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

🧵 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.…

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

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

Link: jacc.org/doi/10.1016/j.…

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 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.…

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 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.…

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 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.…

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 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

💚Top Ten Slides from day 1 of #BSEcho2022 💚

A thread for all those who echo

1) Should we use the highest beat/signal in AF? Slide shown by Sanjeev Bhattacharyya

1/n 2) Peripartum cardiomyopathy - don't miss it and remember need to counsel/risk stratisfy if considering future pregnancies. Slide shown by @BSE_President Claire Colebourn at #BSEcho2022

2/n

💥My top 10 learning points from the #ESCCongress 2022💥

A thread for cardiologists/general physicians

1) Addition of IV acetazolamide to IV furosemide in AHF results in 46% higher incidence of successful decongestion after 3 days

EVIDENCE: ADVOR nejm.org/doi/full/10.10… 2) Revascularization with PCI does not improve event-free survival in pts with severe LVSD over OMT alone
(HF cohort, not acute ACS pts or significant angina)

Evidence: REVIVED
nejm.org/doi/full/10.10…

#ESCCongress

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

💥The new NICE valve guidelines are out! 💥

When do they recommend intervention in severe non-symptomatic valve disease? And how does this compare to the ESC 2021 valve guidelines?

A thread...

References:
nice.org.uk/guidance/ng208…
escardio.org/Guidelines/Cli…

1/n Indications for referral for surgery for severe asymptomatic AS:

❤️Some match ESC guidelines (Vmax >5m/s, LVEF <55%, symptoms on exercise testing)
❤️lower cut off for raised BNP (2x ULN compared to ESC’s 3x ULN)
❤️include valve area <0.6cm2 (not mentioned by ESC)

2/n

💥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 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

Have there been changes in when to intervene with the new 2021 ESC/EACTS guidelines for the management of valvular heart disease?

Yes, and in general the bar for intervention is now lower

Thread follows...

#ESCCongress

1/n 1)The indications for surgery in severe asym AR have changed

- LVEDD has disappeared from the summary table& diagram
- but LVEDD>65mm is mentioned in the text as a possible indicator for surgery (less than previous >70mm) if there is progressive LV size⬆️/⬇️EF

#ESCCongress

2/n

💥My top 10 learning points from the #ESCCongress💥

A thread for cardiologists/general physicians

1) Post acute MI, transfuse if ≤8g/dL

Evidence: REALITY trial- not yet published – summary reported acc.org/latest-in-card…

1/n 2) SGLT2i in addition to standard HF treatment significantly ⬇️CV death, including in non-diabetic pts

Evidence: EMPEROR-Reduced (nejm.org/doi/full/10.10…)
& metanalysis of DAPA-HF and EMPEROR-Reduced (thelancet.com/journals/lance…)

#ESCCongress
2/n

Incidental finding of dilated aortic root/ thoracic aortic aneurysm – what should you do?

Fully-referenced thread covering when to intervene, how to follow up and what else to think about

1/n To start with the basics: the size of the aortic root varies based on sex, height, weight and age, so these details are required to put a basic figure into context.

ncbi.nlm.nih.gov/pmc/articles/P… 2/n

Iron deficiency is a common in pts with HF & is important even in the absence of anaemia – correcting it improves exercise tolerance, HF symptoms, and QoL.

Do you know when to give IV iron in HF?
Do you know the evidence behind it?

A thread on IV iron in heart failure 1/n ESC guidelines recommend IV iron in patients with HFrEF (EF<40%), Hb <15g/dL and iron deficiency, which is defined as:
🔸Ferritin <100mcg/l or
🔸Ferritin 100 to 299mcg/l and transferrin saturation <20%

academic.oup.com/eurheartj/arti…

2/n