Ajay Kirtane, MD, on quitting #CardioTwitter.

Cardiovascular Disease

Unraveling the Vaccine-Myocarditis Mystery

It’s pretty clear that myocarditis is a rare complication of the mRNA COVID vaccine. A new study published in Circulation suggests this phenomenon may be related to vaccine-generated spike proteins that dodged antibodies.

Researchers matched 16 children with post-vaccine myocarditis to 45 control children who had been vaccinated without complication: 

• Absolute antibody titers were no different in the myocarditis vs. the control group.
• Autoantibody levels were also similar in both groups.
• T-cell responses were mostly similar–except for one T-cell subtype that was slightly elevated in the myocarditis group. 
• Inflammatory markers (including interleukin cytokines, TNF-α, and INF-γ,) were significantly higher in the myocarditis group. 

Most importantly, the researchers found free spike protein in the blood (not bound by anti-spike antibodies) present in 12 out of the 16 patients with myocarditis, but in *zero* of the 45 control patients. This suggests that these vaccine-generated spike proteins may be the driving force behind mRNA vaccine-related myocarditis in young people.

The Takeaway

The incidence of myocarditis among children infected with SARS-CoV-2 is still much higher than the risk of post-vaccination myocarditis, and these results do not negate the overall efficacy of mRNA vaccines in preventing severe COVID outcomes. 

But we are still left with the puzzling question: Why do some people completely clear the spike protein, while others do not? The search for answers continues. 

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The Wire

• AstraZeneca Acquires CinCor: AstraZeneca is buying CinCor Pharma for $1.8B, capitalizing on the collapse of CinCor’s share price after its lackluster phase 2 data on the aldosterone synthase inhibitor baxdrostat for people with hypertension. But AstraZeneca thinks the drug has promise, and aims to combine baxdrostat with its own diabetes drug Farxiga to target cardiorenal diseases. 

• Top Heart-Healthy Diets: US News and World Report shared its annual list of the best heart-healthy diets for 2023, based on input from a panel of health experts. The DASH diet, which prioritizes foods high in potassium, calcium, and magnesium, landed the coveted #1 slot, followed by the Mediterranean, Flexitarian, and Ornish diets respectively. 

• Silent Suffering Among Cardiologists: In an ACC survey of almost 6k cardiologists across the globe, more than 25% reported experiencing mental health issues. Factors that increased the likelihood of mental health conditions included experiencing emotional harassment (OR: 2.81), discrimination (OR: 1.85), being divorced (OR: 1.85), and being under 55 years (OR: 1.43). Women were more likely to consider suicide within the past 12 months (3.8% vs 2.3%), but were also more likely to seek help compared to men (42.3% vs 31.1%). 

• Canon & Sclmage’s Hemo Alliance: Canon Medical Systems announced a strategic partnership with enterprise imaging company Sclmage, expanding Canon’s hemodynamics capabilities and its reach in the cardiac market. The alliance will combine Sclmage’s cloud-based platform with Canon Fysicon’s QMAPP Hemo hemodynamic monitoring system (used during interventional procedures), while allowing the companies to develop new solutions and business models. 

• FDA Eases Simulation Software Clearance Criteria: The FDA issued a final order reclassifying interventional cardiovascular implant simulation software from class III into the less strenuous class II (special controls) regulatory approval track. 

• Targeting Pocket Infections: Infections associated with cardiac implantable electronic devices (CIEDs) require the device to be extracted, even when the infection is confined to the subcutaneous pocket. But a new study proposes a novel technique to target these localized infections. This technique–dubbed CITA–directly delivers high doses of antibiotics to the infected pocket, and allowed patients to avoid device and lead extraction in 85% of cases, according to a study conducted over 14 years at two centers in Israel.  

• Volta Medical’s Series B: Volta Medical secured €36M in Series B funding to support adoption of its AI software for cardiac ablation, doubling its lifetime funding. The French startup will use the funding to develop its VX1 software, which uses deep learning to help doctors identify abnormalities in 3D heart maps to guide ablation therapies. 

• Uncovering Incidental Cardiac Amyloidosis: A new study examined 17.3k bone scintigraphy exams from 11.5k patients (both cardiac & non-cardiac referrals) and found that 3.3% of them showed incidental abnormal uptake of the cardiac radiotracer DPD, which is often an indicator of cardiac amyloidosis. About half of those DPD-positive patients had confirmed cardiac amyloidosis, and a positive DPD test independently predicted mortality, cardiovascular death, and hospitalization for heart failure at six years. 

• Pathkind Labs and Roche Diagnostics Partner: Pathkind Labs partnered with Roche Diagnostics to advance the treatment of diabetes and cardiac care in India. Pathkind will incorporate Roche Diagnostics’ heart failure biomarker NTProBNP into its diabetes management program. 

• TTE’s High and Variable Costs: A new JACE study revealed that self-pay and commercial rates for transthoracic echocardiography (TTE) are substantially higher than Medicare rates — and they can vary widely. Analysis of 1.9k hospitals’ posted rates revealed that the median commercial and self-pay rates for TTE exams are roughly 3-times Medicare ($1,313 & $1,422 vs. $464). Meanwhile, 90th percentile rates were 2.8-times higher than 10th percentile rates when comparing different plans within the same hospital, and 2.5-times higher when comparing different hospitals in the same regions.

• Physician-Peer Relationships: Patients whose PCP and specialist trained together in medical school report substantially improved experiences. A Harvard-led analysis of 8.6k patient ratings revealed that “co-training ties” between specialists and PCPs were linked to a 9 percentage point increase in the patients’ specialist rating, which suggests there are potentially large gains from developing physician-peer relationships.

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