A tweet from Venk Murthy, MD PhD, after Buffalo Bills safety Damar Hamlin suffered cardiac arrest mid-game on Monday night.

Cardiovascular Disease

Top 10 Cardiology Research Achievements of 2022

The American Heart Association recently revealed the top 10 most impressive advances in CVD research in 2022, from significant improvements in stroke care to pregnancy outcomes. Here they are: 

Linking Childhood Risk Factors to Future Heart Disease – For the first time ever, researchers directly linked childhood risk factors to CV events later in life, underscoring the importance of early intervention and management. 

Treating Hypertension Improves Pregnancy Outcomes – Prescribing blood pressure medications to women with mild hypertension and are less than six months pregnant leads to better pregnancy outcomes without harming fetal growth.

The Placenta Reveals Maternal Heart Health – For women with poor pregnancy outcomes, clues to their long-term CV health might be found in the placenta.

Racial Disparities in Early CVD – Using more than 30 years of data, researchers found that the most significant contributors to racial differences in early CVD were from clinical and neighborhood factors in women, and clinical and socioeconomic factors in men. 

One Pill to Rule Them All – The SECURE trial showed that treatment with a polypill containing aspirin, ramipril, and atorvastatin within 6 months after MI yielded stronger treatment adherence and lowered risk of MACE compared with usual care. (Dive deeper)

Broadening the SGLT2i Patient Pool – Several studies indicated that SGLT2 inhibitor therapy, originally developed for diabetes, is helpful in patients with heart failure regardless of LV function. (Dive deeper)

Double-Drug Strategy in Marfan Syndrome – Angiotensin receptor blockers can cut the rate of aortic root enlargement in half among patients with Marfan syndrome, including those taking  beta-blockers. Using ARBs and beta-blockers together is more effective than either drug alone.  

What’s the Word on Salt? – Reducing sodium intake by using a lower-sodium table salt substitute, containing 25% potassium chloride, lowered stroke risk and reduced healthcare costs. The authors said this strategy should be a priority in any country in which dietary sodium can be substantially reduced.

Preventing Post-Stroke Disability – A phase 3 trial showed that the up-and-coming thrombolytic tenecteplase is as effective as alteplase, the current standard, at preventing further disability 90 days after stroke. A second clinical trial found alteplase can lower the risk of post-stroke neurological problems when used after thrombectomy.

Obesity Drug as Effective as Surgery – A once-weekly injection of tirzepatide (Mounjaro) led to weight loss on par with that achieved through bariatric surgery in people with obesity.

Relieving The Burden of Post-Processing

With the advent of advanced imaging technologies like CCTA come added burdens to technologists and diagnostic imaging centers. See how PIA can relieve the burden of post-processing, saving you time while helping your bottom line.

ACC/AHA Chest Pain Guidelines Highlight FFRct

Coronary CTA + FFRct is now a front-line pathway in the ACC/AHA’s 2021 Chest Pain Guidelines. Check out the clinical data supporting FFRct’s positioning as a “dominant strategy” and how HeartFlowFFRct Analysis impacts patients, physicians, and administrators.

The Wire

• Absence Makes the Heart Grow…Weaker: The impact of physical frailty on heart failure prognosis has been well documented, but what about the impact of social frailty? A new study in Frontiers in Cardiovascular Medicine revealed that social frailty is an independent risk factor for poorer clinical outcomes in older heart failure patients. Specifically, answering “yes” to the question about not feeling helpful toward friends or family more than doubled the risk of death or cardiovascular events (adjusted HR: 2.28). The findings were based on 310 HF patients who were followed for an average of 2 years. 

• physIQ’s Remote Cardiopulmonary Test: physIQ developed a new wearable way to estimate maximum oxygen utilization (VO2Max), providing clinicians with 24 hours of continuous vital signs and activity data. Unlike the in-clinic cardiopulmonary exercise test (the current gold standard) and the 6-minute walk test, physIQ’s eVO2Max is used in a patient’s home and requires no special protocol. The patient simply wears a tiny biosensor for a few days and wirelessly transmits the data to physIQ. 

• Delaying Surgery After COVID: Delaying surgery following a COVID diagnosis might reduce the risk of major postoperative CV complications, suggests a new analysis of 4k patients. The research, which examined mostly GI, orthopedic, and head & neck operations, found that a longer delay was associated with a decreased rate of CV complications (adjusted odds ratio: 0.99 per 10 days). Additionally, older age, being male, Black, higher ASA classification, and those undergoing urologic procedures were more likely to report a complication.

• Survival Varies Widely in US Cath Labs: A new study has revealed a stark difference in cardiac arrest survival rates in US cath labs. Of the 4.8k cath lab patients who experienced arrest, only around one-third survived. The median risk-adjusted survival rate across all hospitals was 36%, but the median survival rates differed dramatically among hospitals in the lowest tertile versus hospitals in the highest tertile (20% vs. 52%). The reality may be even worse, as the authors note that these results are likely the best-case scenario.

• Damar Hamlin Cardiac Arrest: Cardiac arrest dominated mainstream media discussions this week, when Buffalo Bills safety Damar Hamlin collapsed on the field during an NFL game against the Cincinnati Bengals. The team confirmed that the 24-year-old suffered from cardiac arrest after a direct hit to his chest, and is currently in critical condition.

• BioTelemetry to Pay $45M to Resolve Fraud Case: BioTelemetry and its CardioNet subsidiary agreed to pay $44.9M to resolve allegations of false billing to federal healthcare programs. The US Department of Justice alleged that the companies knowingly submitted false claims to Medicare and other federal health plans covering cardiovascular tests analyzed, in part, outside the US and in some cases by unqualified technicians. The DOJ says that BioTelemetry diverted certain ECG data to India when the domestic workflow became backlogged. Both companies now belong to Philips after it acquired BioTelemetry for $2.8B last year.

• Comparing TAVI Devices: A subanalysis of the OBSERVANT II study (N=2.7k) revealed rare and comparable adverse outcomes between five common transcatheter heart valves (THVs): Evolut R and Evolut PRO (Medtronic), Sapien 3 (Edwards Lifesciences), Acurate neo (Boston Scientific), and Portico (Abbott). But some differences did stand out. Patients treated with Sapien 3 were less likely to have moderate-to-severe paravalvular leak but had higher trans-prosthetic gradients. Additionally, patients treated with Sapien 3 and Acurate had lower rates of new-onset left bundle branch block and permanent pacemaker implantation. 

• Philips’ Stellarex Receives Expanded Indication: The FDA’s recent approval of Philips’ Stellarex 0.035” OTW drug-coated angioplasty balloon (Stellarex 035 DCB) expands its indications to include re-opening the part of a blood vessel that is within a previously placed artery. The Stellarex 035 DCB re-opens blocked or narrowed arteries in the thigh and knee due to peripheral artery disease (PAD), and is coated with the drug paclitaxel to prevent the arteries from narrowing again.

• CVD Benefits Accrue with Fewer Than 10k Steps: Taking more steps per day is linked to lower CVD risk among older adults, and the benefits rack up even when individuals walk less than the widely-promoted 10k steps per day. This study, published in Circulation, found that adults over 60 who walked roughly 6k to 9k steps per day had a 40-50% lower risk of CVD compared to those taking 2k steps per day. The walking pace did not impact CVD risk. 

• Reducing Structural Valve Disease: A study in JAMA Cardiology found that the CoreValve/Evolut transcatheter device (Medtronic) was tied to a lower risk of structural valve deterioration compared to surgery after five years (2.2% vs. 4.4%). This risk was particularly low in patients with smaller aortic annuli (23mm or less). Patients who developed SVD were twice as likely to die or be hospitalized for heart problems within five years, suggesting that it may be useful to monitor these patients with Doppler ultrasound.

Cardiovascular Structured Reporting Adoption Benefits

Check out this Change Healthcare report detailing the benefits of cardiovascular structured reporting, and how to drive structured reporting adoption in your own organization.

Reducing Variability in Echo Analysis

What if AI could produce echo measurements that are comparable to expert physicians, but with less variability? That’s precisely what this Nature study revealed about Us2.ai’s solution, finding that its measurements had fewer and smaller differences compared to three human experts than when the experts were compared with each other.

Staging Coronary Artery Disease

Believe it or not, there’s been no clinically relevant atherosclerosis staging system used to characterize heart disease — until now. Check out Cleerly’s four-stage system for evaluating atherosclerotic plaque burden, which is the direct cause of coronary artery disease (CAD).