An X post from Super Mario MD, on the results of SURMOUNT-5 and his own clinical experience.

Cardiology Pharmaceuticals

Tirzepatide Beats Semaglutide in Weight Loss

Has a king of the GLP-1s finally been crowned? Full results from the SURMOUNT-5 trial published in NEJM seem to suggest that Eli Lilly’s tirzepatide (Zepbound/Mounjarno) could be better than Novo Nordisk’s semaglutide (Wegovy/Ozempic).

• Both tirzepatide and semaglutide are highly effective medications for obesity management. 
• However tirzepatide’s efficacy compared to semaglutide in obese adults without T2D was unknown until now.

Weighing the weight loss benefits of each drug, SURMOUNT-5’s researchers randomized 751 obese patients without T2D to receive either tirzepatide (10mg/15mg) or semaglutide (1.7mg/2.4mg) and found that patients on tirzepatide lost far more weight after 72 weeks.

• The average weight loss at week 72 was significantly greater with tirzepatide compared to semaglutide (−20.2% vs. −13.7%). 
• Patients on tirzepatide also lost more waist circumference (−18.4 cm vs. −13.0 cm).
• Tirezepatide also had fewer discontinuations due to gastrointestinal events (2.7% vs. 5.6%) and fewer vomiting adverse events (15.0% vs. 21.3%).

While Lilly takes the weight loss cake, the GLP-1 game is quickly becoming about more than just raw weight loss, with several studies in the last few years touting the cardiac benefits of Novo’s semaglutide.

• TRANSFORM-AF recently showed that semaglutide could help reduce AFib events.

• The STRIDE trial uncovered that semaglutide improves the impact of PAD.
• The SELECT trial found that overweight or obese patients with CVD reduced their risk of MACE on semaglutide.
• Results from SELECT were so strong that Novo eventually used them to secure FDA approval and payor reimbursement for semaglutide’s CV event reduction indication.

Meanwhile, tirzepatide’s SUMMIT trial found it reduced mortality risks in HFpEF patients with obesity, but Lilly has since pulled its request to the FDA to approve tirzepatide for HF.

• It’s also worth noting that SURMOUNT-5 and the other SURMOUNT trials are funded by Lilly.

The Takeaway

SURMOUNT-5 confirms what many have suspected for a while – tirzepatide leads to more weight lost than semaglutide in the same amount of time. Whether or not that advantage will sway prescribers and patients remains to be seen.

Innovating AFib Care

The first manifestation of AFib is often stroke, but many hospitals aren’t set up to coordinate these patients’ post-stroke care. See how UCSD is leveraging Viz.ai’s Viz Connect solution to simplify neuro and EP collaboration in this HRX 2024 interview.

Redefining Percutaneous Coronary Intervention

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Automated and Intelligent EP Reporting

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The Wire

• CTPA Use Grows 50% in 7 Years: The use of CT pulmonary angiography scans to detect pulmonary embolism rose 49% in seven years at a large urban hospital, but the rate of positive scans remained about the same. Researchers documented growth in annual volume from 2017-2023 (2.5k to 3.7k scans), with the positivity rate remaining constant at 9.1% – a sign that rising volumes did not compromise diagnostic yield (a possible sign of overuse).

• MAPLE-HCM’s Topline Results: Cytokinetics announced positive topline results from its MAPLE-HCM Phase 3 trial that suggest aficamten may be used as monotherapy for obstructive HCM. MAPLE-HCM randomized 175 patients to receive either aficamten or the standard-of-care beta blocker, metoprolol, and found that aficamten led to a statistically significant improvement in peak oxygen uptake from baseline to Week 24 compared to metoprolol.

• Optison for Pediatric Ultrasounds: GE HealthCare received FDA approval for a new pediatric indication for its Optison ultrasound enhancing agent. Optison improves the quality of suboptimal echocardiogram results by using gas-filled microbubbles that react with ultrasound waves to increase visibility in the heart and endocardial borders. Optison’s new indication approval could help enable easier diagnosis of pediatric patients whose anatomies make echocardiography more difficult.

• CT vs. ICA for Obstructive CAD: In a secondary analysis of the DISCHARGE trial, researchers found that quality-of-life outcomes for patients suspected of coronary artery disease were about the same whether CT or invasive angiography was used first for evaluation. One study in JAMA Cardiology examined 3.6k patients, finding little difference in outcome metrics like health survey responses and reported chest pain at 3.5 years of follow-up. Either test can be used to evaluate chest pain, although CT is obviously less invasive.

• MRI Detects Rare Heart Condition: U.K. researchers discovered that cardiac MRI can detect a rare genetic heart condition called lamin heart disease. As part of a 187 patient JACC study, researchers found that cardiac MRI detected heart inflammation, scarring, and impaired function in people carrying the mutated LMNA gene that would have been missed with tests like ECG and echocardiography.

• K, Ca, and Mg for Stroke Prediction: A recent AHA study suggests serum potassium, calcium, and magnesium levels could be useful for predicting a patient’s risk of ischemic stroke. The study measured serum K, Ca, and Mg levels at baseline in 5,469 patients with ischemic stroke and found that those with the highest (top quartile) serum levels had a 21%-31% lower chance of stroke three months after being measured.

• Skip the Chips! In a surprise to no one, eating ultra-processed foods may harm your heart health. A new JACC study examined 8.3M people on four continents and found a patient’s risk for several diseases increased proportionally to how much processed food they ate. Each additional 100 grams per day of ultra-processed food led to a higher risk of hypertension (+14.5%), cardiovascular events (+5.9%), cancer (+1.2%), and all-cause mortality (+2.6%) among other things.

• IVL + TAVR Combo: Cardiologists have found a new way to use intravascular lithotripsy (IVL) to facilitate transcarotid access for TAVR patients. Published in JACC: Case Reports, cardiologists encountered a patient with severe AS after a CT scan and carotid ultrasound revealed significant calcification and PAD in the patient’s arteries which made transfemoral and transaxillary TAVR too challenging. Creating a third option, the care team used IVL to clear transcarotid access for the TAVR procedure instead and successfully implanted the replacement valve.

• TAVR or SAVR for LFLG AS? New data suggests TAVR and SAVR have similar outcomes in patients with low-flow, low-gradient (LFLG) aortic stenosis. Researchers tracked data from 248 low-risk patients who underwent first-time SAVR or TAVR for LFLG aortic stenosis finding that 30-day mortality, stroke, and pacemaker rates were comparable between the two groups. There was also no significant difference in AV mean gradient or ejection fraction one year post-procedure.

• AI Predicts LBBB Risk: AI could help cardiologists predict when a TAVR procedure might lead to a left bundle branch block (LBBB). Researchers used ECG lead data from 469 patients gathered before TAVR to test a variety of machine learning techniques, finding that XGBoost, a gradient-boosted decision tree machine learning library, was the most accurate for predicting a patient’s LBBB risk after TAVR. XGBoost demonstrated an accuracy of 0.852, a precision of 0.789, and an F1 of 0.82.

• HHS Calls for Healthcare Deregulation: HHS Secretary Robert F. Kennedy, Jr. this week announced a plan to deregulate HHS and FDA by identifying and eliminating “outdated or unnecessary regulations.” The plan’s centerpiece is a “10 to 1” deregulatory policy – for every new regulation proposed, at least 10 existing regulatory actions will be rescinded. What’s more, the total cost of all new regulations for fiscal 2025 “must be significantly less than zero.” A 60-day comment period on the proposal opened this week.

Optum’s CV Imaging Pearls

As populations age, the increasing prevalence of cardiovascular disease means that pressure is mounting for healthcare providers. Watch Optum Insight enterprise imaging CEO Tracy Byers and Chief Product Officer Omer Shalit-Cohen discuss the important role enterprise imaging plays in cardiovascular imaging.

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Identify and Treat Cardiovascular Disease

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The Resource Wire

• PIA’s Post-Processing Solution: Advanced cardiac imaging often calls for a time-consuming post-processing step, requiring costly software, hardware, and training. See how PIA provides this post-processing at lower cost, improved consistency, and greater efficiency. 

• New Horizons in Structural Heart: TAVR and TMVR rates are rising rapidly, placing more pressure on interventional planning. Tune into this Circle CVI and Radcliffe Cardiology breakout detailing how to leverage modern CT workflows to produce efficient and accurate pre-procedural plans.

• The CardioMEMS HF System is Now Covered by Medicare Advantage: Download reimbursement resources and view more information about the expanded coverage for your heart failure patients if coverage criteria is met.

• Us2.ai and Fujifilm Automate CVUS: Fujifilm Healthcare Americas and Us2.ai have partnered to equip the LISENDO 880 cardiovascular ultrasound system with an AI-driven clinical workflow solution. Read more about how Us2.ai fully automates the LISENDO 880’s echocardiogram analysis and reporting. 

• The Monebo Difference in Comprehensive Cardiac Mapping: Monitoring the heart 24/7 means being in tune with the body’s natural cycles. Read about how Monebo’s approach to cardiac monitoring provides visual representations of a patient’s heart rate, cardiac muscle relaxation, and electrical excitation throughout the day.

• Explore Vitrea Advanced Visualization: Discover Canon Medical Healthcare IT’s suite of advanced imaging workflows designed to increase efficiency in cardiovascular imaging, and facilitate the assessment, diagnosis, and treatment of cardiovascular diseases. These cutting-edge tools support the delivery of faster, more accurate care while integrating seamlessly into clinical workflow

• Vista AI Reduces Patient Backlog: Cardiac MRI is infamous for its complexity and backlogs, but it doesn’t need to be that way. See how Vista Cardiac delivered a 50% reduction in scan time variability, enabling shorter scheduling blocks and eliminating a one-month backlog.

• 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!

• Your Cardiology Data is Valuable. Put it To Work. See how one major Midwest health system’s decision to implement Merge Cardio transformed physician and staff workflows, improved data entry speed and accuracy, and increased cost savings.

The Industry Wire

1. UnitedHealth Group CEO Andrew Witty steps down.
2. White House unveils sweeping plan to combat U.S. drug costs.
3. Elizabeth Holmes’ partner launches blood testing startup.
4. Global nurse shortage to shrink by 2030.
5. Mass General Brigham to invest $400M in primary care.
6. Ascension taps Kansas hospital president.
7. Google Chief Health Officer Karen DeSalvo to retire.
8. AI helps unravel a new cause of Alzheimer’s disease.
9. Sanford 1st to pilot new Epic MyChart feature.
10. Children’s Wisconsin names Chief Information and Digital Officer.