One Aunt Minnie Forum commenter on why radiology won’t be able to take cardiac imaging from cardiology.

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Cardiology Pharmaceuticals

Aprocitentan: The New Antihypertensive on the Block

Aprocitentan has proved itself a promising new agent for blood pressure control. In the 730-patient PRECISION trial, aprocitentan (Idorsia Pharmaceuticals) lowered both office and 24-hour ambulatory BP among people with resistant hypertension. 

Clinicians usually treat resistant hypertension with the general diuretic spironolactone, which targets the renin-angiotensin-aldosterone system. But aprocitentan, a dual endothelin receptor antagonist, works on the endothelin pathway –  a previously untapped avenue to BP control. 

PRECISION was a blinded, randomized, placebo-controlled, phase 3 trial conducted in Europe, Asia, Australia, and North America. The study consisted of three consecutive parts:

• In part 1, patients were randomized to take either 12.5 or 25 mg aprocitentan, or placebo, for four weeks. 
• In part 2, all patients took aprocitentan 25 mg for 32 weeks.
• In part 3, patients were rerandomized to aprocitentan 25 mg or placebo for 12 weeks. 

At the end of part 1, patients who took 12.5 and 25 mg aprocitentan saw the following placebo-adjusted blood pressure drops: 

• Office systolic BP decreased by 3.8 and 3.7 mmHg
• Office diastolic BP decreased by 3.9 and 4.5 mmHg
• 24h ambulatory systolic BP dropped by 4.2 and 5.9 mmHg

By the end of part 2, patients showed sustained BP reduction for all 32 weeks. 

At the end of part 3, BP rose in patients who had switched from taking 25 mg aprocitentan to placebo. For those who continued taking aprocitentan, their reduced BP level was maintained. 

Edema was the most common side effect during the initial four weeks (9.1% w/ 12.5 mg, 18.4% w/ 25 mg), although the authors said this could be easily managed with diuretics. 

Notably, the Lancet reviewers held a more skeptical view, questioning whether the result was clinically significant, especially in light of the high rate of edema. They conclude that the utility of aprocitentan remains unclear, particularly compared to existing options like spironolactone. 

The Takeaway

This appears to be a win for aprocitentan, especially since it offers a novel mechanism for BP reduction in patients with resistant hypertension, even if more research is needed to know for sure. 

HeartFlow Analysis Streamlines Care

Faced with cath lab inefficiencies and an increased reliance on stress testing, Cone Health pursued a more advanced solution. See how the HeartFlow FFRct Analysis allowed Cone Health to improve the patient journey through streamlined CAD testing.

Transformation Through Structured Reporting 

Ready to realize the benefits of cardiovascular imaging structured reporting? Check out these quick and powerful Change Healthcare videos detailing the efficiency gains provided by structured reporting and what it takes to drive adoption.

The Wire

• Informed Consent in Genome Sequencing: A cross-sectional study of 1.1k patients with dilated cardiomyopathy revealed large variations in genomic knowledge and trust in researchers between different racial and ethnic groups. A greater proportion of Hispanic (95.8%) and Black (93.9%) participants had a “low” level of knowledge about genomic sequencing limitations compared to White participants (73.5%) and were significantly less likely to trust medical researchers, even after adjusting for educational attainment. This isn’t too surprising, perhaps, given the US’s history of medical racism.

• ASE’s EchoGuide: The American Society of Echocardiography launched its EchoGuide interactive mobile and web application for healthcare professionals. The app includes over fifty calculators, reference tables, and multi-parametric algorithms to help physicians and sonographers build confidence when interpreting or performing echo studies.

• Elon Musk & Eli Lilly: A nine-word tweet from an account named @EliLillyandCo gained worldwide attention last week: “We are excited to announce insulin is free now.” The account carried the blue check mark, historically reserved for verified accounts, but Elon Musk made the mark available for purchase through an $8 monthly Twitter Blue subscription. Within a few hours, the tweet gained over 10k likes and thousands of retweets, and by the time Twitter removed the tweet six hours later, Lilly’s shares had dropped 6%. 

• Comparable Survival Rates for CHD Treatments: Researchers detected no significant differences in overall death rates between adults with coronary heart disease who underwent an invasive procedure to improve circulation and those who followed standard treatment guidelines (which involved diet, exercise, and medication). Over a median of 5.7 years, both treatment approach groups (N=4.8k) experienced comparable all-cause mortality rates (12.7% vs. 13.4%). 

• Siemens Healthineers & HeartVista: HeartVista and Siemens Healthineers announced an agreement to combine HeartVista’s one-click MRI acquisition software with Siemens’ MRI scanners and library of scan sequences. Previously, the software forced customers to choose between HeartVista’s sequences and the MRIs’ native (and more familiar) sequences. Now, the software can unite sequences from multiple sources using Access-i, a Siemens Healthineers interface that allows third-party device integration with Siemens scanners.

• Heart Botox Unhelpful Overall: Botulinum Toxin type A injections did not improve AFib outcomes in patients undergoing cardiac surgery. Researchers randomized 323 patients who had undergone cardiac surgery to receive injections of botulinum toxin type A in doses of either 125 units, 250 units, or placebo. Within 30 days, there were no differences in the rate of AFib lasting at least 30 seconds. A subgroup of patients – those over 64 years who had undergone isolated CABG and who had received the 125-unit dose – did see a significant benefit. 

• Cleerly Partners with Heartbeat Health: Cleerly unveiled a new partnership with virtual cardiology care company Heartbeat Health, enabling early disease identification and management. The partnership allows individuals to proactively obtain a coronary CTA test with Cleerly’s AI-enabled analysis, and then connect virtually with a Heartbeat Health cardiologist to discuss a treatment plan. The alliance comes several months after Heartbeat Health signed a similar remote diagnostics agreement with Caption Health.

• Obesity Meds Vs. Bariatric Surgery: A meta-analysis of six head-to-head studies (322 patients) comparing bariatric surgery to subcutaneous injection of a GLP-1 agonist revealed that weight loss is greater by about 44 pounds with bariatric surgery. Improvements in glycemic control were similar between both weight-loss strategies. Importantly, the studies were carried out between 2007 to 2017, so the newer (and potentially more potent) obesity medications are not taken into account.

• CXR AI CAD Predictions: A new study out of Italy suggests that chest X-ray AI analysis could help identify chest pain patients who are likely to have coronary artery disease. After training and testing using CXRs from 7.7k patients who also underwent coronary angiography (4.1k w/ severe CAD), the CXR AI model predicted CAD with a 0.73 AUC, outperforming Diamond Forrester scores (0.70). The CXR algorithm performed even better when patients’ angina status or Diamond Forrester scores were included in its analysis (AUCs: 0.77 & 0.76).

• Amazon Clinic Launch: Amazon debuted its Amazon Clinic DTC pharmacy. Amazon Clinic is effectively a message-based asynchronous care service (AKA patients fill out a symptom questionnaire so that third-party clinicians can prescribe medications for common conditions), and it’s now up and running in 32 states. If Amazon can successfully get consumers to trust them with their health, it has 200M Prime members that should help keep customer acquisition costs down and lifetime customer value up.

Us2.ai Brings Clarity to Cardiac Imaging

Learn about how Us2.ai is bringing simplicity and clarity to the world of cardiac ultrasound, on the latest episode of The Bleeding Edge of Digital Health featuring Us2.ai’s founders, James Hare and Dr. Carolyn Lam.

When Your Company Saves Your Life

We’re happy to share a special interview detailing how Cleerly’s CCTA AI solution allowed one of its own team members to catch and treat his asymptomatic, life-threatening atherosclerosis.