Now out: The 2021 Multi Society Chest Pain Guideline
A special thanks to the entire writing group led by
@DrMarthaGulati
and to the countless others who have worked on this over the past several years
👏
@ACCinTouch
@AHAScience
& all partner societies
👉
I have given many talks in 2019, but none as special as delivering Cardiovascular Medicine Grand Rounds
@BrighamWomens
today, while surrounded by my closest colleagues, mentors, and trainees.
Here's a post talk picture w/ Dr. Eugene Braunwald and Dr. Peter Libby.
POPULAR TAVI: Drop the clopidogrel post TAVR!
ASA alone (in an elderly population) significantly less bleeding and non-inferior w/ respect to thromboembolic events
Clinical valve thrombosis was rare (study did not assess sub-clinical thrombosis)
#ESCCongress2020
Our advanced CV imaging training program was just approved for another spot. We thus have additional unanticipated opening for July 2020 for either cardiologists (2 yr) or radiologists (1 yr) interested in advanced CV imaging
▶️To apply email Courtney Bibbo: cfbibbo
@partners
.org
Delighted to share our
#MGBLpaRegistry
@JACCJournals
paper led by
@adambermanmd
#Lpa
🔼 risk of CV death, MI, CVA, revasc in both pts w/ and w/out prior ASCVD over median f/u of 12 years
🔑Threshold Lp(a) level for higher risk different in primary vs. secondary prevention 🧵
Hearing various wrong conclusions at
#AHA22
post
#PROMINENT
: "We can ignore TG" "TG doesn't matter"
REMINDER: When ⬆️TG (esp w/ DM or 🔽HDL) focus should be on even more aggressive LDL-C 🔽 (also as more atherogenic LDL particles), DM Rx, weight loss / lifestyle changes
Extensive Coronary Artery Calcifications: No Longer Primary Prevention!
"Perhaps it is time to move beyond the old definitions.... and instead focus on the principle that the intensity of preventive therapies should match patient risk?"
Congratulations to the incomparable
@mdicarli
who was selected to be the next EIC of
@JNCjournal
. His powerful leadership, immense experience (former EIC
@CircImaging
), vast knowledge & inspiring vision will have a profound impact on
@MyASNC
and the field of nuclear cardiology
ESC 2019 Guidelines on Chronic Coronary Syndromes -- a thread on PTP, patient-centered imaging,
#YesCCT
, and other insights...
First: a huge 👏 to
#ESCGuidelines
committee for putting together a practical, up-to-date, and timely guideline on a challenging topic....
"Our next challenge...is to target early plaque which is amenable to regression. We can do that with early intervention" --- what an inspiring and forward thinking keynote talk by the one and only
@lesleejshaw
#SCCT2024
#Prevention
#Plaque
One of the impressive
#AHA2021
slides from today comes from Dr. Marc Pfeffer PARADISE-MI LBCT: "In the last 15-20 years we have had a dramatic improvement in AMI mortality rates, now 1/3 of where we were 2 decades ago, because of use of evidence based medicines."
Enormous congrats to
@Bweber04
for winning the
#SCCT2024
YIA competition "Prevalence and Prognostic Implications of Incidentally Detected Coronary Artery Calcium Using Artificial Intelligence Analysis Among Individuals with Immune Mediated inflammatory Diseases"
#CardioRheum
🏅
Happening now
#AHA23
#LBCT
: Can measuring inflammation on
#CCTA
using Fat Attenuation Index (FAI) identify residual risk beyond risk factors and CCTA clinical read? Important results from ORFAN study (1/3)
Dr. Eugene Braunwald delivering keynote talk
@Heart_SCCT
5th annual Cardiovascular Disease Prevention Symposium: "The Future of Cardiovascular Disease Prevention"
💟"Be optimistic about prevention....we know the causes and we have a pretty good idea of what to do about it"
Well summarized: "Provided there is strict adherence to guideline-based medical therapy, patients with stable ischemic heart disease who fit the profile of those in ISCHEMIA and do not have unacceptable levels of angina can be treated with an initial conservative strategy."
Our latest
#YoungMI
study led by
@davidwbiery
shows:
✴️ ~50% of those who experience MI at a young age were smokers!
✴️ 62% continue to smoke one year post MI
✴️Tobacco cessation: substantial (>70%) ⬇️ in all-cause and CV mortality
➡️ Must improve
#tobaccocessation
post MI
Superb
#SCCTPrevent
talk by
@BudoffMd
on Icosapent Ethyl:
⭐️Linear relationship between CVD events & EPA level achieved
⭐️Plaque regression seen by
#YesCCT
(not observed in HEARTS where EPA and DHA used together)
⭐️MESA:⬆️EPA level & stratified by CAC-->lower event rates
Enormous congratulations to
@khurramn1
on this important award. While some may know him for
#thepowerofzero
many of us are fortunate to know his other powers:
#thepowerof
kindness, mentorship, hard work, leadership, common sense, thinking outside the box, and humility.
SCCT is pleased to recognize
@khurramn1
w/ the Agatston Cardiovascular Disease Prevention award for his extensive contributions to cardiovascular disease prevention through the assessment of risk factors, particularly coronary arthrosclerosis.
Learn more:
How do you treat patients with CAC>1000? Great insight from
@MichaelJBlaha
#PreventionSymposium
⭐️ Most do not need downstream testing
⭐️ High intensity statin / ASA / tight BP control
⭐️ Assess residual risk: GLP1RA, inflammation, further LDL lowering w/ non statin agents
CONSERVE Trial: Among stable patients with no CAD referred for invasive angiography, use of CTA ("selective referral using CCTA" vs. "Direct Referral") was safe and resulted in a marked reduction in use of ICA by ~80% and diagnostic cost savings of 57%
Big day for
#YesCCT
today --
@Heart_SCCT
hearing
@CMSGov
We discussed inaccurate cost estimates of coronary CTA (CPT 75574 ⬇️💲 in 2020 proposal)
@CMSGov
wants to hear from all who perform
#YesCCT
. Stay tuned for details regarding submitting responses...
Would anyone have predicted that
#ACC20
/
#WCCardio
would be
#Virtual
-- at the same time that McCormick Place (site of the meeting) is being converted to a 3,000 bed COVID hospital....
Hot of press
#MGBLPaRegistry
paper by
@ArthurShiyovich
on Lp(a) and SMuRFs (not the characters, but standard modifiable risk factors💙)
👉 Among individuals w/out CVD, high Lp(a) a/w similar risk for MI as 2 SMuRFs (HR~3)
Tomorrow at 11am EST will wrap up our 7 week
@Heart_SCCT
live reading session series with Anomalous Coronary Artery Cases....
A unique collection of cases to highlight various imaging features and their clinical implications
Free registration:
Congrats
@ghoshhajra
on becoming
@Heart_SCCT
president! I am honored & proud to have known you since we were both fellows
@MGHImaging
and to have worked closely together on so many
#YesCCT
efforts over the yrs. Our society & field of CCT are in great hands under your leadership!
Congrats
@ArthurShiyovich
@adambermanmd
who led
#MGBLpaRegistry
#ESC2023
study showing ⬆️ CVD events (including MI & CV death) among pts meeting Ocean(a)Outcomes trial criteria + Lp(a)>200nmol/l
💟CVOT ongoing, but data suggest 🔻Lp(a) may impact multiple endpoints
In 2007 my friend
@khurramn1
began investigating role of CAC=0 in various cohorts; along came
#PowerofZero
, many great friendships and collaborations (
@MichaelJBlaha
) and today a major impact on the 2018 cholesterol guidelines. Congrats to the entire team led by Khurram!
Ever wondered what would happen if CAC testing was available at no cost? (today in US usually out of pocket $)
Answer:
⭐️increased utilization, and more so by women, African Americans, and those with lower income
⭐️improved reclassification / prevention
👏
@UHhospitals
team
Great
#ASPC20
talk by David Maron on implications of
#ISCHEMIA
trial:
-OMT for all with stable CAD
-Angina severity for deciding on revasc
-Stress testing / CCTA has pros and cons
-ETT perhaps bigger role now
-Shared decision making
-CCTA if manageable angina / avoiding cath
Superb talk by
@PalMaurovich
at
@BWHCVImaging
Grand Rounds: High risk plaque features by
#YesCCT
Great examples of use of radiomics, assessing patient risk via plaque analysis, effects of medical therapy
Very High Coronary Artery Calcium (CAC ≥ 1000) and Association with CVD Events, Non-CVD Outcomes, and Mortality: Results from The Multi-Ethnic Study of Atherosclerosis (MESA)
Outstanding
#ACC23
presentation from the MGB Lp(a) Registry by
@Gurleen_Kaur96
"Among individuals with no prior CAD, elevated Lp(a) is associated with higher rates of myocardial infarction in
both females and males". 👏
Amazing
@BWHCVImaging
Grand Rounds by
@PPibarot
on “New Frontiers in the Imaging and Treatment of Aortic Stenosis”
Here is a 🧵 of key points:
Asymptomatic AS: staging to consider earlier intervention, look beyond valve & EF, include GLS, BNP, impact on other chambers...
A truly phenomenal
@BrighamWomens
CV Grand Rounds by the incomparable
@DLBHATTMD
on the evolution of SGLT inhibition
"An amazing chapter in CV history" -Dr. Marc Pfeffer
Lots more to come in this area, including on possible role of SGLT1 inhibition in lowering ischemic events.
In this viewpoint,
@adambermanmd
and I summarize the benefits of CAC testing for shared decision making and enhanced CVD prevention. While now supported by guidelines and many studies, access for this test remains limited due to variable coverage.
Maybe i'm biased but the "winner" so far at
#ESCCongress
is PREVENTION!
Plaque *regression* by IPE
New therapeutics to ⬇️ TG (ASO to APO C3 or ANGPTL3)
AF guidelines: increased focus on prevention
Great talks by Fuster, Luscher, Morris & more
Important global barriers
Thrilled to have
@ToddVillinesMD
deliver
@BWHCVImaging
grand rounds today on “Coronary CTA in 2021: The Case for CT-guided Care” highlighting the value of improved prevention via detection of coronary plaque (1/2)
Important theme from
#ACC21
today: value of EXERCISE & REHAB:
* ⬆️physical function / QOL in older frail adults w/ADHF
(REHAB HF Trial)
* ⬇️ ventricular + atrial arrhythmias
(UK Biobank)
EVAPORATE FINAL
#ESCCongress
: IPE 4 gm/d results in regression of plaque by
#YesCCT
at 18 months while placebo pts (on statin Rx) had progression
@BudoffMd
@DLBHATTMD
Important results for prevention and imaging, further supporting role of CCTA in prevention & clinical trials
Thrilled to have
@AChoiHeart
deliver our
@BWHCVImaging
Grand Rounds today on "Cardiac CT Atherosclerosis Imaging by Artificial Intelligence: Vision for a Brave New World”
▶️Many opportunities for
#AI
to help
#YesCCT
🧵
IYKYK: What was the best part of
#TeamSpirit
at
#SCCT2022
? Beyond the funny commercials, great
#YesCCT
cases, and the superhuman participants reading CCT <5 sec, was the irreplaceable & witty host
@Steph_Achenbach
who remains the
#GOAT
educator and leader for all things CCT
EF Recovery in
#YoungMI
: ~30% of patients w/ MI at a young age had LV dysfunction, and, <50% recover EF by 6 months
EF recovery --> substantial ⬇️ all-cause and CV mortality No recovery --> 25% mortality over median f/u 11 yrs
Thrilled to have Professor
@MarcDweck
deliver
@BWHCVImaging
Grand Rounds: Multimodality Imaging of Aortic Valve Disease
▶️Imaging is key for evaluating:
Can osteoporosis drugs slow down AS progression?
Can vitamin K2 slow AoV calcifications ?
Impact of lowering Lp(a) ?
Great
#ACC2019
study led by
@SanjayDivakaran
with our
#YOUNGMI
team
Diabetes present in 20% of pts with MI under 50 --> significantly higher long term CV death.
Important implications for screening & treatment of DM with agents that can lower risk...
Congrats
@lesleejshaw
! Your contributions to imaging and prevention of cardiovascular disease are immeasurable, as is the impact of your leadership, mentorship of others, and scientific contributions.
Thrilled to e-host Dr. Sanjiv Shah (
@HFpEF
) for
@BWHCVImaging
Grand Rounds. Amazing talk on "Approaches to HFpEF in the Era of Precision Medicine”
▶️HFpEF: a diagnostic mystery -- have an approach to evaluate and treat
▶️Imaging for phenomapping may be key for future trials!
Key message from
#SCCT2022
: Substantial growth of Cardiac CT around the globe!
Fueled by innovations, scientific data, guidelines, and more...
👇trends in England, publications,
@Heart_SCCT
membership
Every CAC report for individuals 30-45 should include info on percentile based on this study (if CAC present)....or at minimum a link to it.
@BWHCVImaging
@ASPCardio
@SCCT
Congrats to
@JonathonLeipsic
and to
@UBC_Radiology
. Jonathon is an inspirational leader, an exceptionally talented radiologist, an incredibly accomplished researcher and above all a kind and warm individual.
Following on the tremendous leadership of
@bruceforster
who served as Chair for over 11 years,
@JonathonLeipsic
extensive experience as St Paul’s Hospital Dept Head and Regional Dept Head will help further advance our Department's Academic, Educational and Research mandate.
Say
#YesCCT
for CTO? In this multi-center randomized trial, pre-procedural CCTA-guidance for CTO-
#PCI
resulted in higher success w/ numerically fewer periprocedural complications than angiography-guidance.
Learn more in the new issue of
#JACCIMG
:
"Photon counting CT will change the world of cardiovascular imaging" --- Prof Cademartiri delivering a truly spectacular
@BWHCVImaging
grand rounds on
#PCCT
#Plaque
#CAD
Even more excited for
#scct2019
after my onsite visit to Baltimore Marriott today...great location, fantastic meeting space, lots of nearby attractions...
Thankful to the entire
@Heart_SCCT
staff and our planning committee.
One of best talks of
#ACC19
was
@rblument1
summary of
#PreventionGuidelines
(hope it was recorded!)
Masterful and truly innovative talk made completely of
#hashtags
-- concise, informative, entertaining, and a spot-on summary of the some of the key highlights.
👏👏👏
Great
#AHA23
presentation by
@ArthurShiyovich
from
#MGBLpaRegistry
: Among pts w/out known ASCVD high Lp(a) has similar risk as having 2 standard modifiable risk factors (SMuRF) ; High Lp(a) important risk factors regardless of presence/number of SMuRF
Congrats
@DLBHATTMD
for leading the immensely important REDUCE-IT trial...and for your superb presentation today! (among the multiple highlights of your presentation, was a random wave of applause when your read out the p-values....lots of zeros)
#AHA18
@AHAMeetings
Having a hard time keeping up with Twitter today?
Too tired to read a 100+ page guideline ?
Join us for a 1 hour
@Heart_SCCT
#CPGuideline
webinar tomorrow at noon EST (part 1 of 2)
Register here:
Superb
@BWHCVImaging
Grand Rounds talk by
@onco_cardiology
on Role of Cardiac CT in Cardio Oncology 👏
Covering role of prior radiation, CHIP, CAC on prior scans --> often missed opportunity, cardiotoxicity monitoring.
ICYMI: Brilliant & immenley important
#SCCT2023
talk on reimbursement by
@PatrycjaGalazka
explaining how payment for pro+tech fees determined, and why
@CMSGov
methodology doesn't account for resources of
#YesCCT
placing it in wrong
#APC
➡️proposed payment for 2024 *even lower*