HF Science News from AHA Scientific Sessions 2020
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HF Science News from AHA Scientific Sessions 2020 Dr Han Naung Tun (Henry Han) MBBS, MD, FACTM
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Updated and Overview of HF Trials in ESC 2020
This document summarizes several late-breaking trials presented at the ESC 2020 conference on heart failure (HF) management. It discusses the EMPEROR-Reduced trial which found that empagliflozin reduced cardiovascular death and HF hospitalization in HF patients regardless of diabetes status. It also mentions the EXPLORER-HCM trial on HFpEF and the PARALLAX trial which found sacubitril/valsartan did not reduce cardiac failure events in HFpEF patients compared to ACE/ARB therapy. Finally, it summarizes the DAPA-CKD trial results showing that dapagliflozin delayed kidney failure in patients with chronic kidney disease with and without diabetes.
Latest Trials on CAD from 2020 ESC Congress
LoDoCo2 Trial: low-dose colchicine reduced the risk of major cardiovascular events in patients with CAD
ATPCI: Trimetazidine in Angina Patients With Recent Successful Percutaneous Coronary Intervention
RAPID CTCA :Early Coronary CT Angiography in Patients With Suspected or Provisionally Diagnosed Acute Coronary Syndrome
OCT and MRI Find an MI Cause in 85% of Women With MINOCA: HARP
Ventricular septal rupture with cardiogenic shock follows by Inferior AMI
This document describes the case of a 58-year-old man who presented with chest pain and was diagnosed with an inferoposterior myocardial infarction complicated by ventricular septal rupture and cardiogenic shock. Initial treatment included medications, percutaneous coronary intervention to open the blocked artery, and supportive care. Despite intensive medical management, the patient's condition deteriorated with the development of ventricular septal defect. Surgical repair was considered but the patient expired from cardiogenic shock before a procedure could be performed. The key learning points are the importance of early recognition of pre-shock states, the high mortality of ventricular septal rupture, and the need for a multidisciplinary approach and care at an experienced center to manage such complex cases.
The patient with AHF on the ICU : Respiratory Support
This document discusses respiratory support for patients with acute heart failure in the intensive care unit (ICU). It provides the following key points:
1. Noninvasive ventilation (NIV), including CPAP and bilevel PAP, should be the first-line treatment for acute pulmonary edema and can reduce intubation rates and mortality compared to conventional oxygen therapy.
2. High-flow nasal cannula oxygen is an alternative to NIV and has been shown to reduce intubation compared to conventional oxygen in patients with acute hypoxemic respiratory failure.
3. Invasive mechanical ventilation should be reserved for patients with significant hypercapnia, acidosis or respiratory distress that cannot be managed with NIV.
AHF - Discharge from ICU to the Regular Ward.
Millions of patients are hospitalized annually for heart failure, with the majority improving with diuretic therapy and being discharged. However, post-discharge mortality and rehospitalization rates remain high, demonstrating an unmet need. The document discusses characteristics of heart failure patients, common treatments, and outcomes following hospitalization. It concludes that most heart failure patients respond well to standard therapy and do not require intensive care, and that criteria are needed to determine appropriate ICU admissions and discharges.
Hospital Readmission of Heart Failure Patients And Its Precipitated Factors a...
Hypertension is one of the most prevalent modifiable risk factor for the development of heart failure (HF). Chronic heart failure (CHF) is the most common cause of readmission for patients in worldwide
Stop That Clot
The document discusses the management of massive pulmonary embolism (PE), which is defined as PE with systolic blood pressure ≤90 mmHg or a pressure drop of >40 mmHg for 15 minutes. It describes evaluating patients for right ventricular dysfunction using CT, echocardiogram, or biomarkers. For confirmed massive PE, initial treatment involves heparin, supportive care, and consideration of thrombolysis which reduces mortality compared to heparin alone but risks bleeding. Catheter-directed thrombolysis or surgical embolectomy are alternatives if thrombolysis is contraindicated or fails.
Bui duy icu
The document discusses the management of massive pulmonary embolism (PE), which is defined as PE with systolic blood pressure ≤90 mmHg or a pressure drop of >40 mmHg for 15 minutes. Initial treatment involves oxygen, pain control, and cautious IV fluids. If PE is confirmed on CT or echocardiogram, thrombolytics are given if not contraindicated. For patients who fail or cannot receive thrombolytics, catheter-based thrombolysis or surgical embolectomy are options. The risks and diagnostic alternatives of renal failure are also covered.
Recommended
Updated and Overview of HF Trials in ESC 2020
This document summarizes several late-breaking trials presented at the ESC 2020 conference on heart failure (HF) management. It discusses the EMPEROR-Reduced trial which found that empagliflozin reduced cardiovascular death and HF hospitalization in HF patients regardless of diabetes status. It also mentions the EXPLORER-HCM trial on HFpEF and the PARALLAX trial which found sacubitril/valsartan did not reduce cardiac failure events in HFpEF patients compared to ACE/ARB therapy. Finally, it summarizes the DAPA-CKD trial results showing that dapagliflozin delayed kidney failure in patients with chronic kidney disease with and without diabetes.
Latest Trials on CAD from 2020 ESC Congress
LoDoCo2 Trial: low-dose colchicine reduced the risk of major cardiovascular events in patients with CAD
ATPCI: Trimetazidine in Angina Patients With Recent Successful Percutaneous Coronary Intervention
RAPID CTCA :Early Coronary CT Angiography in Patients With Suspected or Provisionally Diagnosed Acute Coronary Syndrome
OCT and MRI Find an MI Cause in 85% of Women With MINOCA: HARP
Ventricular septal rupture with cardiogenic shock follows by Inferior AMI
This document describes the case of a 58-year-old man who presented with chest pain and was diagnosed with an inferoposterior myocardial infarction complicated by ventricular septal rupture and cardiogenic shock. Initial treatment included medications, percutaneous coronary intervention to open the blocked artery, and supportive care. Despite intensive medical management, the patient's condition deteriorated with the development of ventricular septal defect. Surgical repair was considered but the patient expired from cardiogenic shock before a procedure could be performed. The key learning points are the importance of early recognition of pre-shock states, the high mortality of ventricular septal rupture, and the need for a multidisciplinary approach and care at an experienced center to manage such complex cases.
The patient with AHF on the ICU : Respiratory Support
This document discusses respiratory support for patients with acute heart failure in the intensive care unit (ICU). It provides the following key points:
1. Noninvasive ventilation (NIV), including CPAP and bilevel PAP, should be the first-line treatment for acute pulmonary edema and can reduce intubation rates and mortality compared to conventional oxygen therapy.
2. High-flow nasal cannula oxygen is an alternative to NIV and has been shown to reduce intubation compared to conventional oxygen in patients with acute hypoxemic respiratory failure.
3. Invasive mechanical ventilation should be reserved for patients with significant hypercapnia, acidosis or respiratory distress that cannot be managed with NIV.
AHF - Discharge from ICU to the Regular Ward.
Millions of patients are hospitalized annually for heart failure, with the majority improving with diuretic therapy and being discharged. However, post-discharge mortality and rehospitalization rates remain high, demonstrating an unmet need. The document discusses characteristics of heart failure patients, common treatments, and outcomes following hospitalization. It concludes that most heart failure patients respond well to standard therapy and do not require intensive care, and that criteria are needed to determine appropriate ICU admissions and discharges.
Hospital Readmission of Heart Failure Patients And Its Precipitated Factors a...
Hypertension is one of the most prevalent modifiable risk factor for the development of heart failure (HF). Chronic heart failure (CHF) is the most common cause of readmission for patients in worldwide
Stop That Clot
The document discusses the management of massive pulmonary embolism (PE), which is defined as PE with systolic blood pressure ≤90 mmHg or a pressure drop of >40 mmHg for 15 minutes. It describes evaluating patients for right ventricular dysfunction using CT, echocardiogram, or biomarkers. For confirmed massive PE, initial treatment involves heparin, supportive care, and consideration of thrombolysis which reduces mortality compared to heparin alone but risks bleeding. Catheter-directed thrombolysis or surgical embolectomy are alternatives if thrombolysis is contraindicated or fails.
Bui duy icu
The document discusses the management of massive pulmonary embolism (PE), which is defined as PE with systolic blood pressure ≤90 mmHg or a pressure drop of >40 mmHg for 15 minutes. Initial treatment involves oxygen, pain control, and cautious IV fluids. If PE is confirmed on CT or echocardiogram, thrombolytics are given if not contraindicated. For patients who fail or cannot receive thrombolytics, catheter-based thrombolysis or surgical embolectomy are options. The risks and diagnostic alternatives of renal failure are also covered.
DAPA-HF Trial
El Dr. Alfonso Valle Muñoz comenta los resultados del estudio con dapagliflozina en insuficiencia cardiaca, presentado en ESC Congress 2019.
1 dan atar - latest landmark trials in hf-1
Professor Dan Atar is a cardiologist who has contributed significantly to clinical trials and guidelines on heart failure and atrial fibrillation. He discloses relationships with several pharmaceutical companies. He summarizes key landmark trials in heart failure treatment. RALES showed spironolactone reduced mortality in severe heart failure. EPHESUS found eplerenone beneficial post-myocardial infarction. EMPHASIS showed benefit in mild heart failure. COMMANDER-HF found no benefit to anticoagulation in sinus rhythm heart failure patients. TOPCAT found spironolactone reduced heart failure hospitalizations but not overall in those with preserved ejection fraction. PARADIGM established mortality benefit for sacubitril/valsart
Brief Infusion Of Eptifibatide Following Percutaneous Coronary Intervention
The BRIEF-PCI trial evaluated the effectiveness of a brief (<2 hour) infusion of the antiplatelet drug eptifibatide compared to the standard 18-hour infusion following elective percutaneous coronary intervention (PCI). The trial found that the abbreviated infusion was not inferior to the standard infusion in preventing post-PCI cardiac enzyme elevation or other clinical outcomes, while significantly reducing the risk of major bleeding. The results suggest a brief eptifibatide infusion may be sufficient for stable patients undergoing elective PCI who are pretreated with clopidogrel.
Novedades en el manejo de la IC Aguda
Ponencia presentada por el Dr. Domingo Pascual Figal en el directo online ‘Lo mejor del Congreso Europeo de IC Atenas 2019’, realizado en la Casa del Corazón el 5 de junio de 2019
Ensayos clínicos en IC preservada: resultados del PARAGON-HF
Ponencia presentada por el Dr. Josep Comín Colet en el directo ‘IC preservada y resultados del PARAGON-HF’, realizado en la Casa del Corazón el 9 de septiembre de 2019.
Jose luis ferreiro simposio cangrelor
Dr. José Luis Ferreiro presented on the incorporation of cangrelor as the newest addition to antiplatelet treatment in PCI. Cangrelor is a direct-acting, reversible P2Y12 inhibitor administered intravenously with an extremely short half-life. Clinical trials demonstrated cangrelor reduced death, MI, ischemia-driven revascularization and stent thrombosis within 48 hours compared to clopidogrel in PCI patients who had not received a pre-treatment P2Y12 inhibitor. Guidelines recommend cangrelor for high-risk PCI when no pre-treatment with a P2Y12 inhibitor is possible. Transition from cangrelor to oral agents requires caution due to a potential gap in platelet
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Oral Apixaban for the Treatment of Acute Venous Thromboembolism.
Done by:
Aziza AlAmri, Nora AlWohayeb, Salma Almakinzi.
Can newer antiplatelets replace clopidogrel
- Clopidogrel is still the standard antiplatelet for many patients with stable IHD or ACS managed conservatively, as well as for primary PCI within 3 hours of chest pain onset, as prasugrel and ticagrelor have certain limitations for these groups.
- For PCI, a 600 mg loading dose of clopidogrel is recommended based on evidence from RCTs showing benefit compared to lower doses.
- Newer antiplatelets like ticagrelor have advantages over clopidogrel but also drawbacks like increased dyspnea and renal issues, while prasugrel requires caution in certain groups due to bleeding risks.
- Cangrelor's IV formulation
Newer anti platelet in stroke
1. Platelets play an important role in both normal hemostasis and pathological thromboses like myocardial infarction and stroke. Antiplatelet drugs are commonly used to prevent strokes.
2. Aspirin is recommended for both primary and secondary stroke prevention. Clopidogrel and dipyridamole are also options for secondary prevention. Combination aspirin/dipyridamole may be better than aspirin alone.
3. Newer antiplatelets like ticagrelor inhibit the P2Y12 receptor more effectively than clopidogrel, but trials found no clear benefit over aspirin for acute stroke. Combining aspirin and clopidogrel long-term increases bleeding risk without
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This document summarizes new developments in pharmacology for interventional cardiology. It discusses the treatment of antithrombotic therapy in patients with atrial fibrillation who have had an acute coronary syndrome or percutaneous coronary intervention. Specifically, it reviews results from the AUGUSTUS trial, which compared apixaban to vitamin K antagonists and aspirin to placebo in over 4,600 such patients. The trial found that apixaban resulted in significantly less bleeding and fewer hospitalizations compared to vitamin K antagonists, without significant differences in ischemic events. Aspirin resulted in higher bleeding risk. Given total data, the document recommends using direct oral anticoagulants over vitamin K antagonists for these patients.Role of CRT and CRTD in CHF
1) The document discusses the role of cardiac resynchronization therapy (CRT) in treating chronic heart failure based on results from clinical trials.
2) Landmark trials like CARE-HF, MADIT-CRT and REVERSE showed that CRT reduces mortality and hospitalization in patients with heart failure symptoms.
3) Later trials also found benefits of CRT in mildly symptomatic patients with reduced left ventricular function and wide QRS duration, including decreased heart failure events and increased left ventricular ejection fraction, though effects on quality of life and exercise capacity were less clear.
Device Therapy in Heart Failure
Lecture on device therapy in heart failure delivered in the Philippine Heart Association Annual Scientific Meeting 2015.
CARE-HF trial - Summary & Results
http://www.theheart.org/web_slides/1135591.do
A randomized study on Cardiac Resynchronization - Heart Failure with NYHA class 3-4 HF despite standard drug therapy, an LVEF and QRS.
Anticoagulation
This document discusses oral anticoagulants and hand surgery. It presents several case studies and findings that show elective hand surgery can be performed safely in patients taking oral anticoagulants like warfarin as long as their INR is below 3.0. Minor bleeding complications were observed but were consistent with minor surgical procedures. The studies found stopping anticoagulation therapy before hand surgery is unnecessary and can increase risks from discontinuing important long-term medications. Clinical judgement should be used to determine risks for individual patients.
Current status of stroke intervention
1. The document summarizes current stroke intervention strategies, including intravenous fibrinolysis (tPA), endovascular interventions like intra-arterial fibrinolysis and mechanical thrombectomy, and decompressive craniotomy.
2. Intravenous tPA is recommended within 3 hours and may be considered within 3-4.5 hours for select patients. Several trials have demonstrated the benefits of intravenous tPA.
3. Intra-arterial fibrinolysis and mechanical thrombectomy are beneficial options for carefully selected patients not eligible for intravenous tPA or who have failed intravenous tPA. Recent trials show improved outcomes with newer mechanical thrombectomy devices compared to older technologies.
2018 ehra practical guide on the use of non vitamin k antagonist oral anticoa...
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Summary of landmark CTO clinical trials and highlights from registries
This document summarizes information from registries and trials on coronary chronic total occlusions (CTO). It discusses CTO lesion analysis scores, access choices, success rates and complications. It reviews several randomized controlled trials comparing CTO percutaneous coronary intervention (PCI) to medical therapy that had modest sample sizes and open-label designs. It also discusses observational data from large registries on temporal trends in CTO PCI procedures, techniques, success rates and complications. The key takeaway message is that adoption of modern CTO techniques has led to increased success rates with lower complications, and RCTs showed improved quality of life while observational data suggests successful CTO revascularization may improve long-term prognosis.
NOAC in coronary artery disease
Rivaroxaban has been studied as an addition to antiplatelet therapy in patients with coronary artery disease in several large trials.
The ATLAS-ACS 2 trial found that low-dose rivaroxaban (2.5mg twice daily) added to dual antiplatelet therapy after acute coronary syndrome reduced the composite of death, heart attack, and stroke compared to placebo, but increased bleeding risk.
The COMPASS trial showed that in stable coronary or peripheral artery disease patients, low-dose rivaroxaban (2.5mg twice daily) added to aspirin reduced the composite of death, heart attack, and stroke compared to aspirin alone, again with increased bleeding.
The risk-
Symplicity htn 3 trial
This document summarizes a clinical trial evaluating the safety and effectiveness of catheter-based renal denervation for treating uncontrolled hypertension. The trial was a prospective, randomized, single-blind study comparing renal denervation to a sham control procedure in over 500 patients. The trial met its primary safety endpoint but did not meet its primary efficacy endpoint of a reduction in systolic blood pressure of at least 5 mmHg. In response, the manufacturer suspended enrollment in other renal denervation hypertension trials pending further review, but will continue post-market surveillance and studies of non-hypertension indications based on the procedure's demonstrated safety profile.
Year in cardiology - ACS
The document discusses several studies related to cardiology. It summarizes the key findings of each study in 1-2 sentences. Some of the studies discussed include:
- A study finding that whole genome sequencing identified genetic risk factors like familial hypercholesterolemia in 1.7% of acute myocardial infarction patients under 55 and a high polygenic risk score in 17% of patients.
- A study finding that plasma levels of the metabolite TMAO were higher in STEMI patients with plaque rupture compared to erosion and may be a novel biomarker for plaque morphology.
- The ALERTS trial which found that an implantable cardiac alert system safely detected rapid ST segment changes but did not meet its
Guidelines and unanswered questions.
This document summarizes guidelines and ongoing questions regarding the use of antithrombotic medications in patients with heart failure and atrial fibrillation. It discusses several large clinical trials that have evaluated anticoagulant and antiplatelet therapies. The risks and benefits of warfarin versus novel oral anticoagulants are assessed based on pivotal trials. Ongoing studies exploring antithrombotic strategies in HF patients in sinus rhythm or with preserved ejection fraction are also summarized.
HeART FAILURE Hfpef
1) HFpEF is the most common form of heart failure, affecting over 70% of heart failure patients over age 65. It is associated with substantial morbidity and mortality.
2) HFpEF is challenging to diagnose because ejection fraction is normal and cardiac congestion is difficult to evaluate non-invasively. It is defined hemodynamically as a clinical syndrome associated with a lack of capacity of the heart to pump blood adequately without elevated cardiac filling pressures.
3) There is currently no effective pharmacological treatment for HFpEF. Treatment focuses on controlling congestion through diuretics, managing comorbidities, and promoting exercise. Future efforts to better characterize HFpEF phenotypes may allow individualized therapies
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1 dan atar - latest landmark trials in hf-1
Professor Dan Atar is a cardiologist who has contributed significantly to clinical trials and guidelines on heart failure and atrial fibrillation. He discloses relationships with several pharmaceutical companies. He summarizes key landmark trials in heart failure treatment. RALES showed spironolactone reduced mortality in severe heart failure. EPHESUS found eplerenone beneficial post-myocardial infarction. EMPHASIS showed benefit in mild heart failure. COMMANDER-HF found no benefit to anticoagulation in sinus rhythm heart failure patients. TOPCAT found spironolactone reduced heart failure hospitalizations but not overall in those with preserved ejection fraction. PARADIGM established mortality benefit for sacubitril/valsart
Brief Infusion Of Eptifibatide Following Percutaneous Coronary Intervention
The BRIEF-PCI trial evaluated the effectiveness of a brief (<2 hour) infusion of the antiplatelet drug eptifibatide compared to the standard 18-hour infusion following elective percutaneous coronary intervention (PCI). The trial found that the abbreviated infusion was not inferior to the standard infusion in preventing post-PCI cardiac enzyme elevation or other clinical outcomes, while significantly reducing the risk of major bleeding. The results suggest a brief eptifibatide infusion may be sufficient for stable patients undergoing elective PCI who are pretreated with clopidogrel.
Novedades en el manejo de la IC Aguda
Ponencia presentada por el Dr. Domingo Pascual Figal en el directo online ‘Lo mejor del Congreso Europeo de IC Atenas 2019’, realizado en la Casa del Corazón el 5 de junio de 2019
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Ponencia presentada por el Dr. Josep Comín Colet en el directo ‘IC preservada y resultados del PARAGON-HF’, realizado en la Casa del Corazón el 9 de septiembre de 2019.
Jose luis ferreiro simposio cangrelor
Dr. José Luis Ferreiro presented on the incorporation of cangrelor as the newest addition to antiplatelet treatment in PCI. Cangrelor is a direct-acting, reversible P2Y12 inhibitor administered intravenously with an extremely short half-life. Clinical trials demonstrated cangrelor reduced death, MI, ischemia-driven revascularization and stent thrombosis within 48 hours compared to clopidogrel in PCI patients who had not received a pre-treatment P2Y12 inhibitor. Guidelines recommend cangrelor for high-risk PCI when no pre-treatment with a P2Y12 inhibitor is possible. Transition from cangrelor to oral agents requires caution due to a potential gap in platelet
Oral apixaban
Oral Apixaban for the Treatment of Acute Venous Thromboembolism.
Done by:
Aziza AlAmri, Nora AlWohayeb, Salma Almakinzi.
Can newer antiplatelets replace clopidogrel
- Clopidogrel is still the standard antiplatelet for many patients with stable IHD or ACS managed conservatively, as well as for primary PCI within 3 hours of chest pain onset, as prasugrel and ticagrelor have certain limitations for these groups.
- For PCI, a 600 mg loading dose of clopidogrel is recommended based on evidence from RCTs showing benefit compared to lower doses.
- Newer antiplatelets like ticagrelor have advantages over clopidogrel but also drawbacks like increased dyspnea and renal issues, while prasugrel requires caution in certain groups due to bleeding risks.
- Cangrelor's IV formulation
Newer anti platelet in stroke
1. Platelets play an important role in both normal hemostasis and pathological thromboses like myocardial infarction and stroke. Antiplatelet drugs are commonly used to prevent strokes.
2. Aspirin is recommended for both primary and secondary stroke prevention. Clopidogrel and dipyridamole are also options for secondary prevention. Combination aspirin/dipyridamole may be better than aspirin alone.
3. Newer antiplatelets like ticagrelor inhibit the P2Y12 receptor more effectively than clopidogrel, but trials found no clear benefit over aspirin for acute stroke. Combining aspirin and clopidogrel long-term increases bleeding risk without
Pablo avanzas novedades farmacologia en intervencionismo
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This document summarizes new developments in pharmacology for interventional cardiology. It discusses the treatment of antithrombotic therapy in patients with atrial fibrillation who have had an acute coronary syndrome or percutaneous coronary intervention. Specifically, it reviews results from the AUGUSTUS trial, which compared apixaban to vitamin K antagonists and aspirin to placebo in over 4,600 such patients. The trial found that apixaban resulted in significantly less bleeding and fewer hospitalizations compared to vitamin K antagonists, without significant differences in ischemic events. Aspirin resulted in higher bleeding risk. Given total data, the document recommends using direct oral anticoagulants over vitamin K antagonists for these patients.Role of CRT and CRTD in CHF
1) The document discusses the role of cardiac resynchronization therapy (CRT) in treating chronic heart failure based on results from clinical trials.
2) Landmark trials like CARE-HF, MADIT-CRT and REVERSE showed that CRT reduces mortality and hospitalization in patients with heart failure symptoms.
3) Later trials also found benefits of CRT in mildly symptomatic patients with reduced left ventricular function and wide QRS duration, including decreased heart failure events and increased left ventricular ejection fraction, though effects on quality of life and exercise capacity were less clear.
Device Therapy in Heart Failure
Lecture on device therapy in heart failure delivered in the Philippine Heart Association Annual Scientific Meeting 2015.
CARE-HF trial - Summary & Results
http://www.theheart.org/web_slides/1135591.do
A randomized study on Cardiac Resynchronization - Heart Failure with NYHA class 3-4 HF despite standard drug therapy, an LVEF and QRS.
Anticoagulation
This document discusses oral anticoagulants and hand surgery. It presents several case studies and findings that show elective hand surgery can be performed safely in patients taking oral anticoagulants like warfarin as long as their INR is below 3.0. Minor bleeding complications were observed but were consistent with minor surgical procedures. The studies found stopping anticoagulation therapy before hand surgery is unnecessary and can increase risks from discontinuing important long-term medications. Clinical judgement should be used to determine risks for individual patients.
Current status of stroke intervention
1. The document summarizes current stroke intervention strategies, including intravenous fibrinolysis (tPA), endovascular interventions like intra-arterial fibrinolysis and mechanical thrombectomy, and decompressive craniotomy.
2. Intravenous tPA is recommended within 3 hours and may be considered within 3-4.5 hours for select patients. Several trials have demonstrated the benefits of intravenous tPA.
3. Intra-arterial fibrinolysis and mechanical thrombectomy are beneficial options for carefully selected patients not eligible for intravenous tPA or who have failed intravenous tPA. Recent trials show improved outcomes with newer mechanical thrombectomy devices compared to older technologies.
2018 ehra practical guide on the use of non vitamin k antagonist oral anticoa...
2018 ehra practical guide on the use of non vitamin k antagonist oral anticoagulants in patients with atrial fibrillation
Summary of landmark CTO clinical trials and highlights from registries
This document summarizes information from registries and trials on coronary chronic total occlusions (CTO). It discusses CTO lesion analysis scores, access choices, success rates and complications. It reviews several randomized controlled trials comparing CTO percutaneous coronary intervention (PCI) to medical therapy that had modest sample sizes and open-label designs. It also discusses observational data from large registries on temporal trends in CTO PCI procedures, techniques, success rates and complications. The key takeaway message is that adoption of modern CTO techniques has led to increased success rates with lower complications, and RCTs showed improved quality of life while observational data suggests successful CTO revascularization may improve long-term prognosis.
NOAC in coronary artery disease
Rivaroxaban has been studied as an addition to antiplatelet therapy in patients with coronary artery disease in several large trials.
The ATLAS-ACS 2 trial found that low-dose rivaroxaban (2.5mg twice daily) added to dual antiplatelet therapy after acute coronary syndrome reduced the composite of death, heart attack, and stroke compared to placebo, but increased bleeding risk.
The COMPASS trial showed that in stable coronary or peripheral artery disease patients, low-dose rivaroxaban (2.5mg twice daily) added to aspirin reduced the composite of death, heart attack, and stroke compared to aspirin alone, again with increased bleeding.
The risk-
Symplicity htn 3 trial
This document summarizes a clinical trial evaluating the safety and effectiveness of catheter-based renal denervation for treating uncontrolled hypertension. The trial was a prospective, randomized, single-blind study comparing renal denervation to a sham control procedure in over 500 patients. The trial met its primary safety endpoint but did not meet its primary efficacy endpoint of a reduction in systolic blood pressure of at least 5 mmHg. In response, the manufacturer suspended enrollment in other renal denervation hypertension trials pending further review, but will continue post-market surveillance and studies of non-hypertension indications based on the procedure's demonstrated safety profile.
Year in cardiology - ACS
The document discusses several studies related to cardiology. It summarizes the key findings of each study in 1-2 sentences. Some of the studies discussed include:
- A study finding that whole genome sequencing identified genetic risk factors like familial hypercholesterolemia in 1.7% of acute myocardial infarction patients under 55 and a high polygenic risk score in 17% of patients.
- A study finding that plasma levels of the metabolite TMAO were higher in STEMI patients with plaque rupture compared to erosion and may be a novel biomarker for plaque morphology.
- The ALERTS trial which found that an implantable cardiac alert system safely detected rapid ST segment changes but did not meet its
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Similar to HF Science News from AHA Scientific Sessions 2020
Guidelines and unanswered questions.
This document summarizes guidelines and ongoing questions regarding the use of antithrombotic medications in patients with heart failure and atrial fibrillation. It discusses several large clinical trials that have evaluated anticoagulant and antiplatelet therapies. The risks and benefits of warfarin versus novel oral anticoagulants are assessed based on pivotal trials. Ongoing studies exploring antithrombotic strategies in HF patients in sinus rhythm or with preserved ejection fraction are also summarized.
HeART FAILURE Hfpef
1) HFpEF is the most common form of heart failure, affecting over 70% of heart failure patients over age 65. It is associated with substantial morbidity and mortality.
2) HFpEF is challenging to diagnose because ejection fraction is normal and cardiac congestion is difficult to evaluate non-invasively. It is defined hemodynamically as a clinical syndrome associated with a lack of capacity of the heart to pump blood adequately without elevated cardiac filling pressures.
3) There is currently no effective pharmacological treatment for HFpEF. Treatment focuses on controlling congestion through diuretics, managing comorbidities, and promoting exercise. Future efforts to better characterize HFpEF phenotypes may allow individualized therapies
Presentatie Prof. Dr. van Gelder en Prof. Dr. Schotten
Atrial Fibrillation as ElectroVasculopathy
Interaction of electrical and vascular factors for the progression of AF
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This review summarizes the pharmacologic options for managing systolic heart failure, focusing on modulating pathways through the renin-angiotensin-aldosterone system. Angiotensin converting enzyme (ACE) inhibitors are recommended for all patients with reduced ejection fraction as clinical trials showed they reduce mortality and attenuate ventricular remodeling. Angiotensin receptor blockers (ARBs) are an alternative for those intolerant of ACE inhibitors. Mineralocorticoid receptor antagonists further block the renin-angiotensin-aldosterone system and clinical trials demonstrated reduced mortality when added to standard therapy.Heart failure update
Heart failure Update as per, 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the
Management of Heart Failure and 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Heart failure
1) The study aims to determine if the urate-lowering agent febuxostat can improve clinical outcomes in chronic heart failure patients with hyperuricemia compared to conventional treatment.
2) It is a randomized, open-label trial that will enroll 200 Japanese chronic heart failure patients with hyperuricemia and assign them to either febuxostat treatment or conventional treatment.
3) The primary outcome is the difference in plasma BNP levels between baseline and 24 weeks of treatment, as measured in a blinded manner. This will investigate the efficacy and safety of febuxostat.
Guidelines and beyond new drug therapy for heart failure with reduced ejectio...
This document provides information on new guidelines and therapies for heart failure patients. It begins by outlining the challenges of managing heart failure patients and their high mortality rates. It then discusses the history of heart failure treatments from ACE inhibitors in the 1990s to newer drugs like ARNi's. The document defines the different types of heart failure - HFrEF, HFmrEF, and HFpEF - and their diagnostic criteria. It explains how neprilysin inhibition enhances natriuretic peptides while simultaneously suppressing the RAAS. Finally, it summarizes that the new drug LCZ696 combines neprilysin inhibition with an ARB to reduce mortality and hospitalization in heart failure patients beyond existing neurohormonal therapies
Pharmacotherapy in Chronical Systolic Heart Failure
This document discusses pharmacological treatment for chronic systolic heart failure. It outlines the goals of treatment as relieving symptoms and preventing hospitalization and death. It provides recommendations from guidelines for evidence-based medications including ACE inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and others. It notes demonstration of benefits from randomized clinical trials including relative risk reductions in mortality from different drug classes.
emphasis_HF_trial.ppt
The EMPHASIS-HF trial studied the effects of adding eplerenone to recommended medical therapy in patients with systolic heart failure and mild symptoms. The trial found that adding eplerenone reduced the primary composite outcome of cardiovascular death or heart failure hospitalization by 37% compared to placebo. Eplerenone also reduced mortality from any cause by 24% and hospitalization from any cause by 23%. The benefits were consistent across subgroups. Safety analysis found eplerenone increased serum potassium similarly to other trials. The study concluded that addition of eplerenone to recommended medical therapy reduces morbidity and mortality for patients with mild systolic heart failure.
SGLT2i and CV Disease .pptx
The document discusses the cardiovascular benefits of SGLT2 inhibitors (SGLT2i). It summarizes studies showing that SGLT2i reduce stressed blood volume, improve cardiac structure and function through various mechanisms like preload reduction, improve diastolic function in human cardiomyocytes, and improve mitochondrial metabolism in myocardial cells. The document also discusses guidelines and studies demonstrating that SGLT2i improve outcomes like reducing hospitalizations for heart failure and can reverse left ventricular remodeling in patients with and without type 2 diabetes.
Clinical trials in ahf
This document from the European Society of Cardiology aims to identify reasons for the lack of progress in introducing new medicines for acute heart failure. It argues that clinical trials have failed due to the heterogeneous nature of patients with acute heart failure, which encompasses several different syndromes. The document also notes that trial designs have been flawed due to issues with the pharmacology of study drugs and inconsistent patient selection criteria across trials. It attempts to provide pragmatic solutions to simplify future clinical trials in order to advance treatment for this condition of unmet medical need.
HOT CLINICAL TRIALS.pptx
The TOMAHAWK trial compared outcomes of patients who experienced out-of-hospital cardiac arrest and received immediate coronary angiography versus the standard of care. The trial found that immediate angiography did not reduce all-cause mortality at 90 days compared to standard care. However, it did result in more patients being discharged from the hospital and fewer patients having severe neurological impairment.
Levosimendan in acs
Levosimendan is a calcium sensitizer and potassium channel opener developed for treating acute decompensated heart failure. It has been studied for use in acute heart failure (AHF) and cardiogenic shock (CS) complicating acute coronary syndrome (ACS). AHF frequently complicates ACS, especially with large infarctions or arrhythmias, and is associated with worse outcomes than AHF without ACS. Levosimendan enhances contractility without increasing calcium levels, and also causes vasodilation. Studies have found levosimendan reduces myocardial damage from ischemia and improves outcomes in AHF/CS compared to other inotropes. Levosimendan may be preferable to vasopress
Trials and errors in cardiovascular medicine 2013
1. A study found that early treatment of a first episode of acute pericarditis with colchicine in addition to standard anti-inflammatory therapy reduced the risk of recurrence compared to anti-inflammatory therapy alone.
2. The STOP-HF trial found that screening high-risk patients for heart failure with BNP and providing further assessment and care for those with elevated BNP resulted in less left ventricular dysfunction, heart failure, and emergency hospitalizations compared to usual care.
3. The EchoCRT trial of CRT in patients with narrow QRS found no benefit of CRT and more deaths with CRT, suggesting CRT is not recommended for patients with narrow QRS.
The current and future managment of ahf
This document summarizes a clinical review on the current and future management of acute heart failure syndromes. It discusses how over 1/3 of heart failure patients will be rehospitalized or die within 90 days of discharge, despite use of evidence-based chronic heart failure therapies in the hospital. Traditional therapies for acute heart failure like diuretics and nitrates remain the standard of care. The review introduces the concept of "cardiac reconstruction" to potentially improve outcomes by preserving or improving myocardial function. It also discusses classifying acute heart failure patients based on their clinical presentation and cardiac structure/function to help guide therapeutic goals and options.
ARNI- Right choice in HF (3).pptx
1) The document discusses the use of sacubitril/valsartan (ARNI), a first-in-class angiotensin receptor neprilysin inhibitor, for the treatment of heart failure.
2) It provides evidence from clinical trials that sacubitril/valsartan reduces cardiovascular death and heart failure hospitalizations compared to enalapril in patients with HFrEF.
3) A recent large trial found that sacubitril/valsartan reduced worsening heart failure events in patients with HFpEF, leading to an expanded FDA approval of the drug.
ACC 2024 Snippets. Dr Spandana, Cardiology pdf
This document contains summaries of several studies presented at the ACC24 conference around cardiovascular diseases like hypertension, angina, CAD, MI, AF, and HF. One study found that CSL112 infusions did not significantly reduce cardiovascular outcomes in AMI patients over 90 days compared to placebo. Another study found that a transcatheter inter-atrial shunt did not improve symptoms or prognosis in HF patients after 2 years regardless of LVEF. A third study found that Empagliflozin reduced HF hospitalization risk by 23-33% in post-MI patients but did not reduce all-cause mortality.
Cardiology: Treatment of Heart Failure
Abstract Heart Failure (HF) is the most widely recognized cardiovascular disorder behind medical clinic affirmation for individuals more established than 60 years old. Hardly any regions in medication have advanced as surprisingly as HF treatment in the course of recent decades. Be that as it may, progress has been reliable just for ceaseless HF with diminished discharge part. In intensely decompensated HF and HF with safeguarded discharge part, none of the medications tried to date have been conclusively demonstrated to improve endurance. Deferring or forestalling HF has gotten progressively significant in patients who are inclined to HF. The anticipation of declining interminable HF and hospitalisations for intense decompensation is likewise critical. The target of this paper is to give a compact and down to earth rundown of the accessible medication medicines for HF. The most ideal proof based medication treatment (counting inhibitors of the renin–angiotensin– aldosterone framework and β blockers) is helpful just when ideally actualized. Notwithstanding, usage may be testing. To accept that ailment the executives projects can be useful in giving a multidisciplinary, comprehensive way to deal with the conveyance of ideal clinical consideration. Keywords; heart failure, multidisciplinary approach, Beat-blocker, RAAS framework
Secondary Prevention after ACS: Focused on Anticoagulant Therapy
Dr. Nathania Marliani Kristanti, SpJP, FIHA. 3rd Pekanbaru Cardiology Update, August 25th 2013. Pangeran Hotel Pekanbaru. Learn more at PerkiPekanbaru.com
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1) Current treatments for HFpEF have not been shown to reduce morbidity or mortality, though trials are investigating new drug classes like ARNIs, soluble guanylate cyclase stimulators, and SGLT2 inhibitors.
2) Lifestyle modifications including exercise training, weight loss, and salt restriction may help symptoms. Exercise training in particular may improve exercise capacity.
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HF Science News from AHA Scientific Sessions 2020
- 1. HF Science News from AHA Scientific Sessions 2020 Dr Han Naung Tun (Henry Han) MBBS, MD, FACTM Heart and Vascular Centre, Rangoon National Representative Heart Failure Specialist of Tomorrow for Myanmar in HFA and Ambassador of Echocardiography in EACVI, ESC Ambassador of Tele-Cardiology Working Group for Asia in ISFTeH @HanCardiomd
- 2. Declaration of interest None to disclose
- 3. Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure - GALACTIC-HF Comparing the Effect of Intravenous Ferric Carboxymaltose on Hospitalizations and Mortality in Iron Deficient Subjects Admitted for Acute Heart Failure - AFFIRM-AHF Empaglifozin on LV Volume SUGAR-DM-HF and EMPA-TROPISM (ATRU-4) Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post Worsening Heart Failure SOLOIST-WHF Trial
- 6. John R. Teerlink, M.D. the GALACTIC-HF Investigators* , NEJM, 2020 In patient with HF , omecamtive mecarbil statically significant reduce the risk of primary composite outcome (first HF event or CV event)
- 7. Conclusion Selectively tagging the cardiac sarcomere with omencative mecarbil, the first in class myotrope is novel approach to improving cardiac function and cardiovascular outcomes In patient with HF , omecamtive mecarbil statically significant reduce the risk of primary composite outcome (first HF event or CV event) The pattern of AEs, including MI, VAs , were similar in the omecamtive mecarbil and placebo group Further analyses of GALATIC HF will provide grater insight into subgroups who may demonstrate grater benefit, such as patients with lower EF in whom improving cardiac function may have a greater role
- 8. AFFIRM-AHF The Lancet DOI: (10.1016/S0140-6736(20)32339-4
- 9. AFFIRM-AHF Trial , The Lancet DOI: (10.1016/S0140-6736(20)32339-4
- 10. AFFIRM-AHF Trial , The Lancet DOI: (10.1016/S0140-6736(20)32339-4
- 11. Effect of Empagliflozin on Left Ventricular Volumes in Patients with Type 2 Diabetes, or Prediabetes, and Heart Failure with Reduced Ejection Fraction (SUGAR-DM-HF) Randomized Trial of Empagliflozin in Non-Diabetic Patients with Heart Failure and Reduced Ejection Fraction EMPA-TROPISM (ATRU-4) Matthew M. Y. Lee et al, Cir 2020 Carlos G. Santos-Gallego et al, JACC ,2020 Total number of pts: 84 Duration of follow-up: 6 months Mean patient age: 61.9 years Percentage female: 36% N- 105 patients Mean age 68.7 [SD 11.1] years
- 12. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure (SOLOIST-WHF Trial) Deepak L. Bhatt et al In patients with diabetes and recent worsening heart failure, sotagliflozin therapy, initiated before or shortly after discharge, resulted in a significantly lower total number of deaths from cardiovascular causes and hospitalizations and urgent visits for heart failure than placebo. DL Bhatt et al. SOLOIST-WHF Trial N Engl J Med 2020