Sarah Hudson Profile picture
Aug 29, 2022 7 tweets 6 min read Read on X
We have GDMT and CRT for HFrEF, we will soon also have BAT (Baroreflex Activation Therapy)?

See 🧵below to learn more about this treatment that has significantly improved QoL, exercised capacity and NTproBNP in a RCT...

#ESCCongress
1/n
The #ESCCongress session started with @FudimMarat discussing how it worked – explaining how pts with HF have poor baroreflex sensitivity, that baroreflex down-regulation is related to worse HF symptoms & barostim provided chronic improvement in muscle sym nerve activity

2/n
Next William Abraham talked about what has been learnt from clinical trials, focusing on BeAT-HF which was an RCT that showed BAT significantly improved exercise capacity, QoL, NYHA class and NTproBNP, and was safe

Paper: jacc.org/doi/10.1016/j.…

#ESCCongress

3/n
The final speaker was @JBauersachsMD who described real world experience – how it is implanted and followed up and its CE mark indication (pts who are NYHA III and EF </= 35% despite treatment with appropriate HF guideline directed therapy

#ESCCongress

4/n
So where does this leave BAT? Well, it is CE marked & FDA approved, but has not yet shown a mortality benefit & the ESC HF guidelines state that evidence is currently insufficient to support a specific recommendation for a ⬇️ in mortality or hospitalization

#ESCCongress 5/n
And what about price?
A 2018 analysis listed the system price at 21000euros, but claimed this could still be cost effective/QALY.
An American study suggests it is less costly than OMT alone btn yrs 2&3

ncbi.nlm.nih.gov/pmc/articles/P…
cvrx.com/wp-content/upl…
6/n
It will be interesting to see whether BAT moves into the mainstream in the coming years, and even if no mortality benefit is seen, a significant QoL benefit should not be underestimated. 7/7

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More from @sarahhudsonuk

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
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
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
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
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
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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