Jean Marie Ruddy, MD, Vascular surgeon with clinical interests in lower extremity venous insufficiency and atherosclerotic disease of the abdominal aorta, carotid artery, and extremity vessels at Medical University of South Carolina. Anne Kroman DO, PhD, Cardiac Electrophysiologist at Medical University of South Carolina. Ryan Tedford, MD, Dr. Peter C. Gazes Endowed Chair in Heart Failure; Professor of Medicine at Medical University of South Carolina; Chief, Heart Failure; Medical Director, Cardiac Transplantation; Director, AHFTX Fellowship Program. In this video, she and her colleagues speak about the article MUSC doctors first at academic medical center to perform ‘game-changing’ new heart failure device procedure.
Two MUSC Health doctors are the first at an academic medical center and just the second in the world to employ a new, minimally invasive procedure to implant a heart failure therapy device – and, in an unusual turn of events, they're both women in traditionally male-dominated specialties.
Jean Marie Ruddy, M.D., a vascular surgeon, is the lead investigator at the MUSC site for the testing of this innovative implantation procedure for Barostim. Anne Kroman, D.O., Ph.D., a cardiac electrophysiologist, is the site co-principal investigator for the BATwire percutaneous implant research employing the Barostim Neo System.
Following successful trials headed by MUSC Health cardiologist Michael Zile, M.D., Barostim received breakthrough device approval from the US Food and Drug Administration in 2019. The device stimulates the nerve that regulates blood pressure with electrical impulses, causing the blood arteries to relax.
Although the gadget cannot cure heart failure, it can significantly enhance patients' quality of life. According to cardiologist Ryan Tedford, M.D., section chief of heart failure, medical director of cardiac transplantation, and professor in the College of Medicine, it's intended for patients who aren't getting enough benefit from medication but aren't sick enough for a heart pump or heart transplant.
On Thursday, his patient became the first at MUSC Health to undergo the innovative type of implantation.
To insert the electrode, the first method of implantation required a vascular surgeon to create an incision in the patient's neck. However, in a "engineering achievement," the new approach being investigated would allow the device to be implanted through a wire, according to Ruddy. Kroman explained that it is comparable to how pacemaker wires are now implanted.
Instead, the surgeons used ultrasound to locate the region of the blood vessel where the proper nerve is located, then advanced a needle into place to guide the wire through. The whole thing took around an hour and a half. Although it is believed that this will become an outpatient treatment, participants must be hospitalized overnight for the duration of the experiment.
Patients who have already had the device implanted have reported an improvement in their quality of life, according to Ruddy and Kroman. Patients are typically short of breath before the treatment, even while walking about, and may have given up cherished activities – Ruddy noted one patient who was eager to return to fishing.
According to Tedford, there are a substantial number of people who could benefit from this type of treatment, either because they aren't sick enough for more serious procedures or because they don't match the criteria for those surgeries.
Michelle M. Kittleson, MD, PhD, Director, Heart Failure Research, Director, Post Graduate Medical Education in Heart Failure and Transplantation, Professor of Medicine at Cedars-Sinai. In this video, she speaks about A Clinician's Guide to the 2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure.
The American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA) 2022 Guideline for the Management of Heart Failure provides clinicians with patient-centered recommendations for preventing, diagnosing, and managing heart failure patients (HF). 1 The document, the result of nearly two years of work by the writing committee's 26 members, includes 159 pages of text (including 40 pages of references), 14 sections, 33 tables, 15 figures, and 192 recommendations—a daunting task for any clinician interested in optimizing the care of patients with HF. What is the best strategy to approach a new policy?
Heart Failure and Cardiomyopathies
Description
Heart Failure and Cardiomyopathies
Jean Marie Ruddy, MD, Vascular surgeon with clinical interests in lower extremity venous insufficiency and atherosclerotic disease of the abdominal aorta, carotid artery, and extremity vessels at Medical University of South Carolina. Anne Kroman DO, PhD, Cardiac Electrophysiologist at Medical University of South Carolina. Ryan Tedford, MD, Dr. Peter C. Gazes Endowed Chair in Heart Failure; Professor of Medicine at Medical University of South Carolina; Chief, Heart Failure; Medical Director, Cardiac Transplantation; Director, AHFTX Fellowship Program. In this video, she and her colleagues speak about the article MUSC doctors first at academic medical center to perform ‘game-changing’ new heart failure device procedure.
Two MUSC Health doctors are the first at an academic medical center and just the second in the world to employ a new, minimally invasive procedure to implant a heart failure therapy device – and, in an unusual turn of events, they're both women in traditionally male-dominated specialties.
Jean Marie Ruddy, M.D., a vascular surgeon, is the lead investigator at the MUSC site for the testing of this innovative implantation procedure for Barostim. Anne Kroman, D.O., Ph.D., a cardiac electrophysiologist, is the site co-principal investigator for the BATwire percutaneous implant research employing the Barostim Neo System.
Following successful trials headed by MUSC Health cardiologist Michael Zile, M.D., Barostim received breakthrough device approval from the US Food and Drug Administration in 2019. The device stimulates the nerve that regulates blood pressure with electrical impulses, causing the blood arteries to relax.
Although the gadget cannot cure heart failure, it can significantly enhance patients' quality of life. According to cardiologist Ryan Tedford, M.D., section chief of heart failure, medical director of cardiac transplantation, and professor in the College of Medicine, it's intended for patients who aren't getting enough benefit from medication but aren't sick enough for a heart pump or heart transplant.
On Thursday, his patient became the first at MUSC Health to undergo the innovative type of implantation.
To insert the electrode, the first method of implantation required a vascular surgeon to create an incision in the patient's neck. However, in a "engineering achievement," the new approach being investigated would allow the device to be implanted through a wire, according to Ruddy. Kroman explained that it is comparable to how pacemaker wires are now implanted.
Instead, the surgeons used ultrasound to locate the region of the blood vessel where the proper nerve is located, then advanced a needle into place to guide the wire through. The whole thing took around an hour and a half. Although it is believed that this will become an outpatient treatment, participants must be hospitalized overnight for the duration of the experiment.
Patients who have already had the device implanted have reported an improvement in their quality of life, according to Ruddy and Kroman. Patients are typically short of breath before the treatment, even while walking about, and may have given up cherished activities – Ruddy noted one patient who was eager to return to fishing.
According to Tedford, there are a substantial number of people who could benefit from this type of treatment, either because they aren't sick enough for more serious procedures or because they don't match the criteria for those surgeries.
Jean Marie Ruddy, MD, Vascular surgeon with clinical interests in lower extremity venous insufficiency and atherosclerotic disease of the abdominal aorta, carotid artery, and extremity vessels at Medical University of South Carolina. Anne Kroman DO, PhD, Cardiac Electrophysiologist at Medical University of South Carolina. Ryan Tedford, MD, Dr. Peter C. Gazes Endowed Chair in Heart Failure; Professor of Medicine at Medical University of South Carolina; Chief, Heart Failure; Medical Director, Cardiac Transplantation; Director, AHFTX Fellowship Program. In this video, she and her colleagues speak about the article MUSC doctors first at academic medical center to perform ‘game-changing’ new heart failure device procedure.
Two MUSC Health doctors are the first at an academic medical center and just the second in the world to employ a new, minimally invasive procedure to implant a heart failure therapy device – and, in an unusual turn of events, they're both women in traditionally male-dominated specialties.
Jean Marie Ruddy, M.D., a vascular surgeon, is the lead investigator at the MUSC site for the testing of this innovative implantation procedure for Barostim. Anne Kroman, D.O., Ph.D., a cardiac electrophysiologist, is the site co-principal investigator for the BATwire percutaneous implant research employing the Barostim Neo System.
Following successful trials headed by MUSC Health cardiologist Michael Zile, M.D., Barostim received breakthrough device approval from the US Food and Drug Administration in 2019. The device stimulates the nerve that regulates blood pressure with electrical impulses, causing the blood arteries to relax.
Although the gadget cannot cure heart failure, it can significantly enhance patients' quality of life. According to cardiologist Ryan Tedford, M.D., section chief of heart failure, medical director of cardiac transplantation, and professor in the College of Medicine, it's intended for patients who aren't getting enough benefit from medication but aren't sick enough for a heart pump or heart transplant.
On Thursday, his patient became the first at MUSC Health to undergo the innovative type of implantation.
To insert the electrode, the first method of implantation required a vascular surgeon to create an incision in the patient's neck. However, in a "engineering achievement," the new approach being investigated would allow the device to be implanted through a wire, according to Ruddy. Kroman explained that it is comparable to how pacemaker wires are now implanted.
Instead, the surgeons used ultrasound to locate the region of the blood vessel where the proper nerve is located, then advanced a needle into place to guide the wire through. The whole thing took around an hour and a half. Although it is believed that this will become an outpatient treatment, participants must be hospitalized overnight for the duration of the experiment.
Patients who have already had the device implanted have reported an improvement in their quality of life, according to Ruddy and Kroman. Patients are typically short of breath before the treatment, even while walking about, and may have given up cherished activities – Ruddy noted one patient who was eager to return to fishing.
According to Tedford, there are a substantial number of people who could benefit from this type of treatment, either because they aren't sick enough for more serious procedures or because they don't match the criteria for those surgeries.
Michelle M. Kittleson, MD, PhD, Director, Heart Failure Research, Director, Post Graduate Medical Education in Heart Failure and Transplantation, Professor of Medicine at Cedars-Sinai. In this video, she speaks about A Clinician's Guide to the 2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure.
The American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA) 2022 Guideline for the Management of Heart Failure provides clinicians with patient-centered recommendations for preventing, diagnosing, and managing heart failure patients (HF). 1 The document, the result of nearly two years of work by the writing committee's 26 members, includes 159 pages of text (including 40 pages of references), 14 sections, 33 tables, 15 figures, and 192 recommendations—a daunting task for any clinician interested in optimizing the care of patients with HF. What is the best strategy to approach a new policy?
Michelle M. Kittleson, MD, PhD, Director, Heart Failure Research, Director, Post Graduate Medical Education in Heart Failure and Transplantation, Professor of Medicine at Cedars-Sinai. In this video, she speaks about A Clinician's Guide to the 2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure.
The American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA) 2022 Guideline for the Management of Heart Failure provides clinicians with patient-centered recommendations for preventing, diagnosing, and managing heart failure patients (HF). 1 The document, the result of nearly two years of work by the writing committee's 26 members, includes 159 pages of text (including 40 pages of references), 14 sections, 33 tables, 15 figures, and 192 recommendations—a daunting task for any clinician interested in optimizing the care of patients with HF. What is the best strategy to approach a new policy?
Justin Ezekowitz, MBBCh, MSc, Professor Department of Medicine Division of Cardiology, co-director of the Canadian VIGOUR Centre at the University of Alberta. In this video, he speaks about SODIUM-HF: Study of Dietary Intervention Under 100 MMOL in Heart Failure (SODIUM-HF).
Brief Synopsis:
SODIUM-HF is a multicenter clinical trial in ambulatory patients with chronic heart failure to assess the efficacy of a reduced sodium diet on a composite clinical outcome comprised of all-cause mortality, cardiovascular hospitalizations, and cardiovascular emergency department visits. The study's premise is that patients who follow a low-sodium diet will have fewer clinical events (fewer hospital readmissions or emergency department visits, longer survival) than those who were randomly assigned to Usual Care.
Justin Ezekowitz, MBBCh, MSc, Professor Department of Medicine Division of Cardiology, co-director of the Canadian VIGOUR Centre at the University of Alberta. In this video, he speaks about SODIUM-HF: Study of Dietary Intervention Under 100 MMOL in Heart Failure (SODIUM-HF).
Brief Synopsis:
SODIUM-HF is a multicenter clinical trial in ambulatory patients with chronic heart failure to assess the efficacy of a reduced sodium diet on a composite clinical outcome comprised of all-cause mortality, cardiovascular hospitalizations, and cardiovascular emergency department visits. The study's premise is that patients who follow a low-sodium diet will have fewer clinical events (fewer hospital readmissions or emergency department visits, longer survival) than those who were randomly assigned to Usual Care.
Mikhail N. Kosiborod, MD, Professor of Medicine, Director of Cardiometabolic Research and Co-Director of the Saint Luke’s Michael & Marlys Haverty Cardiometabolic Center of Excellence. In this video, he speaks about A Study to Test the Effect of Empagliflozin in Patients Who Are in Hospital for Acute Heart Failure (EMPULSE).
Brief Synopsis:
This is a study of adults admitted to the hospital with acute heart failure. The goal of this trial is to see if beginning a drug called empagliflozin immediately after being admitted to the hospital helps persons with acute heart failure.
Participants will be enrolled in the trial for approximately three months. Participants are still in the hospital at the start. Later, they visit the hospital three times and receive one phone call. Participants are randomly assigned to one of two groups. One group receives one empagliflozin pill every day. The other group chooses
One placebo tablet per day. Placebo tablets resemble empagliflozin tablets but contain no medication. Empagliflozin is an SGLT-2 inhibitor, which is a type of medication. It is employed in the treatment of type 2 diabetes.
During the trial, doctors look to see if participants have any more heart failure events, such as needing to go to the hospital again due to heart failure. Participants respond to questions regarding how their heart failure affects their daily lives. The outcomes are then compared between the empagliflozin and placebo groups. The participants' overall health is also checked on a regular basis by the doctors.
Mikhail N. Kosiborod, MD, Professor of Medicine, Director of Cardiometabolic Research and Co-Director of the Saint Luke’s Michael & Marlys Haverty Cardiometabolic Center of Excellence. In this video, he speaks about A Study to Test the Effect of Empagliflozin in Patients Who Are in Hospital for Acute Heart Failure (EMPULSE).
Brief Synopsis:
This is a study of adults admitted to the hospital with acute heart failure. The goal of this trial is to see if beginning a drug called empagliflozin immediately after being admitted to the hospital helps persons with acute heart failure.
Participants will be enrolled in the trial for approximately three months. Participants are still in the hospital at the start. Later, they visit the hospital three times and receive one phone call. Participants are randomly assigned to one of two groups. One group receives one empagliflozin pill every day. The other group chooses
One placebo tablet per day. Placebo tablets resemble empagliflozin tablets but contain no medication. Empagliflozin is an SGLT-2 inhibitor, which is a type of medication. It is employed in the treatment of type 2 diabetes.
During the trial, doctors look to see if participants have any more heart failure events, such as needing to go to the hospital again due to heart failure. Participants respond to questions regarding how their heart failure affects their daily lives. The outcomes are then compared between the empagliflozin and placebo groups. The participants' overall health is also checked on a regular basis by the doctors.
Dr. Massar Omar works as a Doctor of Medicine and research fellow at the Mayo Clinic in Rochester Minnesota. In this podcast Dr. Omar discusses Hemodynamic Determinants of Activity Measured by Accelerometer in Patients With Stable Heart Failure.
Link to Abstract-
https://www.jacc.org/doi/10.1016/j.jchf.2021.05.013
Abstract-
This study examined the link between accelerometer recordings and cardiac pathophysiology measured with right heart cauterization at rest and with exercise in patients with HFrEF.
Background
Patient-worn accelerometers are increasingly being used in patients with heart failure with reduced ejection fraction (HFrEF) to assess activity and serve as surrogate endpoints in heart failure trials.
Methods
Physical average daily activity (PADA) and total average daily activity according to accelerometer units were assessed in 63 patients (mean age 58 ± 10 years; mean ejection fraction 26% ± 4%). Patients underwent hemodynamic exercise testing and accelerometry. Patients were divided according to PADA in PADALow and PADAHigh activity level groups based on median counts per minute of physical activity.
Results
Patients in the PADALow group were older and more frequently treated with diuretics. At rest, the PADALow group was characterized by a lower cardiac index (2.2 ± 0.4 L/min/m2 vs 2.4 ± 0.4 L/min/m2; P = 0.01) and stroke volume (70 ± 19 mL vs 81 ± 17 mL; P = 0.02) but not pulmonary capillary wedge pressure (12 ± 5 mm Hg vs 11 ± 5 mm Hg; P = 0.3). The PADALow group reached a lower cardiac index (4.8 ± 1.7 L/min/m2 vs 6.6 ± 1.7 L/min/m2; P < 0.001) but not in pulmonary capillary wedge pressure (31 ± 12 mm Hg vs 27 ± 8 mm Hg; P = 0.2) at peak exercise. The attenuated increase was associated with an attenuated increase in stroke volume (94 ± 32 mL vs 121 ± 29 mL; P < 0.001) rather than a reduced increase in heart rate (42 ± 23 beats/min vs 52 ± 21 beats/min; P = 0.07). PADA and total average daily accelerometer units were associated with patient-reported functional impairment according to the Kansas City Cardiomyopathy Questionnaire but not with New York Heart Association functional class.
Conclusions
Among stable ambulatory patients with HFrEF, lower daily activity is associated with poorer cardiac index reserve and reduced cardiac index during exercise. (Empagliflozin in Heart Failure Patients With Reduced Ejection Fraction; NCT03198585)
Dr. Tamer M.A. Mohamed's works as Assistant Professor of Medicine at the University of Louisville. His research has focused on innovative mechanisms and therapeutics for cardiac hypertrophy and heart failure in animal models for the past 12 years. Translation of those results into human medication therapy for cardiac disease is one of Dr. Mohamed's primary focuses. In this podcast Dr. Mohamed discusses the Transient Cell Cycle Induction in Cardiomyocytes to Treat Subacute Ischemic Heart Failure.
https://www.researchgate.net/publication/358010698_Transient_Cell_Cycle_Induction_in_Cardiomyocytes_to_Treat_Subacute_Ischemic_Heart_Failure
Background: After a myocardial infarction (MI), the heart's regeneration ability is impaired. In vitro and in vivo, ectopic introduction of Cdk1/CyclinB1 and Cdk4/CyclinD1 complexes (4F) stimulates cardiomyocyte proliferation in 15-20% of infected cardiomyocytes and improves cardiac function after MI in mice, according to a prior study. Methods: On a single cell level, we used temporal single-cell RNAseq to identify the essential reprogramming steps during 4F-induced cardiomyocyte growth. We also hoped to begin the first preclinical testing of 4F gene therapy as a candidate for the treatment of ischemia-induced heart failure utilizing rat and pig models of ischemic heart failure. Results: At 48 hours after infection with 4F, full cell cycle reprogramming was observed in 15% of the cardiomyocyte population, which was primarily associated with sarcomere disassembly and metabolic reprogramming (n=3/timepoint/group), as revealed by temporal bulk and single-cell RNAseq and further biochemical validations of mature hiPS-CMs treated with LacZ or 4F adenoviruses. A polycistronic non-integrating lentivirus (NIL) expressing 4F was used to achieve transient overexpression of the protein in cardiomyocytes. Each NIL is directed by the TNNT2 promoter (TNNT2-4Fpolycistronic-NIL). In rats (n=10) and pigs (n=6-7), TNNT2-4Fpolycistronic-NIL or control virus was administered intramyocardially one week after MI. TNNT2-4Fpolycistronic-NIL-treated animals demonstrated a substantial improvement in left ventricular ejection fraction and scar size four weeks after injection when compared to control virus-treated animals. Rats given TNNT2-4Fpolycistronic-NIL demonstrated a persistent improvement in cardiac function four months following therapy, with no signs of cardiac arrhythmias or systemic carcinogenesis (n=10/group). Conclusions: Using an unique transitory and cardiomyocyte-specific viral construct, this study gives mechanistic insights into the process of forced cardiomyocyte proliferation and increases the clinical practicality of this technique by limiting the carcinogenic potential of cell cycle factors.
Dr. Tamer M.A. Mohamed's works as Assistant Professor of Medicine at the University of Louisville. His research has focused on innovative mechanisms and therapeutics for cardiac hypertrophy and heart failure in animal models for the past 12 years. Translation of those results into human medication therapy for cardiac disease is one of Dr. Mohamed's primary focuses. In this video Dr. Mohamed discusses the Transient Cell Cycle Induction in Cardiomyocytes to Treat Subacute Ischemic Heart Failure.
https://www.researchgate.net/publication/358010698_Transient_Cell_Cycle_Induction_in_Cardiomyocytes_to_Treat_Subacute_Ischemic_Heart_Failure
Background: After a myocardial infarction (MI), the heart's regeneration ability is impaired. In vitro and in vivo, ectopic introduction of Cdk1/CyclinB1 and Cdk4/CyclinD1 complexes (4F) stimulates cardiomyocyte proliferation in 15-20% of infected cardiomyocytes and improves cardiac function after MI in mice, according to a prior study. Methods: On a single cell level, we used temporal single-cell RNAseq to identify the essential reprogramming steps during 4F-induced cardiomyocyte growth. We also hoped to begin the first preclinical testing of 4F gene therapy as a candidate for the treatment of ischemia-induced heart failure utilizing rat and pig models of ischemic heart failure. Results: At 48 hours after infection with 4F, full cell cycle reprogramming was observed in 15% of the cardiomyocyte population, which was primarily associated with sarcomere disassembly and metabolic reprogramming (n=3/timepoint/group), as revealed by temporal bulk and single-cell RNAseq and further biochemical validations of mature hiPS-CMs treated with LacZ or 4F adenoviruses. A polycistronic non-integrating lentivirus (NIL) expressing 4F was used to achieve transient overexpression of the protein in cardiomyocytes. Each NIL is directed by the TNNT2 promoter (TNNT2-4Fpolycistronic-NIL). In rats (n=10) and pigs (n=6-7), TNNT2-4Fpolycistronic-NIL or control virus was administered intramyocardially one week after MI. TNNT2-4Fpolycistronic-NIL-treated animals demonstrated a substantial improvement in left ventricular ejection fraction and scar size four weeks after injection when compared to control virus-treated animals. Rats given TNNT2-4Fpolycistronic-NIL demonstrated a persistent improvement in cardiac function four months following therapy, with no signs of cardiac arrhythmias or systemic carcinogenesis (n=10/group). Conclusions: Using an unique transitory and cardiomyocyte-specific viral construct, this study gives mechanistic insights into the process of forced cardiomyocyte proliferation and increases the clinical practicality of this technique by limiting the carcinogenic potential of cell cycle factors.
Barry H. Greenberg, MD, is a board-certified cardiologist and a pioneer in the field of heart failure internationally. At UC San Diego Health, he is the director of the Advanced Heart Failure Treatment Program. In this podcast Dr. Greenberg discusses the Prognostic Value of Global Longitudinal Strain in Patients With Heart Failure With Improved Ejection Fraction.
https://www.jacc.org/doi/10.1016/j.jchf.2021.08.007
Abstract
The researchers wanted to see if global longitudinal strain (GLS) is linked to the natural history of patients with heart failure (HF) who had a better ejection fraction (HFimpEF).
Background
The ejection fraction (EF) of the left ventricle (LV) generally improves in people who have a low EF. Patients with HFimpEF, on the other hand, have a wide range of clinical outcomes. GLS, a sensitive biomarker of LV systolic function, could help this population estimate the risk of future occurrences.
Methods
Retrospective examination of HF patients with LVEF greater than 40% on index echocardiography who had LVEF less than 40% on initial study and improved by 10%. On index echocardiography, GLS was measured using 2-dimensional speckle-tracking software. The primary outcome was the time it took for cardiovascular death or HF hospitalization/emergency treatment to occur for the first time.
Results
The median absolute values of GLS (aGLS) and LVEF from index echocardiogram were 12.7 percent (IQR: 10.8 percent-14.7 percent) and 52 percent (IQR: 46 percent -58 percent) for the 289 patients with HFimpEF, respectively. The primary endpoint occurred less frequently in patients with aGLS above the median than below it (21 percent vs 34 percent; P = 0.014); HR of 0.51; 95 percent CI: 0.33-0.81; P = 0.004; HR of 0.51; 95 percent CI: 0.33-0.81; P = 0.004; HR of 0.51; 95 percent CI: 0.33-0.81; P = 0.004; HR of 0.51; 95 percent CI: 0.3 When aGLS on index echocardiogram was assessed as a continuous variable, each 1% increase was associated with a lower likelihood of the composite endpoint; HR 0.86; 95 percent CI: 0.79-0.93; P 0.001, an association that persisted after multivariable adjustment; HR 0.90; 95 percent CI: 0.82-0.97; P = 0.01. Lower aGLS was linked to a higher chance of LVEF worsening.
Conclusions
GLS is a powerful predictor of future HF episodes and heart function impairment in patients with HFimpEF.