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Sarah Hudson Profile picture
@sarahhudsonuk
Aug 30, 2021 • 10 tweets • 12 min read • Read on X
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💥My top 10 learning points from the #ESCCongress 2021💥

A thread for cardiologists/general physicians

1) There is a treatment for HFpEF!

Empagliflozin significantly ⬇️composite of HF hospitalisation & CV death by 21%

Evidence: EMPEROR-Preserved nejm.org/doi/full/10.10…

1/n Image
2) A more aggressive BP target (110 to 130 Vs 130 to 150) in elderly patients resulted in lower rates of cardiovascular events

Evidence: STEP study -nejm.org/doi/full/10.10…

2/n #ESCCongress ImageImageImageImage
3) Using a salt substitute ⬇️risk of stroke, major CV events and total mortality.

Evidence: SSaSS study - nejm.org/doi/full/10.10…

3/n #ESCCongress ImageImageImageImage
4) Patients with OOHCA & ROSC without STE or LBBB on ECG have no benefit of immediate angiography Vs initial intensive care evaluation with delayed angiography if indicated

Evidence: TOMAHAWK - nejm.org/doi/full/10.10…

4/n #ESCCongress ImageImageImageImage
5) Dapagliflozin decreases risk of serious ventricular arrhythmia, cardiac arrest or sudden death when added to conventional therapy in pts with HFrEF by 21%

Evidence: Post hoc analysis of DAPA HF - academic.oup.com/eurheartj/adva…

5/n #ESCCongress Image
6) Influenza vaccine given early after an MI or high-risk coronary disease results in a lower risk of all-cause death/MI/stent thrombosis

Evidence: IAMI - ahajournals.org/doi/10.1161/CI…

6/n #ESCCongress ImageImageImageImage
7)Giving high risk COVID pts treatment dose LMWH has a NNT of 8 to prevent one major thromboembolic event and death

Evidence: HEP-COVID trial (not yet published; clinicaltrials.gov/ct2/show/NCT04…)

7/n #ESCCongress ImageImageImageImage
8) Putting an ILR into pts will find more AF (threefold increase in detection) but even with anticoagulation current evidence does NOT show this to decrease stroke (?due to short duration of AF)

Evidence: LOOP study - thelancet.com/journals/lance…

8/n #ESCCongress ImageImageImageImage
9) In pts discharged after at least 3d hospitalisation with COVID,use of rivaroxaban 10mg OD for 35d in those with ⬆️IMPROVE score resulted in better clinical outcomes without increased bleeding

Evidence:MICHELLE trial,not yet published acc.org/latest-in-card…

9/n #ESCCongress ImageImageImageImage
10) Exercise improves freedom from AF and decreases AF symptom severity

Evidence: ACTIVE AF (not yet published; escardio.org/The-ESC/Press-…)

10/10 #ESCCongress ImageImageImageImage

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More from @sarahhudsonuk

Sarah Hudson Profile picture
Oct 8, 2023
Ten current papers for the curious cardiologist - 2023 week 40 - including CTCA in type 2 MI, peripartum cardiomyopathy outcomes, IE prophylaxis and enteric-coated Vs uncoated aspirin.

Sources: @CircAHA, @ESC_Journals, @Open_HeartBMJ @JACCJournals, @JAMAcardio, @NEJM

🧵 Image
1) CTCA with FFR in 50 pts with type 2 MI showed 92% had CAD, and 26% had obstructive disease, supporting use of aspirin and lipid lowering therapy in pts with T2MI.

Link: jacc.org/doi/10.1016/j.…
Image
2) Scottish data on peripartum cardiomyopathy incidence (1 in 4950 deliveries) and outcomes (8% mortality at a median of ~8yrs)

Link: academic.oup.com/eurheartj/adva…
Image
Read 12 tweets
Sarah Hudson Profile picture
Oct 1, 2023
Ten current papers for the curious cardiologist, including transcatheter valve in the mitral position, NTproBNP in a healthy population, impact of diagnosing type 2 MI and effect of smoking cessation post PCI.

Sources:
@CircAHA , @ESC_Journals, @Heart_BMJ, @JACCJournals

🧵 Image
1) MITRAL trial outcome looking at 5 yr survival after transcatheter Sapien valve use in mitral position

Link: jacc.org/doi/10.1016/j.…
Image
2) NTproBNP levels in a healthy US population demonstrated variation with age, sex and race.

Link: jacc.org/doi/10.1016/j.…
Image
Read 12 tweets
Sarah Hudson Profile picture
Sep 24, 2023
Ten current papers for the curious cardiologist, including mitraclip in secondary MR, possible cause of AVB in young pts, use of calcium score from non-gated chest CT to risk stratify pts pre non-cardiac surgery and HF pts and pregnancy.

🧵1/n Image
1) Use of MitraClip in pts with secondary MR – COAPT-PAS, US prospective observational study of 5000 pts, showed significantly⬇️mortality & HF hospitalisation compared to pts in COAPT-RCT GDMT arm ( 33.7% Vs 46.2%)

Link:

2/njacc.org/doi/10.1016/j.…
2) High Hs-cTnT post cardiac surgery is associated with ⬆️ 30d mortality but not 5yr. Thresholds defining mortality-associated postoperative myocardial injury were 170xURL for CABG (resulting in a 30d HR of 12.6) and 41xURL for AVR (30d HR of 4.4)

Link: jacc.org/doi/10.1016/j.…
Read 11 tweets
Sarah Hudson Profile picture
Aug 20, 2023
Ten current papers for the curious general cardiologist, including ticagrelor monotherapy post PCI, MRA use in cardiac amyloid, asystole post shock from wearable defibs & ⬇️in mortality using telemonitoring in HF

Sources: @ESC_Journals, @JACCJournals, @JAMACardio

1/n Image
1) At 3 months post PCI, the TWILIGHT RCT published in @JACCJournals showed ticagrelor monotherapy compared to continued DAPT (ticagrelor and aspirin) resulted in lower bleeding risk with no increase in ischaemic risk

Link:

2/njacc.org/doi/10.1016/j.…
2) The MACT proof of concept pilot trial (200pts) showed in ACS pts undergoing PCI it was feasible to discontinue aspirin the day after PCI & continue ticagrelor or prasugrel antiplatelet monotherapy combined with low-dose colchicine.

Link:

3/njacc.org/doi/10.1016/j.…
Read 11 tweets
Sarah Hudson Profile picture
Aug 6, 2023
Ten current papers for the curious general cardiologist, including troponin in stable CAD, coronary assessment in VT storm, balloon pulmonary angioplasty and CIED infections

Sources: @CircAHA, @ESC_Journals , @JACCJournals, @JAMACardio

1/n Image
1) Use of hs-cTnI to risk stratify pts with chronic CAD: 1 in 25 had trop >99th percentile & these pts had a 4x ⬆️risk MI/CV death vs pts <5ng/L. -MICA study in @JACCJournals

Link:

2/njacc.org/doi/10.1016/j.…
2) Meta analysis shows normal stress CMR in pts with known or suspected CAD is associated with lower MACE for at least 3.5yrs - in @JAMACardio

Link:

3/njamanetwork.com/journals/jamac…
Read 12 tweets
Sarah Hudson Profile picture
May 5, 2023
Top Ten slides from day 1 of the @BSHeartFailure meeting @JubileeHospital conference centre in Glasgow. A 🧵for all in the #HF MDT

1) Hypotension with HF meds- less than you might think- mean SBP⬇️ at 6m 1-2mmHg with eplerenone & 2mmHg with SGLT2i

Slide shown by @_antocannata Image
2) Summary slide of drugs that may be used in shock plotted on a scale of inotropy and vasoconstriction.

Slide shown as part of a case discussion by Daniel Doherty #HF Image
3) A reminder that the absence of crackles and a normal CXR do not exclude ⬆️ PCWP

Slide shown by @drpmcampbell #HF Image
Read 11 tweets

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