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Henry Han Profile picture
@HanCardiomd
Aug 28, 2021 • 6 tweets • 12 min read • Read on X
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SGLT2 Inhibitor HFpEF Data: From Context to Clinical Pearls
By @JavedButler1

#ESCCongress @lamcardio @BSHeartFailure @JJheart_doc @ESC_Journals @ESC_Lavinia @escardio @MKIttlesonMD @ShelleyZieroth @hvanspall @mmamas1973 @aayshacader @pabeda1
The drug ⬇️ the risk of ≥ 50% ⬇️ in eGFR or renal death in EMPEROR-Reduced (HR 0.51; 95% CI 0.33-0.79), but not in EMPEROR-Preserved (HR 0.95; 95% CI 0.73-1.24) #ESCCongress @ESC_Lavinia @escardio
Prior outcomes Trials in #HFpEF and Traditional Mx of HFpEF
What makes EMPEROR-P difference from them?
#ESCCongress @escardio @ESC_Lavinia @lamcardio @JJheart_doc @CMichaelGibson @biljana_parapid @mmamas1973 @ShelleyZieroth @aayshacader @AndrewJSauer @DrRyanPDaly @RyanTedfordMD
#ESCCongress
Risk Factors and Comorbidities : HFpEF Vs HFrEF

@escardio
#ESCCongress
HFpEF has recently been recognized 📌as the single greatest unmet need in CV Medicine
📌The landscape of HFpEF Tx is changing
📌Additional Studies are needed to confirm these results
Unroll @threadreaderapp #ESCCongress

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More from @HanCardiomd

Henry Han Profile picture
May 21, 2023
#HFA_ESC @escardio scientific updates

Patient profiling in HFpEF

What are therapeutic options for #HFpEF in 2023 ?

#HeartFailure2023 @NicolasGirerd @DrMarthaGulati @Marta33717088 @LauraMeems @CharlesFauvel @Giccardio_fr @HFA_President @WilfriedMullens @escardio ImageImageImageImage
Numbers of emerging treatments are under investigation for HFpEF

#HeartFailure2023 @markcpetrie20 @DrMarthaGulati @Marta33717088 @LauraMeems @CharlesFauvel @Giccardio_fr @HFA_President @WilfriedMullens ImageImageImageImage
📍#SGLT2i should be initiated in all HFpEF patients without contraindications, ideally once stable during hospitalization for index event.

#HeartFailure2023 @MarcoMetra @HFA_President @WilfriedMullens ImageImage
Read 4 tweets
Henry Han Profile picture
May 20, 2023
Is it important for physicians to understand mechanisms to treat heart failure? By Legendary #MiltonPacker

@HFA_President @WilfriedMullens @FH_Verbrugge @JavedButler1
@jozinetm @_antocannata @DjawidHashemi
@doctorchecho @h_arfsten
@SotiriaLiori @LauraMeems @escardio ImageImageImageImage
Physicians make decisions NOT by memorizing trials or guidelines, but by having a conceptual framework about drugs and diseases

#HeartFailure2023 @ESC_Journals @escardio @WilfriedMullens @HFA_President @ARakisheva @FH_Verbrugge @WilfriedMullens ImageImageImageImage
How Physician Thinking and Decision-Making Is Supposed to Work

Dr. #MiltonPacker proved it in these 4 slides

#HeartFailure2023 @HFA_President @JavedButler1 @MarcoMetra @gcfmd @mmamas1973 @pabeda1 @WilfriedMullens @ESC_Journals ImageImageImageImage
Read 4 tweets
Henry Han Profile picture
May 20, 2023
State of the art: Are #HFpEF phenotypes, a needed classification?

#Hypertension phenotype by Dr. Michele Senni

#HeartFailure2023 @lamcardio @JavedButler1 @JamalRanaMD @AHajduczok @WilfriedMullens @FH_Verbrugge @ShelleyZieroth ImageImageImageImage
Has #hypertension a greater prognostic impact in HFpEF than #HFrEF?

Should we treat HTN differently in
#HFpEF patients compared to patients without HF?

What are the current evidences ?

#HeartFailure2023 ImageImageImageImage
#Spironolactone Use and Improved
Outcomes in Patients With #HFpEF With Resistant #Hypertension

#HeartFailure2023 @escardio Image
Read 4 tweets
Henry Han Profile picture
Oct 19, 2022
The natural history of SMR and its longitudinal progression until the onset of severe #MR

There are two distinct patterns of progression of SMR patients with various implications

academic.oup.com/ehjcimaging/ad… #EHJCVI @GeraldMaurer @denisamuraru @alessia_gimelli @JGrapsa @iamritu Image
Cluster 1 had higher LAV, LVEDV, and #LVESV, along with lower EF and less septal thickness, but slower EF and LVESV progression compared with Cluster 2.

Moderate SMR was more frequent in Cluster 1, whereas Cluster 2 had more non/trivial and mild #SMR

#EchoFirst #EHJCVI Image
On time-to-event analysis, there were no differences in terms of mortality and occurrence of MV interventions, #LVAD , and HTx

A higher likelihood of MV interventions (including Sx and #TEER) was observed in Cluster 2 type with fewer LVAD procedures

#EchoFirst #EHJCVI ImageImageImage
Read 6 tweets
Henry Han Profile picture
Oct 19, 2022
This study shows that more than 1/3 of patients with new-onset #HeartFailure have #RVD

📌During up-titration of #GDMT, 49% show normalization of RV function

📌The improvement is associated with better outcomes, independent of LV function

onlinelibrary.wiley.com/doi/abs/10.100… @ESC_Journals ImageImage
RV dysfunction as a predictor of clinical outcome in newly-Dx #HeartFailure

This analysis demonstrates #RVD at baseline and follow-up was associated with a higher risk of all-cause ☠️ [ HR- 1.66 (1.27-2.16) ] and HF 🏥 [ HR -2.20 (1.51-3.21) ]

onlinelibrary.wiley.com/doi/abs/10.100… #EJHF
Recovery of RV function is associated with better outcomes

This study also stated that improvement of TAPSE to ≥ 17mm during follow-up was associated with a reduction in all-cause ☠️ and #HeartFailure 🏥 (HR- 0.56[0.31-0.99] ), independent of
baseline TAPSE, age, sex, and LVEF
Read 4 tweets
Henry Han Profile picture
Oct 3, 2022
#COAPT Risk Score for Death or #HeartFailure 🏥

📍Simple risk score using 4 clinical (COPD, #NYHA class, Afib/Aflut, and #CKD)

📍4 #EchoFirst (#LVEF, LVESD, RVSP, and #TR) variables + 1 treatment-related variable (#TEER)

jacc.org/doi/10.1016/j.… @JACCJournals @GreggWStone ImageImageImageImage
Using data from the #COAPT trial, a simple risk score using 4 clinical and 4 Echo parameters + 1 treatment-related variable (#TEER), which provides prognostic insight into the 2-year rates of ☠️ or #HeartFailure 🏥 in patients with symptomatic #HF and severe #FMR

@JACCJournals
There was consistent benefit from TEER with MitraClip across all risk strata

FMR and HF pts are at ⬆️ risk for ☠️ and recurrent HFH, despite best Med Rx & invasive Tx including MV TEER

👉🏻Future studies are needed to externally validate the COAPT risk score in pts with HF & FMR
Read 6 tweets

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