Author Interviews, Heart Disease, JAMA, Surgical Research / 19.09.2016 Interview with: Nish Patel, MD and Nileshkumar J. Patel, MD University of Miami Miller School of Medicine What is the background for this study? Response: Out of hospital cardiac arrest (OHCA) is estimated to affect approximately 300,000 people in the United States annually. Pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) contributes 23-54% of OHCA patients, with the median values at the lower end of this range. Coronary artery disease is thought to be responsible for up to 70% of these OHCA cases. It has been suggested that urgent coronary intervention in unconscious patients after cardiac arrest may improve survival. In the 2015 American Heart Association (AHA) guidelines, coronary angiography is recommended in patients with OHCA patients with a suspected cardiac etiology and ST elevations (STE) on ECG (Class of recommendation I, Level of evidence B), and it should be considered in patients after cardiac arrest presenting without STE but with suspected cardiac etiology of cardiac arrest (Class of recommendation II a, Level of evidence B). However, there is paucity of information about the use of coronary angiography and percutaneous coronary intervention (PCI) and its potential benefit for the VT/VF OHCA patient population. Therefore, we reviewed the Nationwide Inpatient Sample (NIS), to examine temporal trends of coronary angiography and PCI in VT/VF OHCA in the United States, for patients with and without STE. We also studied the temporal trends of survival to discharge in these patient populations. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Heart Disease / 19.09.2016 Interview with: Islam Elgendy, MD Cardiology Fellow University of Florida What is the background for this study? What are the main findings? Response: The optimal systolic blood pressure target in adults with coronary artery disease is not well known. The Eighth Joint National Committee Panel recommended a target therapeutic goal <150 mm Hg for adults aged ≥60 years and <140 mm Hg in those aged <60 years. These recommendations are inconsistent with the different society guidelines (such as American Heart Association/American College of Cardiology, European Society of Cardiology, and American Society of Hypertension) which recommended a therapeutic target < 140 mm Hg. Given that the dyad of hypertension and coronary artery disease is the most prevalent chronic disease dyad among adults, we aimed to assess the long term risk of all-cause mortality with the different systolic blood pressure targets. Using the extended follow-up data from the US cohort of the INVEST trial, we demonstrated that achieving a systolic blood pressure of 130 to <140 mm Hg in the initial 2-3 years of treatment is associated with reduced all-cause mortality after ≈11.6 years of follow-up in hypertensive patients with coronary artery disease. (more…)
AHA Journals, Author Interviews, Brigham & Women's - Harvard, Endocrinology, Heart Disease, Thyroid Disease / 17.09.2016 Interview with: Layal Chaker, MD, MSc PhD candidate Department of Endocrinology and Epidemiology Erasmus Medical Center Rotterdam, The Netherlands What is the background for this study? What are the main findings? Response: The association of thyroid function with coronary heart disease is well–established but not much was known about the association of thyroid function with sudden cardiac death. We conducted the study with the hypothesis that thyroid hormone levels affect cardiovascular risk factors and therefore could also affect the risk of sudden cardiac death (SCD). We were surprised to see that when we control our analyses for these cardiovascular risk factors, the association of high and high-normal thyroid function with SCD remained similar, suggesting that other pathways could play a role. Thyroid hormone has different effects on the cardiovascular systems and future studies should identify which pathway could be responsible for the increased risk of sudden cardiac death with higher thyroid hormone levels. This could lead to better assessment of individual risk and identify possible prevention targets. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Heart Disease / 17.09.2016 Interview with: Holly Mattix-Kramer, MD, MPH Public Health Sciences Medicine, Nephrology Associate Professor Loyola Medicine, Illinois What is the background for this study? What are the main findings? Response: The background is that the Systolic Blood Pressure Lowering Intervention Trial (SPRINT) showed that intensive systolic blood pressure lowering reduces all-cause mortality by 27% compared to standard blood pressure lowering among adults age 50 years and older without diabetes or stroke but with high cardiovascular disease risk. We applied these findings to the U.S. population and asked "What if intensive systolic blood pressure lowering were applied to the U.S. population who meet SPRINT eligibility criteria? We found that approximately 18.1 million U.S. adults meet SPRINT criteria and that their annual mortality rate is 2.2%. If intensive systolic blood pressure lowering reduces all-cause mortality by 27%, then the annual mortality rate would be reduced to 1.6% and approximately 107,500 deaths would be prevented each year. (more…)
Author Interviews, Gender Differences, Heart Disease, JAMA, Menopause / 15.09.2016 Interview with: Taulant Muka, MD, MPH, PhD Postdoctoral Researcher Erasmus University, Rotterdam What is the background for this study? What are the main findings? Response: Menopause marks a major life transition for women, resulting in the loss of ovarian follicle development. Although menopause is a universal phenomenon among women, the timing of the final menstrual period differ greatly between women, and is considered a marker of aging. By quantifying data of nearly 310,329 non-overlapping women, we found that women who experienced an early menopause (i.e. younger than 45 years) have an excess risk of CHD, CVD-mortality and all-cause mortality. Furthermore, being 45-49 years at menopause compared to ≥50 years was associated with increased risk of carotid atherosclerosis. (more…)
Author Interviews, Heart Disease, Infections, Surgical Research / 14.09.2016 Interview with: Josep Rodés-Cabau, MD Director, Catheterization and Interventional Laboratories Quebec Heart and Lung Institute Professor, Faculty of Medicine, Laval University Quebec City, Quebec, Canada What is the background for this study? What are the main findings? Response: Infectious endocarditis (IE) is one of the most serious complications after surgical prosthetic valve replacement. There are however scarce data regarding the incidence, predictive factors, treatment, and outcomes of IE post-TAVR. To date, the present study represents the largest series of IE post-TAVR, and the main findings can be summarized as follows: (1) the incidence of infective endocarditis (IE) post-TAVR is similar to that reported for IE after surgical prosthetic valve replacement; (2) among patients undergoing TAVR, younger age, male sex, a history of diabetes mellitus, and moderate-to-severe residual aortic regurgitation were associated with a higher risk of IE, (3) Enterococci species was the most frequently isolated pathogen, (4) IE post-TAVR was associated with a very high rate of in-hospital complications and mortality during index hospitalization and at follow-up. (more…)
Annals Internal Medicine, Author Interviews, Heart Disease, Transplantation / 14.09.2016 Interview with: Prof. Xavier Jouven Service de Cardiologie Hôpital Européen Georges Pompidou Paris What is the background for this study? What are the main findings? Response: There are many cardiac arrests (around 300 000 per year in United States). The possibility to collect organs from a certain proportion of those cardiac arrests represents an important opportunity to fill the gap of the organ shortage. It is absolutely mandatory to identify patients with no chance of survival. This study showed 3 criteria which allow this early identification. Several thousands of patients die every year waiting for organ transplantation. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, Stroke / 13.09.2016 Interview with: Menno Huisman, MD, PhD Associate professor Department of Medicine Leiden University Medical Center The Netherlands What is the background for this study? What are the main findings? Response: GLORIA™-AF is one of the largest ongoing global registry programs examining the use of oral antithrombotic agents in real-world clinical practice. The program is designed to characterize the population of newly diagnosed patients with non-valvular atrial fibrillation (NVAF) at risk for stroke, and to study patterns, predictors and outcomes of different regimens for stroke prevention. At the ESC Congress 2016, we presented the first Phase II results of GLORIA-AF from approximately 3,000 NVAF patients, which showed that treatment with PRADAXA was associated with low incidences of stroke, major bleeding and life threatening bleeding. Less than 1% of PRADAXA-treated patients experienced a stroke over two years (0.63%). Major bleeding occurred in 1.12% of PRADAXA-treated patients and 0.54% experienced a life-threatening bleed. (more…)
Author Interviews, Heart Disease, Weight Research / 13.09.2016 Interview with: Maria Korre, ScD Post-Doctoral Research Fellow Environmental & Occupational Medicine & Epidemiology Program Department of Environmental Health Harvard T.H. Chan School of Public Health What is the background for this study? Response: Cardiovascular disease (CVD) is the leading cause of on-duty death among firefighters (45% of on-duty fatalities) and a major cause of morbidity. It is crucial to note though, that the risk of on-duty CVD events is not evenly distributed among all firefighters, but is highly concentrated among the most susceptible individuals. Given that firefighting is an inherently dangerous occupation and many of its hazards cannot be engineered out of the job, we have concentrated our efforts on understanding what can make an individual firefighter susceptible. As in the general population, these cardiovascular events are largely due to coronary heart disease (CHD), however, there is an increasing recognition of the role of left ventricular (LV) hypertrophy/cardiomegaly in the risk of sudden cardiac death (SCD) independent of the presence of CHD. Evidence suggests an improved prognostic value, when LV hypertrophy is based on the accurate assessment of LV mass. LV mass is a strong predictor of CVD events and despite it’s critical prognostic significance, it’s measurement and role in clinical practice has yet to be established. In this paper we aimed to identify the most important predictors of LV mass after indexing for height among career male firefighters as assessed by both echocardiography and cardiac magnetic resonance. (more…)
Author Interviews, Heart Disease, Stem Cells / 12.09.2016 Interview with: Rafael Kramann, MD, FASN RWTH Aachen University Division of Nephrology and Clinical Immunology Pauwelsstr 30 52074 Aachen, Germany What is the background for this study? What are the main findings? Response: Vascular calcification contributes centrally to the increased cardiovascular morbidity and mortality in patients with diabetes or chronic kidney disease. Vascular calcification is of major clinical importance as it predicts cardiovascular events, affects plaque stability contributing to stroke and myocardial infarction and also contributes to chronic heart failure by stiffening of the arterial wall. However, the cellular origin of vascular calcification is incompletely understood. While it is known that resident vascular smooth muscle cells and circulating macrophages are involved the contribution of adventitial cells is controversial and partly unknown. Our data indicates that adventitial progenitor cells marked by expression of Gli1 are key drivers of vascular calcification in athero- and arteriosclerosis. Genetic ablation of this cell population completely abolished vascular calcification in a mouse model of high lipid load and chronic kidney disease. Identification of this progenitor population might be the first step towards a cell-specific targeted therapy of vascular calcification. (more…)
Author Interviews, BMJ, Heart Disease, Stroke / 12.09.2016 Interview with: Ayodele Odutayo, DPhil student Centre for Statistics in Medicine Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Oxford, UK What is the background for this study? What are the main findings? Response: Atrial fibrillation is associated with an increased risk of all cause mortality and stroke, as well as higher medical costs and a reduced quality of life. The association between atrial fibrillation and cardiovascular outcomes other than stroke is less clear. We found that atrial fibrillation is associated with a wide range of cardiovascular events, including cardiovascular mortality, major cardiovascular events, heart failure, ischaemic heart disease, chronic kidney disease, and sudden cardiac death, as well as stroke and all cause mortality. The relative and absolute risk increase associated with many of these events is greater than that of stroke. Interventions are needed to reduce the risk of non-stroke cardiovascular outcomes in adults with atrial fibrillation. (more…)
Author Interviews, Gender Differences, Heart Disease, Surgical Research / 11.09.2016 Interview with: Michael A. Gaglia Jr., MD, MSc, FACC, FSCAI Scientific Lead, Population Research Medstar Cardiovascular Research Network Interventional Cardiology Medstar Heart and Vascular Institute Washington, DC 20010 What is the background for this study? Response: Cardiovascular outcomes vary according to gender in a variety of disease states. For example, short-term mortality is higher among women presenting with an acute coronary syndrome in comparison to men. There is a similar trend for higher short-term mortality of women undergoing coronary artery bypass grafting, although this is in part due to a relatively higher burden of comorbidities. Female gender is also a well-established risk factor for bleeding complications after percutaneous coronary intervention. In regards to women undergoing surgical aortic valve replacement for severe aortic stenosis (AS), however, the data is equivocal; some studies suggest higher mortality for women, whereas others suggest improved survival for women. The emergence of transcatheter aortic valve replacement (TAVR) as the preferred therapeutic option for patients with severe AS at high or extreme risk for surgery offered another opportunity to examine gender disparities in outcomes. The evidence base for the impact of gender upon TAVR, however, is still evolving. A recent meta-analysis suggested improved long-term survival among women after TAVR. And in general, previous studies also suggest more vascular and bleeding complications in women when compared to men. The goal of this study was relatively simple: to compare outcomes between women and men undergoing TAVR at a single center. (more…)
AHA Journals, Author Interviews, Heart Disease, Hospital Readmissions, Outcomes & Safety / 09.09.2016 Interview with: Sheila Eckenrode, RN, CPHQ Project Manager Medicare Patient Safety Monitoring System (MPSMS) Qualidigm What is the background for this study? What are the main findings? Response: We sought to investigate the association at the hospital-level between 21 in-hospital adverse event rates and both mortality and readmission rates for Medicare Fee-For-Service patients with AMI. We used data from the Medicare Patient Safety Monitoring System (MPSMS), the nation's largest randomly selected hospital medical record-abstracted patient safety database, and data from the Centers for Medicare & Medicaid Services, which includes hospital performance on mortality and readmissions for over 4,000 Medicare-certified hospitals, to assess the association between hospital performance on patient safety and hospital performance on 30-day all-cause mortality and readmissions for Medicare fee-for-service patients discharged with AMI. We found that hospital performance on patient safety is associated with hospital performance on mortality and readmission rates for AMI. Hospitals with poorer patient safety performance are likely to have higher 30-day all-cause mortality and readmission rates for these patients. (more…)
Author Interviews, Biomarkers, Heart Disease / 08.09.2016 Interview with: Dr. Juan Sanchis Full professor of Medicine Cardiology Department, University Clinic Hospital. Medicine Department, University of Valencia Valencia. Spain What is the background for this study? What are the main findings? Response: Decision making in acute chest pain in the emergency departments remains challenging despite the introduction of new troponin assays (high-sensitivity assays) capable of detecting any amount of myocardial damage. The upper limit of normality of high-sensitivity troponin is established at the 99th percentile of a normal reference population. This is the limit for the diagnosis of acute myocardial infraction. Detectable troponin levels below the 99th percentile, though non diagnostic of acute myocardial infarction, might be considered as of uncertain significance since some patients might still suffer from unstable angina. Undetectable troponin (far below the 99th percentile), however, could rule out unstable angina meaning that such patients could safely be discharged from the emergency department according to some studies. Therefore, if this were fully demonstrated, clinical evaluation could play a secondary role. We investigated clinical data in comparison to undetectable high-sensitivity troponin in patients with normal high-senstivity troponin levels (below the 99th percentile). The main findings indicate that clinical data can guide decision making and perform at least equally well as undetectable high-sensitivity troponin for ruling out unstable angina, in patients presenting at the emergency department with chest pain and normal troponin. (more…)
Author Interviews, Emory, Gender Differences, Heart Disease, Stem Cells / 07.09.2016 Interview with: Arshed A. Quyyumi MD; FRCP Professor of Medicine, Division of Cardiology Emory University School of Medicine Co-Director, Emory Clinical Cardiovascular Research Institute Atlanta GA 30322 What is the background for this study? What are the main findings? Response: Circulating progenitor or stem cells were discovered in adults 15 years ago. We now know that they may be stimulated by injury or ischemia, and they go down in number and function with aging, particularly when aging is associated with risk factors. Women with chest pain despite normal coronary arteries are thought to have ischemia because of microvascular dysfunction. We found that these women, with the worst microvascular function (measured as coronary flow reserve), had higher levels of circulating stem or progenitor cells. This implies that the mild ischemia they are having during their normal daily life, leads to stimulation of their stem cells. Also, the vascular abnormality may be a stimulus for repair. (more…)
Author Interviews, Cancer Research, Heart Disease, Pediatrics / 06.09.2016 Interview with: Steven E. Lipshultz, MD, FAAP, FAHA Schotanus Family Endowed Chair of Pediatrics / Carman and Ann Adams Endowed Chair in Pediatric Research / Professor, Carman and Ann Adams Department of Pediatrics / Professor of Medicine (Cardiology), Oncology, Obstetrics/Gynecology, Molecular Biology/Genetics, Family Medicine/Public Health Sciences, & Pharmacology /Professor in the Center for Molecular Medicine and Genetics Wayne State University School of Medicine President, University Pediatricians & Interim Director, Children’s Research Center of Michigan Pediatrician-in-Chief, Children’s Hospital of Michigan What is the background for this study? What are the main findings? Response: Surviving childhood cancer has dramatically and increasing improved to the point where more than 80% will achieve a 5-year event free survival. Many of these survivors look forward to decades of active productive life. More than half of these survivors have been treated with therapies know to be associated with late cardiotoxicity that can be pervasive, persistent, and progressive and associated with cardiovascular morbidity and mortality. In this article we review both the course and prevention of this cardiotoxicity. We focus in part on anthracycline chemotherapy that is widely used and known to be cardiotoxicity. We further review studies we and others have conducted to examine the effectiveness of dexrazoxane, an iron chelator, that when given before each anthracycline dose results in anthracycline cardioprotection for long term survivors. In some reported studies this has allowed for higher cumulative anthracycline doses to be safely given. In other cases this has allowed for simultaneously being able to safely treat children with malignancies that would be refractory to conventional therapy more potent therapies that would normally have additive cardiotoxicity. (more…)
Author Interviews, Exercise - Fitness, Heart Disease / 06.09.2016 Interview with: Richard Moon, MD Professor of Anesthesiology Professor of Medicine Medical Director, Center for Hyperbaric Medicine & Environmental Physiology Duke University Medical Center Durham, NC 27710 What is the background for this study? Response: For several years we have been investigating the causes of immersion pulmonary edema (IPE, also known as swimming-induced pulmonary edema or SIPE). We determined that during exercise while immersed in cold water pulmonary artery and wedge pressures of individuals who are SIPE-susceptible are higher than normal. This demonstrated that SIPE is a form of hemodynamic pulmonary edema. It is certainly plausible that SIPE could cause death, and indeed a few fatal cases had been reported in the medical literature, mostly in scuba divers. After reading of deaths in young, apparently fit and healthy triathletes we hypothesized that some of these deaths were probably due to  swimming-induced pulmonary edema . It is easy to diagnose SIPE in a living individual, using a stethoscope or chest x-ray/CT. However, since almost anyone who dies from any cause, particularly if attempted resuscitation has occurred, will have pulmonary edema at autopsy. Before concluding that death has occurred due to SIPE, other clues are therefore necessary. (more…)
Author Interviews, Heart Disease, Hospital Readmissions, Surgical Research / 04.09.2016 Interview with: Christian A. McNeely, M.D. Resident Physician - Internal Medicine Barnes-Jewish Hospital Washington University Medical Center What is the background for this study? Response: Prior research has demonstrated that readmission in the first 30 days after percutaneous coronary intervention (PCI) is common, reported around one in six or seven Medicare beneficiaries, and that many are potentially preventable. Since 2000, there have been significant changes in the management of coronary artery disease and the use of PCI. Additionally, in the last decade, readmission rates have become a major focus of research, quality improvement and a public health issue, with multiple resulting national initiatives/programs which may be affecting care. Therefore, in this study, we sought to examine contemporary trends in readmission characteristics and associated outcomes of patients who underwent PCI using the Medicare database from 2000-2012. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Outcomes & Safety, Surgical Research / 04.09.2016 Interview with: Senthil Selvaraj, MD, MA and Deepak L. Bhatt, MD, MPH Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA What is the background for this study? What are the main findings? Response: There has been significant controversy in the effect of off-hours presentation in ST-elevation myocardial infarction (STEMI). Off-hours presentation has been associated with longer treatment time, an independent predictor of worse outcomes in STEMI, though a number of other studies have shown no difference as well. Moreover, little data has been generated from clinical trials, which has the advantage of comprehensive and adjudicated outcomes. In our analysis of nearly 2,000 STEMI patients from the CHAMPION PHOENIX study (a randomized, controlled trial of cangrelor in percutaneous coronary intervention), we found that off-hours presentation was not associated with worse efficacy or safety outcomes at 48 hours or 30 days. More specifically, outcomes not typically reported in registry data, such as ischemia-driven revascularization and stent thrombosis, were not significantly different between the groups. Interestingly, treatment times were actually faster in the “off-hours” group as well. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 02.09.2016 Interview with: Dr Marlous Hall PhD Senior Epidemiologist Leeds Institute of Cardiovascular and Metabolic Medicine What is the background for this study? What are the main findings? Response: It is well known that death rates following heart attacks have fallen considerably over recent decades. Many studies have looked at the effect of medications and invasive strategies, and their association with better clinical outcomes is clear. However, a big question remains: why have heart attack deaths fallen? Is it due to increased use of medications and treatment, is the risk of patients simply lower over time due to things like earlier diagnosis or are patients generally healthier with fewer comorbidities such as diabetes? Answering this is not straightforward - as “gold standard” studies like clinical trials on historic data cannot be done. An alternative approach is to look for patterns in data observed from routine care to look at all these factors together. This study used a large and rich dataset covering heart attack care in the UK (Myocardial Ischaemia National Audit Project (MINAP)). This dataset was linked to outcome data from the Office for National Statistics to allow us to look at all the different factors that could influence the change in mortality over time. (more…)
Author Interviews, Baylor College of Medicine Houston, Diabetes, Health Care Systems, Heart Disease / 02.09.2016 Interview with: Salim S. Virani, MD, PhD and Julia Akeroyd MPH Health Services Research and Development Michael E. DeBakey Veterans Affairs Medical Center Houston What is the background for this study? Response: Given the increase in the number of Americans seeking primary health care due to the Affordable Care Act, combined with current and anticipated physician shortages in the US, there is a growing need to identify other models of primary care delivery to address chronic diseases. (more…)
Author Interviews, Biomarkers, Heart Disease, Kidney Disease / 31.08.2016 Interview with: Xiaobing Yang, MD Division of Nephrology, Nanfang Hospital Southern Medical University What is the background for this study? Response: AKI is a common complication in patients with acute decompensated heart failure (ADHF) and associated with increased death and worse clinical outcomes. Early detecting which patients are going to suffer progressive AKI or proceed to death could help physicians to plan and initiate timely managements. We analyzed data and samples of 732 ADHF patients from a prospective, multicenter study in China. We demonstrated that kidney injury biomarkers, measured at the first time of AKI clinical diagnosis, could predict which patients were going to have AKI progression or worsening of AKI with death. Notably, three urinary biomarkers, including urinary angiotensinogen (uAGT), urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary IL-18 (uIL-18), were all able to forecast which patients with the earliest stages of AKI were most likely to suffer progressive AKI. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Pharmacology / 31.08.2016 Interview with: Aaron S. Kesselheim, M.D., J.D., M.P.H. Associate Professor of Medicine at Harvard Medical School Director, Program On Regulation, Therapeutics, And Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women's Hospital Boston MA 02120 What is the background for this study? What are the main findings? Response: It has been previously reported that the number of new cardiovascular drugs approved by the U.S. Food and Drug Administration (FDA) has declined in recent years. So we sought to empirically assess trends in the development of new cardiovascular therapeutics. (more…)
Author Interviews, Heart Disease, Lancet, Surgical Research / 31.08.2016 Interview with: Prof Lars Wallentin, MD PHD Senior Professor Cardiology Uppsala Clinical Research Center, Uppsala University What is the background for this study? Response: The FRISC2 study was performed 1996 – 1998 and reported 1999 for the first time a significant reduction in death and myocardial infarction by early invasive compared to non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). The results at 6 months, 1, 2 and 5 years were published in The Lancet and pivotal in changing the treatment guidelines and thereby improving outcomes in patients with NSTE-ACS. These findings were within the next few years verified in the TACTICS-TIMI18 and RITA3 trials. However the later performed ICTUS trial, starting after these results were published and accordingly with a substantial early crossover to the invasive arm, showed neutral results. Recently the reduction in event rates by an early invasive strategy was again validated in patients above 80 years of age, which were less well represented in the initial trials. These benefits of an early invasive strategy have previously been shown sustained for at least five years based on results from the FRISC2, RITA3, and ICTUS trials. The FRISC2 and TACTICS-TIMI18 trials also showed that the benefits with an early invasive strategy seemed confined to patients with signs of myocardial necrosis as indicated by elevated troponin level at entry. In addition the FRISC2 trial found that the benefits were larger in patients with signs of inflammatory activity as indicated by a high level of growth differentiation factor 15 (GDF-15) at entry. These pivotal results have been the basis for the current international treatment guidelines recommending an early invasive treatment strategy in patients with NSTE-ACS and elevated troponin and/or other indicators of a raised risk. (more…)
Author Interviews, Heart Disease, NEJM, Surgical Research / 31.08.2016 Interview with: Dr. Kaare Harald Bønaa Principal investigator University of Tromsø, Norway What is the background for this study? Response: The NORSTENT study was designed shortly after the “Barcelona fire storm” in 2006 that raised severe safety concerns against drug-eluting stents (DES). At that time there was evidence for increased risk of stent thrombosis with DES. How this could influence long term results compared to PCI with bare metal stents (MMS) was not known. Accordingly, we designed the NORSTENT study with the primary composite endpoint of all-cause mortality and non-fatal spontaneous myocardial infarction at a medial of 5 years of follow-up. (more…)
AHA Journals, Author Interviews, Heart Disease, Hospital Readmissions, Surgical Research / 31.08.2016 Interview with: Jason H. Wasfy, MD, MPhil Assistant Medical Director, Massachusetts General Physicians Organization Director of Quality and Analytics Massachusetts General Hospital Heart Center What is the background for this study? What are the main findings? Response: Reducing preventable readmissions after PCI is a way to both improve the quality of care for our patients and improve value for patients with coronary artery disease. Through a variety of tactics, we were able to reduce the 30 day readmission rate for patients after PCI by nearly half. Keep in mind that this is only the readmission rate to our hospital, so we will need to confirm these results with data including patients who may have been readmitted to other hospitals after a PCI at Mass General. (more…)
Author Interviews, Heart Disease, NEJM, Obstructive Sleep Apnea, Sleep Disorders / 30.08.2016 Interview with: Prof. Craig Anderson, PhD Professor of Stroke Medicine and Clinical Neuroscience Medicine, The George Institute for Global Health University of Sydney What is the background for this study? What are the main findings? Response: We wished to prove whether treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP ) can modify the risk of cardiovascular disease. The is a lot of association data from epidemiological and clinical studies but no large scale international clinical trials assessing the effects of CPAP on the prevention of serious cardiovascular events like heart attack and stroke. Our study in nearly 3000 adults with prior heart attack or stroke and moderate to severe obstructive sleep apnea showed that CPAP treatment did not prevent recurrent cardiovascular events or major cardiovascular risk factors. However CPAP did improve wearers' sense of wellbeing, mood and work productivity. (more…)
Author Interviews, Diabetes, Heart Disease, Stem Cells / 30.08.2016 Interview with: Jolanta U Weaver, FRCP MRCS PhD CTLHE Senior Lecturer in Diabetes Medicine Honorary Consultant Diabetologist Newcastle What is the background for this study? What are the main findings? Response: Vascular stem cells, which are associated with an improvement of heart disease, are improved in type 1 diabetes by repurposing metformin, known to reduce heart disease in type 2 diabetes. We treated patients with type 1 diabetes with metformin for 8 weeks. The metformin dose varied between 500 mg a day to 2000 mg a day, depending on what patients were happy to take. Subjects were requested to keep diabetic control unchanged to study the direct effect of metformin on heart disease. Circulating endothelial progenitor cells (vascular stem cells) count, Hill’s colonies and pro angiogenic cells function (in test tube) improved in comparison to patients, who did not take metformin but remained on standard therapy. Endothelial cells associated with vascular damage, on the other hand, were reduced following metformin therapy confirming improved vascular health. The glycaemic control remained unchanged (as planned at the onset of the study) to allow us to examine the effect of metformin ALONE on vascular health. Patients did not suffer any serious side effects. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Transplantation / 30.08.2016 Interview with: Dr. Laith Alshawabkeh MD ‎Senior Fellow Brigham & Women's and Boston Childrens Hospitals / Harvard Medical School What is the background for this study? Response: As the number of adults living with congenital heart disease continues to increase, there is paucity of evidence on the trajectories and patterns of their comorbidities. In all, heart failure is the leading cause of death in this group of patients. Unfortunately, landmark trials and advances in medical therapy which promoted increase survival in patients with the usual heart failure (non-congenital) has not been translated into those with congenital heart disease. Heart transplantation remains one of the (if not the only) sustainable option for many patients with congenital heart disease at the end stage of heart failure. Recent studies have shown that adults with congenital heart disease who underwent transplantation experienced higher risk of postoperative mortality compared to their non-congenital counterparts; however, patients with congenital heart disease who survived the first year post-transplantation enjoyed significantly better long-term survival, indicating that with careful selection those patients might benefit tremendously from transplantation. Much less is known about the outcome of these patients while they are waiting for an organ. As such, this study sought to examine the outcomes of patients with congenital heart disease while listed for heart transplantation and to investigate correlates of adverse outcomes (mortality and delisting due to clinical worsening). (more…)
Author Interviews, Heart Disease, Stem Cells / 30.08.2016 Interview with: Javed Butler, M.D., MPH, FACC, FAHA Chief of the Cardiology Division and Co-Director of the Heart Institute at Stony Brook University Stony Brook Heart Institute What is the background for this study? What are the main findings? Response: It was previously assumed that stem cells must be delivered directly to the myocardium to improve patient outcomes. However, this delivery mechanism – either in the coronary artery or the myocardium – may not be feasible for millions of patients and for repeat injections. This study represents the first clinical trial to observe the effects of intravenous (IV) administration of ischemia-tolerant mesenchymal stem cells (itMSCs) in patients with chronic heart failure. Results show that an IV injection strategy is safe and well-tolerated.In addition, the data illustrate statistically significant improvement in 6-minute walk test, quality-of-life scores as assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ) and favorable immune modulatory benefits. (more…)