived at American clinicians annual holiday tradition: urging Congress to not allow cuts to Medicare services that exacerbate financial uncertainty for practices, further threaten patient access to care, and disproportionately impact Americas rural and senior populations, said B. Hadley Wilson, MD (Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC), president of the American College of Cardiology (ACC), in a press release. For decades we have spent December looking for a quick fix to a problem that requires significant reforms. We must seek and establish sustainable payment practices that allow clinicians to continue providing access to high-quality care. While addressing this upcoming cut is critical, it is a short-term adjustment that will not create a long-term solution. It is necessary to protect patients now while we work together on lasting reform.

The ACC, as well as other medical groups like the American Medical Association (AMA), are urging members of Congress to pass the Preserving Seniors Access to Physicians Act of 2023 (HR 6683), proposed by Congressman Greg Murphy, MD, of North Carolina. This would eliminate the planned 3.37% Medicare cuts scheduled for January 1, 2024.

Last month, a total of 54 medical societies, including the ACC, the Society for Cardiovascular Angiography & Interventions (SCAI), and the Society of Thoracic Surgeons (STS), sent a joint letter to Congress demanding the full cut be dropped.

Because physicians, unlike other providers, dont receive an automatic inflationary update within Medicare, a cut of this magnitude would be detrimental for most, especially given the current rate of inflation growth. Medicare physician payments have dropped by 26% in the last 20 years, while practice expenses have risen by 47% over the same period, according to the ACC.

Continuing down this road is unsustainable, said AMA President Jesse M. Ehrenfeld, MD, MPH (Vanderbilt University Medical Center, Nashville, TN), in an AMA press release. These cuts will be felt first and hardest in rural and underserved areas that continue to face significant healthcare access challenges.

That said, Ehrenfeld continued, as Kate McCallister famously said in Home Alone, This is Christmasthe season of perpetual hope. . . . We urge lawmakers to act quickly, preserve Medicare access, and pass this vital legislation.

Excerpt from:

Cardiologists' Holiday Wish: Medicare Pay Cuts Roasting on an Open Fire - TCTMD

Cardiology

Jean-Philippe Collet, Thrombosis Expert and Trialist, Dies at 59 – TCTMD

Jean-Philippe Collet, MD, PhD (Hpital de la Piti-Salptrire, Paris, France), an interventionalist and well-respected authority on antithrombotic therapies, died suddenly at home on December 15, 2023, at age 59. News of his death was confirmed by colleagues and his institution.

Well known for his leadership in co-chairing the 2020 European Society of Cardiology guidelines for non-ST-segment elevation acute coronary syndromes as well as conducting prominent research on antithromboticsincluding the ATLANTIS and ARCTIC trialsCollet will be remembered for his genuine care for patients and colleagues alike, modest yet effective demeanor, and passion for the field of cardiology.

Professor Collet was more than a colleague; he was a friend, a confidant and a role model to all those lucky enough to work alongside him, his colleague and mentor Gilles Montalescot, MD, PhD (Centre Hospitalier Universitaire Piti-Salptrire, Paris, France), wrote in an email that was circulated throughout their institution. His colleagues, his students, his patients and all those who had the chance to know him mourn the loss of an exceptional man, of rare intelligence and humanity, who devoted his life to cardiology.

To TCTMD, Montalescot reminisced about how their careers intertwined. He was my first buddy in cardiology 30 years ago and we started building this group that we have here, he said. Now it's a big group of cardiologists and a big network of cardiology centers, but we built that network together, Jean-Philippe and myself. We were the two pioneers, and one has disappeared.

Accomplished Yet Humble

Several themes emerged from Collets colleagues, who remember him for reaching unusual levels of achievement while remaining steadfastly kind and modest.

I am so devastated, P. Gabriel Steg, MD (Hpital Bichat, Paris, France), told TCTMD. He was a long-standing friend and colleague, warm, generous, hardworking, brilliant yet humble, highly respected by colleagues and staff, and loved by patients and families.

Calling Collet a friend first, Pierre Sabouret, MD (Hpital de la Piti-Salptrire, Paris, France), told TCTMD that his kindness stood out over the more than 20 years they knew each other. I want to underline that before being an international expert, he was a gentleman, he said.

Remembering Collet as both accomplished and unpretentious, Davide Capodanno, MD, PhD (University of Catania, Italy), told TCTMD that his loss will leave a gap in the field of cardiology. What really impressed me was that he was famous, but at the same time, always a person that came to you trying to have a conversation, he said. It was very easy to speak with him. And when you realize how famous he was and how friendly he was, this approach tells you how great he was as a man.

Thomas Cuisset, MD, PhD (CHU Timone, Marseille, France), too, said Collets attitude was special. Jean-Philippe was unique in the way that he made possible what many think contradictory; being one of the most famous French cardiologists, head of [his department], chair of ESC guidelines, but also a truly passionate clinician, dedicated to education, and always so friendly and supportive for the younger generation, he told TCTMD in an email. I had the privilege to work with him, and all this inspiration will stay [with me] forever.

Sunil Rao, MD (NYU Langone Medical Center, New York, NY), who also took to X (formerly Twitter) to express his condolences, called Collet "a powerful force in cardiology."

"Not only was he on the cutting edge of science, but he was also a gentleman and very approachable," Rao told TCTMD. "He will be greatly missed, but his legacy lives on in his contributions to the field, which will never be forgotten."

Eric Van Belle, MD, PhD (CHU Lille, France), a frequent research partner most recently on ATLANTIS, called Collet a trailblazer and his death a major loss. We were following his path, he said. Most of us were trying to be as good as he was, which was difficult to do. He was a very good example for all of us. He pushed us in a good direction by inspiring us.

Holger Thiele, MD (Heart Center Leipzig at University of Leipzig, Germany), who served as co-author of the 2020 ESC guidelines, told TCTMD Collet was suited to the job because he knew everything about all the evidence, in particular on antiplatelet therapy, and he was always extremely concise.

Outside of his work, Thiele added, Collet loved to be athleticthe pair would often run togetherand he enjoyed riding his motorcycle, which he would take on multiday trips to places like Rome and Barcelona for ESC Congresses.

Training and Leadership

Collet trained in cardiology at Universit Paris XII and earned his PhD in thrombosis at the University of Rouen, France. Since 2022, Collet served as head of the department of cardiology at his institution, where he also served as director of the cath lab.

John Weisel, PhD (Perelman School of Medicine, University of Pennsylvania, Philadelphia), who mentored Collet as a PhD candidate as well as a postdoctoral fellow, remembered him as very low key but enthusiastic and glad to try to do things. Weisel told TCTMD: He was probably my most productive postdoctoral fellow in the sense that I think in that 1 year he eventually got 13 papers out of the work he did.

What was unique about Collet was that he combined clinical expertise with basic science to improve patient care, Weisel continued, adding that he also really paid attention to people.

Montalescot called Collets natural leadership skills indisputable. He transformed the cardiology department into a place of excellence and innovation, where each member of the team was encouraged to reach their full potential, Montalescot continued, noting Collets charisma and ability to inspire as well as his kindness. Always approachable and modest, he was generous, attentive and loved by all his colleagues. We will always remember his kind smile, his availability and his willingness to share his knowledge.

Sabouret agreed, saying, I hope that [Collets team] will follow his model in terms of research but also in terms of attitude.

Collet was also a professor of cardiology at Sorbonne Universit and a founding and senior member of the academic research organization ACTION. His research interests were many, including finding new models for experimental thrombosis, demonstrating the prognostic role of biomarkers, and comparing antithrombotic therapies.

Throughout his career, Collet published almost 500 articles as well as 45 book chapters and 200 abstracts. One of his early works was lauded for playing an important role in the discovery of the clopidogrel resistance polymorphism.

A member of many organizations, including the French Society of Cardiology, European Society of Cardiology, Working Group 18, and European Association of Percutaneous Cardiovascular Interventions, Collet also served as an associate editor of JACC: Cardiovascular Interventions since 2018.

Collet is survived by his wife, Hlne, and their children, Antoine, Alexis, and Olivier.

Read more here:

Jean-Philippe Collet, Thrombosis Expert and Trialist, Dies at 59 - TCTMD

Cardiology

Piedmont Cardiologist Starts Non-Profit to Resolve Cardiac Crisis in Ethiopia – The Citizen.com

Piedmont interventional cardiologist Tesfaye Telila, M.D., is on a mission to resolve what can be deemed a cardiac crisis in his homeland of Ethiopia. As the population in that country adopted a more western lifestyle, the incidence of heart disease has risen drastically. Knowing this epidemiologic shift and the increase in premature deaths due to heart attacks and strokes, Dr. Telila founded the nonprofit organization, Heart Attack Ethiopia, to raise the needed funds to raise awareness, and train more interventional cardiologists, in a country where only five cardiac surgeons exist for 120 million people. According to research published in ScienceDirect, more than 15,000 patients are on the waitlist for cardiac surgery in Ethiopia.

The mission of our organization is to establish a sustainable cardiovascular service line in Ethiopia, Dr. Telila said. In this first phase of our intervention, we are recruiting volunteers to provide mission-based lifesaving heart attack care at currently available institutions in Ethiopia and eventually establish a more comprehensive Cardiovascular Center of Excellence that will be operated by the local healthcare professionals and that is fully accessible to everyone in need of emergency lifesaving cardiovascular care irrespective of their socioeconomic background

Dr. Telila is also working to establish a collaborative common ground between the Ethiopian government and the State of Georgia to build and virtually integrate cardiovascular centers in Ethiopia with cardiac centers in Georgia with the aim of alleviating the critical shortage of trained cardiac professionals. Currently, the country of Ethiopia has no established primary percutaneous coronary intervention (PCI) center to provide a timely treatment for patients with heart attacks. A somewhat interrupted lifesaving cardiac care is only provided at four local centers in Addis Ababa, a city of over 7 million people. While one is a charity, patients at the other three centers must have the needed funds to pay out of pocket for their heart attack care if they are lucky to get to the center on time despite the lack of EMS services.

Cardiovascular disease remains the number one killer in the world and 75 to 80 percent of all cardiovascular deaths occur in the low and middle income countries. So, incidents that people would survive here in the U.S. are mostly fatal in Ethiopia Dr. Telila said. We can make a big impact in the world by collaborating with healthcare systems like Piedmont, medical device companies and industries, recruiting volunteers to save lives while also expanding our footprints internationally

Dr. Telila received his medical degree from Addis Ababa University in Addis Ababa, Ethiopia before moving to the U.S. where he completed his internal medicine residency and Cardiovascular fellowships. He received his fellowship in interventional and structural cardiology from the University of Wisconsin in Madison, Wisc. He is board certified in Internal Medicine, Cardiovascular Disease, Interventional Cardiology, Nuclear Cardiology and Adult Echocardiography. He now treats patients at Piedmont Fayette and Piedmont Newnan hospitals.

To learn more about cardiovascular services at Piedmont, visit piedmont.org/heart. To learn more about Heart Attack Ethiopia and how you can help, visit heartattackethiopia.org.

See original here:

Piedmont Cardiologist Starts Non-Profit to Resolve Cardiac Crisis in Ethiopia - The Citizen.com

Cardiology

New vest developed by cardiologists uses advanced heart imaging to screen for sudden cardiac arrest – Cardiovascular Business

We identified a problem in cardiology, Captur said in a statement. Heart imaging has made remarkable progress in recent decades, but the electrics of the heart have eluded us. The standard technology to monitor the hearts electrical activity, the 12-lead electrocardiogram (ECG), has barely changed in 50 years. We believe the vest we have developed could be a quick and cost-effective screening tool and that the rich electrical information it provides could help us better identify peoples risk of life-threatening heart rhythms in the future.

The teams analysis includes data from 77 healthy volunteers who were imaged using the ECGI vest. The authors concluded that its use is feasible and shows good reproducibility in younger and older participants.

To date, more than 800 patients have been treated using this new screening tool. The group is currently exploring its options when it comes to the large-scale manufacturing of additional vests.

Click here to read the full analysis.

See original here:

New vest developed by cardiologists uses advanced heart imaging to screen for sudden cardiac arrest - Cardiovascular Business

Cardiology

Differentiating Cardiac Amyloidosis and HCM with Multi-Parametric Non-Contrast Cardiac MRI – Physician’s Weekly

The following is a summary of Multi-parametric non-contrast cardiac magnetic resonance for the differentiation between cardiac amyloidosis and hypertrophic cardiomyopathy, published in the December 2023 issue of Cardiology by Steen et al.

Researchers conducted a retrospective study to assess whether myocardial strain and T1 mapping derived from Fast Strain-Encoded Cardiac Magnetic Resonance (SENC-CMR) could effectively differentiate between Hypertrophic Cardiomyopathy (HCM) and Cardiac Amyloidosis.

They analyzed 99 patients (57 with hypertrophic cardiomyopathy and 42 with cardiac amyloidosis). Assessed were LV-ejection fraction, LV-mass index, septal wall thickness, and native T1 mapping values. Global and segmental circumferential/longitudinal strain were calculated in basal, mid-ventricular, and apical segments and constructed as a ratio by dividing native T1 values by basal segmental strain (T1-to-basal segmental strain ratio).

The results showed equal myocardial strain distribution in apical and basal segments in HCM patients. At the same time, cardiac amyloidosis exhibited apical sparing with less impaired apical strain (apical-to-basal ratio of 1.01 0.23 versus 1.20 0.28, P<0.001). T1 values were significantly higher in amyloidosis than in HCM patients (1170.7 66.4 ms versus 1078.3 57.4 ms, P<0.001). The T1-to-basal segmental strain ratio showed high accuracy for differentiation (Sensitivity = 85%, Specificity = 77%, AUC = 0.90, 95% CI = 0.810.95, P<0.001). In multivariable analysis, age and the T1-to-basal-strain ratio were the most robust factors for HCM and cardiac amyloidosis differentiation.

Investigators concluded that T1-to-basal strain, a quick MRI measure, effectively distinguished heart conditions HCM and amyloidosis, skipping risky contrast injections.

Source: link.springer.com/article/10.1007/s00392-023-02348-4

Go here to see the original:

Differentiating Cardiac Amyloidosis and HCM with Multi-Parametric Non-Contrast Cardiac MRI - Physician's Weekly

Cardiology

The benefits of implementing FFR-CT in clinical practice – Cardiovascular Business

He said the integration of FFR-CT not only informs medical decisions, but also profoundly impacts patient care. Gupta said the images can be shown to patients to help explain their condition to empower them with a deeper comprehension of their condition. Sharing FFR-CT results and images with referring providers and patients also fosters a collaborative approach, ensuring everyone involved comprehends the nuances of the diagnosis and treatment strategy.

Valley Health System sends about 25-29% of patients undergoing coronary CT exams to also undergo a HeartFlow analysis. Rather than employing FFR-CT universally, Gupta's team judiciously selects patients falling within the intermediate category, typically encompassing those with coronary disease that appears to block from 40% to 90% of a vessel. This selective approach allows for a nuanced assessment of patients who stand to benefit most from FFR information. It is not merely about determining who needs a catheterization procedure, but understanding the physiology of the disease for appropriate decision-making.

"We make sure that the referring providers, who are many times interventionalists, understand what the disease is, the severity of disease and if the patient is going to benefit form an invasive procedure. Alternatively, we would do FFR and we will find disease, which in some cases may not necessarily need invasive angiogram, despite knowing that there is significant disease. This is partly because we know from medical literature that medical management is equally good if not better, especially in a lower risk population. So we are trying to stratify the patient population. Thirdly, I think it provides a peace of mind to the patients, because they understand their disease better," Gupta explained.

Efficiency is paramount in cardiac care, and Gupta underscored the fast turnaround times for FFR-CT results. Reports are usually available within a day, he said, and it can be even quicker in emergency cases.

Implementing FFR-CT as a gatekeeper has impacted cath lab utilization. While diagnostic catheterizations may see a reduction, the precision of FFR-CT aids interventionalists in planning procedures more efficiently. Guta said this can help reduce radiation exposure and optimize contrast use. Also, the 3D FFR-CT images can serve as a clear roadmap for interventions, contributing to enhanced patient safety and procedural efficacy.

"I believe that it is actually helping the interventionalist plan the procedure in which we are finding frequently, at least at our center, they would either take very limited pictures of the coronary arteries or use special kinds of catheters where they can directly go for intervention based on what the study results shows on the CT and the FFR. They also know upfront exactly what to fix and what not to fix," Gupta explained.

One unique factor about Valley Health System is it uses a collaborative model for reading cardiac exams, combining the expertise of both radiologists and cardiologists. Gupta said their joint efforts, coupled with robust quality control processes, ensure the optimal integration of FFR-CT into clinical practice.

"We basically thrive on each other's strength. So we have a couple of very high-quality radiologists working with a couple of high-quality cardiologists and we are continually expanding our team," Gupta said.

Beyond its conventional use in coronary artery stenosis, Gupta's team is exploring other novel applications of FFR-CT. This includes evaluating anomalous coronary artery physiology, studying gender-based differences in chest pain presentations and evaluating patients during transcatheter aortic valve replacement (TAVR) pre-procedural workups.

"We are able to do a CT angiogram at the same time of a TAVR evaluation for the coronary arteries. We combine it with FFR data to try to risk prognosticate what is the risk of any event during the TAVR procedure and determine if they need an invasive angiogram or any kind of interventional procedure. So it really helps optimize high-risk, frail patients in terms of more optimal outcome," Gupta said.

FFR-CT was included as a recommendation in the 2021 ACC/AHA chest pain guidelines to evaluate chest pain. It was the first clinical artificial intelligence (AI) algorithm to be included in any U.S. cardiology guidelines.

View original post here:

The benefits of implementing FFR-CT in clinical practice - Cardiovascular Business

Cardiology

Hybrid coronary revascularization vs. CABG for multivessel CAD: New meta-analysis tracks long-term outcomes – Cardiovascular Business

Hybrid coronary revascularization (HCR) and coronary artery bypass grafting (CABG) are associated with comparable long-term mortality rates among patients with multivessel coronary artery disease (MVCAD), according to new data published in the American Journal of Cardiology.[1] However, HCR patients were more likely to experience certain adverse events.

HCR, as the name suggests, is a combination of two different revascularization techniques. It includes both minimally invasive for the left anterior descending (LAD) coronary artery and traditional percutaneous coronary intervention (PCI) for non-LAD lesions.

Previous studies showed the short-term benefits of HCR, including comparable mortality, reduced lengths of intubation and hospital stay, and less transfusion than CABG, wrote first author Junichi Shimamura, MD, with the division of cardiothoracic surgery at Westchester Medical Center in New York, and colleagues. However, the current guidelines do not recommend HCR as a routine procedure. This is partly because the previous analyses were based on retrospective data, and there is a lack of randomized controlled trials and meta-analyses in a large population with a long-term outcome.

Shimamura et al. tracked data from 13 different studies comparing the two techniques. The mean patient age was 64.3 years old, and the mean follow-up period was 5.1 years.

Read more:

Hybrid coronary revascularization vs. CABG for multivessel CAD: New meta-analysis tracks long-term outcomes - Cardiovascular Business