MedscapeLIVE Cardiology Newsletter

November 2022

HOC Faculty Weigh In: The Upcoming HOC & Best Cases of 2022

Welcome to this month’s MedscapeLIVE! Cardiology E-News. In this issue, the faculty of Medscape’s upcoming Going Back to the Heart of Cardiology 2022 conference, which is December 3-5, come together and share a few pearls from their presentations, and also their most interesting cases of 2022—which make for pretty interesting and informative reading!
In our October issue, I spoke with Dr. Javed Butler, co-chair of Medscape’s Going Back to the Heart of Cardiology 2022 conference. If you missed it, you can view that interview here.
Also check out this issue’s Pulse, with articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine. 

Don’t miss it!—Register now for in-person or virtual attendance: 
Going Back to the Heart of Cardiology Conference (3rd Annual)

Saturday-Monday December 3-5, 2022; Hilton La Jolla Torrey Pines; San Diego, California

  • Cath Lab Challenge!: An Exclusive Virtual Interventional Session: Interventional cath lab teams from Columbia, Duke, Stanford, Vermont present/discuss innovative cases of best practice approaches to conquering novel and complex coronary, structural, and peripheral disease challenges.
  • Sessions 1-4: Heart Failure and Myocardial Disease; Rhythm Disorders: Atrial Fibrillation Insights and Case Considerations; Cardioprevention, CV Risk Reduction, and Cardiometabolic Updates; Arterial and Venous Disease: Key Insights
  • Register here: https://na.eventscloud.com/ereg/newreg.php?eventid=666012

Thank you to these doctors and faculty for sharing their presentation pearls and most interesting cases of the year. Don’t forget to check out details and the agenda for Medscape’s Going Back to the Heart of Cardiology 2022 conference and register here. Dr. Butler shared last month that, as a CME opportunity, the biggest value this meeting brings is that “In a short time frame, you literally get updated on most, if not all, of the major issues related to cardiovascular medicine… and that too by experts who are involved in the cutting-edge research.” Don’t miss it!
Contact me at [email protected] with any comments and/or suggestions. Happy Holidays! –Colleen Hutchinson

 
HOC Faculty Weigh In: The Best Cases of 2022

Colleen: What is your most interesting case in 2022? 
Dr. Nasrien Ibrahim:
To me the interesting thing about the case was the idea of second chances. A patient who had not done well with their 1st LVAD got a second chance at a second LVAD and is now thriving with a heart transplant. It's the idea of being forgiving and understanding that some individuals have the odds stacked against them and that we have a role in ensuring they have the tools needed to succeed. 

Dr. Geoff Barnes: Our PERT team was called to care for a patient with a massive/high-risk saddle PE who had been transferred from an outside hospital. Upon arrival, the patient was still intubated but had significantly improved hemodynamic measures and no longer required vasopressor support. There was no sign of right ventricular dysfunction on imaging at the time the patient arrived in our cardiac ICU. However, on echocardiogram, we noted a 5cm mass attached to the tricuspid valve and pacemaker lead. We underwent an exhaustive workup for signs of infection, all of which were unrevealing. After extensive discussion between the PERT members, including the ICU team, cardiac surgery, vascular medicine, infectious disease, and interventional radiology, our team elected to remove the thrombus using a catheter-based approach. This highlights the importance of multidisciplinary care.

Dr. Thomas Maddox: One of our astute ED colleagues picked up a very subtle, Type A Wellen’s pattern on a patient’s EKG.  Sure enough, when we got them into the lab, they had a sub-total proximal LAD plaque rupture.

Dr. Pamela Morris: Patient with severe primary biliary cirrhosis with severe hyperlipidemia due to lipoprotein X—masquerading as familial hypercholesterolemia.

Dr. Sheldon Litwin: I recently had followup with a woman who has heart failure with preserved ejection fraction (HFpEF). I first met her several years ago when she was hospitalized for acute decompensated heart failure. She had multiple HF hospitalizations over the preceding 2 years and was increasingly refractory to diuretics (including high dose loop diuretics given by continuous infusion). Her serum creatinine level had risen to > 4 and she was still functional class 4 and severely volume overloaded. She also had moderate right ventricular dysfunction and moderate tricuspid regurgitation. We were considering palliative care but decided to do a trial of intravenous dobutamine in hopes of improving LV relaxation, right ventricular function, and renal blood flow. She had a very dramatic improvement and eventually was discharged to home with continuous inotropic therapy delivered by a small infusion pump. She did remarkably well with creatinine coming down to ~ 2, resolution of peripheral edema, improvement of RV function and TR by echo, and improvement to functional class 1. She has now maintained her good functional status and has a very good quality of life. I have offered her the option of stopping the infusion to see if she can get by without it, and she has respectfully declined. 

Dr. Anne Curtis: I recently cared for a 20-year-old transgender male who complained of palpitations. His symptoms could have easily been written off as inappropriate sinus tachycardia. However, a Holter monitor showed long episodes of a narrow complex tachycardia at 120 bpm with a subtle difference in P wave compared to sinus rhythm. He will be undergoing catheter ablation in the near future, and we expect to be able to cure him.

Dr. Robert Eckel: This 54-year-old woman with a strong FHx of T2DM and CVD has new onset T2DM, treated hypertension, dyslipidemia on statin, and is referred for evaluation of cardiometabolic risk for CVD.  She has known treated hypothyroidism and obstructive sleep apnea on CPAP. No tobacco, rare alcohol, on South Beach diet, almost no physical activity, and works at a desk job. Lisinopril 20 mg daily, Levothyroxine 100 mg daily, Atorvastatin 40 mg daily, Metformin, 500 mg bid. She weighs 179 lbs., WC – 96 cm, BMI 29.5 kg/m2, BP 142/82, Cholesterol – 210 mg/dL, TG – 340 mg/dL, HDL-C – 38 mg/dL, LDL-C – 104 mg/dL, Creatinine 1.0 mg/dL, UAC – 75 mg/g, HbA1c – 7.4%, TSH – 1.6 mU/L. What would be most important in the evaluation and treatment of this patient with moderate hypertriglyceridemia: Reducing the HbA1c to <7.0%?; Reducing fasting TG to <150 mg/dL?; Weight reduction?; Measuring apo B?; Reducing LDL-C to <70 mg/dL?

Dr. Javed Butler: Acute myocarditis in shock - recovered to totally normal EF, young patient.

Colleen: What is one pearl from your upcoming presentation at the HOC 2022? 
Dr. Anne Curtis:
In patients with atrial fibrillation undergoing percutaneous coronary intervention for acute coronary syndrome, triple therapy should be used in most patients for less than one week, discontinuing aspirin at that point and continuing clopidogrel and a direct oral anticoagulant.

Dr. Javed Butler: Device therapy in HF should be considered upstream and not only as a last resort treatment.

Dr. Nasrien Ibrahim: Every patient with HFrEF should be on a 4-drug regimen! Initiate early and titrate rapidly. 

Dr. Sheldon Litwin: Obesity is the single most important driver of cardiovascular disease in 2022. It is a major risk factor for coronary artery disease, atrial fibrillation, and most importantly congestive heart failure. Significant obesity complicates the diagnosis and treatment of most cardiovascular conditions. As a group, cardiovascular providers have not addressed obesity as a cardiovascular problem. There are effective and safe pharmacological and surgical approaches to the treatment of obesity. Although most CV practitioners are uncomfortable prescribing weight loss agents, fears about safety tend to be overstated and some of the older medications are quite inexpensive and easy to use. It is time for us to step up as a group and tackle obesity as a cardiovascular disease.

Dr. Geoff Barnes: One takeaway from my lecture is that both PCCs and andexanet alpha have been shown to be effective at “reversing” DOAC-related life-threatening bleeding. However, these patients remain very high risk for thrombotic complications after acute management of their bleeding condition. So, consider when anticoagulation can be re-initiated to prevention subsequent stroke and other thrombotic events.

Dr. Pamela Morris: Newer guidance recommends even lower levels of LDL-C in patients at very high risk (less than 55 mg/dL), as well as for those with extensive subclinical atherosclerosis (“primary prevention and a half”—less than 70 mg/dL).

Dr. Robert Eckel: It’s time to develop a new medical subspeciality – Cardiometabolic Medicine.

Dr. Thomas Maddox: Digital home monitoring is really starting to mature to into an effective management tool for HF patients.

 

The Pulse

European Heart Journal Article: Heart failure in cardio-oncology and adult congenital heart disease: new challenges and therapeutic targets
https://academic.oup.com/eurheartj/article/43/42/4443/6806189?searchresult=1

Circulation: Arrhythmia and Electrophysiology Editorial: What Is the Threshold for Dyssynchrony in Patients Undergoing Atrioventricular Junction Ablation for Atrial Fibrillation?
https://www.ahajournals.org/doi/10.1161/CIRCEP.122.011515

JAMA Cardiology Original Investigation: Professional Preferences and Perceptions of Cardiology Among Internal Medicine Residents: Temporal Trends Over the Past Decade
https://jamanetwork.com/journals/jamacardiology/article-abstract/2797068

Cardiology News: First-line AFib ablation cuts risk of progression vs. drug therapy
https://www.mdedge.com/cardiology/article/259383/arrhythmias-ep/first-line-afib-ablation-cuts-risk-progression-vs-drug

The 2022 3rd Annual Going Back to the Heart of Cardiology: 
https://na.eventscloud.com/website/36345/

JACC Original Investigation: Hospitalizations and Mortality in Patients With Secondary Mitral Regurgitation and Heart Failure: The COAPT Trial
https://www.sciencedirect.com/science/article/abs/pii/S0735109722068334

NEJM Editorial: Defibrillation after Cardiac Arrest — Is It Time to Change Practice?
https://www.nejm.org/doi/full/10.1056/NEJMe2213562?query=recirc_top_ribbon_article_1

Medical Intelligence Quiz: Fast Facts Friday
https://www.mdedge.com/cardiology/quiz/11902/fast-facts-friday/fast-facts-friday-november-11-2022?channel=59610

Cardiology News: Tirzepatide lowers weight across all groups with obesity
https://www.mdedge.com/cardiology/article/259375/obesity/tirzepatide-lowers-weight-across-all-groups-obesity

Circulation: Heart Failure Article: Quality of Life Trajectory and Its Mediators in Older Patients With Acute Decompensated Heart Failure Receiving a Multi-Domain Rehabilitation Intervention: Results From the Rehabilitation Therapy in Older Acute Heart Failure Patients Trial 
https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.122.009695

 

October 2022

Hot Topics in Cardiology: Catching Up with Javed Butler, MD, MBA, MPH

Welcome back to this month’s MedscapeLIVE! Cardiology E-News. This month I speak with Dr. Javed Butler, who serves as co-chair of Medscape’s Going Back to the Heart of Cardiology 2022 conference. Dr. Butler is the President, Baylor Scott and White Research Institute, Dallas, Texas. We discussed some upcoming conference highlights, some pearls from his talk, The Present and Future of Device-Based Care in HF, and what’s new to share within the Session 1 focus of Heart Failure and Myocardial Disease.

In our September issue, I spoke with Dr. Fatima Rodriguez—faculty co-chair of Going Back to the Heart of Cardiology 2022. If you missed that interview, you can view it here.
Also check out this issue’s Pulse, with articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine. 

Housekeeping on CME opportunities—register and add this to your calendar:
Going Back to the Heart of Cardiology Conference (3rd Annual)
Saturday-Monday December 3-5, 2022; Hilton La Jolla Torrey Pines; San Diego, California

  • Cath Lab Challenge!: An Exclusive Virtual Interventional Session: Interventional cath lab teams from Columbia, Duke, Stanford, Vermont present/discuss innovative cases of best practice approaches to conquering novel and complex coronary, structural, and peripheral disease challenges.
  • Sessions 1-4: Heart Failure and Myocardial Disease; Rhythm Disorders: Atrial Fibrillation Insights and Case Considerations; Cardioprevention, CV Risk Reduction, and Cardiometabolic Updates; Arterial and Venous Disease: Key Insights
  • Register here: https://na.eventscloud.com/ereg/newreg.php?eventid=666012

Thank you to Dr. Butler for sharing his time and expertise in this interview. Don’t forget to check out details for Medscape’s Going Back to the Heart of Cardiology 2022 conference and register here. Please contact me at [email protected] with any comments and/or suggestions. Happy Halloween!

–Colleen Hutchinson

 

Interview: Catching Up with Javed Butler, MD, MBA, MPH

Dr. Butler is the President, Baylor Scott and White Research Institute, Dallas, Texas and serves as Co-Chair of the 3rd Annual Going Back to the Heart of Cardiology conference.

Colleen: At Medscape’s 3rd Annual Going Back to the Heart of Cardiology conference, you are a conference co-chair. What are some of the highlights of this conference that you feel will be of import to attendees?
Dr. Butler: I think the biggest value this meeting brings is that, in the short time frame, you literally get updated on most, if not all, of the major issues related to cardiovascular medicine - and that too by experts who are involved in the cutting-edge research.

Colleen: You are presenting on The Present and Future of Device-Based Care in HF. What are some takeaways you will share?
Dr. Butler:
The main takeaway is that there is a significant persistent residual risk for patients with heart failure despite advances in medical therapy, which underscores the need for innovation in both drug- and device-based therapies. Traditionally, many devices were developed for advanced end-stage disease, but now many newer devices are focused on both management protocols for patients as well as disease modification at an earlier stage.

Colleen: Last year you presented on Breakthroughs in HFrEF: New and Emerging Treatment Strategies for Advanced Disease. This year, Session 1 is Heart Failure and Myocardial Disease. Is there much new to share on this topic?
Dr. Butler: Both the ACC/AHA/HFSA and the ESC guidelines have since come out, as well as new secondary analyses from major HFrEF clinical trials—so this session will highlight all of the latest knowledge bases, as well as what the guidelines are suggesting.

 
The Pulse

European Heart Journal Article: New tools to predict and new therapeutic targets to treat life-threatening ventricular arrhythmias
https://academic.oup.com/eurheartj/article/43/40/3983/6764845

Circulation: Cardiovascular Intervention Original Investigation: First-in-Human Undermining Iatrogenic Coronary Obstruction With Radiofrequency Needle (UNICORN) Procedure During Valve-in-Valve Transcatheter Aortic Valve Replacement
https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.122.012399

JAMA Cardiology Original Investigation: Catheter-Directed Thrombolysis vs Anticoagulation in Patients With Acute Intermediate-High–risk Pulmonary Embolism: The CANARY Randomized Clinical Trial
https://jamanetwork.com/journals/jamacardiology/article-abstract/2797198

Cardiology News: Early estrogen loss increases cardiovascular risk in women
https://www.mdedge.com

The 2022 3rd Annual Going Back to the Heart of Cardiology: 
https://na.eventscloud.com/website/36345/

JACC Original Investigation: Atrial Fibrillation and Dapagliflozin Efficacy in Patients With Preserved or Mildly Reduced Ejection Fractions
https://www.sciencedirect.com/science/article/pii/S0735109722065299

NEJM Perspective: Atrial Fibrillation — What Is It and How Is It Treated?
https://www.nejm.org/doi/full/10.1056/NEJMp2212939

Medical Intelligence Quiz:
https://www.mdedge.com/cardiology/quiz/11878/fast-facts-friday/fast-facts-friday-october-28-2022

Circulation: Heart Failure Article: Health of the Food Environment Is Associated With Heart Failure Mortality in the United States
https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.122.009651

 

 

September 2022

Hot Topics with Dr. Fatima Rodriguez

Welcome back to this month’s MedscapeLIVE! Cardiology E-News. This issue I speak with Dr. Fatima Rodriguez, Assistant Professor in Cardiovascular Medicine at Stanford Prevention Research Center, Stanford, California. She is also the Associate Editor of the NEJM Journal Watch and serves as Co-Chair with Robert Harrington, MD, of the 3rd Annual Going Back to the Heart of Cardiology conference. Dr. Rodriguez shares her thoughts on the upcoming meeting and what will be new and unique there, the conundrum of racial and ethnic disparities in cardiac care, the most impactful recent research in her body of work, thoughts on peer review, and structural discrimination in fellowship recruitment in cardiology—let’s dismantle it!
Also check out this issue’s Pulse, with articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine. 

Housekeeping on CME opportunities—register and add this to your calendar:
Going Back to the Heart of Cardiology Conference (3rd Annual)
Saturday-Monday December 3-5, 2022; Hilton La Jolla Torrey Pines; San Diego, California

  • Cath Lab Challenge: An Exclusive Virtual Interventional Session: Interventional cath lab teams from Columbia, Duke, Stanford, Vermont present/discuss innovative cases of best practice approaches to conquering novel and complex coronary, structural, and peripheral disease challenges.
  • Sessions 1-4: Heart Failure and Myocardial Disease; Rhythm Disorders: Atrial Fibrillation Insights and Case Considerations; Cardioprevention, CV Risk Reduction, and Cardiometabolic Updates; Antithrombotic Therapy in Arterial and Venous Disease: Key Insights
  • Register here: https://na.eventscloud.com/ereg/newreg.php?eventid=666012

A special thank you to Dr. Rodriguez for sharing her time and insights on these topics! Please contact me at [email protected] with any comments and/or suggestions.

Colleen Hutchinson

 

Interview: Dr. Fatima Rodriguez

Fatima Rodriguez, MD, MPH, is Assistant Professor in Cardiovascular Medicine, Stanford Prevention Research Center, Stanford, California. She is also the Associate Editor of NEJM Journal Watch and serves as Co-Chair with Robert Harrington, MD, of the 3rd Annual Going Back to the Heart of Cardiology conference.

As co-chair of this year’s Going Back to the Heart of Cardiology conference, how might it be different than from meetings past, and what are some of the hottest topics to which we can look forward?
Dr. Rodriguez:
Bob and I are excited to finally be back in person to host this year’s Going Back to the Heart of Cardiology in sunny San Diego, CA! One of the most exciting things about cardiology is that practice-changing evidence is rapidly generated across all disciplines in our specialty. Heart failure in particular has a center spotlight this year with the evolving, changing therapeutic options and opportunities to improve use and adherence to guideline-directed therapy. Of course, I’m always partial to cardiovascular disease prevention, and there are some great sessions on how we can reduce residual cardiovascular disease risk and antiplatelets in secondary prevention. In addition to reviewing new clinical trial data and clinical practice guidelines, this year we will also have a strong focus on health equity and increasing diversity in our professional lives. 

You’ve co-authored quite a few papers in the last few years. What is some of your most recent research that you feel will be impactful in the care of your (and others’) patients?
Dr. Rodriguez:
I’m fortunate to work with a wonderful group of collaborators, mentors, and trainees to answer research questions related to improving cardiovascular disease prevention and promoting cardiovascular health. I’m very excited about ongoing collaborations with biomedical informatics colleagues at Stanford University using electronic health records to better understand and tackle barriers to guideline-directed care for prevention. 
We are also working on opportunistic screening for incidental coronary calcium on CT scans done for other purposes. This is information that already exists and is largely unused in helping patients and clinicians engage in shared decision-making about preventive therapies to reduce cardiovascular risk and events. Finally, we are studying how we can optimize the delivery of telehealth to improve access to cardiovascular care for patients with limited English proficiency and with other barriers to digital inclusion. 

In our May issue, Dr. Ileana Piña interviewed Dr. Deborah Crabbe, a non-invasive cardiologist but also founder of the Collaborative for Cardiovascular Health Equity. How would you summarize the current state of cardiac care as it pertains to racial and ethnic disparities and improving the care of diverse patients? Is everybody doing as much as they can be? Industry, medical associations, hospitals?  
Dr. Rodriguez: This is a terrific question and one that I spend a lot of time thinking about as a cardiologist and researcher in this space. The short answer is that we need to do more and focus on equity, not as an afterthought, but as a critical component of all that we do in cardiac care. We are not doing enough, but I am optimistic that all sectors are moving in the right direction given the national spotlight on this issue following the COVID-19 pandemic. The time to act is now. 

As Associate Editor of NEJM Journal Watch, what are your thoughts on peer review, and where improvements in the process of medical publishing can be made (if any)?
Dr. Rodriguez:
The peer-review process is an important step in ensuring scientific integrity and reproducibility of our studies. However, there are many ways in which it can be improved. 
I think individuals should get compensated for peer-review (financially and through academic advancement), journals should have diverse intellectual input in their editorial boards, and the turnaround on reviewing high-impact science should be much faster. 

What can be done to dismantle structural discrimination in fellowship recruitment in cardiology? (JAMA Netw Open. 2021;4(1):e2031473)
Dr. Rodriguez:
Structural racism is unfortunately pervasive in every aspect of our personal and professional lives. For fellowship recruitment in cardiology, there are several best practices to try to mitigate its effect. First, it is important that we consider holistic review of fellowship applicants. Lived experiences matter for the care of our patients and diversity in our fellowship classes equates with excellence and innovation. Second, interviewers should all engage in anti-bias training prior to talking with applicants. We all have biases and need to recognize and check them. Third, efforts to improve diversity must be intentional, with transparent metrics to measure successes and areas in need of improvement. For example, Duke University recently published data on a program that effectively increased enrollment of women and underrepresented groups into their fellowship program (Rymer et. al). Finally, structural changes are needed to create a culture and climate in the cardiology workplace that is welcoming to all individuals. 

 

The Pulse

European Heart Journal Article: Atrial fibrillation and heart failure: novel insights into the chicken and egg dilemma
https://academic.oup.com/eurheartj/article-abstract/43/36/3376/6599046?redirectedFrom=fulltext

Circulation: Cardiovascular Intervention Original Investigation: Combined Analysis of Two Parallel Randomized Trials of Sirolimus-Coated and Paclitaxel-Coated Balloons in Coronary In-Stent Restenosis Lesions
https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.122.012305

JAMA Cardiology Original Investigation: Self-expanding Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients  
https://jamanetwork.com

Cardiology News: Early or delayed menopause and irregular periods tied to new-onset atrial fibrillation
https://www.mdedge.com

The 2022 3rd Annual Going Back to the Heart of Cardiology: 
https://na.eventscloud.com/website/36345/

JAMA Cardiology Original Investigation: Aspirin for Primary Prevention of Cardiovascular Events in Relation to Lipoprotein(a) Genotypes
https://www.sciencedirect.com/science/article/abs/pii/S0735109722057205

NEJM Original Article: Cerebral Embolic Protection during Transcatheter Aortic-Valve Replacement
https://www.nejm.org/doi/full/10.1056/NEJMoa2204961?query=featured_cardiology

Medical Intelligence Quiz: Nutrition for chronic heart failure inpatients
https://www.mdedge.com/

Circulation: Heart Failure Article: Proteomic Analysis of Effects of Spironolactone in Heart Failure With Preserved Ejection Fraction
https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.121.009693

European Heart Journal Article: Pulmonary hypertension, sarcoidosis, and inflammatory and dilated cardiomyopathy: new light shed on prevalence, mechanisms, and treatment
https://academic.oup.com/eurheartj/article/43/36/3371/6708324

 

 

August 2022

Discussion with Dr. Malissa Wood: Cardiology and Gender: How Are Mars and Venus Different?

Welcome back to this month’s MedscapeLIVE! Cardiology E-News. This issue I speak with Dr. Malissa Wood, cardiologist and clinical researcher, as well as Associate Chief of Cardiology for Diversity and Health Equity, at Massachusetts General Hospital and Associate Professor of Medicine at Harvard Medical School. Her research focuses on ischemic heart disease in women with a focus on spontaneous coronary artery dissection. Dr. Wood is also the Chair of the Board of Governors and Trustee of the American College of Cardiology.

Also check out this issue’s Pulse, with articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine. 
Don’t forget to check out details of the upcoming 2022 3rd Annual Going Back to the Heart of Cardiology conference here. 
A special thank you to Dr. Wood for sharing her time and insights on these topics! Please contact me at [email protected] with any comments and/or suggestions.

–Colleen Hutchinson

 

Interview: Malissa J. Wood

Dr. Wood is a cardiologist and clinical researcher at Massachusetts General Hospital. Her research focuses on ischemic heart disease in women with a focus on spontaneous coronary artery dissection. She is an Associate Profess of Medicine at Harvard Medical School and is the Associate Chief of Cardiology for Diversity and Health Equity at MGH. She is also the Chair of the Board of Governors and Trustee of the American College of Cardiology.

Colleen: Dr. Wood, you recently coauthored “Echocardiography in Women: How Are Mars and Venus Different?” So…how are they different?!?
Dr. Wood:
Echocardiography has allowed us to identify distinct structural and physiologic cardiac differences between men and women. Even when body surface area is accounted for, women have smaller left ventricular (LV) chambers and stroke volumes, a tendency toward concentric LV remodeling with preservation of ventricular function, and greater arterial stiffness when compared to men. Women are also more likely to exhibit higher ejection fractions in the presence of valvular regurgitation, yet the cardiac thresholds for treatment in the guidelines do not distinguish between the sexes. In this paper we endorse the creation of sex-specific algorithms in future expert consensus documents guiding the diagnosis and treatment of valvular heart disease, heart failure, and thoracic aortic disease.

Colleen: You also recently published the article, “Does Patient-Physician Gender Concordance Influence Patient Perceptions or Outcomes?” in the Journal of the American College of Cardiology. What are the takeaways?
Dr. Wood: Cardiologists and underrepresented in medicine groups (URiM) also continue to be under-represented in cardiology compared with the demographics of the patients we care for. In this paper, we discussed the potential favorable impact gender concordance may have on overall cardiovascular outcomes. We recognize that there currently have been very few studies performed to examine the impact of patient-provider gender concordance on outcomes. We therefore emphasized the need for further investigation into the impact of concordance on patient outcomes and explore the potential mechanisms responsible for this favorable impact. We suggested the following: 1) Continued efforts to increase gender diversity in the physician workforce; 2) Development of gender- and sex-specific medical education; and 3) Ongoing research in this area. This discussion of concordance of course also likely applies to racial and ethnic concordance as well.

Colleen: What are your thoughts on gender differences in publication authorship?
Dr. Wood:
Females remain underrepresented in cardiovascular medicine; therefore, it should come as no surprise that females remain underrepresented in senior authorship roles on clinical guidelines, scientific statements, and research publications. As we become more successful in recruiting women to cardiovascular medicine, hopefully more women will take on senior roles in authorship. We need more male allies and upstanders to promote the careers of their female colleagues.

Colleen: What solutions have you found in balancing family and career?
Dr. Wood:
For those also responsible for caring for loved ones at home, make sure things are taken care of at home so that you can focus while at work. Find trustworthy, capable people to help manage your home, treat them well, and let them know they are appreciated! I have also learned to be comfortable with the concept of sequencing- the idea that we can achieve many things, but we cannot achieve them all at the same time! 

Colleen: Your recent article, “Childbearing Among Women Cardiologists: The Interface of Experience, Impact, and the Law,” was published in Journal of the American College of Cardiology. What can be done to address the need regarding childbearing and improve the professional and personal lives of women cardiologists, plus attractiveness of cardiology to potential trainees? 
Dr. Wood: Fair, consistent, parental leave policies must be created and implemented as they have been for years in other fields. Flexible career options should also be created to allow parents to continue to work while recognizing that they may need more time to attend to the needs of their families. There also needs to be zero tolerance for unfair and illegal leave practices, which have largely targeted young mothers. Many states are now also supporting family leave policies. This is another area where advocacy can have an impact. I encourage the readers to familiarize themselves with the policies in their state and to advocate on a state and federal level for uniform parental leave policies similar to those that have been present for years in Canada and many other countries around the globe. 

 

Rapid Fire:

Biggest, or one of the biggest, honors of my career to date: AHA Mentorship for Women Award (2013), Cathy E Minehan Endowed Chair for Cardiovascular Disease in Women 
Best tool in my clinical arsenal: My ears—listening is a critical clinical skill—both for listening to the patient’s history and for cardiac auscultation when performing a physical examination. Listening is a skill that remains underutilized today.    
Most challenging issue my counterparts and I face today: Volume of administrative tasks that take us away from direct patient care.
Genes and the development of SCAD: The key to unlocking potential therapies. 
Most critical new advance in my area of medicine: Non-invasive imaging of the coronary arteries.
Advice for junior members in the field: Follow your passion!
Habit that helps you be productive: Daily exercise and meditation.

 

The Pulse

European Heart Journal Article: A focus on congenital heart disease and neonatal cardiac regeneration: an exciting future
https://academic.oup.com/eurheartj/article/43/28/2643/6646499

Circulation: Cardiovascular Intervention Original Investigation: Risk Prediction in Percutaneous Coronary Intervention: Solving the Last Mile Problem
https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.122.012262

JAMA Cardiology Original Investigation: Association Between Early Left Ventricular Ejection Fraction Improvement After Transcatheter Aortic Valve Replacement and 5-Year Clinical Outcomes
https://jamanetwork.com/journals/jamacardiology/article-abstract/2794436

Cardiology News: RADIANCE II: Positive signal for ultrasound renal denervation
https://www.mdedge.com/cardiology/article/256580/hypertension/radiance-ii-positive-signal-ultrasound-renal-denervation

The 2022 3rd Annual Going Back to the Heart of Cardiology: 
https://na.eventscloud.com/website/36345/

JAMA Cardiology Original Investigation: Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest: Results of the Randomized, Multicentric EMERGE Trial
https://www.sciencedirect.com/science/article/abs/pii/S0735109722048173

NEJM Original Article: Empagliflozin in Heart Failure with a Preserved Ejection Fraction
https://www.nejm.org/doi/full/10.1056/NEJMoa2107038

Medical Intelligence Quiz: Valvular AFib in TAVR
https://www.mdedge.com/cardiology/quiz/9826/arrhythmias-ep/valvular-afib-tavr?channel=185

Circulation: Heart Failure Article: Trending Cardiac Biomarkers During Pregnancy in Women With Cardiovascular Disease
https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.121.009018

European Heart Journal Article: The promise of the metaverse in cardiovascular health
https://academic.oup.com/eurheartj/article/43/28/2647/6590383
 

 

 

July 2022

Discussion with Dr. Harriette Van Spall: Optimizing Heart Failure and Trial Design, The Need for A Medical Publishing Overhaul, Facing Institutionalized Sexism, and what’s behind the CCS/CHFS Heart Failure Guidelines Update 

Welcome back to this month’s MedscapeLIVE! Cardiology E-News. This issue I speak with Dr. Harriette Van Spall, a cardiologist, data scientist, and clinical trialist, with expertise in heart failure, health research methods, and implementation science. Her research is funded by the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada. We cover several topics, including optimizing heart failure and trial design, the need for a medical publishing overhaul, the CCS/CHFS Heart Failure Guidelines Update—what does it mean for us?, women researchers facing institutionalized sexism, and her recent article, “Heart failure with preserved ejection fraction: recent concepts in diagnosis, mechanisms and management” published in Heart.
This issue’s Pulse includes articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine. 
Don’t forget to check out details of the upcoming 2022 3rd Annual Going Back to the Heart of Cardiology conference here. 
A special thank you to Dr. Van Spall for sharing her time and insights on these topics! Please contact me at [email protected] with any comments and/or suggestions.

–Colleen Hutchinson

 

Colleen: Dr. Van Spall, you recently coauthored “CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure with Reduced Ejection Fraction.” What does this guidelines update mean for practicing clinicians?
Dr. Van Spall: The CCS/CHFS HF guidelines may have been one of the first in the world to recommend simultaneous, rather than sequential, initiation and uptitration of the 4 classes of evidence-based HFrEF pharmacotherapies. We recommended the simultaneous initiation of B-blockers, ARNI/ACEi/ARB, MRA, and SGLT2i rather than the historic approach of initiating and uptitrating individual classes, reassessing the patient’s symptoms, and then determining whether another class ought to be initiated. These guidelines also offer the option of initiating ARNI instead of ACEi/ARB as first line RAASi therapy. 
https://www.onlinecjc.ca/article/S0828-282X(21)00055-6/fulltext

Colleen: You also recently published the article, “Heart failure with preserved ejection fraction: recent concepts in diagnosis, mechanisms and management,” in Heart. What are the takeaways?
Dr. Van Spall: While the classification of HF has relied heavily on cut-points in LVEF, recent evidence points toward a gradual shift in underlying mechanisms, phenotypes, and response to therapies as LVEF increases. For example, among patients with HF, the proportion of hospitalizations and deaths due to cardiac causes decreases as LVEF increases. Medication classes that are efficacious in HFrEF have been less so at higher LVEF ranges, decreasing the risk of HF hospitalization but not cardiovascular or all-cause death in HFpEF. These observations reflect the burden of non-cardiac comorbidities and change in cardiac and noncardiac pathophysiological mechanisms as EF increases. There are knowledge gaps in the pathophysiology and mechanism of HF beyond an LVEF of 60%, and there appears to be little response to HF therapies in this range of EF.

In trials that include patients with HF and mildly reduced and preserved EF, treatment with SGLT2i decreases the risk of composite cardiovascular events, driven by a reduction in HF hospitalizations; RAASi and MRAs result in smaller reductions in HF hospitalisations among such patients. The effect of beta blockers in these patients is unclear.

Comprehensive management of HFpEF includes exercise as well as treatment of risk factors and comorbidities. Obesity and hypertension are important modifiable risk factors for the primary prevention of HF, where our efforts must lie.
https://heart.bmj.com/content/early/2022/01/11/heartjnl-2021-319605

Colleen: Clinical trial leadership has traditionally been made up of older men. How will changing that tradition affect the way clinical trials are performed?
Dr. Van Spall: Leadership and advancement in research relies on informal networks and alliances that often work best for men. Even in our generation, we see researchers and colleagues publish men-only research manuscripts and trial steering committees comprised of men. A vast majority of clinical trials continue to be led by men.
Our work has shown that compared to clinical trials with male senior authors, those with female senior authors are more likely to have women first authors. Women-led trials have more women in their steering committees, and more women and Black, Indigenous, and people of color enrolled as participants. Thus, recruiting and retaining women clinical trialists may build capacity for clinical trial leadership among more women and increase the gender diversity on trial authorship and executive teams. In addition, it may facilitate enrollment of more diverse participants in clinical trials.
https://www.jacc.org/doi/abs/10.1016/j.jacc.2020.08.062
https://www.ahajournals.org
https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.121.008685
https://onlinelibrary.wiley.com/doi/10.1002/ejhf.2034
 
Colleen: What solutions might be explored to address the inequities of clinical trial leadership?
Dr. Van Spall:
We proposed multi-level strategies to close the gender gap in clinical trial leadership in a recent publication. I will focus here on what institutions must do to create a level playing field for their researchers to have equal opportunity to ascend to positions of leadership.

  1. Purposeful recruitment, retention, and promotion policies that reduce biases against and barriers to the advancement of women 
  2. Mentorship and sponsorship programs for women researchers
  3. Open calls and fair processes for research access to datasets, funding opportunities, and research chairs
  4. Equal pay and resources for equal work – this means equal research time and salary support for investigators regardless of demographic
  5. Transparent reporting of gender-disaggregated metrics on recruitment, research salary support, research awards, and promotions 
  6. Transparent reporting of gender-disaggregated metrics on trial leadership committees, including Principal Investigators, and Steering Committees, Data Safety Monitoring Boards, and Event Adjudication Committees
  7. Gender transformative policies to harness the potential of diverse investigators, with organizational cultures that recognize and stop bullying, harassment, and discrimination. https://www.jacc.org/doi/abs/10.1016/j.jacc.2021.04.038

Colleen: How do women and men differ in heart failure?
Dr. Van Spall: There are sex or biological differences that influence the incidence and treatment response in heart failure. The top cause of HF in males across the world is ischemic heart disease, and the top cause in females is hypertensive heart disease. There are some risk factors unique in females, including hypertensive disorders of pregnancy, gestational diabetes, and peripartum cardiomyopathy. Because of the protective effect of estrogen and lower prevalence of ischemic heart disease at a younger age, females are older at the time of HF diagnosis than are males. Because of the differences in underlying etiology, females have a preponderance for HF with preserved EF, and males have a preponderance for HF with reduced EF. 
Females appear to respond to RAASi therapy at higher EF thresholds than males. They may also experience more harm from digoxin than males do. They may be more responsive to CRT therapy than males. Females have higher rates of survival than males when hospitalized for HF but are at higher risk of stroke than males in the setting of atrial fibrillation. This may be related to underutilization of anticoagulation in females.
The terms ‘women’ and ‘men’ refer to gender rather than sex, and gender can be associated with disparities in healthcare. Women are less likely to receive invasive care, transplant referrals, and specialized HF services than men. Because they are older at the time of diagnosis, they may be predeceased by their spouse and require greater social supports or healthcare services. They may experience worse quality of life during hospitalization and experience greater clinical benefit from supportive healthcare services following discharge from the hospital. 

https://www.onlinecjc.ca/article/S0828-282X(20)31196-X/fulltext
https://jamanetwork.com/journals/jama/fullarticle/2725688
https://pubmed.ncbi.nlm.nih.gov/34302417/ 
https://www.ahajournals.org/doi/full/10.1161/CIRCHEARTFAILURE.121.008548
https://www.ahajournals.org/doi/10.1161/JAHA.120.018495

Colleen: I see you published an interesting article, “Medical publishing under review,” in the European Heart Journal. Is it time for an overhaul?
Dr. Van Spall:
Yes. We would do well to standardize submission formats and turnaround times for peer reviews, adopt checklists to improve the quality of peer review, consider peer reviews and responses from rejected submissions to other journals, and implement blinded reviews. We can capitalize on technology to detect research fraud, duplication, and plagiarism. There are additional strategies we could adopt to move power back from journals to scientists who bear the costs of research, publication, and subscription but have no control over the process or timelines of publication.
https://academic.oup.com/eurheartj/article/42/7/723/5998965?login=false

 

Rapid Fire 

Biggest, or one of the biggest, honors of my career to date:
Dr. Van Spall:
This week, I was surprised to receive a national, peer-reviewed research award in cardiovascular sciences, a recognition that I would never have dreamed I could achieve. It has not been announced publicly yet, so I shall keep the name under wraps. I’m grateful to the person from another institute who nominated me for it. And I’m grateful for every research grant and award I’ve received to date, as each facilitates growth for my program and my mentees.
Best tool in my clinical arsenal:
Dr. Van Spall:
The preventable death of my father who didn’t receive timely coronary revascularization for high-risk multivessel disease when I was a cardiology trainee has left me with a unique perspective on what we ought to do better for patients. My best tool may be the skill of listening to and advocating for the patient and family member. Algorithms and risk tools can further augment clinical decision making and help remove some of the biases that fool us as clinicians. 
Most challenging issue my counterparts and I face today: 
Dr. Van Spall:
Across the world, women researchers face institutionalized sexism. Women often receive less research opportunity and salary support than their men counterparts. Many women quietly suffer through gender discrimination and harassment in their workplaces. Women who exhibit intellectual independence and leadership, or who don’t adhere to gender norms, appear to be at particular risk of this.
Social media platforms for knowledge translation in HF: 
Dr. Van Spall:
Twitter (I can’t manage more than one)
Sex-specific guidelines for cardiovascular disease: 
Dr. Van Spall: Yes, but we need more balanced clinical trial recruitment and meaningful sex-specific subgroup analysis to inform these. One way of achieving this is to stop automatically excluding women of childbearing years, who are pregnant, or who are lactating from clinical trial participation.
Most critical new advance in my area of medicine: 
Dr. Van Spall:
Digital health technology has transformed the way we store and access health records, deliver health care, and engage patients in self-management and self-care. As a class of medications, SGLT2 inhibitors have been groundbreaking in treating heart failure and chronic kidney disease and in preventing heart failure in patients with diabetes and cardiovascular disease. 

 

The Pulse

European Heart Journal Article: Cardiac magnetic resonance: challenges, opportunities, and developments
https://academic.oup.com/eurheartj/article/43/26/2427/6628726

Circulation: Cardiovascular Intervention Original Investigation: Reduction of Gastrointestinal Bleeding in Patients with Heyde Syndrome Undergoing Transcatheter Aortic Valve Implantation
https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.122.011848

JAMA Cardiology Original Investigation: Rare and Common Genetic Variation Underlying the Risk of Hypertrophic Cardiomyopathy in a National Biobank
https://jamanetwork.com/journals/jamacardiology/currentissue

Journal of the American College of Cardiology Original Investigation: Beyond Structural Angiography: The Emergence of Functional Coronary Angiography
https://www.sciencedirect.com/science/article/abs/pii/S0735109722048173

Cardiology News: Inflation and health care: The prognosis for doctors
https://www.mdedge.com/cardiology/article/256208/business-medicine/inflation-and-health-care-prognosis-doctors

The 2022 3rd Annual Going Back to the Heart of Cardiology: 
https://na.eventscloud.com/website/36345/

JAMA Cardiology Original Investigation: Assessment of Artificial Intelligence in Echocardiography Diagnostics in Differentiating Takotsubo Syndrome from Myocardial Infarction
https://jamanetwork.com/journals/jamacardiology/article-abstract/2790718?widget=personalizedcontent&previousarticle=2791887

NEJM Original Article Brief Report: Genetically Modified Porcine-to-Human Cardiac Xenotransplantation
https://www.nejm.org/doi/full/10.1056/NEJMoa2201422?query=featured_cardiology

Medical Intelligence Quiz: Survival on the heart transplant list
https://www.mdedge.com/cardiology/quiz/9698/heart-failure/survival-heart-transplant-list?channel=224

Circulation: Heart Failure Article: Medical Therapy for Functional Mitral Regurgitation
https://www.ahajournals.org/doi/abs/10.1161/CIRCHEARTFAILURE.122.009689

European Heart Journal Article: Integrated care for optimizing the management of stroke and associated heart disease: a position paper of the European Society of Cardiology Council on Stroke
https://academic.oup.com/eurheartj/article/43/26/2442/6583481

 

 

June 2022

The Business of Transplant with Dr. Nasrien Ibrahim

Welcome back to this month’s MedscapeLIVE! Cardiology E-News. In this issue, I speak with Dr. Nasrien Ibrahim, who is an advanced heart failure and transplant cardiologist, researcher, physician activist, and book author. She is also the Founder and Executive Director of The Equity in Heart Transplant Project™. She also serves as Associate Editor for the Journal of the American College of Cardiology: Heart Failure. Her research interests include improving adherence to guideline-directed therapies in heart failure patients and improving access to heart transplant in historically excluded and systemically oppressed patient populations. We cover several topics, including structural inequities that exist in heart disease care, race or ethnicity’s role in the use of heart transplantation, under-representation of minoritized individuals in medicine, and Dr. Ibrahim’s recent publication: Is it time to revisit ICD indications?
This issue’s Pulse includes articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine. 
Don’t forget to check out details of the upcoming 2022 3rd Annual Going Back to the Heart of Cardiology conference here
Please contact me at [email protected] with any comments and/or suggestions.

Colleen Hutchinson

 

Dr. Ibrahim, how would you characterize current efforts to solve the problem of under-representation of minoritized individuals in medicine?
Dr. Ibrahim:
I think it’s great that we’re finally having these conversations, and that we millennials and even more so generation Z are using our platforms to call for change. I don’t want to sound pessimistic, but talk is one thing and undoubtedly important to create awareness, but actions have thus far lagged behind. It’s important to start recruitment of individuals of diverse backgrounds early in the pipeline, as early as elementary school, but even more important to retain and promote to the upper echelons of our profession. 
If you look around at the medical societies, occupants of the C suites of institutions, and chairs of departments among other positions capable of creating tangible change, these positions are occupied by white men. So until you see physicians of diverse backgrounds in positions where archaic systems can be disrupted and dismantled, this is all just talk. I think it’s crazy that one person can be chair of a department for 10 to 15 years; we need term limits in medicine to allow others the opportunity to lead.

How does race or ethnicity play a role in the use of heart transplantation?
Dr. Ibrahim:
If you look at organ allocation in heart transplant, majority of transplants happen in white individuals. We published this data in JAHA in 2020 and the numbers have not changed for years. People will say that the number of heart transplants is higher in white patients because there are more white individuals than any other race or ethnicity in the US, which is true, but you must remember that black patients have a significantly higher burden of heart failure than all other racial or ethnic group in the US. Black patients present earlier and sicker, and they have a higher heart failure-related mortality than other racial and ethnic groups. Specifically, in the age group of 35 to 64 years, black men have the highest heart failure-related mortality, which is alarming, because this is the age group that should be considered for advanced heart failure therapies such as heart transplant. 
Much work remains to be done to not only understand the mechanisms of the disparities, which structural racism undoubtedly plays a huge role in, but to implement strategies to dismantle them and work toward more equitable organ allocation.

What factors should be considered when thinking about the structural inequities that exist in the care of heart disease?
Dr. Ibrahim:
The inequities in heart disease exist across the entire spectrum from prevention of heart disease all the way to who receives a heart transplant. We know, for example, that black and brown individuals have a higher burden of hypertension and diabetes, both major risk factors for the development of heart disease, and we know social determinants of health play a role in both disease processes. So even when we’re talking about who is at risk for heart disease and who would benefit the most from preventive measures, inequities exist there. We know black individuals for example receive less transcatheter aortic valve replacement (TAVR) than white individuals, and if you look at this data, it’s really crushing. In my world, we talked about inequities in organ allocation in heart transplant, which really starts with who we think is even “worthy” of being referred for an evaluation for heart transplant and down to who can afford novel guideline-directed medical therapies that we know reduce morbidity and mortality. Knowing that inequities exist at every level, we must work to dismantle them at every level from a policy level, an institutional level, and all the way to the individual clinician level. I always tell my mentees to look around the spaces you’re in and figure out how you can make things better. Everyone’s responsible.

Can you tell us about your newly launched Equity in Heart Transplant Project™?
Dr. Ibrahim:
I like to think about heart transplant selection criteria in three buckets- medical, financial, and social. Medical criteria in my mind are the easiest- is the patient sick enough to require a heart transplant or are they too sick to survive an operation? When it comes to financial requirements, selection committees want to know if patients are insured or insurable, and if patients can cover the costs of estimated deductibles. Insurance plans vary widely, and patients have been quoted small to absurd deductibles. Embarrassingly, in the US we ask patients to fundraise to cover the deductibles. If a patient cannot afford insurance deductibles, I’m unsure that their circle of friends and family has the likes of Bill Gates, so often these fundraising efforts end up being unsuccessful.
As you can imagine, the patients most likely to be ineligible based on finances are mostly black or brown, from rural areas, and might be single parents living paycheck to paycheck, or any number of clinical scenarios. The highest deductible I have seen quoted was around $5,000 per month if the patient received a hepatitis C heart transplant, which is outrageous and unaffordable to most people in the US. 
The last bucket, the social one, is also ripe with modifiable risk factors that result in patients with the highest risk of poor outcomes being ineligible for heart transplant. These factors include things such as substance use, existence of a caregiver (imagine an immigrant with no family in the US), ability to move within a certain mile radius of the transplant center postoperatively, and any number of modifiable risk factors that deem patients ineligible for listing. The stories of patients we have allowed to die based on finances and other modifiable risk factors haunt me and ignited the fire within me to found the Equity in Heart Transplant Project™️. The first patient that made me realize that I needed to do something to help was a veteran who was not able to cover deductibles or identify stable housing, and I could not believe we were letting someone who served our country die based on modifiable risk factors. 
They always ask what’s your villain origin story, well, this was my activist origin story. The goal of this nonprofit is to raise money for patients who are otherwise eligible for heart transplant but cannot afford insurance deductibles, or maybe cannot afford or pay for housing within the specified mile radius of the transplant center, or maybe they need to pay a nanny to take care of the children while one parent recovers from heart transplant and the other assumes the role of caregiver. Our nonprofit would cover these costs. My goal is to help as many patients as possible. The other secondary missions of the nonprofit are to raise awareness of the safety and efficacy of heart transplant in communities in which the medical community must earn their trust and to raise awareness of the importance of organ donation. But we cannot ask black and Latin people, for example, to donate their organs if we’re not transplanting these individuals at appropriate rates. 
I realize this is just a band-aid on a much larger structural problem, but I know we will be able to help many patients. For bigger impact, we must disrupt and dismantle policies that have left the sickest patients without access to heart transplant. I was privileged to be chosen as one of the Commonwealth Fund Fellows in Minority Health Policy at Harvard University starting July 2022 and I am incredibly excited about improving access to heart transplant through policy change.
 
This past January in Heart Failure Reviews, you published the article, “Is it time to revisit ICD indications?” What are some of the main pearls from this publication?
Dr. Ibrahim:
We wrote that perspective to bring up a controversial subject, which is: Is 90 days enough time to see the full reverse remodeling from guideline directed medical therapies? Or do we need new trials because of the arrival of novel therapies such as SGLT2i and ARNI, which Jim Januzzi and his team have shown result in cardiac reverse remodeling all the way to 12 months out?
The guidelines remain that an ICD should be considered after 90 days of optimal medical therapy, and that’s how we should practice until and if the guidelines change. What’s critical here is optimization of guideline-directed medical therapies—4 classes of GDMT, early and rapid titration, every patient notwithstanding any contraindications, no excuses. We know the mortality benefit is immense, quality of life is improved, patients stay out of the hospital, and a number of other benefits that are seen early on, within 2 to 4 weeks of initiation of GDMT. 

Your article, “The Impact of Health Care Disparities on Patients with Heart Failure,” was published in the Journal of Cardiac Failure last month. What are some of the takeaways for readers that can make a difference in helping in the care of patients with heart failure?
Dr. Ibrahim: The theme here is the same—awareness of the disparities and the awful impact they have, understanding mechanisms for the disparities, and then at every level implementing strategies to dismantle them. Strategies are needed from system to individual levels.

What is a new treatment modality that excites you as an advanced heart failure and transplant cardiologist?
Dr. Ibrahim:
I was excited about the modified pig heart transplant done at the University of Maryland. Unfortunately, of course, the patient died 3 months later, and we will be forever grateful for being brave enough to allow this experimental operation, but maybe there is a future for xenotransplantation. Human donor hearts are a limited resource, demand far exceeds supply, and despite expanding the donor pool, using hepatitis C hearts for example, many patients die every year waiting for a heart transplant. I am cautiously optimistic.

 

Thought Leader Rapid Fire

Most critical new advance in heart failure treatment: The addition of SGLT2i and ARNI to our toolbox has been phenomenal. These drugs have added mortality benefit to beta blockers and MRA and among other benefits, improve quality of life, a measure critically important to the patients we take care of. They are miracle drugs.
My mentors: Drs. Jim Januzzi, JoAnn Lindenfeld, and Chris O’Connor. Each has played a critical role in my personal and professional development and selflessly catapulted me on a career path that I could not have even dreamt of for myself. I am forever grateful.
Advice that has helped in my career: “They’re going to call you a B (insert five-letter word here, ha!) whether you speak up or you don’t, so you might as well speak up every single time”
Best tool in my clinical arsenal: My eyes and my hands! My eyes have helped me many times decide “sick vs. not sick” within seconds of walking into a patient’s room. And my hands on a patient’s lower extremities help me decide “shock vs. no shock.”
Biggest, or one of the biggest, honors of my career to date: Dr. Chris O’Connor asking me to become the associate program director of the cardiology fellowship at Inova Heart and Vascular Institute with no prior medical education experience and also being junior faculty and with his and the fellowship council’s backing turning the program around in <9 months from one where 0% of fellows said they would train there again to a whopping 63%! Proudest moment of my career. I learned so much about myself, I learned so much about people, I learned to listen more and to be kinder, and most important, I figured out exactly what kind of leader I want to be “when I grow up” 
Best recent medical journal article I read: I recently read a recent article featuring two of my friends, Drs. Essien and Youmans, titled “Building Inclusion and Belonging in Training Environments“ in the Journal of Graduate Medical Education. Every training program director should read it, and it can be accessed here:
https://meridian.allenpress.com/jgme/article/14/3/333/482803/Building-Inclusion-and-Belonging-in-Training

 
The Pulse

European Heart Journal Article: The complex link among heart failure, atrial fibrillation, and lung diseases, and an update on cardiac transplantation
https://academic.oup.com/eurheartj/article/43/23/2165/6607726

Circulation: Cardiovascular Intervention Original Investigation: Upping the Transcatheter Edge-to-Edge Repair Game: Patient Selection Based on Newly Described Echocardiographic Measurements
https://www.ahajournals.org/doi/abs/10.1161/CIRCINTERVENTIONS.122.012174

JAMA Cardiology Original Investigation: Trends in 10-Year Outcomes Among Medicare Beneficiaries Who Survived an Acute Myocardial Infarction
https://jamanetwork.com/journals/jamacardiology/currentissue

Journal of the American College of Cardiology Original Investigation: Beyond Structural Angiography: The Emergence of Functional Coronary Angiography
https://www.sciencedirect.com/science/article/abs/pii/S0735109722048173

Cardiology News: Air pollution tied to ventricular arrhythmias in those with ICDs
https://www.mdedge.com/cardiology/article/255500/heart-failure/air-pollution-tied-ventricular-arrhythmias-those-icds

The 2022 3rd Annual Going Back to the Heart of Cardiology
https://na.eventscloud.com/website/36345/

JAMA Cardiology Original Investigation: Trends in 10-Year Outcomes Among Medicare Beneficiaries Who Survived an Acute Myocardial Infarction
https://jamanetwork.com/journals/jamacardiology/article-abstract/2791887

NEJM Original Article: Empagliflozin in Heart Failure with a Preserved Ejection Fraction:
https://www.nejm.org/doi/full/10.1056/NEJMoa2107038

Medical Intelligence Quiz: New AHA guidelines for heart health
Fast Facts Friday, June 17, 2022
https://www.mdedge.com/cardiology/quiz/11556/fast-facts-friday/fast-facts-friday-may-6-2022

Circulation: Heart Failure Article: Right Heart Failure Following Left Ventricular Device Implantation: Natural History, Risk Factors, and Outcomes: An Analysis of the STS INTERMACS Database
https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.121.008706

European Heart Journal Article: The Atrial Fibrillation Heart Team—guiding therapy in left atrial appendage occlusion with increasingly complex patients and little evidence
https://academic.oup.com/eurheartj/article/43/18/1691/6433264

 

 

May 2022

Doctor to Doctor: Dr. Deborah Crabbe Interviewed by Dr. Ileana L. Piña

Welcome back to MedscapeLIVE! Cardiology E-News. This month Dr. Ileana L. Piña interviews Dr. Deborah Crabbe, who is a non-invasive cardiologist and Professor of Medicine in the Lewis Katz School of Medicine at Temple University, Philadelphia. She is also the founder of the Collaborative for Cardiovascular Health Equity in North Philadelphia, PA. Drs. Crabbe and Piña cover several topics, including whether African American women have different hypertrophic pathways as a response to hypertension, the best approach for better adherence from women hypertensives, and solving the problem of the disproportionate number of African Americans impacted by heart disease—is everybody doing as much as they can be?

This issue’s Pulse includes articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine. 

Don’t forget to check out details of the upcoming 2022 3rd Annual Going Back to the Heart of Cardiology conference here. 

A special thank you to Dr. Crabbe for sharing her time and insights on these topics, and to Dr. Piña for interviewing Dr. Crabbe! Please contact me at [email protected] with any comments and/or suggestions.

–Colleen Hutchinson

 

Interview: Dr. Deborah L. Crabbe is Interviewed by Dr. Ileana L. Piña

Deborah L. Crabbe, MD, FACC, FAHA, FCPP is a non-invasive cardiologist. She holds the rank of Professor of Medicine in the Lewis Katz School of Medicine at Temple University. She is the founder of the Collaborative for Cardiovascular Health Equity in North Philadelphia. Her work has been focused on racial, ethnic, and sex-specific disparities in cardiovascular disease. In her institution, she works to improve health literacy for minority populations and to increase their access to clinical trials that study cardiovascular conditions which uniquely impact minorities and women. 

Ileana L. Piña, MD, MPH, is a heart failure and cardiac transplantation expert. She is Clinical Professor of Medicine, Central Michigan University College of Medicine; Adjunct Professor of Epidemiology and Biostats, Case Western University, Population & Quantitative Health Sciences, and also serves as an advisor/consultant to the FDA's Center for Devices and Radiological Health. She has been a volunteer for the American Heart Association since 1982. Originally from Havana, Cuba, she is passionate about enrolling more women and minorities in clinical trials. 

Dr. Piña: Dr. Crabbe, do you believe that African American women have different hypertrophic pathways as a response to hypertension? 
Dr. Crabbe:
Whether African American women have different hypertrophic pathways in response to hypertension is an interesting question. Several studies have shown that left ventricular hypertrophy is more common among African Americans in general. Black women compared to white women have been shown to have a 2- to 3-fold greater prevalence of LVH, independent of differences in body habitus. When hypertension is considered, the increase in LV mass has been more robust among black women compared to white women between ages 30 and 65. This observation begs the question of whether different pathogenic mechanisms and pathways may also be in play. Intriguing data from the Jackson Heart Study using proteomic profiling of Black subjects has shown the association of 110 proteins with LV mass suggesting several potential pathways specific to African American’s that may be involved in the pathophysiology of LVH. If different hypertrophic pathways exist, one wonders the role that upstream factors such as social determinants of health, environmental, or even genetic factors play. Regarding women, sex differences in LV remodeling have been reported during aging and in response to pressure overload. 

Dr. Piña: We know that patients do not take medications as indicated for both hypertension and heart failure. For hypertension this is because it is silent and they do not have symptoms. What, in your opinion, is the best approach to get better adherence from women hypertensives? 
Dr. Crabbe:  Education is key. As we both know, early on poorly controlled hypertension can be asymptomatic for a significant number of people. Among the most vulnerable of patients—those from low-income communities especially—poor health literacy exists. In my opinion, poor health literacy is quite deadly as it can result in poor compliance and poor outcomes overall. For both men and women, I think education is key and being willing to work with that patient to get him/her to see the need for medications is paramount.
While most African Americans are aware of the problem of hypertension and can point to family members with the condition, it is less clear that as a group, they fully understand the impact of poor blood pressure control. I think that most African Americans can identify the association between poor blood pressure control and stroke. I suspect that this does not extend to understanding the relationship between poor blood pressure control and heart failure, renal failure, or increasing the risk for cardiovascular disease outcomes such as myocardial infarction. I would also say that consistency in the health message and patience is important. It once took me several years to get one of my female patients to accept blood pressure treatment, but after persistent messaging, listening to and addressing her concerns, and building a relationship, she finally accepted therapy. Numerous studies suggest that African Americans prefer informed decision-making models that allow their voice to be heard, are more empowering, and allow greater preparative time to consider decisions in the context of family and community before discussion with the health care provider. So focusing on risks and benefits to a particular therapy is helpful, I believe, in producing buy-in with this patient group.  

Dr. Piña: Women with LBBB seem to improve more from CRT than men and at a smaller QRS. Do you believe that the QRS width may be more related to delay in depolarization of an LV that is hypertrophied, rather than a true left bundle delay? 
Dr. Crabbe: I think that the QRS width is likely intertwined with the development of LVH as we can see along the process of developing a cardiomyopathy related to hypertension, some patients with LVH will have progression of their EKGs from LVH to development of an IVCD and subsequent LBBB.  

Colleen: Coming off last month being both Heart Month and Black History Month, what do you feel needs to be done to solve the problem of the disproportionate number of African Americans impacted by heart disease? Is everybody doing as much as they can be? Industry, medical associations, hospitals? 
Dr. Crabbe: I believe we have overcome an important hurdle, which is that the racial/ethnic disparities which exist in the United States are now painfully apparent to everyone. In this moment, I do believe that multiple sectors of the healthcare industry are responding and interested in devoting resources to tackle the problem. In my opinion, to truly eliminate racial disparities it will require a coordinated, multi-dimensional and well-focused response to the problem—preferably with various components of the response working synergistically. I do not believe, in the current structure of health care delivery, that we often achieve this goal. I believe that the problem will be solved on the local level, where the care is delivered. For example, in low-income communities it is faulty to think that you will be able to achieve the good clinical outcomes without managing the “wild cards” that exist for these patients. By wild cards, I mean, things like the social determinants of health, poor health literacy, and issues related to access to care. These factors create confounding variables to the delivery of evidence-based care. The system needs to be more effective at achieving control of these variables within both an individual patient, a local safety net hospital, and a local community. If our system is effective at tackling these issues, then it should be evident among individual patients as well as the local and regional communities. A lot of money is being thrown at the problem, but how are we coordinating our response so that the resources to tackle these problems result in synergy? 
To this end, I am a big advocate in mobilizing local communities to improve awareness and health literacy and increasing public health messaging. I also believe that greater investments are needed to support safety net hospitals so they can be more effective “boots on the ground” as they tackle the problems of delivering care to low-income minority patients who largely receive their care in these institutions. According to America’s Essential Hospitals (AHE: a national association of safety net hospitals), by conservative estimates, these institutions provide outpatient care to 72.2 million patients, provide emergency care to 13.8 million patients, and manage 2.5 times greater inpatient volumes than other acute care hospitals. They notoriously train a significant number of medical trainees. There are huge opportunities to develop the next generation of physicians and other health care providers who are better trained regarding the challenges of providing coordinated care to low income and minority populations. While I am encouraged about the efforts that are being undertaken to address racial disparities in care, I think that we need a better roadmap, improved coordination of efforts, and mobilization of the patients themselves to achieve synergistic improvements. 

 

The Pulse

Circulation: Cardiovascular Intervention Original Investigation: Neonatal Myocardial Infarction: A Proposed Algorithm for Coronary Arterial Thrombus Management
https://www.ahajournals.org/doi/abs/10.1161/CIRCINTERVENTIONS.121.011664

JAMA Cardiology Original Investigation: Association of Titin Variations With Late-Onset Dilated Cardiomyopathy
https://jamanetwork.com/journals/jamacardiology/article-abstract/2788570
 
Journal of the American College of Cardiology Original Investigation: Distribution of Coronary Artery Calcium by Age, Sex, and Race Among Patients 30-45 Years Old
https://www.sciencedirect.com/science/article/abs/pii/S0735109722044837

Cardiology News: Cutting dementia risk in AFib: Does rhythm control strategy matter?
https://www.mdedge.com

The 2022 3rd Annual Going Back to the Heart of Cardiology: 
https://na.eventscloud.com/website/36345/

European Heart Journal Article: The risk of ‘hidden’ sodium and of low vitamin D levels
https://academic.oup.com/eurheartj/article/43/18/1687/6576446

JAMA Cardiology Original Investigation: Trends in 10-Year Outcomes Among Medicare Beneficiaries Who Survived an Acute Myocardial Infarction
https://jamanetwork.com/journals/jamacardiology/article-abstract/2791887

NEJM Original Article: CT or Invasive Coronary Angiography in Stable Chest Pain (from The DISCHARGE Trial Group):
https://www.nejm.org/doi/full/10.1056/NEJMoa2200963?query=featured_cardiology

Medical Intelligence Quiz; Fast Facts Friday, May 6, 2022
https://www.mdedge.com/cardiology/quiz/11556/fast-facts-friday/fast-facts-friday-may-6-2022

Circulation: Heart Failure Article: Cardiogenic Shock From Heart Failure Versus Acute Myocardial Infarction: Clinical Characteristics, Hospital Course, and 1-Year Outcomes
https://www.ahajournals.org/doi/abs/10.1161/CIRCHEARTFAILURE.121.009279

European Heart Journal Article: The Atrial Fibrillation Heart Team—guiding therapy in left atrial appendage occlusion with increasingly complex patients and little evidence
https://academic.oup.com/eurheartj/article/43/18/1691/6433264

 

 

April 2022

Hot Topics in Cardiology: James Januzzi, MD, Interviews Hanna K. Gaggin, MD, MPH

Welcome back to MedscapeLIVE! Cardiology E-News. This month features an interview with Dr. Hanna Gaggin, who is a cardiologist, educator, and clinical investigator at Massachusetts General Hospital and Harvard Medical School. Her research focuses on evidence-based application of precision medicine in cardiology. Dr. Gaggin is involved in single and multi-center clinical trials to evaluate heart failure, heart failure with preserved ejection fraction, cardiac amyloidosis and myocardial infarction phenotypes using novel machine learning techniques, biomarkers and longitudinal data. Dr. James Januzzi agreed to interview Dr. Gaggin on several important topics, including: Are biomarkers useful in people with cardiac amyloidosis? What is the best approach for the diagnostic workup of suspected cardiac amyloidosis? How do changes in NT-proBNP tell us about responses to heart failure therapies? And what role do natriuretic peptides play in the outpatient evaluation and followup of people with chronic heart failure? Read on for her insights and her perspective on juggling all of these academic endeavors with motherhood. Also don’t miss our Rapid Fire section, where Dr. Gaggin opines on critical new cardiology advance, best medical journal article, her mentors, one thing she wishes her patients understood better, and more!
This issue’s Pulse includes articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine. 
Don’t forget to check out details for online access to the 3rd Annual Going Back to the Heart of Cardiology 2022 conference here. 
A special thank you to Dr. Januzzi for interviewing Dr. Gaggin for this interview, and to Dr. Gaggin for sharing her time and insights! Please contact me at [email protected] with any comments and/or suggestions.

Colleen Hutchinson

 
From One Thought Leader to Another… Dr. Hanna K. Gaggin, MD, MPH, FACC Interviewed by James Januzzi, MD

Hanna K. Gaggin, MD, MPH, is a cardiologist, educator and clinical investigator at Massachusetts General Hospital and Harvard Medical School. Her research focuses on evidence-based application of precision medicine in cardiology. She is involved in single and multi-center clinical trials to evaluate heart failure, heart failure with preserved ejection fraction, cardiac amyloidosis and myocardial infarction phenotypes using novel machine learning techniques, biomarkers and longitudinal data.

Dr. James Januzzi, who is the Hutter Family Professor of Medicine, Harvard Medical School; Cardiology Division, Massachusetts General Hospital; Cardiometabolic Trials, Baim Institute for Clinical Research; and Trustee, American College of Cardiology.

Dr. Januzzi: What role do natriuretic peptides play in the outpatient evaluation and followup of people with chronic heart failure?
Dr. Gaggin:
In patients with chronic heart failure (HF), comparison of natriuretic peptide levels such as NT-proBNP or BNP, compared to their baseline or dry natriuretic peptide levels, is critically important in using natriuretic peptides to help evaluate for heart failure exacerbation and determine prognosis. In general, an NT-proBNP value of 1,000 pg/mL or less correlates with better prognosis in the outpatient setting.
In patients without a known diagnosis of HF, natriuretic peptides help to rule out or screen for HF as a cause of dyspnea in the outpatient setting. It’s worth noting that in the outpatient setting, the cutoff value for natriuretic peptide levels is lower (e.g. NT-proBNP of 125 pg/mL in sinus rhythm and 365 pg/mL for those in atrial fibrillation and BNP of 35 pg/mL) than for acute heart failure cutoff value in the emergency department setting (NT-proBNP of 450 pg/mL for age <50 yo, 900 pg/mL for age 50-75yo and 1800 pg/mL for >75 yo).

Dr. Januzzi: How do changes in NT-proBNP tell us about responses to heart failure therapies?
Dr. Gaggin:
A downward trend in natriuretic peptides generally corresponds to better responses to chronic heart failure therapies and outcomes. Some caveats, while SGLT2 inhibitors benefit chronic heart failure patients, natriuretic peptide levels may or may not go downwards dramatically in response to SGLT2 inhibitors. Of course, acute volume status change will also influence natriuretic peptide levels.

Dr. Januzzi: Are biomarkers useful in people with cardiac amyloidosis?
Dr. Gaggin:
Yes! There is so much more work to do in cardiac amyloidosis and biomarkers. We use natriuretic peptide and troponin levels to determine cardiac amyloidosis stages routinely and they closely correlate with clinical outcomes. Because how sensitive both biomarkers are to acute volume changes, we have to make sure to measure them when patients are not in acute decompensated heart failure. Measuring transthyretin (TTR, also known as prealbumin) levels appears be helpful in following clinical course in TTR cardiac amyloidosis and response to therapy. 

Dr. Januzzi: What is the best approach for the diagnostic workup of suspected cardiac amyloidosis?
Dr. Gaggin:
Cardiac amyloidosis is more common than we previously thought, so first be on the lookout for clinical clues: heart failure with LVEF >40-45%, lower ECG voltage than expected based on increased left ventricular wall thickness, atrial fibrillation, elevated natriuretic peptide and troponin out of proportion to clinical heart failure status, conduction delay, history of spinal stenosis, bilateral carpal tunnel syndrome or TAVR, and neuropathy. Echocardiogram is a must and, if available, with global longitudinal strain analysis. The main cardiac amyloidosis-specific studies are as follows:

  • Nuclear scan for TTR amyloidosis: Technetium-99m (Tc-99m) pyrophosphate scan (PYP, mainly available in the US) or 3, 3-diphosphono-1,2-propanodicarboxylicacid (DPD, outside of the US) 
  • AL amyloidosis evaluation: with serum and urine electrophoresis with immunofixation and serum free light chains. 

The latest 2022 ACC/AHA/HFSA HF guidelines include a nice diagnostic evaluation algorithm for cardiac amyloidosis.

Colleen: You’re a busy cardiologist, scientist, and mom of 3. How would you characterize the juggle? Is it hard being in academia as a female in your specialty?
Dr. Gaggin:
Constantly juggling is the perfect word to describe my life! &#128512 I’m not going to lie; being a mom to three little kids is not easy, and without the support of my husband and Mom, I couldn’t do what I do. I often work odd hours and I am still trying hard not to do all-nighters. I have come to terms with the fact that I won’t be able to do everything at the same time—a hard lesson to learn! Having the right support at work (mentors, leadership, research and clinical team) makes such a difference, too. Being a woman in cardiology, let alone academia, brings its own challenges, but having great mentors—I’ll single out Jim Januzzi here—really helped guide me.

Colleen: Do most clinicians know how to optimally use biomarkers in the management of HF? If not, what is needed to educate?
Dr. Gaggin:
I think most clinicians are familiar and confident with using natriuretic peptides in the setting of acute heart failure evaluation. There is more education needed in learning the nuances of using natriuretic peptides in the outpatient setting, heart failure with preserved ejection fraction, obesity, and atrial fibrillation. More education is needed in understanding how to utilize other biomarkers such as troponin and novel biomarkers for prognosis.

 

Rapid Fire!

Most critical new advance in my area of medicine

Artificial intelligence, deep learning including machine learning to improve phenotypes in heart failure and potentially tailor therapy in the future. Amazing what they are beginning to do in imaging!

Best recent medical journal article

1) 2022 ACC/AHA/HFSA heart failure guidelines, Long-term survival with tafamidis in TTR amyloid cardiomyopathy (Elliott 2022 Circ HF), and 2) Prevalence of TTR amyloid cardiomyopathy in HFpEF (AbouEzzeddine 2021 JAMA Card).

Most challenging issue my counterparts and I face today

Burnout—everyone is stretched at work and at home; and overload of EMR/paperwork and messages.

Biggest, or one of the biggest, honors of my career to date

Mentoring and being mentored. My patients! Being a mom.

Best tool in my clinical arsenal

GDMT for HF

My mentor

Dr. Jim Januzzi! Drs. Rick Ruberg, Nandita Scott, Ahmed Tawakol, Robert Vorona to name a few!

One thing I wish my patients understood better

The importance of lifestyle changes, Mediterranean diet, regular exercise including strength training.

 

The Pulse

European Heart Journal Article: Conversing with Nobel Laureate Ferid Murad
https://academic.oup.com/eurheartj/article/43/14/1372/6359111

Circulation: Cardiovascular Intervention Original Investigation: Periprocedural Pericardial Effusion Complicating Transcatheter Left Atrial Appendage Occlusion: A Report From the NCDR LAAO Registry:
https://www.ahajournals.org/doi/abs/10.1161/CIRCINTERVENTIONS.121.011718

JAMA Cardiology Original Investigation: Association of Myocardial Fibrosis and Stroke Volume by Cardiovascular Magnetic Resonance in Patients With Severe Aortic Stenosis With Outcome After Valve Replacement (The British Society of Cardiovascular Magnetic Resonance AS700 Study):
https://jamanetwork.com/journals/jamacardiology/article-abstract/2790671

Journal of the American College of Cardiology Original Investigation: Long-Term Cardiovascular Outcomes After Bariatric Surgery in the Medicare Population
https://www.sciencedirect.com/science/article/abs/pii/S0735109722003722

Medical Intelligence Quiz; Fast Facts Friday, April 8, 2022
https://www.mdedge.com/cardiology/quiz/11516/fast-facts-friday/fast-facts-friday-april-8-2022?channel=59610

Cardiology News: FDA approves leadless, single-chamber pacemaker system:
https://www.mdedge.com

Going Back to the Heart of Cardiology 2022:
https://na.eventscloud.com/website/36345/

NEJM Original Article: Childhood Cardiovascular Risk Factors and Adult Cardiovascular Events:
https://www.nejm.org/doi/full/10.1056/NEJMoa2109191?query=featured_cardiology

Circulation: Heart Failure Article: The RAISE Trial: A Novel Device and First-in-Man Trial
https://www.ahajournals.org/doi/abs/10.1161/CIRCHEARTFAILURE.121.008362

European Heart Journal Article: Drugs may worsen blood pressure control: focus on the underestimated role of non-steroidal anti-inflammatory drugs
https://academic.oup.com/eurheartj/article/43/14/1377/6523310

 

 

 

March 2022

Rapid Fire with Dr. James Januzzi, Dr. Ileana Piña, and Dr. Javed Butler

Welcome back to MedscapeLIVE! Cardiology E-News. We’re back again this month with some of our thought leaders in cardiology, including Dr. James Januzzi, Dr. Ileana Piña, and Dr. Javed Butler, talking shop in a rapid-fire format—including their biggest career honor to date, where they go for continuing education, the FDA approval process, best tool in their clinical arsenal, and biggest challenge they face as a clinician today. Read on for those and more insights from these thought leaders.

Our last issue included discussion with Dr. Ileana L. Piña, who is the Clinical Professor of Medicine, Central Michigan University College of Medicine; Adjunct Professor of Epidemiology and Biostats, Case Western University, Population & Quantitative Health Sciences; and Senior Staff Fellow, Medical Officer FDA, CDRH. Dr. Piña and I discussed her role at the FDA, various issues surrounding both females and Hispanics in cardiology and academia, heart failure with preserved ejection fraction (HFpEF), and the power of SGLT2s. If you missed that interview, you can view it here.
This issue’s Pulse includes articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine. 
Also, don’t forget that Medscape’s Going Back to the Heart of Cardiology 2021conference is still available for on-demand access here.
A special thank you to these doctors for sharing their time and expertise. Please contact me at [email protected] with any comments and/or suggestions.

Colleen Hutchinson

 

Rapid Fire 

Dr. Ileana L. Piña is Clinical Professor of Medicine, Central Michigan University College of Medicine; Adjunct Professor of Epidemiology and Biostats, Case Western University, Population & Quantitative Health Sciences, and also serves as an advisor/consultant to the FDA's Center for Devices and Radiological Health.
Dr. Javed Butler is the Patrick H. Lehan Chair in Cardiovascular Research, and Professor and Chairperson for the Department of Medicine at the University of Mississippi Medical Center in Jackson, Mississippi.
Dr. James Januzzi is the Hutter Family Professor of Medicine, Harvard Medical School; Cardiology Division, Massachusetts General Hospital; Cardiometabolic Trials, Baim Institute for Clinical Research; and Trustee, American College of Cardiology.

Biggest, or one of the biggest, honors of my career to date:
Dr. Butler:
The opportunity to serve.
Dr. Januzzi: Receiving an endowed Professorship at Harvard Medical School at age 46 was a shock and something that I am eternally grateful for. Also, becoming a Trustee of the American College of Cardiology is an honor of a lifetime.
Dr. Piña: Giving grand rounds at Stanford and Harvard during the pandemic! I had never been invited.

My mentor:
Dr. Januzzi: Interestingly, I immediately think of my clinical mentors shaping my approach to research: Dr. Roman DeSanctis, Dr. Dolph Hutter, and my dad, Dr. James Januzzi, Sr.
Dr. Butler: The late Mihai Gheorghiade.
Dr. Piña: Nanette Wenger, MD. 

Best tool in my clinical arsenal:
Dr. Piña: Being a good listener to the patient's story.
Dr. Butler: Patience.
Dr. Januzzi: Easy answer: guideline-directed medical therapy for heart failure. Turn an ejection fraction of 15% back to normal with just 4 pills. It's one of the most under-emphasized things in medical training and something we need to keep educating about. 

FDA approval process for medical devices and drugs: 
Dr. Butler:
Excellent.
Dr. Piña: I work for the FDA so cannot comment.
Dr. Januzzi: I have a deep respect for the challenges they face. They are amenable to discussions with trialists, which is something I really admire.

Most challenging issue my counterparts and I face today: 
Dr. Piña:
Many patients and short visit times with systems demanding more $$$ from us in RVUs.
Dr. Januzzi: Lack of respect on all sides: payers, patients, administrators. For a brief moment during the early days of the first COVID surge, there was a sense that medical providers were finally valued--that has gone by the wayside now.
Dr. Butler: Time spent on doing mandated but low impact activities.

Best recent medical journal article:
Dr. Butler:
EMPEROR Preserved trial in the New England Journal of Medicine 
Dr. Januzzi: EMPEROR-Preserved in the New England Journal of Medicine.  First definitively proven therapy for HFpEF?  Yes please.
Dr. Piña: The SGLT2 inhibitor data.

Where I go for continuing education: 
Dr. Butler:
Medical journals.
Dr. Januzzi: The shift to online learning has really changed the game. That's my new go-to.
Dr. Piña: Mostly reading the literature. Many CMEs are delivered with definitive purpose in mind, not necessarily a true balanced approach.

Most critical new advance in my area of medicine: 
Dr. Piña:
Finally having a truer definition of HFpeF.
Dr. Januzzi: The combination of TAVR for aortic stenosis as well as the rapid knowledge base established for medical therapy of HF with reduced EF. You can take someone dying of heart failure and given him or her an entirely new life with either (or both) treatments.
Dr. Butler: Have not solved yet BUT actually now focusing on implementation science.

Best part of my job: 
Dr. Butler:
People!
Dr. Januzzi: The patients--when I'm on clinical service, I realize why I love doing trials so much...it's about creating new possibilities for people to live longer and better.
Dr. Piña: The patients and my colleagues who think with me.

 

The Pulse

Circulation: Cardiovascular Intervention Original Investigation: Effect of Platelet Inhibition by Cangrelor Among Obese Patients Undergoing Coronary Stenting: Insights From CHAMPION
https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.121.011069

JAMA Cardiology: When an Aortic Bioprosthesis Fails in a Low-risk Patient, Randomize
https://jamanetwork.com/journals/jamacardiology/article-abstract/2790334

Journal of the American College of Cardiology Original Investigation: Effect of Pelacarsen on Lipoprotein(a) Cholesterol and Corrected Low-Density Lipoprotein Cholesterol
https://www.sciencedirect.com/science/article/pii/S0735109722001644

MDEdge From the Journals: Transplant teams have short window before heart is compromised after cardiac death
https://www.mdedge.com/cardiology/article/252885/transplant/transplant-teams-have-short-window-heart-compromised-after

Going Back to the Heart of Cardiology 2021: Virtual Conference 2021:
https://na.eventscloud.com/website/23556/agenda/

NEJM Original Article: CT or Invasive Coronary Angiography in Stable Chest Pain
https://www.nejm.org/doi/full/10.1056/NEJMoa2200963

Medical Intelligence Quiz; Fast Facts Friday, March 18, 2022
https://www.mdedge.com/cardiology/quiz/11487/fast-facts-friday/fast-facts-friday-march-18-2022?channel=59610

Circulation Article: Association Between Age and Outcomes of Catheter Ablation Versus Medical Therapy for Atrial Fibrillation: Results from the CABANA Trial
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055297

European Heart Journal Article: From blue lips to artificial intelligence: the history of a US centre of excellence
https://academic.oup.com/eurheartj/article-abstract/43/11/1022/6514459?redirectedFrom=fulltext

 

 

February 2022

Hot Topics in Cardiology: Interview with Ileana L. Piña, MD, MPH, FAHA, FACC, FHFSA
Welcome back to MedscapeLIVE! Cardiology E-News. This month I speak with Dr. Ileana L. Piña, who is the Clinical Professor of Medicine, Central Michigan University College of Medicine; Adjunct Professor of Epidemiology and Biostats, Case Western University, Population & Quantitative Health Sciences; and Senior Staff Fellow, Medical Officer FDA, CDRH. Dr. Piña and I cover a number of topics, including what our cardiology community should be focusing on this month, her role at the FDA, various issues surrounding both females and Hispanics in cardiology and academia, heart failure with preserved ejection fraction (HFpEF), and the power of SGLT2s.
This issue’s Pulse includes articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine. 
Having just run from December 6-10, Medscape’s Going Back to the Heart of Cardiology 2021 conference is still available for on-demand access following the conference here.
A special thank you to Dr. Piña for sharing her time and expertise for this interview. Check her out here speaking as well on iron deficiency and IV iron. Don’t forget to check out details for online access to the Going Back to the Heart of Cardiology 2021 conference here. Please contact me at [email protected] with any comments and/or suggestions.

Colleen Hutchinson

 

Interview: Ileana L. Piña, MD, MPH, FAHA, FACC, FHFSA

Ileana L. Piña, MD, MPH, is a heart failure and cardiac transplantation expert. She is Clinical Professor of Medicine, Central Michigan University College of Medicine; Adjunct Professor of Epidemiology and Biostats, Case Western University, Population & Quantitative Health Sciences, and also serves as an advisor/consultant to the FDA's Center for Devices and Radiological Health. She has been a volunteer for the American Heart Association since 1982. Originally from Havana, Cuba, she is passionate about enrolling more women and minorities in clinical trials. 

Colleen: With February being American Heart Month, what do you think this community of cardiologists should focus on accomplishing as a group, considering the current challenges we face on a global health level?
Dr. Piña: We need to remember that the number 1 killer around the world is heart disease. Educating the public, our patients, and their caregivers is an important step to recognizing the risks factors for heart disease and symptoms with disease manifest, and for individuals to seek care from healthcare providers. 
Many of the deaths from heart disease are preventable. That fact should be a sobering thought and provide the impetus to enact prevention measures globally. In areas where there are disparities of care and lack of access to care, leaders in the public health sector must take responsibility and find avenues for solutions. 

Colleen: How do like your FDA role as compared to all past hats you’ve worn in medicine?
Dr. Piña:
I am honored to be a Medical Officer at the FDA in Cardiovascular Devices. It is my privilege to work with an incredible group of professionals, including biomedical engineers, other physicians, veterinarians, and statisticians. I learn from them with each file or application that we review. As an immigrant, I believe that through my work at the FDA, I am giving back to this country that took my parents and I in, and it allows me to work for the benefit of all Americans. 

Colleen: How would you characterize females in academia in cardiology?
Dr. Piña:
We are getting closer, but I don't think we've really broken the glass ceiling, particularly in cardiology. It’s better today for junior faculty, but there is a drop-off for more senior positions. We see there are women deans—certainly more women deans than there used to be. These include chairs of medicine, and chiefs of cardiology, but many do not last in the job long for various reasons. So they achieve it, and it’s listed as a statistic, but it’s not lasting.

Colleen: What would you say in terms of the role of associations and academic institutions in helping females in cardiology with leadership positions and research opportunities?
Dr. Piña:
Associations and academic institutions are becoming more aware of the need for a balance of fairness and offering deserving women leadership roles. The AHA and ACC are such organizations for cardiologists. For some organizations, however, we, the Hispanics, are invisible. When conversations turn to diversity, race and sex are paramount and salient, but the issue of ethnicity, Hispanic, non-Hispanic...often this is totally invisible and not addressed.

Colleen: So the Hispanic female cardiologist or cardiac surgeon is especially challenged?
Dr. Piña:
Yes. And there are not that many of us.

Colleen: Are you able to exact any change on the committees you sit on?
Dr. Piña:
I would think that the fact that I work hard, and I've been, hopefully, building capital. Every chance I get, I point out the need for true diversity, equity, and belonging for all underrepresented groups in every organization of which I am a member as well as in clinical trials.

Colleen: What would your advice be to somebody coming in who wants to follow in your footsteps?
Dr. Piña:
I'd say keep fighting because they can't ignore you forever. As we know, those entering coming in through the door of our southern borders are coming from many countries, but they are primarily Hispanic. The putative Hispanic paradox—similar risk factors but better survival for heart disease, may be a factor of age. As the Hispanic population ages, I truly believe that we will see the paradox disappear and the mortality rate match those of African Americans. We need more Hispanic providers with cultural sensitivity and more Hispanic investigators. 
If you look around at the high leadership positions in various societies, the Hispanics are just not there. In the cardiac societies, they're not there. 

Colleen: What about the availability of mentors for both females and Hispanics to help them in this regard?
Dr. Piña:
Nonexistent that I know of. There's one organization that I've seen online that does advertise mentoring of Hispanics, but no one I know has been involved with it. I do know that the National Minority Forum is concerned about mentoring our young people and advising them on career choices.
One piece of advice that I would give is to seek mentors that fulfill your need. Don't isolate yourselves. Why are you isolating yourself when what you want to be is integrated?
I don't want to be part of the “Hispanic’ group of any society. I want to be inside the society and working for all its members.

Colleen: It's a shame though, because some people think that that's probably the path they need to take to advance.
Dr. Piña:
That's what they may think they need to take, and that's not the path. I think the organizations are the ones that need to open their eyes and say, "We really need to be diverse in ethnicity, not just in race." There are many more of us than there are African Americans in the United States. Twice as many. And the Hispanics in the United States are equally at risk for heart disease as the African Americans. Isolation is not the idea.

Colleen: What is a hot topic you look forward to seeing evolve?
Dr. Piña:
I think the big story is heart failure with preserved ejection fraction (HFpEF).
It's a big story about something that is not totally developed yet. We have the empagliflozin drug, which appears to be positive at least at most ejection fractions. It starts to lose it a little bit over 60. We have sacubitril/valsartan—different mechanism. The SGLT2 is more effective than sacubitril/valsartan because after a 57% ejection fraction, the effect is diluted, although a different drug mechanism. We may be left using both. 
And so I think we are redefining HFpEF. The trials have shown us that HFpEF is not what we thought, and that true HFpEF probably really starts in the high 50s.
And these 40, 45’s that we've been calling HFpEF, is nothing more than heart failure (HF) with mildly reduced ejection fraction (HFmrEF).
We are rediscovering a definition, and I think that's newsworthy and exciting.
The other thing that's coming soon is the dapagliflozin trial, which I think is very similar-- I'm not sure which ejection fractions they picked, but this will be reported on maybe by ACC in April.
I anticipate that this is going to be a class effect for the drug, that the dapagliflozin data will be as good as the empagliflozin data.
And also something to watch is their mortality benefit because right now, of the SGLT2s, the combined endpoint may appear to be positive, but when you break it down, it's all in hospitalizations, not in mortality. Except the DAPA-HF trial did have a mortality benefit, and everybody's saying, "Well, that's because the patient population is different." You know, they enriched the population with sicker patients.
I don't know. But it's going to be something worth looking at.

Colleen: What would you say is one of the most beneficial recent advances in your area that's helped you be able to better help patients?
Dr. Piña:
The SGLT2s. I think that story is a very powerful story. We haven't had a drug that is actually protective of the kidney. You know, and every single one of them so far is very similar. The protection of the GFR is very similar, even similar to the SOLOIST-WHF trial of canagliflozin. So there's something there. We don't know how they work, which was the other funny thing. We don't have a mechanism. I think eventually, we'll find out. We think there may be something metabolic. But when you look at the curves of heart failure hospitalizations and they break up almost immediately, that's different. I mean, we've seen curves that break up after six months and a year. But these break up almost at the beginning. So, whatever the impact is, it's pretty powerful. And it's not remodeling of the ventricle because the remodeling would take at least three months.
It may be a metabolism factor. We are not certain. There is enhanced glucose excretion, And there's a bit of a diuretic effect, but I don't think it's all a diuretic effect. Certainly, a diuretic has never been shown to increase survival. On the contrary, I think they're detrimental. So that may be beyond the SGLT2 and is maybe a refocus on diuretic use. I've been one that uses diuretics only as needed. Everybody doesn't need the 20 of Lasix daily, and I think more and more clinicians are starting to realize that. I realized that long time ago, and we've cut back. My ideal patient is totally off diuretic and only takes it when needed, because it stimulates everything you're trying to block with the other drugs. That's the problem with it.

 
The Pulse

Circulation: Cardiovascular Intervention Original Investigation: Coronary Access After Transcatheter Aortic Valve Replacement With Commissural Alignment: The ALIGN-ACCESS Study
https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.121.011045

JAMA Cardiology Original Investigation: High-Throughput Precision Phenotyping of Left Ventricular Hypertrophy with Cardiovascular Deep Learning
https://jamanetwork.com/journals/jamacardiology/fullarticle/2789370
 
Journal of the American College of Cardiology Original Investigation: Independent Association of Lipoprotein(a) and Coronary Artery Calcification with Atherosclerotic Cardiovascular Risk
https://www.sciencedirect.com/science/article/abs/pii/S0735109721084485

Cardiology News: AHA targets ‘low-value’ heart care in new scientific statement:
https://www.mdedge.com

Going Back to the Heart of Cardiology 2021: Virtual Conference 2021:
https://na.eventscloud.com/website/23556/agenda/

NEJM Original Article: Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation:
https://www.nejm.org/doi/full/10.1056/NEJMoa2115961?query=featured_cardiology

Medical Intelligence Quiz; Fast Facts Friday, February 18, 2022
https://www.mdedge.com

Circulation: Heart Failure Article: Peripheral Venous Pressure-Assisted Exercise Stress Echocardiography in the Evaluation of Pulmonary Hypertension During Exercise in Patients with Suspected Heart Failure With Preserved Ejection Fraction
https://www.ahajournals.org/doi/abs/10.1161/CIRCHEARTFAILURE.121.009028

European Heart Journal Article: A cardiovascular risk calculator to save millions of lives
https://academic.oup.com/eurheartj/article-abstract/43/8/706/6330651?redirectedFrom=fulltext

 

 

January 2022

Welcome back to MedscapeLIVE! Cardiology E-News. This month I speak with Dr. James Januzzi, who is the Hutter Family Professor of Medicine, Harvard Medical School; Cardiology Division, Massachusetts General Hospital; Cardiometabolic Trials, Baim Institute for Clinical Research; and Trustee, American College of Cardiology. Dr. Januzzi co-chaired Medscape’s recent Going Back to the Heart of Cardiology 2021 conference session, “Heart Failure: Keeping Beat Up with the Beat of Latest Developments,” and shares some of its highlights here, as well as in the session “SGLT2s in Patients with T2D and ASCVD or HF.” He also shared pearls from the recent Journal of the American College of Cardiology publication he coauthored (which is also this issue’s Suggested Reading), “2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure with Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee.”  

This issue’s Pulse includes articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine. 

Having just run from December 6-10, Medscape’s Going Back to the Heart of Cardiology 2021 conference featured 6 live-streamed sessions—each with 6 to 7 faculty presentations on a hot topic in cardiovascular disease management, as well as lively faculty discussion and Q&A. This was an educational event not to miss, but if you did, each session is now available for immediate on-demand access following the conference here.

Thank you to Dr. Januzzi, for sharing his time and expertise for this interview. Don’t forget to check out details for online access to the Going Back to the Heart of Cardiology 2021 conference here. Please contact me at [email protected] with any comments and/or suggestions.

– Colleen Hutchinson

 

Interview: James Januzzi, MD

Colleen: At Medscape’s 2nd Annual Going Back to the Heart of Cardiology conference, you co-chaired the session, “Heart Failure: Keeping Beat Up with the Beat of Latest Developments.” What were some of the highlights of this session that you feel are of import to attendees?
Dr. Januzzi: I was so grateful for the invitation to co-chair the session with Dr. Javed Butler and Ileana Pina, two absolute superstars in the heart failure community. There is something for everyone at this conference. Some of the valuable highlights in this session were talks on optimizing guideline-directed medical therapy in heart failure, the growing role of SGLT2 inhibitors, how we might care for heart failure with preserved ejection fraction, and then hearing from one of my colleagues from the MGH Heart Center, Dr. Hanna Gaggin, who spoke on biomarkers in heart failure. Dr. Muthu Vaduganathan spoke on how we’re managing patients with heart failure during COVID, such a terribly important topic. A master clinician, Michelle Kittleson then offered important tips about patient-centric care. Lastly, a not-to-be-missed talk by Dr. Martha Grogan focused on cardiac amyloidosis, a diagnosis that I think is far more common than people realize.
This conference is one-stop shopping to hear about the hottest topics in heart failure, delivered by global leaders in the field.

Colleen: You presented as well in the session “SGLT2s in Patients with T2D and ASCVD or HF.” What are some pearls or takeaways you shared?
Dr. Januzzi: The growth of our understanding of how valuable the SGLT2 inhibitors are has been nothing short of amazing.  We have learned so much about how to reduce risk in diabetes in such a short period of time.  I talked about WHY we should use SGLT2 inhibitors, IN WHOM, and HOW to use them.  My hope is that the viewers come away recognizing the optimal means to tailor these valuable therapies to the right patients.

Colleen: You served as a main author on this past year’s Journal of the American College of Cardiology publication, “2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure with Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee.” Can you summarize this article’s most critical and useful expert consensus recommendations?
Dr. Januzzi: It was an honor to serve as the Vice-Chair of the 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment.  This document focuses on a broad range of topics with a central goal to assist clinicians to better care for patients suffering from heart failure. In this updated document, among the topics we review is an updated set of recommendations for medical care of reduced ejection fraction heart failure.  The present document has two major changes: first, sacubitril/valsartan has now been elevated to front-line, without the need to pre-treat with an ACE inhibitor or ARB.  Second, we now incorporate SGLT2 inhibitors as a foundational therapy as part of the “4 pillars” of heart failure care.  I’m proud that the document keeps a focus on providing clinicians useful tips on how to best initiate therapies, monitor their effects, and how to recognize when they need help from an advanced heart failure specialist.  We also discuss managing complex care decisions such as multidisciplinary management of comorbidities, we review managing costs of care, and also how to manage the eventual need for end-of-life care.  This publication is a “toolbox” for clinicians to best learn about how to manage their patients in a high-quality manner.

 

Suggested Reading:

Article: 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. Writing Committee, Maddox TM, Januzzi JL Jr, Allen LA, Breathett K, Butler J, Davis LL, Fonarow GC, Ibrahim NE, Lindenfeld J, Masoudi FA, Motiwala SR, Oliveros E, Patterson JH, Walsh MN, Wasserman A, Yancy CW, Youmans QR. J Am Coll Cardiol. 2021 Feb 16;77(6):772-810. doi: 10.1016/j.jacc.2020.11.022. Epub 2021 Jan 11. PMID: 33446410.
https://pubmed.ncbi.nlm.nih.gov/33446410/

Dr. Januzzi: See my comments above about this publication—This is a “toolbox” for clinicians to best learn about how to manage their patients in a high-quality manner!

 

The Pulse

Journal of the American College of Cardiology Original Investigation: Evolution of Incidence, Management, and Outcomes Over Time in Sports-Related Sudden Cardiac Arrest
https://www.sciencedirect.com/science/article/abs/pii/S0735109721081572

Circulation: Heart Failure Article: Machine Learning-Based Prediction of Myocardial Recovery in Patients with Left Ventricular Assist Device Support
https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.121.008711

European Heart Journal Article: Recognition for heart failure breakthrough
https://academic.oup.com/eurheartj/article/43/2/93/6296965

JAMA Cardiology Original Investigation: Effect of Treatment With Sacubitril/Valsartan in Patients With Advanced Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial 
https://jamanetwork.com/journals/jamacardiology/article-abstract/2785700

Journal of the American College of Cardiology Original Investigation: Lipoprotein(a) and CT Angiography: Novel Insights into High-Risk Plaque Progression
https://www.sciencedirect.com/science/article/abs/pii/S0735109721081894

Cardiology News: Breastfeeding linked to lower CVD risk in later life:
https://www.mdedge.com/cardiology/article/250958/preventive-care/breastfeeding-linked-lower-cvd-risk-later-life

Going Back to the Heart of Cardiology 2021: Virtual Conference 2021: December 6–10:
https://na.eventscloud.com/website/23556/agenda/

NEJM Original Article: 24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk:
https://www.nejm.org/doi/full/10.1056/NEJMoa2109794?query=featured_cardiology

Medical Intelligence Quiz; Fast Facts Friday, January 21, 2022
https://www.mdedge.com/cardiology/quiz/11370/fast-facts-friday/fast-facts-friday-january-21-2022

 

 

December 2021

Happy Holidays from Medscape Cardiology! In our September inaugural issue, I spoke with Robert A. Harrington, MD—the co-chair of MedscapeLIVE!’s recent conference, Going Back to the Heart of Cardiology 2021, and we discussed his recent term as President of the American Heart Association (AHA), preventive cardiology and the public health interest in it, and the conference. If you missed that interview, you can view it here. In this December issue, Dr. Harrington again shares his valuable perspective on current issues and challenges in cardiology, including most promising recent advances, biggest challenge and career success, telethealth and COVID in cardiology, and more. 
Dr. Harrington joined forces with Dr. Michael Gibson, his conference co-chair, to assemble a critical faculty and presentation lineup at the Going Back to the Heart of Cardiology 2021 virtual MedscapeLIVE! conference. Having just run from December 6-10, the conference featured 6 live-streamed sessions—each with 6 to 7 faculty presentations on a hot topic in cardiovascular disease management, as well as lively faculty discussion and Q&A. This was an educational event not to miss, but if you did, each session is now available for immediate on-demand access following the conference here.
This issue’s Pulse includes articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine
Thank you to Dr. Harrington, for again sharing his time and expertise for this Part 2 segment. Don’t forget to check out details for online access to the Going Back to the Heart of Cardiology 2021 conference here. Please contact me at [email protected] with any comments and/or suggestions.

Colleen Hutchinson

 

Interview: Robert Harrington (Part 2)

Robert A. Harrington, MD, is a cardiologist and is the Arthur L. Bloomfield Professor of Medicine and Chair, Department of Medicine, at Stanford University. He served as President of the American Heart Association in 2019-2020. You can find him on Twitter at: @HeartBobH 

What is some of the most recent research and/or most promising advances in the field of cardiology?
Dr. Harrington:
Cardiovascular medicine continues to be a field where the boundaries of what we know and what we can do are always being pushed. Structural heart disease, including valvular heart disease, is a major source of innovation and invention as teams of clinical cardiologists and engineers are pushing to create new technologies for repair or replacement of structural defects. 
On the other end of the disease spectrum, research in preventive cardiology is tackling major issues in metabolism, including lipids and diabetes. The SGLT2 inhibitor findings are an example of these innovative approaches to care, now across a broad spectrum of cardiovascular disease.
 
What has been your biggest challenge and your biggest success in your career as a cardiologist?
Dr. Harrington:
An ongoing challenge remains the desire to balance all the many professional obligations with clinical care, research, teaching/mentoring, and administrative duties. While I have always enjoyed the many research projects that our groups have led, my greatest professional joy has been the mentoring of cardiology fellows and junior faculty, some of whom are now leading their own clinical and research groups.
 
What have we learned from telehealth and COVID? Will those lessons be forgotten or maintained?
Dr. Harrington:
Telehealth accelerated with the pandemic to a point where many health systems were seeing video visits accounting for 70 to 80% of all ambulatory visits. While there has been a gradual return to in-person visits, for some specialties that are managing chronic diseases—as in cardiology, clinicians and patients have learned to appreciate the benefits, including easy access, lack of travel, time away from home and work, etc. But important work remains to be done that will help us understand if outcomes are actually better using these telehealth methods, how to incorporate a set of monitoring devices into that care, how to utilize imaging and laboratory testing, and how to address some of the reimbursement and regulatory challenges associated with the use of the communications platform.
 
As chair of the second annual Going Back to the Heart of Cardiology conference, what would you say are some of the hottest topics in cardiology that the 2021 conference will cover?
Dr. Harrington:
Prevention. Prevention. Prevention. Advances in heart failure therapies. Advances in structural heart disease. New trials in antithrombotic therapies. Digital health. Applying AI/ML to cardiovascular medicine, especially imaging.

 

Rapid Fire with Bob Harrington:

Best career advice you’ve ever received: Careers are not linear; pay attention to opportunity.
Most important thing you’ve learned about clinical research: The best clinical researchers are excellent clinicians. The best questions come from clinical observations.
Your mentor: Many, but will call out Rob Califf!
Advice to the cardology med student: Work hard, be curious, watch, listen, learn.
Favorite book: Too many to list.  Always reading a fiction and non-fiction book

 

The Pulse

Journal of the American College of Cardiology Original Investigation:  Longitudinal Oral Anticoagulant Adherence Trajectories in Patients With Atrial Fibrillation
https://www.sciencedirect.com/science/article/abs/pii/S0735109721078128

Circulation: Heart Failure Article: Out-of-Pocket Costs for SGLT-2 (Sodium-Glucose Transport Protein-2) Inhibitors in the United States
https://www.ahajournals.org/doi/abs/10.1161/CIRCHEARTFAILURE.121.009099

European Heart Journal Article: Management of arrhythmias: the increasing role of artificial intelligence, genetics and cardiac resyncronization
https://academic.oup.com/eurheartj/article/42/46/4703/6455583

JAMA Cardiology Review Article: Association of Differences in Treatment Intensification, Missed Visits, and Scheduled Follow-up Interval With Racial or Ethnic Disparities in Blood Pressure Control
https://jamanetwork.com/journals/jamacardiology/newonline

Circulation Article: 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000001038

Cardiology News: ACC, AHA issue new coronary revascularization guideline:
https://www.mdedge.com/cardiology/article/249789/interventional-cardiology-surgery/acc-aha-issue-new-coronary

Going Back to the Heart of Cardiology 2021: Virtual Conference 2021: December 6–10:
https://na.eventscloud.com/website/23556/agenda/

NEJM Original Article: Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes:
https://www.nejm.org/doi/full/10.1056/NEJMoa2110956?query=featured_cardiology

Cardiology News: SGLT2 inhibitor use tied to fewer atrial arrhythmias
https://www.mdedge.com/cardiology/article/249371/arrhythmias-ep/sglt2-inhibitor-use-tied-fewer-atrial-arrhythmias

Medical Intelligence Quiz Fast Facts Friday Dec. 10: 
https://www.mdedge.com/cardiology/quiz/11263/fast-facts-friday/fast-facts-friday-december-10th-2021

 

 

November 2021

Hot Topics in Cardiology: Catching Up with Javed Butler, MD, MBA, MPH

Welcome back to MedscapeLIVE! Cardiology E-News. This month I speak with Dr. Javed Butler, who serves as co-chair of Medscape’s Going Back to the Heart of Cardiology 2021 conference. Dr. Butler is the Patrick H. Lehan Chair in Cardiovascular Research and Professor and Chairperson for the Department of Medicine at the University of Mississippi Medical Center. We discussed the most critical and useful expert consensus recommendations from his recent publication with co-authors, Treatment of HF in an Era of Multiple Therapies: Statement from the HF Collaboratory, and Dr. Butler also shared pearls from his conference presentation, “Breakthroughs in HFrEF: New and Emerging Treatment Strategies for Advanced Disease,” highlights from the meeting, and what goes into chairing a session and assembling topics and presenters.

Going Back to the Heart of Cardiology 2021 is a virtual MedscapeLIVE! conference that runs from December 6-10, 2021, and features 6 live-streamed sessions—each with 6 to 7 faculty presentations on a hot topic in cardiovascular disease management, as well as lively faculty discussion and Q&A. This will be an educational event not to miss. (If you do, however, each session will also be available for immediate on-demand access following the conference.)

In our October issue, I spoke with Dr. Michael Gibson, MD—co-chair of Going Back to the Heart of Cardiology 2021. As a renowned interventional cardiologist, cardiovascular researcher, and educator, along with overseeing the Baim and PERFUSE research institutes at Harvard Medical School, Dr. Gibson has a critical perspective on innovation in cardiology. We discussed the most applicable innovations and research findings in cardiology treatment, applying AI/ML to cardiovascular medicine, and some of his recent publications. If you missed that interview, you can view it here.

In this issue, don’t miss the Suggested Reading, in which Dr. Butler shares a critical current publication that he found to be valuable and feels will benefit all cardiologists. This issue’s Pulse includes articles from Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, New England Journal of Medicine, Cardiology News, and JAMA Cardiology. Also featured is a Medscape Fast Five Quiz: Clinical Management of Atrial Fibrillation, and Medscape blogger Dr. Ileana L. Piña speaks with Dr. Andrew Coats on agreeing on a universal definition of heart failure.

Thank you to Dr. Butler for sharing his time and expertise in this interview. Don’t forget to check out details for the Going Back to the Heart of Cardiology 2021 conference here. Please contact me at [email protected] with any comments and/or suggestions. Happy Holidays!

Colleen Hutchinson

 

Interview: Javed Butler, MD, MBA, MPH

Dr. Butler is the Patrick H. Lehan Chair in Cardiovascular Research, and Professor and Chairperson for the Department of Medicine at the University of Mississippi Medical Center in Jackson, Mississippi.

Colleen: At Medscape’s 2nd Annual Going Back to the Heart of Cardiology conference, you are co-chairing the session, “Heart Failure: Keeping Up with the Beat of Latest Developments.” What goes into chairing this session, and what were your goals with your colleagues in assembling topics and presenters?
Dr. Butler: The pace of medical advances is quite fast, and it is important that the clinical community be apprised of at least the most clinically relevant updated information in a timely manner. The selection of both topics and relevant speakers with impeccable reputations and deep insights into the selected topics was based on this single premise in mind – giving a timely, comprehensive, clinically relevant update to the practicing clinicians.

Colleen: What are some of the highlights of this session that you feel will be of import to attendees?
Dr. Butler: This is a short but nevertheless very comprehensive program that covers drugs, biomarkers, guidelines, management strategies, both heart failure with reduced and preserved ejection fraction, and, finally, timely relevant topics like the COVID pandemic and how to navigate it from a heart failure perspective. Thus, this will be a fast-paced but comprehensive hopefully tour de force on all things heart failure.

Colleen: You are presenting as well in this session on Breakthroughs in HFrEF: New and Emerging Treatment Strategies for Advanced Disease. What are some pearls or takeaways you will be sharing?
Dr. Butler: The two main points to take away are 1) to treat patients aggressively earlier in the disease process to avoid development of advanced disease, and 2) to realize that we are not without options for managing patients even with advanced disease.

Colleen: As an author on this year’s JACC Heart Failure publication, Treatment of HF in an Era of Multiple Therapies: Statement from the HF Collaboratory, can you summarize its most critical and useful expert consensus recommendations?
Dr. Butler: The most important message is that while certainly with advances in therapy the complexity of medical management has increased, so have the chances of our patients living a longer, healthier life. Thus, it is important to give all recommended therapy as soon as possible and in as optimally tolerated target doses as possible. We also discussed what future research may help us get closer to our goal of precision medicine in heart failure.

 

Suggested Reading:

Article: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. McDonagh TA, Metra M, ESC Scientific Document Group, et al. Eur Heart J. 2021 Sep 21;42(36):3599-3726.
https://pubmed.ncbi.nlm.nih.gov/34447992/

Dr. Butler: There are many important trials’ main results, and major secondary analyses are being published at a rapid rate. It is difficult to keep up with all of this. The ACC/AHA/HFSA guidelines are not out yet, but the European Society of Cardiology (ESC) guidelines did just come out recently, and they summarize all the latest advances in one place. Having this reference handy will help answer pretty much any question a clinician might have.

 

The Pulse

Going Back to the Heart of Cardiology 2021: Virtual Conference 2021 December 6–10
https://na.eventscloud.com/website/23556/agenda/

The Heart.org Commentary: Can We Agree on a Universal Definition of Heart Failure? Ileana L. Piña, MD, MPH speaks with Andrew J.S. Coats, MA, DM, DSc, MBA on her blog at:
https://www.medscape.com/viewarticle/954453

Journal of the American College of Cardiology Original Investigation: 
Effect of β-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction

https://www.sciencedirect.com/science/article/pii/S0735109721063166

Circulation Article: In Patients With Recently Diagnosed Atrial Fibrillation, Think Anticoagulation and Rhythm Control
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055163

Journal of the American Heart Association article: Rate of Heart Failure Following Atrial Fibrillation According to Presence of Family History of Dilated Cardiomyopathy or Heart Failure: A Nationwide Study
https://www.ahajournals.org/doi/10.1161/JAHA.120.021286

Cardiology News: FDA flags cardiac perforation risks during leadless pacemaker implantation
https://www.mdedge.com/cardiology/article/248868/arrhythmias-ep/fda-flags-cardiac-perforation-risks-during-leadless

NEJM Original Article: The Importance of Context in Covid-19 Vaccine Safety
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8427533/

JAMA Cardiology Original Investigation: Prevalence of Transthyretin Amyloid Cardiomyopathy in Heart Failure with Preserved Ejection Fraction
https://jamanetwork.com/journals/jamacardiology/article-abstract/2781977

Medscape Fast Five Quiz: Clinical Management of Atrial Fibrillation
https://reference.medscape.com/viewarticle/924961?src=

European Heart Journal Article: How epidemiology can improve the understanding of cardiovascular disease: from mechanisms to treatment
https://academic.oup.com/eurheartj/article/42/44/4503/6432965

 

 

 

We’re excited to announce that there will be a special live mural painting during the 2nd Annual Going Back to the Heart of Cardiology Virtual Conference. This mural will be painted by the visual artist Ferran Torras in the virtual conference center on Monday, December 6, and Tuesday, December 7. Don't miss out on this one-of-a-kind work created right in front of your eyes! In addition, a conference attendee will have the opportunity to win the completed mural. We hope to see you there!

Scroll down to learn more about Ferran Torras and what’s in store for the Going Back to the Heart of Cardiology Virtual Mural Painting in our meet-the-artist interview below.

 

MEET THE ARTIST: FERRAN TORRAS

Ferran Torras AKA Wall and Wall Ferran Torras is a multi-disciplinary artist from Barcelona with a background in design and illustration. He showcased his artwork in galleries, museums, and cultural centers throughout the world. These include the following locations: Spain, England, France, Poland, and San Francisco. His work of art is a blend of art and technology to create an immersive interactive experience. Ferran founded Wall and Wall in 2015 and has worked with clients such as Capital One, Kiva, WeWork, Google, and Facebook. 

What inspires you as an artist? 

Ferran Torras: “I get inspiration from many sources. Though, the one that works best is a nice long walk, especially if it’s out in nature. When I’m lacking ideas or creativity, another trick is to open my ‘inspirational’ folder where for years I’ve saved images that I love from artists, illustrators, sculptors, and photographers that I admire-- I just sit and look at one image after another, and often one triggers that spark that I’m looking for."

What do you enjoy most about creating murals? 

Ferran Torras: "My background is in brand design, illustration, and murals to combine particular aspects of that work that I enjoy a lot. I enjoy the process of brainstorming and the challenge of coming up with a creative idea that speaks to the client and the brand. The moment of translating it onto a large canvas is similar to illustrating on paper, but much bigger."

What can we look forward to seeing during the Going Back to the Heart of Cardiology Virtual Mural Painting? 

Ferran Torras: “I hope you will be inspired by, and enjoy the process of creating a mural from start to finish. I want to make the whole experience as interactive as possible by making you, the viewer, a participant of the experience by including your submissions and thoughts in the mural.”

To be immersed in Ferran Torras’s work of art or to find out more information about the 2nd Annual Going Back to the Heart of Cardiology Virtual Conference, click here!

 

 

October 2021

Hot Topics in Cardiology with C. Michael Gibson, MS, MD
 

Welcome back to MedscapeLIVE! Cardiology. In our September inaugural issue, I spoke with Robert A. Harrington, MD—the co-chair of Medscape’s upcoming conference, Going Back to the Heart of Cardiology 2021, and discussed his recent term as President of the AHA, preventive cardiology and the public health interest in it, and the upcoming conference. If you missed our inaugural issue, featuring an interview with Robert A. Harrington, MD, you can view it here.
This month I speak with Dr. Michael Gibson—a renowned interventional cardiologist, cardiovascular researcher, and educator. Dr. Gibson is the CEO of the combined non-profit Baim and PERFUSE research institutes at Harvard Medical School. These institutes have led over 1,000 studies, published 3,000 manuscripts, and led 60 FDA submissions from their network of 7,000 global sites. His work has been cited over 136,000 times, and he is repeatedly ranked by Thomson Reuters as one of the world's most highly cited authors in all of science in the past decade. Additionally, in 2021, Dr. Gibson was named in the 50 Most Influential Voices in Healthcare by Medika Life.

Dr. Gibson lends his expertise to Going Back to the Heart of Cardiology 2021 in assembling a critical faculty and presentation lineup for this meeting that he co-chairs with Dr. Robert Harrington. Going Back to the Heart of Cardiology 2021 is a virtual MedscapeLIVE! conference that will run from December 6-10, 2021, and will feature 6 live-streamed sessions—each with 6 to 7 faculty presentations on a hot topic in cardiovascular disease management, as well as lively faculty discussion and Q&A. This will once again be an educational event not to miss. (If you do, however, each session will also be available for on-demand access following the conference.)

In this issue, following Dr. Gibson’s interview, don’t miss the Rapid Fire section in which he also shares some quick responses to different topics and terms I threw at him. This issue’s Pulse includes a Journal of the American Heart Association article on equity in heart transplant allocation, a link to the AHA FAQs regarding its recent pivot from hybrid to all-virtual format, and articles in Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine. 

Thank you to Dr. Gibson for sharing his time and expertise in this interview. Don’t forget to check out details for the Going Back to the Heart of Cardiology 2021 conference here. Please contact me at [email protected] with any comments and/or suggestions. 

Colleen Hutchinson

 
Interview: Mike Gibson

C. Michael Gibson, M.S., M.D. is an interventional cardiologist, cardiovascular researcher & educator. He is the CEO of the combined non-profit Baim and PERFUSE research institutes at Harvard Medical School.

Colleen: Can you share with us what you feel are the most useful and applicable innovations and/or research findings in cardiology treatment? 
Dr: Gibson:
Probably the most important recent research advances are the SGLT2 Inhibitors. I expect they will enjoy broad use not only in diabetes, but also in the management of patients with both HFrEF and HFpEF.
  
As co-chair, what would you say is a hot topic that will be covered the second annual Going Back to the Heart of Cardiology conference?
Dr. Gibson:
Given the recent positive data for empagliflozin (Jardiance) in improving outcomes in HFpEF in the EMPEROR-Preserved trial, that will be an important topic. There are conflicting data on the optimal duration of dual antiplatelet therapy after ACS, and that needs to be sorted out.

Where are we in terms of applying AI/ML to cardiovascular medicine, and do you see it as a game changer?
Dr. Gibson:
There are advances in the use of AI and ML in the interpretations of echo images and EKGs. Coupled with iPhone probes, these could expand the use of echo and its interpretation to remote areas. We have used AI in predicting clinical outcomes, but it was no better than standard logistic regression.

Your Journal of Medical Virology article, “Effect of azithromycin and hydroxychloroquine in patients hospitalized with COVID-19: Network meta-analysis of randomized controlled trials,” looks at evidence from randomized controlled trials (RCTs) to determine if azithromycin (AZ) or hydroxychloroquine (HCQ) is associated with improved clinical outcomes. Were you surprised by the results? 
Dr. Gibson: Not at all. We should rely upon randomized trials and not observational studies to inform decisions about safety and effectiveness of drugs, including those during a pandemic.

Can you summarize the main findings of your recent TWILIGHT (Ticagrelor with Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial research on ticagrelor monotherapy in patients with PCI?
Dr. Gibson:
Among high-risk patients who underwent PCI and completed 3 months of dual antiplatelet therapy, ticagrelor monotherapy was associated with a lower incidence  of clinically relevant bleeding than ticagrelor plus aspirin, with no higher risk of 
death, myocardial infarction, or stroke. This adds to literature that supports shortening the duration of DAPT in appropriate patients.

Please tell us a little about the BAIM Institute and the PERFUSE Study Group. 
Dr. Gibson:
The Baim Institute was formerly known as the Harvard Clinical Research Institute (HCRI). We have now merged many of our efforts with the PERFUSE Study Group I founded years ago. We are a full service ARO that performs both device and pharmaceutical trials as well as outcomes studies. The institutes have led over 1,000 studies, published 5,500 manuscripts in the peer review literature (including 144 in the New England Journal of Medicine) and have led 60 FDA submissions from their network of 7,000 sites worldwide. We welcome participation and training of young physicians in our program!

 

Rapid Fire with Mike Gibson:

Best tool in your cardiologist arsenal: A brain.
My most frustrating treatment issue: People demanding ivermectin and other drugs that don’t work in COVID.
Going Back to the Heart of Cardiology conference: Excited to co-moderate what I’m sure will be exciting sessions!
Publication you are most proud of: My invention of the TIMI Frame Count and TIMI perfusion grades.
Best career advice ever received: The advice I give: your job is from 9 to 5. Your career is from 5 to 9.
COVID vaccine in teens and myocarditis: Overall the advantages of vaccination outweigh the risks.
Your mentor: Eugene Braunwald & life.
Favorite book: WikiDoc.or,g the free copyleft textbook of medicine co-authored by 2,500 MDs, and revised millions of times
Biggest career challenge and accomplishment to date: Turning around a bankrupt ARO and making it viable and sustainable

 
The Pulse

American Heart Association (AHA) 2021 Scientific Sessions FAQs: An update and information on this year’s now all virtual event:
https://professional.heart.org

Going Back to the Heart of Cardiology 2021: Virtual Conference 2021 December 6–10
https://na.eventscloud.com/website/23556/agenda/

Journal of the American College of Cardiology Original Investigation Editorial Comment: 
Impact of New ICD Codes on Acute MI Characteristics and Outcomes: What You Call It Matters

https://www.sciencedirect.com/science/article/abs/pii/S0735109721057168

Circulation Article: Early Rhythm Control Therapy in Patients with Atrial Fibrillation and Heart Failure
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056323

Journal of the American Heart Association article: Equity in Heart Transplant Allocation: Intended Progress Up the Hill or an Impossibility?
https://www.ahajournals.org/doi/10.1161/JAHA.121.022817

Cardiology News: Poor lung function linked to risk for sudden cardiac death
https://www.mdedge.com/cardiology/article/246192/cardiology/poor-lung-function-linked-risk-sudden-cardiac-death

Circulation Article: Effect of Colchicine on Myocardial Injury in Acute Myocardial Infarction
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056177

NEJM Original Article: The Importance of Context in Covid-19 Vaccine Safety
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8427533/

JAMA Cardiology Clinical Guidelines Synopsis: Guideline Update on Indications for Transcatheter Aortic Valve Implantation Based on the 2020 American College of Cardiology/American Heart Association Guidelines for Management of Valvular Heart Disease
https://jamanetwork.com/journals/jamacardiology/article-abstract/2781977

Cardiology News Article: A new weight loss threshold for T2d remission after bariatric surgery?
https://www.mdedge.com/cardiology/article/246364/diabetes/new-weight-loss-threshold-t2d-remission-after-bariatric-surgery

European Heart Journal Article: The new frontiers in valvular heart disease: from artificial intelligence to new pharmacological targets in aortic stenosis
https://academic.oup.com/eurheartj/article/42/30/2871/6344966?searchresult=1

 

 

 

August 2021

Welcome to the inaugural cardiology e-news, MedscapeLIVE Cardiology! I am excited to manage this new cardiology MedscapeLIVE publication. As you’ll see below, we have some e-news features in store for you that will be beneficial.
First, every issue will feature a candid interview with either one or multiple thought leaders in cardiology, and then a Rapid Fire section in which one must provide quick and short response to different topics and terms. In this inaugural issue, I interview Robert A. Harrington, MD—the co-chair of MedscapeLIVE's upcoming conference, Going Back to the Heart of Cardiology 2021, and get his thoughts on his recent term as President of the American Heart Association (AHA), preventive cardiology and the public health interest in it, and the upcoming conference. From his years at Duke to more recent years at Stanford, along with having recently served as President of the AHA, Dr. Harrington brings a well-informed and critical knowledge of current issues and challenges in cardiology, as well as pulse on current best practices, to both this interview and to the conference that he co-chairs with Dr. Michael Gibson. Going Back to the Heart of Cardiology 2021 is a MedscapeLIVE! conference. This second annual virtual event, which will run from December 6-10, 2021, features 6 live-streamed sessions, each of which will include 6 to 7 faculty presentations on a hot topic in cardiovascular disease management, as well as lively faculty discussion and Q&A. This will once again be an educational event not to miss. (If you do, however, each session will also be available for immediate on-demand access following the conference.)
Given the ever-changing nature of cardiology and the current healthcare environment, and the challenge to keep up with rapid advances being made in this field, each issue will also feature a cardiology resource section called The Pulse to keep you updated on critical research, resources, and new developments. This includes association updates and guidelines, crucial recent publications, and other helpful cardiology best practices information so you have all you need in one place at your fingertips to stay informed. Get ready to be engaged and entertained, as well as educated, in the coming months. We have great things in store for you!
Thank you to this month’s interview participant, Dr. Harrington, for sharing his time and expertise. Don’t forget to check out details for the Going Back to the Heart of Cardiology 2021 conference here.
Here’s to a new MedscapeLIVE tool designed to keep you plugged in and informed, to the new names and faces you will see in these issues, and to developing a lasting rapport with you, the readership! We want to be a helpful, quick, and interesting monthly source of information for all things cardiology. Please contact me at [email protected] with any comments and/or suggestions.

Colleen Hutchinson

 

Interview: Robert Harrington (Part 1 of 2)

Robert A. Harrington, MD, is a cardiologist and is the Arthur L. Bloomfield Professor of Medicine and Chair, Department of Medicine, at Stanford University. He served as President of the American Heart Association in 2019-2020. You can find him on Twitter at: @HeartBobH 

As a Past President of the American Heart Association, how would you describe your term, and what you are continuing to work on as a Past President?
Dr. Harrington:
Serving as President of the AHA was a humbling experience in that you get to see up close the incredible reach of the organization in science and public health advocacy with almost 40 million volunteers. I was also the President during the beginning months of the COVID 19 pandemic and am proud of the work AHA did to rapidly provide science-based information to clinicians, scientists and the public about the intersection of COVID infection and cardiovascular disease and stroke. As a Past President, I remain fully committed to AHA’s mission to be a “relentless force for a world of longer, healthier lives.”

How would you define the term preventive cardiology, which is such a major focus currently?
Dr. Harrington:
Prevention is the key to avoiding the start and/or the progression of cardiovascular disease. In most understandings, it refers more specifically to the prevention of the consequences of atherosclerotic vascular disease, namely myocardial infarction, stroke and death.

With the intense public health interest in this area, and with the new advocacy and health policy efforts, as well as new technologies being developed and used to assist in public health management, what do you foresee for the future of public health?
Dr. Harrington: The pandemic has certainly shown us both the benefits and the limitations of the US public health infrastructure. But the lessons learned from the pandemic, including around issues of health equity, certainly can be applied to the public health needs for addressing the societal burden of chronic diseases, such as cardiovascular disease.

As chair of the second annual Going Back to the Heart of Cardiology conference, what would you say are some of the hottest topics in cardiology that the 2021 conference will cover?
Dr. Harrington:
Prevention. Prevention. Prevention. Advances in heart failure therapies. Advances in structural heart disease. New trials in antithrombotic therapies. Digital health. Applying AI/ML to cardiovascular medicine, especially imaging.

 

Rapid Fire with Bob Harrington:

Advice to the med student who wants to be a cardiologist: work hard, be curious, watch, listen, learn
Best career advice you’ve ever received: Careers are not linear—pay attention to opportunity
Appreciate most about Stanford: the innovative science culture coupled with a spirit of collegiality, and all located in Silicon Valley.
Miss most about Duke: our many friends, the emphasis on the importance of the clinical culture and the amazing resources of the DCRI.
Your mentor: many but will call out Robert Califf
Favorite book: Too many to list. Always reading a fiction and non-fiction book.
Most important thing you’ve learned about clinical research: The best clinical researchers are excellent clinicians. The best questions come from clinical observations.

 
The Pulse

Journal of the American College of Cardiology Focus Issue on Cardiac Imaging
https://www.sciencedirect.com/journal/journal-of-the-american-college-of-cardiology/vol/48/issue/10

Circulation: Heart Failure Article: Patient-Specific Computational Fluid Dynamics Reveal Localized Flow Patterns Predictive of Post–Left Ventricular Assist Device Aortic Incompetence
https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.120.008034

European Heart Journal Article: The new frontiers in valvular heart disease: from artificial intelligence to new pharmacological targets in aortic stenosis
https://academic.oup.com/eurheartj/article/42/30/2871/6344966?searchresult=1

JAMA Cardiology Review Article: State of the Nation’s Cardiovascular Health and Targeting Health Equity in the United States
A Narrative Review:
https://jamanetwork.com/journals/jamacardiology/article-abstract/2780126

Circulation Article: Relationship Between Residual Mitral Regurgitation and Clinical and Quality-of-Life Outcomes After Transcatheter and Medical Treatments in Heart Failure—COAPT Trial
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.053061

Cardiology News: Myocarditis tied to COVID-19 shots more common than reported?
https://www.mdedge.com

Going Back to the Heart of Cardiology 2021: Virtual Conference 2021: December 6–10:
https://na.eventscloud.com/website/23556/agenda/

NEJM Original Article: Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19:
https://www.nejm.org/doi/full/10.1056/NEJMoa2103417

Cardiology News: CDC: Vaccination may cut risk of COVID reinfection in half 
https://www.mdedge.com

JAMA Invited Commentary: Leveraging Large Clinical Data Sets for Artificial Intelligence in Medicine
https://jamanetwork.com/journals/jamacardiology/article-abstract/2782552

Cardiology News: Aerobic exercise reduces BP in resistant hypertension
https://www.mdedge.com/cardiology/article/244030/hypertension/aerobic-exercise-reduces-bp-resistant-hypertension