🚨
@HFSA
is now starting:
DEVICES IN HEART FAILURE MEETING: FROM MECHANISMS TO IMPLEMENTATION
Mark your🗓️ ➡️Friday Sept. 27th. Right before the main
#HFSA
meeting in
#Atlanta
💡Lectures
💡Hands-on sessions
🚀Tech Exhibits
🛜Networking
‼️Reduction in cerebral blood flow (CBF) is found in various forms of
#Dysautonomia
and leads to a broad spectrum of symptoms such as dizziness, fatigue, shortness of breath, all the way out to syncope. Yet, CBF is often not monitored.
🔥🚨Pressures Do Not Equal Volumes🚨
#1
We present ➡️ Discordance of Pressure and Volume: Potential Implications for Pressure-Guided
Remote Monitoring in Heart Failure
➡️We explored pressure-volume relationship
in ambulatory HF pts. managed with CardioMEMS
I am a cardiologist, and my work place is above the diaphragm?! Why should I care about the
#liver
and
#NAFLD
(non-alcoholic fatty liver disease)?
⚡️Our therapies in many cases reach well beyond the heart
⚡️In order to improve outcomes we have to tackle comorbidities
A🧵
Initiation of
#SGLT2i
in patients w/ acute heart failure (in-hospital or within 3 days of discharge): yes or no?
📍48%⬇️odds of rehospitalization for HF
📍Improvement in KCCQ
📍No⬆️risk of AKI, hypotension, or hypoglycemia
Meta-analysis by
@HusamSalah
Can NAFLD drive some HFpEF phenotypes? Check out our review in
@JACCJournals
in which we propose 3 NAFLD-related HFpEF phenotypes: obstructive HFpEF, metabolic HFpEF/NAFLD, and advanced liver disease/cirrhosis HFpEF.
🚨Venous Tone and Stressed Blood Volume in Heart Failure: JACC Review Topic of the Week
We discuss the contribution of the vascular system, in particular the often neglected veins to the modulation of blood volume in health and disease
@jaccjournals
🚨Very excited to report the 1st US case of Pulmonary Arterial Denervation🫁for heart failure♥️ and preserved ejection fraction (HFpEF) and high pulmonary vascular resistance (PVR) using the Gradient System. Desperate need for therapies. Big team effort!
The landscape of device based therapies in heart failure has seen a major shift in the last years. This is in parts due to a change in the regulatory environment. Our review covers devices for chronic HF, approved and in the pipeline:
@JACCJournals
Largest device trial in HFpEF is out.
Placement of an atrial shunt device did not reduce the total rate of heart failure events or improve health status in the overall population of patients with heart failure and ejection fraction of 40+
#1
Cuff-less blood pressure monitors will change the way we monitor blood pressure and treat hypertension
⚡️Think of the shear amount of information that will come our way when patients/medical teams gain access to beat by beat, minute by minute blood pressure data, 24/7, 365
Breakthrough results for Jardiance® (empagliflozin) confirm EMPEROR-Preserved as first and only successful trial for heart failure with preserved ejection fraction
Finally we got a winner for HFpEF.
🧵
#1
The lymphatic system has been suggested as a key player in the pathophysiology of heart failure. Lymphatic vessels drain fluid and prevent tissue edema. Daily ~3L are drained back into the venous system.
What is the relationship between lymphatic system (LS) function and signs of congestion in AHF? We used the VEGF-C (as a proxy of LS) and analysed its' relation with several clincal signs of congestion and mortality in AHF
1. "Heart" Failure is not only a problem of the heart. The ability to modulate preload (aka Preload Reserve) is central to activity/exercise. Find the review on ⚡️Extracardiac Abnormalities of Preload Reserve in HFpEF⚡️
@sobotka_paul
MarkDunlap
@CircHF
🎉Ending the week on a high note with our first Fire 1 inferior vena cava remote monitoring sensor implant —>Measures IVC distention and collapse at a high resolution —>Can we get to assessing pressures and volumes at the same time?
We tested the feasibility of a novel continuous monitoring of external carotid blood flow as a proxy for CBF using a novel in-ear device. An in-ear wearable device designed to measure blood flow and more.
@HopkinsMedicine
@VUMC_heart
Tandri, Tripathi
🚨Using the power of the diaphragm (one of the biggest muscles) to support the heart.
➡️A Novel Implantable Therapy Concept: Synchronized Diaphragmatic Stimulation for the Treatment of Symptomatic Heart Failure. Prelim data summarized:
@JACCJournals
#1
On the heels of the most recent study on Splanchnic Nerve Modulation, a 🧵on concept behind it:
The majority of heart failure patients are not fluid overloaded yet suffer from shortness of breath with minor activity and prior to HF decompensation
🚨Endovascular Ablation of the Right Greater Splanchnic Nerve in Heart Failure with Preserved Ejection Fraction: Early Results of the REBALANCE-HF Trial Roll-in Cohort
Excited to present on behalf of the team
#HeartFailure2022
@escardio
@HFpEF
Online at
Great thread on the link of Ehlers Danlos Syndrome (EDS) and Dysautonomia/POTS.
To extend on the observations some additional points 🧵:
#1
EDS is commonly associated with venous abnormalities such as nutcracker physiology of abdominal vessels or May Thurner syndrome.
During med residency in late 1990s, I noticed that patients w/ hypermobile joints ("double jointed") frequently had episodes of unexplained tachycardia, headache/lightheadedness.
Very exciting news ⚡️
@statwearable
is now live and one can sign up to get their hands on the device for
#dysautonomia
,
#LongCovid
etc.
Key features:
-Measures heart rate, surrogates of brain blood flow and blood pressure 🫀🧠
-continued...
‼️Reduction in cerebral blood flow (CBF) is found in various forms of
#Dysautonomia
and leads to a broad spectrum of symptoms such as dizziness, fatigue, shortness of breath, all the way out to syncope. Yet, CBF is often not monitored.
Unexplained Dyspnea on Exertion: The Difference the Right Test Can Make
⚡️We present a case of repeat invasive CPET⚡️
Supine CPET➡️ HFpEF
Upright CPET➡️ Preload reserve failure aka "
#CardioVenous
" syndrome
Exercise and Body Position Matter🚨
@VishalNRao
🚨News Alert: First patient in a gene transfer study specific for
#HFpEF
(aka diastolic HF)🫀 has been successfully treated at
@DukeHeartCenter
! Grateful to the patient, staff and
#Sardocor
. We hope with gene therapy to positively affect the relaxation of the heart
#MUSIC_HFPEF
#1
Pressures do not equal volumes
▶️ What are the implications for heart failure management❓ Specific examples in patients co-managed with pressure and volume guided analysis are now online:
@ShahzebKhanMD
@MGKhouri_md
@DukeHeartCenter
Guide-HF is now out. Use of cardiomems in NYHA II patients, whether with history of HF or 🔺NTproBNP improved pulmonary pressures and primary outcome of HF hosp, urgent HF visits and death (pre-Covid) analysis! When including post Covid patients cardiomems was less impactful
More to come on this technology. Hope this will provide an novel opportunity for the monitoring and management of patients with
#Dysautonomia
and
#LongCovid
@statwearable
Some news today:
Dapagliflozin met primary endpoint in Phase III DAPA-HF trial for treatment of HFrEF. This was a dedicated HF trial. Significant reduction in combined endpoint of CV death and Worsening HF.
@texhern
@robmentz
@_adevore
Not all adipose tissue is alike! We discuss the regional impact of adiposity in
#HFpEF
. A potential critical link to the disease pathophysiology through metabolic and local mechanical interaction.
Led by Vishal Rao, grateful for support by
@robmentz
@ErinMichos
@DukeHFDoc
#EJHF
A hidden tragedy is developing behind the curtain of
#COVID
epidemic. COVID deaths are getting outpaced by non-COVID deaths. There are probably many reasons for that, but the bottom line is: patients in need dont receive/seek care they need
@ACCinTouch
@AHAScience
@TheEconomist
🚨Big news: SELECT trial is positive. Semaglutide (GLP-1agonist) was tested in a mega trial of >17.000 patients with overweight/obesity and established cardiovascular disease with no prior history of diabetes
20%⬇️ in MACE (Major adverse cardiac events)⚡️
The device provided near-continuous data on eCBF both during baseline and during periods of syncope. Moreover, changes in the external carotid blood preceded syncope during tilt by several minutes. The in-ear device may improve the sensitivity or maybe even replace tilt testing?!
🚨The spectrum of post-myocardial infarction care: From acute ischemia to heart failure
❓Incidence and pathogenesis of HF post-MI
❓Current strategies to prevent and treat onset of HF post-MI
➡️Promising therapeutic strategies, and knowledge gaps
What's is the role of the diaphragm in cardiovascular disease? And can targeting the diaphragm provide a novel treatment pathway for heart failure?
Check our JACC Review Topic of the Week
@jaccjournals
Diaphragmatic Function in CV Disease
👉 diaphragm key role in modulating CV hemodynamics
👉HF is associated with diaphragmatic dysfunction
👉stimulation of the diaphragm can ↗️ preload reserve, enhance atrioventricular synchrony, and ⤵️ pericardial restraint
@secardiologia
Tackling one of the proposed root causes of Heart Failure with Preserved Ejection Fraction (HFpEF):
#Inflammation
⚡️
Very excited to be part of the HERMES trial and can’t wait to kick it off shortly! 🛫
IL-6 inhibition in patients with LVEF >40%, N=5,600, ~700 sites globally
🚨First-in-human study of surgical ablation of the greater splanchnic nerve for the treatment of
#HFpEF
First evidence for sustained hemodynamic and functional benefit out to 12 months
@NaHomolce
🇨🇿 + Wroclaw University 🇵🇱
@ESC_Journals
@AxonTherapies
#6
A lot more investigations into these syndromes are needed. Greatly under-appreciated, under-tested and often mis-diagnosed. The right tests matter and more attention to the "dysautonomia" space is needed!
@Dysautonomia
@manesh_patelMD
@camfrazmills
🚨In
#heartfailure
preload modulation is an increasingly popular target for device and drug based therapies. We summarize why preload matters and how to think about mechanisms of action. Not all therapies work the same way
@BurkhoffMd
@CircHF
HFpEF and NAFLD are closely linked. We estimated the degree of liver fibrosis using a score based system (NFS/FIB-4). Advanced fibrosis appeared to be present in 38% by NFS, and 8% by FIB4. There was a limited independent association between liver fibrosis and clinical outcomes.
#South_Korea
is amazing! Excited to present on MASLD (formerly NAFLD) and heart failure at the Korean Diabetes and Metabolism Meeting
-HF and MASLD are on the rise
-Are they same disease or does one drive the other?
-HFpEF seems to be the main phenotype of overlap
1
Not all HFpEF is alike. There are many ways to phenotype HFpEF. Can we though differentiate an ambulatory from a hospitalized HFpEF phenotype?
Despite lower event rates, quality of life is severely and similarly in patients with no history of hospitalization.
@yreddyhf
et al
LVADs and the Kidneys ⬇️
Renal funct. after LVAD implant is characterized by improvement, steady state and subsequent deterioration. True irrespective of initial renal function➡️early renal function improvement assoc. with better survival after LVAD
Where is invasive hemodynamic monitoring today?
Newest pooled analysis of implanted hemodynamic monitors➡️improvement in clinical outcomes such as death and hospitalization
Implantable Hemodynamic-GUIDE Monitors: A CHAMPION Among Devices for Heart Failure
Spot urine sodium in acute heart failure: differences in prognostic value on admission and discharge
Jan Biegus, Piotr Ponikowski et al.
@ESC_Journals
Spot UNa assessed at early phase of hospitalization and discharge have different prognostic significance
A highlight from
#ACC23
was new data on
#remote_monitoring
,
#interventional_HF
John Boehmer presented the BMAD trial, a
multicenter, concurrent control trial consisting of 2 arms. Not randomized.
The device▶️ non invasive patch➡️Lung water, ecg, heart rate, resp rate, activity
📢COVID-19 and Incident Heart Failure in
@NatureComms
🟥 COVID-19 hospitalization is associated w/ a 45% higher hazard of incident HF
🟥 More pronounced association among pts who are younger, White, or w/ established CVD
🌟-team
@HusamSalah
@CaugheyPhD
Thanks to
@acc
for the opportunity to present on preload reduction therapies. Concurrently the new paper
@jaccjournals
Summary of the evidence on splanchnic nerve modulation/ablation today. Where we started and where we are going 🏃♂️
@crfheart
@BurkhoffMd
🚨Tracking congestion is key for the management of HF patients
▶️Stable hemodialysis patients were studied
▶️Inferior vena cava diameter was measured and the peripheral venous pressure during ultrafiltration (removal of extra fluids from the body)
🔖Recap of
#THT2024
Presentation on the SCALE-HF 1 trial
Remote monitoring is a competitive space
The ideal gold-standard is invasive monitoring but what we use in clinical practice day to day are
🚨Scales🚨
We tested the "Cardiac Scale" and congestion index
@DCRINews
🚨Inter-Atrial Shunt (IAS) therapy in HFpEF. Who benefits and who doesn't?
Pulmonary vascular disease and⬆️PVR with exercise was associated lack of benefit or even harm.
In reverse benefit seen with lower exertion PVR.
➡️There is still hope for IAS
The global expert panel meeting is a wrap. Collegues/friends from all over the world have joined to discuss rationale, enrollment, retention, diversity/equity and inclusion for the
#HERMES
trial
We test an IL-6 inhibitor Ziltivekimab in
#HFpEF
@MajaCikes
#stop_inflammation
🚨News for the
#Interventional_HF
Space:
While the trial did not reach statistical significance on the primary endpoint, it did contain additional clinically meaningful prespecified analyses that favored Barostim, including:
#3
The consequence are abdominal symptoms often reported by EDS and dysautonomia/POTS patients such as Chronic abdominal pain, Bladder fullness, Flank pain etc...
The Clinical Problem of Pelvic Venous Disorders
Recap of
#HFSA
We presented the secondary analysis of the PARAGLIDE-HF trial
Trial tested Sacubitril/Valsartan vs Valsartan in HFmrEF and HFpEF
-Sacubitril/Valsartan came out on top
-Symptomatic hypotension (SH) was one of the most frequent side effects
⬆️in Sacubitril/Valsartan
In
@JAHA_AHA
⚡️with ultrafiltration there is a risk of increased creatinine (“AKI”) as seen in CARRESS‐HF. We found that ⬆️ initial fluid removal not associated with more “AKI”. But in HFpEF (EF>40%) UF use ⬆️ AKI and higher fluid removal ⬇️ outcomes
#2
The issue with venous distension in the abdomen and pelvis is that it creates venous pooling/obstruction to blood return. Its mostly in the abdomen and not legs!
#5
The inability to fill the heart (preload) with blood when upright ▶️ heart "runs empty". This diminishes the amount of blood being ejected from the heart. The likely consequence:
- Chronic fatigue
- Shortness of breath
- Foggy brain sensation
- Chest pain
- Migranes
...
⚡️Harvesting the power of the diaphragm in
#HeartFailure
. We present a case of "Synchronized diaphragmatic stimulation: a case report of a novel extra‐cardiac intervention for chronic heart failure"
#4
Venous pooling in the abdomen and pelvis, however also leads to so called "
#CardioVenous
Syndrome" also known as "
#Preload
-Reserve-Failure".
Extracardiac Abnormalities of Preload Reserve
#1
The Pandemic That Never Left ➡️ HEART FAILURE
🚨Although the mortality related to COVID-19 has eased significantly from 2021 highs, COVID-19-related mortality was LOWER than Heart Failure-related mortality both at its peak and throughout the pandemic
⚡️New study on
#RemoteMonitoring
#Interventional_HF
The purpose of this study was to study safety and dynamic response of a novel, inferior vena cava (IVC) sensor in a chronic model. Measuring the area and collapse of IVC serves as measure of congestion.