54-year-old New Jersey woman, Lisa Pisano, who became the world’s first recipient of a combined LVAD heart pump and gene-edited pig kidney transplant.

Heart Failure

Could Statins Be The Next Breakthrough HFpEF Treatment?

A new JAMA study suggests that statins might have a massive impact on HFpEF care, even among patients who don’t have atherosclerosis.

Statins are one of the most-prescribed drug classes in the world, but there’s still little data on their heart failure benefits, especially for HFpEF patients. 

• The two major RCTs evaluating statins as a heart failure treatment (CORONA and GISSI-HF) didn’t show significant benefits, although they mainly focused on HFrEF patients. 
• Several observational studies suggest that statins do benefit HFpEF patients, specifically showing the medication’s mortality improvements, although the studies were smaller, non-US, and didn’t target patients without ASCVD.

This new study looked to further establish statins’ HFpEF impact. The researchers analyzed data from 7,970 VA patients who were diagnosed with HFpEF between 2002 to 2016, and didn’t have known ASCVD or a history of statin use at baseline.

Nearly half of the patients (47%) initiated statins after their HFpEF diagnosis, while the overall cohort included 5,314 deaths and 4,859 MACE events. 

Over a six-year follow-up and after propensity score overlap weighting, the statin-users had…

• 22% lower risk of all-cause mortality
• 21% lower risk of MACE
• 31% lower risk of all-cause hospitalization
• 28% lower risk of HF hospitalization

How do we explain these massive improvements? The authors believe that statins’ HFpEF benefits “go beyond its impact on atherosclerosis,” specifically citing statins’ ability to reduce inflammation and lower AFib risks (both of which are linked to HFpEF).

The Takeaway

These results suggest that a valuable HFpEF add-on treatment might be sitting in 47 million Americans’ drug cabinets, and they state a solid case for launching more research to assess statins’ HFpEF impact – including RCTs.

HeartFlow FFRCT Catches Missed Blockages

Karen Moore had always been diligent about her heart health, which is why she was concerned when she began showing symptoms of heart disease but all of her tests came back negative. See how Karen and her physician used HeartFlow FFRCT to catch a 90% blockage and place a stent in the right location, before it was too late.

From CPACS to CVIS

Cardiovascular imaging has come a long way from CPACS. Explore the evolution of cardiology image and data management in this Merge by Merative executive brief, and see what makes CVIS such a significant advancement.

Experience the Future of Learning: Medtronic Academy 2.0 is Here!

Unlock your ultimate destination for structural heart medical education with the newly redesigned Medtronic Academy 2.0. Gain access to expert-led courses, webinars, and a wealth of resources to stay ahead in cardiovascular care. Visit now!

The Wire

• First LVAD + Pig Kidney Transplant: NYU Langone surgeons performed the world’s first combined LVAD heart pump and gene-edited pig kidney transplant, in a 54-year-old woman with heart and kidney failure who wasn’t a human organ transplant candidate due to chronic comorbidities. The woman received her LVAD transplant days before the gene-edited pig kidney, as well as a pig’s thymus gland to aid against rejection. The procedure represents another milestone towards advancing xenotransplants, following several recent attempts at pig heart transplants.

• AFib in Younger Patients: A new AHA study suggests that AFib is more common, and more consequential, among younger patients than many previously thought. The analysis of over 67k people treated for AFib between 2010 and 2019 found that nearly a quarter of the patients were under 65 years (vs. common estimate of 2%), while under-65 AFib sufferers were far more likely to be hospitalized for MI, HF, and stroke than patients without AFib.

• AtaCor Series C: Extravascular cardiac rhythm management leads startup AtaCor Medical wrapped up a $28M Series C round (A-C funding now >$62M) to support the FDA submission of its extravascular temporary pacing lead system and to complete a pilot study for its third generation EV-ICD lead system. AtaCor’s EV cardiac pacing and defibrillation lead systems are designed to allow patients to receive CRM therapy without placing any hardware inside the patient’s heart, allowing faster and less-invasive therapy, while keeping patients’ hearts “untouched.” 

• SGLT2i’s High Risk Heart Protection: A new meta-analysis highlighted the effectiveness of SGLT2 inhibitors across diverse patient groups, finding that they reduce overall MACE by 9%. The study of over 78k patients with diabetes at high risk for HF, ASCVD, or CKD, found that SGLT2i’s MACE reductions were mainly driven by decreases in cardiovascular death, particularly heart failure (HR=0.68) and sudden cardiac death (HR=0.86). However, they had no significant effect on MI or stroke.

• Hello Heart’s Elder Impact: A new JACC study suggests that Hello Heart’s mobile self-management program is particularly effective with older users. Among 8,148 people aged 65+ using the Hello Heart app, 84% reduced systolic BP within 26 weeks (mean drop of 18.1 mmHg), 80% reduced LDL-C by 3.9 months (-76.6 mg/dL), and 70.4% lost weight by three months (-8.8 pounds). The 65+ study participants also had 45% higher app engagement than younger users.

• Mammography CVD Screening: A new study supports the idea that mammography can be leveraged for CVD screening by using AI to detect breast arterial calcifications. Researchers from Solis Mammography used iCAD’s ProFound Breast Health Suite to find BAC on mammograms from more than 117k women, finding an overall BAC prevalence of 15%, with prevalence rising with age (4.2% in <50yrs, 41% ≥70yrs).

• Provisio’s IVUS Clearance: Provisio Medical announced the FDA 510(k) clearance of its flagship Provisio SLT IVUS System, which uses Sonic Lumen Tomography (SLT) technology to give peripheral vascular specialists real-time dimensions of a vessel’s flow lumen without the need for user input. Provisio’s support crossing catheter enables simultaneous vessel lumen measurement and visualization, with guidewire support and delivery of radiopaque contrast agents, allowing accurate intravascular measurements without  changing physician workflows.

• 2D Echo’s RV Limits: New research in JASE found significant limitations for using 2D echo measurements like tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) for assessing right ventricular function. FWLS showed the closest correlation with reduced RVEF (<45%) when compared to 3D echo, with 92% specificity and just 59% sensitivity. The study emphasized combining 2D parameters to assess RV function more accurately, particularly in settings without access to 3D echo.

• Do Lipid-Lowering EHR Alerts Work? The PROMPT-LIPID trial found that EHR alerts that encourage escalating lipid-lowering therapy (LLT) might not have a significant impact, unless clinicians stop dismissing them. Among 47 clinicians and 1,370 randomized patients, a similar share of the alerts group patients had their LLT increased as patients who didn’t have EHR alerts (14.1% vs. 10.4%). However, among patients whose doctors didn’t dismiss the alerts, LLT intensification more than doubled (OR=2.33), underscoring the need to tackle clinician alert dismissals.

• USPSTF Opens CAC Scoring Review: The USPSTF has opened a review of its recommendations on using CT-based coronary artery calcium scoring for cardiovascular risk assessments. The group’s most recent review – issued in 2018 – said CAC scoring had no benefit over traditional risk factors, but since then multiple studies have been published highlighting its prognostic power, and CAC adoption has increased significantly. The USPSTF is taking comments through May 22.

• Physicians Warm Up to GenAI: A Wolters Kluwer survey showed that physicians are quickly warming up to generative AI, with 68% reporting they’ve changed their views over the last year and are now more likely to think the tech will be beneficial for healthcare. Of the 100 physicians surveyed, 81% say GenAI will improve interactions with patients, and over half believe it will reduce time spent not focused on patients by over 20%. A surprising 89% said transparency into training data and methods would be a deciding factor.

Incidental CAC Predicts Long-Term Risks

What if you could identify which of your asymptomatic patients have high risks of future cardiac events? Stanford-led researchers used Bunkerhill Health’s Incidental CAC algorithm to do just that, finding that patients with ≥100 incidental CAC scores had a 24% 10-year risk of developing ASCVD and far higher risks of major adverse events.

Precision QRS Detection

QRS detection is essential for any ECG algorithm, and Monebo’s Kinetic QRS ECG Algorithm sets the standard for accuracy. Kinetic QRS accurately detects the QRS complex, no matter the amplitude, waveform, or noise levels.

The Resource Wire

• Making the Leap to Outsource Post-Processing: Interested in how to outsource cardiac image post-processing, but not sure where to start? PIA walks you through how to assess and compare vendors, understand pricing models and payment options, and outline your requirements to identify vendors who meet your clinical needs.

• Where to Go for Cardio AI? TeraRecon’s Cardio Suite is a collection of hand-selected, vendor-neutral Cardiology AI algorithms that aid in the analysis and interpretation of echocardiograms and chest CTs. Learn about TeraRecon’s AI offering and how they improve efficiency and accuracy here.

• Echo AI for HFpEF: New research comparing Us2.ai to gold-standard invasive hemodynamic measurement showed that in patients with HFpEF, echo AI measurements are interchangeable with manual core-lab measures to diagnose increased filling pressures – and could improve HFpEF detection.

• A New Standard of Cardiovascular Care: Heart disease is the leading cause of death, so it might be time to change how we think about heart attack prevention. Read Cleerly’s manifesto on why our current approach is unsustainable, how Cleerly’s AI-based platform can transform care, and what it will take to change today’s unacceptable heart disease statistics.