Discover and read the best of Twitter Threads about #ACC21
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Join here tomorrow for the launch of a new accredited tweetorial on the expanding role of #SGLT2i in CV disease! Earn 0.5 CE/CME credits: physicians, nurses, pharmacists! Expert faculty @mvaduganathan. #medtwitter @academiccme #diabetesmanagement @endocrinenetwrk
1) Welcome to a Tweetorial on #SGLT2i & CV health. “Flozinators of the world, unite!” Accredited for 0.50h by @academiccme: #physicians, #nurses, #pharmacists. I am @mvaduganathan . . . 
. . . and this educational activity, which is intended for healthcare providers, is supported by grants from Abbott, AstraZeneca, Bayer, Chiesi, and NovoNordisk.
While #EuroPCR is in full swing, here is a special #ACC21 #tweetorial brought to you by @ANazmiCalik focusing on what you need to remember about the results of the main #interventionalcardiology trials 📈📉📊 released at the conference! #CardioTwitter
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1/9 #ACC21 #Tweetorial @ANazmiCalik
#ADAPTABLE: Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness
Take 🏠:
-if the patient isn't on Aspirin, START w/ 81mg
-if the patient is on 81 mg Aspirin, STAY
-if the patient is on 325mg, MAY STAY
#ADAPTABLE: Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness
Take 🏠:
-if the patient isn't on Aspirin, START w/ 81mg
-if the patient is on 81 mg Aspirin, STAY
-if the patient is on 325mg, MAY STAY
2/9 #ACC21 #Tweetorial @ANazmiCalik
#LAAOS III: Left Atrial Appendage Occlusion Study III
Take home 🏠 message:
Among patients with AF undergoing cardiac surgery, surgical LAA occlusion reduces ischemic stroke by 33%, compared to no occlusion.
#LAAOS III: Left Atrial Appendage Occlusion Study III
Take home 🏠 message:
Among patients with AF undergoing cardiac surgery, surgical LAA occlusion reduces ischemic stroke by 33%, compared to no occlusion.
#ACC21 late-breakers🧵
1/Antiplatelets: Let's start with #aspirin
❌ADAPTABLE :Aspirin 325 mg vs 81 mg in ASCVD pts
No difference in death/ MI/ stroke/major bleeding
💎pragmatic trial: EHR-identified pts
💎significant dose switching in 325 mg group
nejm.org/doi/full/10.10…
1/Antiplatelets: Let's start with #aspirin
❌ADAPTABLE :Aspirin 325 mg vs 81 mg in ASCVD pts
No difference in death/ MI/ stroke/major bleeding
💎pragmatic trial: EHR-identified pts
💎significant dose switching in 325 mg group
nejm.org/doi/full/10.10…
✅Host Exam: Aspirin vs Clopidogrel in chronic Maintenance monotherapy after #PCI w/ DES
#Clopidogrel monotherapy reduced composite of death, non-fatal MI, stroke, ACS re-admission, BARC >=3 bleeding, compared to #aspirin monotherapy.
❓East Asian paradox
thelancet.com/journals/lance…
#Clopidogrel monotherapy reduced composite of death, non-fatal MI, stroke, ACS re-admission, BARC >=3 bleeding, compared to #aspirin monotherapy.
❓East Asian paradox
thelancet.com/journals/lance…
✅TALOS- AMI: De-escalation ✅
In pts w/ no major events in 1st month after index PCI, de-escalation of DAPT from #ticagrelor to #clopidogrel is superior to tica-only DAPT in terms of net clinical benefit, with
⬇️decreased bleeding 🩸risk
- no increase in ischaemic risk
#ACC21
In pts w/ no major events in 1st month after index PCI, de-escalation of DAPT from #ticagrelor to #clopidogrel is superior to tica-only DAPT in terms of net clinical benefit, with
⬇️decreased bleeding 🩸risk
- no increase in ischaemic risk
#ACC21
Essentials of Stable Ischemic Heart Disease
♦️Plaque Characteristics & Progression
♦️Choosing From Imaging Toolbox
♦️Perils of Polypharmacy
♦️Who & When To Revascularize
♦️Overview of Guidelines
🧵on this great @ACCinTouch session from today #ACC21 #ACCMedStudent
♦️Plaque Characteristics & Progression
♦️Choosing From Imaging Toolbox
♦️Perils of Polypharmacy
♦️Who & When To Revascularize
♦️Overview of Guidelines
🧵on this great @ACCinTouch session from today #ACC21 #ACCMedStudent
1/Plaque Progression #ACC21
Non-atherosclerotic intimal lesions➡️progressive atheroscl. lesions (fibroatheroma)➡️lesions w/ acute thrombi
Plaque rupture = lesion growth
Lumen area maintained till 40% narrowing
Narrowing beyond 40% occurs w/ plaque rupture+intraplaque hemorrhage
Non-atherosclerotic intimal lesions➡️progressive atheroscl. lesions (fibroatheroma)➡️lesions w/ acute thrombi
Plaque rupture = lesion growth
Lumen area maintained till 40% narrowing
Narrowing beyond 40% occurs w/ plaque rupture+intraplaque hemorrhage
2/Plaque Characteristics #ACC21
Coronary artery calcification begins as micro-calcification➡️fragment➡️sheet➡️nodular
Stable plaque?
🔸Associated with DM, HTN, smoking
🔸Most common is fibrocalcific plaque (mostly sheet Ca)
Unstable plaque is mostly fragmented Ca
Coronary artery calcification begins as micro-calcification➡️fragment➡️sheet➡️nodular
Stable plaque?
🔸Associated with DM, HTN, smoking
🔸Most common is fibrocalcific plaque (mostly sheet Ca)
Unstable plaque is mostly fragmented Ca
#ACC21
Join us now - Prevention and Health Promotion and the year in review. Dr. Donna Polk presenting.
acc21.virtual-acc.org/topic-essentia…
Join us now - Prevention and Health Promotion and the year in review. Dr. Donna Polk presenting.
acc21.virtual-acc.org/topic-essentia…
🔟 No mention of 2020 could possibly ignore the effects of the global pandemic on research, patient care, and the way we share knowledge. #COVID19 #ACC21
9⃣ Imaging indices correlate with prognosis.
- Transplant/VAD-free survival correlates with MPI-DTI z-score
- Left atrial strain correlates with PCWP and helps identify graft rejection/failure
#ACC21
- Transplant/VAD-free survival correlates with MPI-DTI z-score
- Left atrial strain correlates with PCWP and helps identify graft rejection/failure
#ACC21
💥The Ultimate Guide to Lipids💥
🟢Lipid biology
🟢Physical exam clues for lipid disorders
🟢Lipid tests & interpretation
🟢CV risk assessment
🟢Fundamentals of lipid management
🟢Review of guidelines
🧵on this great @ACCinTouch session from today #ACC21 #ACCMedStudent #ACCPrev
🟢Lipid biology
🟢Physical exam clues for lipid disorders
🟢Lipid tests & interpretation
🟢CV risk assessment
🟢Fundamentals of lipid management
🟢Review of guidelines
🧵on this great @ACCinTouch session from today #ACC21 #ACCMedStudent #ACCPrev
1/ Lipid Biology #ACC21 #ACCMedStudent
Lipoprotein-central core of cholesterol ester/TG surrounded by apolipoprotein
Dietary fat➡️chylomicrons➡️TG metabolized in muscle & adipose by lipoprotein lipase➡️chylomicron remnants liver uptake➡️VLDL➡️FFA & IDL ➡️LDL➡️LDL receptor uptake
Lipoprotein-central core of cholesterol ester/TG surrounded by apolipoprotein
Dietary fat➡️chylomicrons➡️TG metabolized in muscle & adipose by lipoprotein lipase➡️chylomicron remnants liver uptake➡️VLDL➡️FFA & IDL ➡️LDL➡️LDL receptor uptake
2/ Lipid Biology continued...#ACC21 #ACCMedStudent
HDL formed by liver/intestines - acquire cholesterol through reverse cholesterol transport
Lp(a) - modified LDL particle w/ additional apolipoprotein (a). Oxidation pro-inflammatory,⬆️atherosclerosis.
HDL formed by liver/intestines - acquire cholesterol through reverse cholesterol transport
Lp(a) - modified LDL particle w/ additional apolipoprotein (a). Oxidation pro-inflammatory,⬆️atherosclerosis.
When sacubitril/valsartan crushed it in 2014 in PARADIGM-HF for HFrEF, there were a few voices of criticism.
At #ACC21 the PARADISE-MI of entresto vs ramipril in post-MI patients w heart failure failed to show significance.
My summary
medscape.com/viewarticle/95…
Thread/
At #ACC21 the PARADISE-MI of entresto vs ramipril in post-MI patients w heart failure failed to show significance.
My summary
medscape.com/viewarticle/95…
Thread/
The specific message is obviously that based on this study, sac/val has no role over ACE/ARB in post-MI patients with heart failure and LV dysfunction.
We cannot ignore costs of care. And low BP was worse in the ARNI group.
We cannot ignore costs of care. And low BP was worse in the ARNI group.
The larger message--there is nearly always a larger message--is that we may have over-estimated this drug class.
It missed significance now in 2 of 3 outcome trials.
In PARAGON-HF of HFpEF and now PARADISE-MI.
Re PARADIGM, we know large effect sizes often don't replicate
It missed significance now in 2 of 3 outcome trials.
In PARAGON-HF of HFpEF and now PARADISE-MI.
Re PARADIGM, we know large effect sizes often don't replicate
Of interest to the #CHD and #ACHD community, Matthew Gillespie of @HeartCare4Kids, a leader in transcatheter pulmonary valves, gave an update on the state of the art over in the Right Sided Valve Interventions session, and as he rightly points out, it all started with CHD! #ACC21
Who needs pulmonary valve replacement?
👉~40K babies born w/ #CHD each yr
👉~22% have RVOT abnormalities
👉For those w/ RV-PA conduits we've had Melody/Sapien valves
👉For the 85% of RVOT pts w/o conduits with PR, these usu won't work due to dilated/distorted/dynamic RVOTs
#ACC21
👉~40K babies born w/ #CHD each yr
👉~22% have RVOT abnormalities
👉For those w/ RV-PA conduits we've had Melody/Sapien valves
👉For the 85% of RVOT pts w/o conduits with PR, these usu won't work due to dilated/distorted/dynamic RVOTs
#ACC21
Work that started ~2004 with Phil Bonhoeffer culminated in first-in-man implantation of a self-expanding RVOT valve reported in 2010 with several devices now available incl. the Medtronic Harmony devices and the Edwards Alterra combined with their Sapien valve in the US. #ACC21
Here are a couple of #ACC21 posters on pregnancy outcomes for women with heart disease, one from @LLUHealth on #CHD with RVOT dysfunction and one from @HopkinsMedicine on valvular heart disease, worth checking out. @doctorpianist @AllisonGHaysMD @kalamityjack #CardioObstetrics
In @abbykhanmd's talk Saturday, she highlighted three commonly used risk models for predicting adverse outcomes in pregnant women with heart disease: the modified WHO criteria, CARPREG II, and ZAHARA. #ACC21
Generally speaking, left-sided obstructive lesions (AS/MS) are known to impart the highest risk, while pulmonary valve disease and aortic regurgitation are regarded as relatively low risk and MR/TR fall somewhere in between. #ACC21
#ACCMedStudent, it's Day 2 of #ACC21! Benefits of virtual meeting⏪old sessions available onDemand.
Great @ACCinTouch session yesterday on Advanced Heart Failure Therapies, ending w/ debate on Transplant vs. LVAD! #ACCHFT
🧵on some take-home points from the 6 presentations
Great @ACCinTouch session yesterday on Advanced Heart Failure Therapies, ending w/ debate on Transplant vs. LVAD! #ACCHFT
🧵on some take-home points from the 6 presentations
1/ Moving Beyond NYHA Class #ACC21
Vague w/ wide inter & intra observer variability
Utility breaks down in advanced HF
🌟Reclassifying advanced HF: INTERMACS Profiles (lower score = sicker) helps prognosis/triage
🔑Assign profile after identifying features of advanced HF
Vague w/ wide inter & intra observer variability
Utility breaks down in advanced HF
🌟Reclassifying advanced HF: INTERMACS Profiles (lower score = sicker) helps prognosis/triage
🔑Assign profile after identifying features of advanced HF
2/ Cardiac Transplantation #ACC21
♦️ Strategies to expand cardiac donor pool➡️ donation after circulatory death (DCD) - first performed in Duke Dec 2019
♦️ Advances in post-transplant care➡️prevention of cardiac allograft vasculopathy & molecular tools for rejection monitoring
♦️ Strategies to expand cardiac donor pool➡️ donation after circulatory death (DCD) - first performed in Duke Dec 2019
♦️ Advances in post-transplant care➡️prevention of cardiac allograft vasculopathy & molecular tools for rejection monitoring
#ACC21
Ensuring diversity - acc21.virtual-acc.org/engage-channel/
Come listen to these wonderful talks in how we strengthen diversity -
Ensuring diversity - acc21.virtual-acc.org/engage-channel/
Come listen to these wonderful talks in how we strengthen diversity -
#ACC21
I love the advice to have cross professional recruiting, e.g. include other #ACCCVT in recruiting physicians and vice-versa.
I love the advice to have cross professional recruiting, e.g. include other #ACCCVT in recruiting physicians and vice-versa.
#ACC21
Make interprofessional practice a baseline. Implement this early and foundational to curricula.
Make it "a thing" to utilize the strengths of team members in care.
Respect the title! All have earned theirs. Introduce by title in front of the patient
#CardioTwitter
Make interprofessional practice a baseline. Implement this early and foundational to curricula.
Make it "a thing" to utilize the strengths of team members in care.
Respect the title! All have earned theirs. Introduce by title in front of the patient
#CardioTwitter
#ACC21
Nice work #STRENGTHTrial team! #OM3
First - primary endpoints not achieved. This is a sub-study.
Questions attempted to address:
- Could higher EPA explain favorable outcomes?
- Could DHA component have exactly counterbalanced benefits of EPA?
1/
Nice work #STRENGTHTrial team! #OM3
First - primary endpoints not achieved. This is a sub-study.
Questions attempted to address:
- Could higher EPA explain favorable outcomes?
- Could DHA component have exactly counterbalanced benefits of EPA?
1/
#ACC21
Recall #STRENGTHtrial randomized 13,000+. Similar MACE outcomes to #REDUCEIT.
STRENGTH sub-study looks at top tertile achieved EPA and DHA compared to corn oil.'
2/
Recall #STRENGTHtrial randomized 13,000+. Similar MACE outcomes to #REDUCEIT.
STRENGTH sub-study looks at top tertile achieved EPA and DHA compared to corn oil.'
2/
#ACC21
-Interesting that high intensity statin use in top tertile was 10% less than other tertiles and corn oil group.
-LDL-C was 7 mg/dL higher in top tertile group than next highest (T1)
-Achieved EPA (443%) and DHA (68%) is c/w with dose 2200 mg, 800 mg respectively
3/
-Interesting that high intensity statin use in top tertile was 10% less than other tertiles and corn oil group.
-LDL-C was 7 mg/dL higher in top tertile group than next highest (T1)
-Achieved EPA (443%) and DHA (68%) is c/w with dose 2200 mg, 800 mg respectively
3/
🌟Future of Dyslipidemia Management🌟
🧵on this great session from #ACC21 #ACCMedStudent
1/ Team-based approach to improve CV outcomes
🔸pharmacist interventions reduce LDL-C
🔸sessions with dietitian improves lipids &📉costs
🔸Multi-D lipid clinic⬆️guideline-directed treatment
🧵on this great session from #ACC21 #ACCMedStudent
1/ Team-based approach to improve CV outcomes
🔸pharmacist interventions reduce LDL-C
🔸sessions with dietitian improves lipids &📉costs
🔸Multi-D lipid clinic⬆️guideline-directed treatment
2/ Familial Hypercholesterolemia (FH)
♦️ Genetically inherited, autosomal dominant
♦️ LDL-C >190 mg/dL
♦️ Family hx of premature coronary disease
Presence of corneal arcus (ring of cholesterol precipitate) or tendon xanthoma (>8mm Achilles tendon) before age 45 highly suggestive
♦️ Genetically inherited, autosomal dominant
♦️ LDL-C >190 mg/dL
♦️ Family hx of premature coronary disease
Presence of corneal arcus (ring of cholesterol precipitate) or tendon xanthoma (>8mm Achilles tendon) before age 45 highly suggestive
3/ Genetic Testing for pts at risk due to family history or w/ FH phenotype
🌟Up to 30% of patients with very high LDL-C have high polygenic risk score (PRS) vs. single gene mutation🌟
🌟Up to 30% of patients with very high LDL-C have high polygenic risk score (PRS) vs. single gene mutation🌟
9/19
#Tweetorial #CMD #ACC21
#CMD shares similar RFs w epicardial atherosclerosis (traditional ASCVD RFs) & is associated with several biomarkers of inflammation, oxidative stress & coagulation
🔗futuremedicine.com/doi/10.2217/fc…
🔗sciencedirect.com/science/articl…
🔗atherosclerosis-journal.com/article/S0021-…
#Tweetorial #CMD #ACC21
#CMD shares similar RFs w epicardial atherosclerosis (traditional ASCVD RFs) & is associated with several biomarkers of inflammation, oxidative stress & coagulation
🔗futuremedicine.com/doi/10.2217/fc…
🔗sciencedirect.com/science/articl…
🔗atherosclerosis-journal.com/article/S0021-…
10/19
#Tweetorial #CMD #ACC21
There is significant overlap between #CMD & epicardial disease
Large number of patients w/ #CMD also have epicardial atherosclerosis (obstructive or non-obstructive) & epicardial endothelial dysfunction
🔗onlinelibrary.wiley.com/doi/abs/10.100…
#Tweetorial #CMD #ACC21
There is significant overlap between #CMD & epicardial disease
Large number of patients w/ #CMD also have epicardial atherosclerosis (obstructive or non-obstructive) & epicardial endothelial dysfunction
🔗onlinelibrary.wiley.com/doi/abs/10.100…
11/19
#Tweetorial #CMD #ACC21
In our IVUS study:
✅ Most patients with #CMD had significant plaque burden
✅ Patients with #CMD had higher plaque burden & more diffuse atherosclerosis as compared to patients w/o CMD
🔗jacc.org/doi/full/10.10…
#Tweetorial #CMD #ACC21
In our IVUS study:
✅ Most patients with #CMD had significant plaque burden
✅ Patients with #CMD had higher plaque burden & more diffuse atherosclerosis as compared to patients w/o CMD
🔗jacc.org/doi/full/10.10…
#CMD #Tweetorial
⚡ Coronary Microvascular Dysfunction ⚡
1/19
📌 What Is #CMD❓
📌 Why Is #CMD Important❓
Based on my #ACC21 #ACCImaging presentation
⚡ Coronary Microvascular Dysfunction ⚡
1/19
📌 What Is #CMD❓
📌 Why Is #CMD Important❓
Based on my #ACC21 #ACCImaging presentation
2/19
#Tweetorial #CMD #ACC21
Let’s start by talking about angina
✅ Angina w/o obstructive CAD is very prevalent
🔗ahajournals.org/doi/full/10.11…
#Tweetorial #CMD #ACC21
Let’s start by talking about angina
✅ Angina w/o obstructive CAD is very prevalent
🔗ahajournals.org/doi/full/10.11…
3/19
#Tweetorial #CMD #ACC21
✅ Angina ➡ poor prognosis
✅ Angina with no obstructive CAD = ⬆ risks of CV events compared to no angina, even after adjusting for traditional RFs & co-morbidities
🔗academic.oup.com/eurheartj/arti…
#Tweetorial #CMD #ACC21
✅ Angina ➡ poor prognosis
✅ Angina with no obstructive CAD = ⬆ risks of CV events compared to no angina, even after adjusting for traditional RFs & co-morbidities
🔗academic.oup.com/eurheartj/arti…
Starting off the Nuts & Bolts of Pregnancy and Congenital Heart Disease session with a pre-test question... #CardioObstetrics #ACC21 #ACHD
Keep this chart in mind. Pregnancy is a prolonged period of cardiovascular stress with increased cardiac output, plasma volume, and heart rate. Things get really interesting during labor/delivery with acute increases in BP and CO.
Various risk scores available: Modified WHO classification, CARPREG II, ZAHARA score. But clinical experience is extremely important since CHD patients are very heterogeneous and may not be well-represented in studies
