May 12 2023 This Week in Cardiology Medscape
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Category Archives: Cardiology
What’s new in cardiac imaging? 2 experts discuss the latest trends – Cardiovascular Business
Picking the best cardiac imaging test
"Coronary disease is a growing area for cardiac imaging. The trend we are seeing is that both anatomic and structural imaging play a very important role in certain patient populations. And physiologic imaging is also very relevant for patient populations that are higher risk," DiCarli explained. "So the way the clinical evidence is shaping up, for low and intermediate risk patients, CT seems to be a very effective test to exclude significant coronary disease and help clinicians assess the burden of atherosclerosis. It is very difficult to challenge CT on its negative predictive value as a rule-out test for coronary disease."
For patients who have more coronary disease, or known coronary disease, these patients are better suited for physiological imaging, such as nuclear or MRI, DiCarli said.
Patients with more advanced cardiovascular disease often have higher amounts of calcium in their coronary vessels, making CT more difficult to interpret.
"In these patients, functional imaging for the detection of ischemia and ventricular function starts to become become more relevant and can potentially lead to better decisions," Beanlands said.
The best cardiac centers will have a mix of CT, MR, SPECT and PET to offer the best imaging modality to answer specific questions is specific patients. Over the past decade, there has been a reduction in the number of SPECT exams, but an increase in the number of cardiac CT, MRI and PET exams. The use of echocardiography is still the most widely used cardiac imaging modality and is considered the frontline imaging test for most patients, he said.
CT is considered an anatomical test that can show very detailed images of the anatomy, but until recently, it did not offer functional information. Even if a coronary has a clear blockage, CT cannot offer a physiological assessment of whether the blockage is flow limiting or not. At least, that was the case until multiple studies validated fractional flow reserve CT (FFR-CT), which uses computational fluid dynamics to estimate the coronary blood flow past a lesion or series of narrow vessel segments. FFR-CT was also included in the 2021 chest pain guidelines. However, FFR-CT has the barriers of access and cost. While a growing number of centers are using it, the overall number is still relatively small.
"Cardiac MRI is also a wonderful option for imaging coronary disease. MRI also can quantify perfusion and patients with microvascular disease," DiCarli said.
In addition, he added, MRI has the best soft tissue delineation of any of the cardiac imaging modalities. However, it has certain limitations, including high costs, potentially limited access and the longer exam times.
Beanlands, a former president of the American Society of Nuclear Cardiology (ASNC), said single photo emission computed tomography (SPECT) is the most widely used nuclear imaging technology in both the U.S. and around the world.
"It's been a go-to technology for many, many years, but it has pitfalls that make it more challenging," he explained. "People are developing technologies to offer quantification of flow, which has some advantages."
Beanlands also said that clinical studies to validate SPECT quantification software are still ongoing, but that technology is already in clinical use withpositron emission tomography (PET). PET in many ways is seen as a better technology, with clearer imaging, use of fused CT for attenuation correction, the CT also adds anatomical imaging, and it has the ability to calculate coronary flow reserve. But PET adoption has been limited because of the cost for these systems and the required change in radiotracers and workflow.
"PET is emerging more and more and is becoming widely used, because it has the advantage of this flow quantification, which really can distinguish the patients who are high risk and low risk. It has the potential to risk stratify patients with that important piece of information," Beanlands explained. "And not only for coronary disease, but for what we call microvascular disease."
He said PET may play an increasing role to better quantify the extent of these microvascular diseases, like myocardial ischemia with no obstructive coronary arteries (INOCA), or myocardial infarction with non-obstructive coronary arteries (MINOCA).
For years these patients, particularly women who have a higher prevalence of these conditions, where brushed off and told the chest pain was just in their head, because there was no clearly seen obstruction inside their coronaries, Beanlands said.
Another advantage associated with PET is that the rubidium radiotracer used only has a 75 second half life, so the exams are very faster compared to SPECT.
"I think PET is ahead of SPECT," Beanlands said. "Don't get me wrong, SPECT is useful and you want to be using it in certain patients. But, PET as significant advantages pretty much in all areas."
DiCarli agreed PET is a better imaging modality and more accurate. However, while it may be better, he said access to PET is still limited, so SPECT will likely remain the workhorse nuclear technology for years to come.
He added that PET also has a new imaging agent in trials to improve perfusion imaging that does not require an on-site cyclotron, or the use of an expensive rubidium generator. DiCarli said the agent can be produced by commercial cyclotrons off-site and sent as unit doses to the hospital. This will lower the cost of ownership for PET systems and accelerate wider adoption. He said it is possible the new agent may see FDA clearance in the next two years.
"That will help open access in ways that we have not been able to realize with the currently approved FDA radiopharmaceutical," DiCarli said.
Another trend in cardiac imaging is the area of visualizing inflammation in the heart. This includes amyloidosis, sarcoid, pericarditis, myocarditis and other inflammatory disorders.
"We have seen over the last fives years a tremendous growth in the referrals for those patients," DiCarli explained. He added that imagers also have learned how to use the complimentary advantages of PET and MRI together for a more accurate diagnosis.
Beanlands said inflammation also plays a role in atherosclerosis, so being able to image it may play a future role in how these patients are managed.
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What's new in cardiac imaging? 2 experts discuss the latest trends - Cardiovascular Business
Study reveals a novel method for assessing an important measure of heart function – News-Medical.Net
Coronary heart disease is the leading cause of adult death worldwide. The coronary angiography procedure provides the clinical standard diagnostic assessment for nearly all related clinical decision-making, from medications to coronary bypass surgery. In many cases, quantifying left ventricular ejection fraction (LVEF) at the time of coronary angiography is critical to optimize clinical decision-making and treatment decisions, particularly when angiography is performed for potentially life-threatening acute coronary syndromes (ACS).
Since the left ventricle is the heart's pumping center, measuring the ejection fraction in the chamber provides critical information about the percentage of blood leaving the heart each time it contracts. Presently, measuring LVEF during angiography requires an additional invasive procedure called left ventriculography where a catheter is inserted into the left ventricle and contrast dye is injected which carries additional risks and increases the contrast exposure.
In a study published May 10 in JAMA Cardiology, senior author and UCSF cardiologist Geoff Tison, MD, MPH, and first author Robert Avram, MD, of the Montreal Heart Institute, set out to determine whether deep neural networks (DNNs), a category of AI algorithm, could be used to predict cardiac pump (contractile) function from standard angiogram videos. They developed and tested a DNN called CathEF, to estimate LVEF from coronary angiograms of the left side of the heart.
CathEF offers a novel approach that leverages data that is routinely collected during every angiogram to provide information that is not currently available to clinicians during angiography, effectively expanding the utility of medical data with AI and provides real-time LVEF information that informs clinical decision-making."
Geoff Tison, UCSF Associate Professor of Medicine and Cardiology
The researchers performed a cross-sectional study of 4042 adult angiograms matched with corresponding transthoracic echocardiograms (TTEs) from 3679 UCSF patients and trained a video-based neural network to estimate reduced LVEF (less than or equal to 40%) and to predict (continuous) LVEF percentage from standard angiogram videos of the left coronary artery.
The results showed that CathEF accurately predicted LVEF, with strong correlations to echocardiographic LVEF measurements, the standard noninvasive clinical approach. The model was also externally validated in real-world angiograms from the Ottawa Heart Institute. The algorithm performed well across different patient demographics and clinical conditions, including acute coronary syndromes and varying levels of renal function-;patient populations that may be less well suited to receive the standard left ventriculogram procedure.
"This study presents a novel method for assessing LVEF, an important measure of heart function, during any routine coronary angiography without requiring additional procedures or increasing cost," said Avram, an interventional cardiologist and former UCSF research fellow. "LVEF is essential for making decisions during the procedure and for managing patient care."
Although the algorithm was trained on a large dataset of angiograms from UCSF and then separately validated in a dataset from the Ottawa Heart Institute, the investigators are undertaking further research to test this algorithm at the point-of-care and determine its impact on the clinical workflow in patients suffering heart attacks. To this end, a multi-center prospective validation study in patients with ACS is underway to compare the performance of CathEF and the left ventriculogram with TTEs performed within 7 days of ACS.
"This work demonstrates that AI technology has the potential to reduce the need for invasive testing and improve the diagnostic capabilities of cardiologists, ultimately improving patient outcomes and quality of life," said Tison.
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Journal reference:
Avram, R., et al. (2023) Automated Assessment of Cardiac Systolic Function From Coronary Angiograms With Video-Based Artificial Intelligence Algorithms. JAMA Cardiology. doi.org/10.1001/jamacardio.2023.0968.
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Study reveals a novel method for assessing an important measure of heart function - News-Medical.Net
Cardiology has embraced AI more than most other specialties – Cardiovascular Business
Artificial intelligence (AI) algorithms are being used more and more by cardiologists and other cardiovascular professionals. In fact, of the more than 500 clinical AI algorithmscleared by the U.S. Food and Drug Administration (FDA), cardiology has more than all but one other specialty: radiology has more than 400, and cardiology has more than 60.
Those numbers continue to grow, suggesting that this is just the beginning for cardiology's relationship with this evolving technology.
Beyond the clinical, patient-facing AI algorithms the FDA reviews, there are hundreds more non-clinical algorithms now embedded into back-end health IT systems to speed workflow, improve efficiency, complete time-consuming tasks, analyze data and more.
Here is the breakdown for the number of FDA-cleared algorithms across specialties as of the FDA's last update in January 2023.
Radiology396 Cardiology58 Hematology 14 Neurology 10 Clinical chemistry 7 Ophthalmic 7 Gastroenterology and urology 5 General and plastic surgery 5 Pathology 4 Microbiology 4 Anesthesiology 4 General Hospital 3 Orthopedic 1 Dental 1
See the complete list of FDA-cleared algorithms here
Additionally, the American College of Radiology (ACR) also maintains a frequently updated database of medical imaging AI FDA approvals. According the the ACR database, and additional 35 medical imaging AI algorithms were cleared between January and March 30, 2023. This included 8 new cardiac related algorithms, bringing the total for cardiology to 66. Radiology algorithms overall are now at 431.
The first AI algorithm was cleared by the FDA in 1995, and fewer than 50 algorithms were approved over the next 18 years. However, the numbers have increased rapidly in the past decade, and more than half of algorithms on the U.S. market were cleared between 2019 to 2022more than 300 apps in just four years. Last October, the FDA approved 178 new AI and machine learning (ML) systems. That number is expected to grow rapidly into the future, the FDA has said.
Ami Bhatt, MD, theAmerican College of Cardiology (ACC)chief innovation officer and adult congenital heart disease cardiologist at Mass General Hospital, said artificial intelligence really needs to be renamed "collaborative intelligence," because it is really a collaboration between a human doctor and the machine to leverage the best abilities both have to offer to improve patient care and efficiencies in healthcare. The ACC has been a big advocate for bringing more cardiology AI to the market to help augment physicians amid a growing shortage of cardiologists in the U.S.
"It's simply that the human eye can't necessarily take all of that data and process it the way a computer can. So we are not saying we are replacing humans with computers, we are trying to allow clinicians to work at the top of their license and to given them some guidance as to what may be a good direction to go in. And there are times when our clinical acumen will supersede what a computer may suggest, and that is OK and that needs to happen, because then we reteach that computer how to learn," Bhatt explained.
Bhatt also emphasized that this does not mean every physician has to be an expert when it comes to AI.
"[Physicians just] need to understand there is some AI here with computational aspects, and here is what it is meant to do. Any beyond that, they just need to use their clinical acumen," she said.
Bhatt and others have also noted that AI needs to be seamlessly integrated into workflow, just like medical devices or reporting software to make it usable by clinicians.
"We really need to upscale cardiologists' understanding of this technology. We live in a digital world and medicine tends to be fairly conservative, but I think people are recognizing AI is here to stay and we have to embrace it. In the clinical community, we need to be at the forefront,"explainedEd Nicol, MD, consultant cardiologist and honorary senior clinical lecturer withKings College London,and president-elect of theSociety of Cardiovascular Computed Tomography (SCCT).
The academic discussions on AI and its future applications are largely over. What is now being discussed are actual FDA-cleared products sold on the market and in clinical use.
Making this more real is the fact that the first cardiology AI algorithm is now included in practice guidelines in both Europe and the United States. TheACC/AHA 2021 Chest Pain Guidelinesinclude the recommended use of AI-driven fractional flow reserve hemodynamic flow measurements derived from noninvasive CT imaging (FFR-CT).
"If you had said to me 15 years ago we were going to have some sort of computational fluid dynamics tool in the U.S. chest pain guidelines, you would have been laughed at. Everyone would have said you were crazy. But that is the reality, we see FFR-CT in the international guidelines, based on evidence. That will be the first, I suspect, of many," Nicol said.
He said the biggest thing cardiologists need to understand is how the AI they are evaluating or using works. This way they can understand if there are issues in the AI-generated data and how they should validate it.
"We the clinicians really need to own this," Nicol explained. "And you can really only own this and challenge it if you understand it and the strengths and weaknesses of AI. We are not trying to change the whole radiology/cardiology community into programmers, but they need to understand how those programs work, even if they do not understand all the strings of computer code."
"One of the things I am amazed about is the rapid progression of non-invasive imaging and using artificial intelligence to try and standardize analysis," explainedJuan Granada, MD, president and CEO of theCardiovascular Research Foundation (CRF), when describing key technology trends he sees in cardiology.
AI in cardiac imaging enables faster exam reads by automating quantification and making measurements more consistent, eliminating the usual variability between radiologists or cardiologists. Granada believes AI will soon play a big part in cardiac care in all of its the subspeciality areas, including interventional cardiology.
While there are FDA-cleared AI algorithms to automatically assess ECG data and wearable heart monitor data,most of the cardiac AI has been concentrated in imaging. In addition, many of the radiology-cleared algorithms are actually specifically for cardiovascular, peripheral vascular and neurovascular imaging. These include uses in CT, MRI, nuclear imaging and cardiac ultrasound.
"AI is coming along in many areas of echocardiography. It is just exploding and it is very exciting," explained echocardiography expertPatricia A. Pellikka, MD. She is the editor-in-chief ofJournal of the American Society of Echocardiography, director of theMayo Clinic Ultrasound Research Centerand a consultant for Mayo Clinic department of cardiovascular medicine."One of the areas is the use of AI too help improve ultrasound acquisition of images by teaching inexperienced users how to get the image. Another area is applying AI to the data that is already acquired to remeasure things, or to apply AI to all the measurements that have already been obtained to detect disease."
In her research at Mayo, Pellikka has been involved with the development of AI that looks at the ultrasound images to directly detect disease. The algorithms can pick out radiomic signatures of disease in the image that may not be evident to the human eye.
"I think the potential there is enormous," Pellikka said.
Over the past few years there has been a big increase in the use of point-of-care ultrasound (POCUS) systems in a variety of settings, including clinics, physician offices, emergency departments and ICUs. These echos are being performed by much less experienced sonographers than those in hospital echo labs.A couple AI vendors have developed FDA-cleared algorithms to show POCUS users how to move their probe into the correct position and walk them through how to acquire each of the standard echo views. The AI also tells the operator when they are in the correct position and judges the quality of the images they are acquiring. Many echo experts say this can significantly improve exam diagnostic quality, leading to fewer repeat exams, faster and better diagnosis of patients.
"This will extend the reach of cardiovascular ultrasound to places and times when there isn't an experienced cardiac sonographer available to do the imaging. I think the potential for this is extremely exciting," Pellikka explained.
AI is also being used to speed up patient assessments by automating echo strain, ejection fractions and other measurements. Pellikka said several vendors have now developed FDA-cleared algorithms in these areas. This automation can eliminate the need for a sonographer to perform manual contouring of the ventricles, or manually using calipers to take various measurements. She said the sonographer can still edit these AI-generated contours if they feel they are incorrect. Overall, she said this results in a much faster exam or post-processing of the exam, enabling more patient throughput.
Importantly, Pellikka and other echo experts say this type of AI automation also reduces the variability in measurements between different sonographers. AI automatically picks the same landmark locations to perform measurements, helping deliver more consistency. This is especially important when monitoring patients over time.
"I think this is just the tip of the iceberg and I think we will be automating many other measurements as well, such as automatic assessment of valvular heart disease. All of this is going to increase the standardization of echocardiography and make it so the communication between one center doing an echo and another is more standardized than it is today," Pellikka said.
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Cardiology has embraced AI more than most other specialties - Cardiovascular Business
Getting to the heart of it: Leading cardiologists share the journey of care – The Salem News
Salem resident Frank Curtin, then 56, was in cardiac arrest when he arrived at Salem Hospital.
I ended up crashing right in the lobby of the emergency room, Curtin explained. The next thing I remember is I was on the table. They were doing chest compressions on me.
The doctors went through resuscitation for the next 15 to 20 minutes to try to get his pulse back.
We were working tirelessly to get him back to his family, said Dr. Lola Ojutalayo, explaining that they immediately contacted Medflight to transport him to Mass General Hospital where he recovered thanks to the treatment at both Salem and Boston.
Franks story is one of thousands where a life was saved because of the quality care from a team of board certified cardiologists at Salem Hospital and their partnership with Mass General Brigham.
This team is being led by two women of color who are determined to change the narrative around women in leadership: Chief of Cardiology Sohah N. Iqbal, MD, and Medical Director Lola Ojutalayo, MD.
Historically, cardiology has been mostly an all boys club, explained Ojutalayo, who lives in North Reading.
Ojutalayo was born in the U.K. while her parents studied in London but identify as Nigerian American. She moved to New Jersey when she was 12 years old and eventually completed her medical training at Drexel University College of Medicine Philadelphia, where she had her two sons.
I love spending time with them and traveling to learn new cultures, Ojutalayo said.
She has also held positions as an Interventional Cardiologist at St. Josephs Health in New York and at Mass. General Hospital.
According to a 2021 article published in the Journal of the American Heart Association, while 50% of medical school graduates in the United States are women, only 21% of cardiology fellowships are awarded to women and only 13% of practicing cardiologists are women. Among operators who perform coronary interventional procedures in the U.S., only 4.5% are women.
Despite efforts from U.S. professional societies to better engage and support women in cardiology, these numbers remain unchanged over the past several years and have been referred to as the leaky pipeline, the article reads.
Iqbal, who has worked at Salem Hospital since 2020, went to college at MIT, completed her medical school at Harvard and then moved to New York for residency at Columbia. Before moving back to Boston, Iqbal completed a cardiology fellowship at New York University where she stayed on as faculty for a decade.
While being the first woman to train in interventional cardiology at a past institution, Iqbal, who now lives in Marblehead, was told by the men who trained her that she wouldnt be able to do it and that she should do things like a man in the cardiac catheterization laboratory.
Words to describe women in the workplace included cupcake and bossy, she explained.
But that didnt stop her from pursuing her passion.
My passion for what I do and the patients I serve has always driven me to want to improve systems. Iqbal said. I needed to find a professional home that would be open to my ideas and not threatened by them.
Salem Hospital is definitely that place, she added.
In 2022, the U.S. News and World Report named Salem Hospital a high-performing hospital, which is the highest award a hospital can receive for U.S. News Best Hospitals Procedures and Conditions ratings.
We are very proud that the exceptional care we offer at Salem Hospital is recognized on a national scale, says Roxanne Ruppel, President and Chief Operating Officer of Salem Hospital. It is a tribute to our extraordinary nurses, physicians and staff who, even during the COVID-19 pandemic, continued to meet the highest standards of care.
The hospital provides fully integrated cardiac evaluation and treatment to North Shore patients including angioplasty, cardiac ablation, cardiac catheterization, cardiac evaluation and testing, cardiac rehabilitation, electrophysiology and percutaneous coronary interventions and stents.
We have such a special community here and I feel lucky to work here, Iqbal said.
Iqbal and Ojutalayo have worked alongside former director Dr. Howard Waldman and Dr. Pat Gordan to develop the Impella and Mobile ECMO programs two devices that make Salem Hospital a leading medical center for critical care.
Iqbal explained that the Impella device is a tiny heart pump that is used to help maintain blood flow during high-risk protected percutaneous coronary interventions (PCI).
The second program is the mobile ECMO program, which stands for extracorporeal membrane oxygenation. The ECMO machine is designed to support critically ill patients by providing cardiopulmonary functions normally performed by the patients hearts and lungs. ECMO can support the heart, lungs, or both.
While Iqbal and Ojutalayo have had to navigate the challenges of working in a male-dominated industry, they have hope for the next generation of female cardiologists.
Unfair as it may be, you push through these biases by working harder, Ojutalayo explained. You go the extra mile to prove yourself. You utilize the resources around you the best that you can. Most of all, you value the people around you who see you, embrace your uniqueness and want to see you succeed.
The hope is that in the future that it might be a little different for those coming behind us, she added.
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Getting to the heart of it: Leading cardiologists share the journey of care - The Salem News
Women with hardened arteries may need stronger treatment to … – European Society of Cardiology
Barcelona, Spain 11 May 2023: Postmenopausal women with clogged arteries are at higher risk of heart attacks than men of similar age, according to research presented at EACVI 2023, a scientific congress of the European Society of Cardiology (ESC),1 and published in European Heart Journal - Cardiovascular Imaging.2 The study in nearly 25,000 adults used imaging techniques to examine the arteries and followed patients for heart attacks and death.
The study suggests that a given burden of atherosclerosis is riskier in postmenopausal women than it is in men of that age, said study author Dr. Sophie van Rosendael of Leiden University Medical Centre, The Netherlands. Since atherosclerotic plaque burden is emerging as a target to decide the intensity of therapy to prevent heart attacks, the findings may impact treatment. Our results indicate that after menopause, women may need a higher dose of statins or the addition of another lipid-lowering drug. More studies are needed to confirm these findings.
Atherosclerosis is the narrowing of arteries due to deposits of fat and cholesterol in what is called plaque. While young women do have heart attacks, in general, women develop atherosclerosis later in life than men and have heart attacks at an older age than men,3 in part because of the protective effect of oestrogen. This study examined whether the prognostic importance of atherosclerotic plaques are the same for women and men at different ages as this could be important for selecting treatments to prevent heart attacks.
The study included 24,950 patients referred for coronary computed tomography angiography (CCTA) and enrolled in the CONFIRM registry, which was conducted in six countries in North America, Europe, and Asia. CCTA is used to obtain 3D images of the arteries in the heart.
Total atherosclerotic burden was rated using the Leiden CCTA score, which incorporates the following items for each coronary segment: plaque presence (yes/no), composition (calcified, noncalcified or mixed), location, and severity of narrowing, for a final value of 0 to 42.4 Patients were divided into three categories previously found to predict the risk myocardial infarction: low atherosclerotic burden (0 to 5), medium (6 to 20) and high (over 20). In addition, obstructive coronary artery disease was defined as 50% narrowing or more.
The primary outcome was the difference in Leiden CCTA score between women and men of similar age. The investigators also analysed sex differences in the rates of major adverse cardiovascular events (MACE), which included all-cause death and myocardial infarction, after adjusting for age and cardiovascular risk factors (hypertension, high cholesterol, diabetes, current smoking and family history of coronary artery disease).
A total of 11,678 women (average age 58.5 years) and 13,272 men (average age 55.6 years) were followed for 3.7 years. Regarding the primary outcome, the study showed an approximately 12 year delay in the onset of coronary atherosclerosis in women: the median Leiden CCTA risk score was above zero at age 64 to 68 years in women versus 52 to 56 years in men (p<0.001). In addition, the overall plaque burden as quantified by the Leiden CCTA score was significantly lower in women, who had more non-obstructive disease.
Dr. van Rosendael said: The results confirm the previously reported delay in the start of atherosclerosis in women. We also found that women are more likely to have non-obstructive disease. It was formerly thought that only obstructive atherosclerosis caused myocardial infarction but we now know that non-obstructive disease is also risky.The burden of atherosclerosis was equally predictive of MACE in premenopausal women (aged under 55 years) and men of the same age group. However, in postmenopausal women (age 55 years and older), the risk of MACE was higher than men for a given score. In postmenopausal women, compared to those with a low burden, those with a medium and high burden had 2.21-fold and 6.11-fold higher risks of MACE. While in men aged 55 years and older, compared to those with a low burden, those with a medium and high burden had 1.57-fold and 2.25-fold greater risks of MACE.
Dr. van Rosendael said: In this study, the elevated risk for women versus men was especially observed in postmenopausal women with the highest Leiden CCTA score. This could be partly because the inner diameter of coronary arteries is smaller in women, meaning that the same amount of plaque could have a larger impact on blood flow. Our findings link the known acceleration of atherosclerosis development after menopause with a significant increase in relative risk for women compared to men, despite a similar burden of atherosclerotic disease. This may have implications for the intensity of medical treatment.
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Women with hardened arteries may need stronger treatment to ... - European Society of Cardiology
You are what you eat: healthier diet may improve fitness – European Society of Cardiology
Sophia Antipolis, 11 May 2023: A healthy diet is associated with greater physical fitness in middle-aged adults, according to research published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).1
This study provides some of the strongest and most rigorous data thus far to support the connection that better dietsmaylead to higher fitness, said study author Dr. Michael Mi of Beth Israel Deaconess Medical Center, Boston, US. The improvement in fitness we observed in participants with better diets was similar to the effect of taking 4,000 more steps each day.
Cardiorespiratory fitness reflects the bodys ability to provide and use oxygen for exercise, and it integrates the health of multiple organ systems, such as the heart, lungs, blood vessels and muscles. It is one of the most powerful predictors of longevity and health.2 While exercise increases cardiorespiratory fitness, it is also the case that among people who exercise the same amount, there are differences in fitness, suggesting that additional factors contribute. A nutritious diet is associated with numerous health benefits, but it has been unclear whether it is also related to fitness.
This study examined whether a healthy diet is associated with physical fitness in community-dwelling adults. The study included 2,380 individuals in the Framingham Heart Study. The average age was 54 years and 54% were women. Participants underwent a maximum effort cardiopulmonary exercise test on a cycle ergometer to measure peak VO2. This is the gold standard assessment of fitness and indicates the amount of oxygen used during the highest possible intensity exercise.
Participants also completed the Harvard semi-quantitative food frequency questionnaire to assess intake of 126 dietary items during the last year ranging from never or less than once per month to six or more servings per day. The information was used to rate diet quality using the Alternative Healthy Eating Index (AHEI; 0 to 110) and Mediterranean-style Diet Score (MDS; 0 to 25), which are both associated with heart health. Higher scores indicated a better quality diet emphasising vegetables, fruits, whole grains, nuts, legumes, fish and healthy fats and limiting red meat and alcohol.
The researchers evaluated the association between diet quality and fitness after controlling for other factors that could influence the relationship, including age, sex, total daily energy intake, body mass index, smoking status, cholesterol levels, blood pressure, diabetes and routine physical activity level. The average AHEI and MDS were 66.7 and 12.4, respectively. Compared with the average score, an increase of 13 points on the AHEI and 4.7 on the MDS was associated with a 5.2% and 4.5% greater peak VO2, respectively.3
Dr. Mi said: In middle-aged adults, healthy dietary patterns were strongly and favourably associated with fitness even after taking habitual activity levels into account. The relationship was similar in women and men, and more pronounced in those under 54 years of age compared to older adults.
To discover the potential mechanism linking diet and fitness, the researchers performed further analyses. They examined the relationship between diet quality, fitness and metabolites, which are substances produced during digestion and released into the blood during exercise. A total of 201 metabolites (e.g. amino acids) were measured in blood samples collected in a subset of 1,154 study participants. Some 24 metabolites were associated with either poor diet and fitness, or with favourable diet and fitness, after adjusting for the same factors considered in the previous analyses. Dr. Mi said: Our metabolite data suggest that eating healthily is associated with better metabolic health, which could be one possible way that it leads to improved fitness and ability to exercise.
Regarding limitations, he noted: This was an observational study and we cannot conclude that eating well causes better fitness, or exclude the possibility of a reverse relationship, i.e. that fit individuals choose to eat healthily.
Dr. Mi concluded: There are already many compelling health reasons to consume a high-quality diet, and we provide yet another one with its association with fitness. A Mediterranean-style diet with fresh, whole foods and minimal processed foods, red meat and alcohol is a great place to start.
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You are what you eat: healthier diet may improve fitness - European Society of Cardiology
Motherhood: The great balancing act – Parkview Health
This post was written by Kaity Brita, NP, PPG Cardiology.
I am a wife to a wonderful husband and mom to two sweet, energetic little girls (ages five and three). I also work full time. Like so many women, I am constantly juggling the demands of all of these roles, and spoiler alert: I dont have it all together. But what I can tell you, is that Im a work in progress, with a goal to be a better version of myself with every passing day.
Working in cardiology, I spend a lot of time focused on the biological function of the heart, but I would also argue that the theoretical aspects are just as critical. No matter where you are in your journey of motherhood, my hope is that I can offer you some tips to help optimize your physical, mental, spiritual and emotional health.
Helpful resources
Fort Wayne Parks Department has features parks and trails to enjoy as a family, as well as programs available in the area.
Mobile apps such as Headspace or Calm are great for incorporating meditation and/or more mindfulness.
The Parkview Center for Health Living offers classes, seminars and one-on-one instructional opportunities. You can always browse the calendar of Classes and Events on parkview.com.
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Single-Pill Antihypertensive Combinations Reduce CV Outcomes … – The Cardiology Advisor
Single-Pill Antihypertensive Combinations Reduce CV Outcomes ... The Cardiology Advisor
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Single-Pill Antihypertensive Combinations Reduce CV Outcomes ... - The Cardiology Advisor
Cardiology Insights from Payal Kohli, MD, FACC | Docwire News – DocWire News
DocWire News medical lead Payal Kohli, MD, FACC, is a noninvasive cardiologist and managing partner of Cherry Creek Heart in Denver, Colorado. Her clinical interests are in preventive cardiology, echocardiography and heart disease in women. She has spoken and presented internationally on cardiovascular clinical research, and has published work in leading journals, including JAMA,Lancet,Circulation, andJACC.
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Cardiology Insights from Payal Kohli, MD, FACC | Docwire News - DocWire News