Discover and read the best of Twitter Threads about #HFrEF

@MJHundertmark

Out ahead of print in @CircAHA and displaying the first 2.5 years of my DPhil @RDMOxford @UniofOxford : EMPA-VISION RCT, investigating the hypothesis that #sglt2i mediate their benefits in #heartfailure via augmentation of cardiac energy metabolism

doi.org/10.1161/CIRCUL…

As SGLT2i induce glucosuria and thus, increase lipolysis and formation of ketone bodies like b-OHB, it was assumed that this effect might mediate their benefits in HF. But is this true? Well, we’ve tested it

We enrolled 36 patients with #HFrEF and 36 with #HFpEF and randomly assigned them #empagliflozin or placebo.

Read 10 tweets

Consejo de Cardiología Clínica y Terapéutica SAC

@clinicasac

#AHA22. DESTACADOS DÍA 1⃣📚.
🧵Seguilo hasta el final.

⛔️DCP trial:
💊Clortalidona vs Hidroclorotiazida.
👥13K hipertensos a 2.5 años.

🏁Resultados: ⛔️sin diferencias significativas en pto final combinado (muerte, IAM, IC stroke, revascularización, muerte -no por cáncer-).

⛔️TRANSFORM-HF:
💊Torsemida vs Furosemida vía oral en #HF
👥2.8 k 🏥con IC descompensada aleatorizados a furosemida vs torsemida después del alta.
🗓️Seguimiento medio 17 meses.

🏁Resultados: ⛔️sin diferencias en mortalidad por todas las causas u hospitalizaciones🏥.

⛔️IRONMAN.
👥1.1K. Fe derisomaltose IV vs plcbo en #HFrEF.
📋Inclusión: FEVI ≤45%, NYHA II–IV, sat. d transferrina <20% o ferritina <100 μg/L, reciente🏥x IC y NTBNP >250 (RS)/> 1000 (FA)

🏁Resultados:⛔️sin diferencias significativas en pto final de muerte CV y🏥por IC.

Read 5 tweets

James Januzzi Jr MD

@JJheart_doc

Here's a question that you might not have considered: how did the dose for #sacubitril/valsartan in #HFrEF get chosen?

Out today is a paper in @JACCJournals led by @RezaMohebiMD that addresses some questions about sac/val dose in HFrEF.

a 🧵

jacc.org/doi/epdf/10.10…

It's a little known fact that prior to the PH3 PARADIGM trial, a PH2 study in HFrEF was not performed--normally PH2 studies provide target doses for the pivotal outcomes trials.

So how was the dose of sacubitril/valsartan chosen??

The target dose of 97/103 mg twice daily was selected to achieve serum concentrations of valsartan = to those in Val-HeFT and VALIANT while simultaneously achieving 90% neprilysin inhibition in normal individuals.

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Consejo de Cardiología Clínica y Terapéutica SAC

@clinicasac

📌🧵TWEETORIAL INSUFICIENCIA CARDIACA: Objetivos & Propuestas de Secuención del tto💊.

@BiykemB propone 8 metas para 👥🏥x ICC💦: peso, TAS, PVC, rales, edemas, disnea, maniobras p/evaluar congestión, BNP, inotrópicos, %FiO2 y GDMT.
🔴actual 🔵objetivo

5c2p.short.gy/TkP6M5

📌#HFrEF ¿Cuál es la secuencia adecuada del tto con los 4⃣💊?
🔸Estrategia previa: 5⃣ pasos en 6⃣ meses.
🔹Estrategia actual: 3⃣ pasos en 1⃣ mes.

"Un retraso de 6 meses es inaceptable, cada💊 ha demostrado⬇️morbi/mortalidad dentro de los 30 días"
5c2p.short.gy/Eyg77A

📌Secuencia II. Desde la congestión al egreso🏥. Propuesta @SeguraCardio
📚Mucha info en una imagen muy interesante
#HFrEF #Cardiotwitter

https://twitter.com/SeguraCardio/status/1578429163467599872?s=20&t=UH1JnA9TljRzSQVrjz3RYQ

Read 4 tweets

cardio-met

@cardiomet_CE

1) Welcome to a new #accredited #tweetorial, Update on New HFrEF Data from ESC 2022 with a Focus on Vericiguat. Our expert author is Giuseppe Galati MD, MMSc in Heart Failure, FHFA, @GiuseppeGalati_ , Consultant #Cardiologist #HeartFailure & #Cardiomyopathies

2) @GiuseppeGalati_ is at San Raffaele Research Hospital, Milan 🇮🇹 @SanRaffaeleMI. This program is intended for #healthcare professionals & is accredited for 0.75h CE/#CME credit for #physicians #physicianassistants #nurses #nursepractitioners #pharmacists.

3) This program is supported by an educational grant from Bayer. See archived programs still open for credit at cardiometabolic-ce.com. Statement of accreditation & faculty disclosures at cardiometabolic-ce.com/disclosures/.🙏 FOLLOW US !

Read 43 tweets

James Januzzi Jr MD

@JJheart_doc

Presented today as late-breaking data at #HFSA2022 and posted online @CircAHA, new data from PROVE-HF regarding impact of #sacubitril/valsartan on #mitralregurgitation in #HFrEF.

Thanks to @DukeHFDoc for presenting in my absence.

What did we find? A 🧵...

It is well-known that MR severity is an important determinant of symptoms and prognosis in those with HFrEF.

Thanks to work from @LindenfeldJoann and @GreggWStone in the COAPT trial, it is also known that repair of MR may improve outcome in HFrEF.

Based on the COAPT and MITRA-FR results, current recommendations are to "optimize" #GDMT prior to decisions on repair of MR. Why?

Thanks to the reverse remodeling effects of #GDMT, MR severity may be reduced, avoiding need for MV repair.

What is known about sac/val and MR?

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@CKD_ce

@ckd_ce

1) Welcome to a new #accredited (0.75h CE/#CME) #tweetorial on challenging case presentations for pts with #cardiometabolic disease, #CaReMe #FOAMed.
Our expert author is Claire Davies. @claireyrivs is a specialist diabetes & endocrinology #pharmacist working in Gateshead in 🇬🇧.

2) She is a member of UKCPA Diabetes & Endocrinology committee @UKCPADiabetes & works across #diabetes, #endocrinology, & emergency/acute care in Secondary Care. She is currently involved in development of regional guidelines & education to support medicines optimisation for PLWD

3a) This program is intended for healthcare professionals and is supported by an educational grant from Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company.

Read 36 tweets

@CKD_ce

@ckd_ce

1) Welcome to our new #accredited #tweetorial which is Part 1 of a 2-part "highlights" program on new #SGLT2i & #DKD data presented at @ERAkidney #ERA22. #Physicians #nurses #pharmacists #PAs and #NPs can all earn 0.5h CE/#CME by following this thread!

2) @ERAkidney #ERA22 is a primary international scientific symposium for interaction and exchange among basic scientists and clinicians working in #Nephrology. It was held in May. Our expert author is Dr. Sheila Bermejo (@shbermejo) from @vallhebron in Barcelona, Spain.

3) This program is #accredited for CE/#CME & is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance. It is not intended for US- or UK-based based HCPs. Accreditation statement & faculty disclosures at ckd-ce.com/disclosures/.

Read 43 tweets

Henry Han, MBBS, MD

@HanCardiomd

Medical Therapy for Functional #MR

#GDMT is the first step and prevails as the mainstay in the treatment of #FMR

This review addresses the medical Tx options for FMR Mx and highlight a targeted approach for each FMR category

#HeartFailure #VHDs ahajournals.org/doi/10.1161/CI… @CircHF

#GDMT plays a pivotal role in LV reverse remodeling (LVRR) in FMR and leads to reduction in severity and improved outcomes for both atrial and ventricular #FMR

#GDMTWorks #VHDs #HeartFailure

Studies report 28% to 50% reduction in grade of #FMR from baseline in patients receiving optimal or maximally tolerated doses of #GDMT (including diuretics) in both ischemic #cardiomyopathy and non-ischemic CMP

#GDMTWorks #VHDs #MR

Read 8 tweets

cardio-met

@cardiomet_CE

1) Welcome to a new #accredited #tweetorial, Prevention and Management of Heart Failure in T2 Diabetes: The Cardiologist’s Perspective! Our expert author is Giuseppe Galati MD, MMSc in Heart Failure, @GiuseppeGalati_ , Consultant #Cardiologist #HeartFailure & #Cardiomyopathies

3) @cardiomet_CE is supported by educational grants from AstraZeneca, Bayer, Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company, & Chiesi. Earn credit from archived programs at cardiometabolic-ce.com. Disclosures at cardiometabolic-ce.com/disclosures/.🙏 FOLLOW US !

Read 56 tweets

cardio-met

@cardiomet_CE

1) Welcome to a new #accredited #tweetorial, Prevention and Management of Heart Failure in T2 Diabetes: The Diabetologist’s Perspective! Our expert author is Melanie J Davies CBE FMedSci @profmjdavies, Prof of Diabetes Medicine, U Leicester, Leicester Diabetes Unit @LDC_Tweets

2) This program is intended for #healthcare professionals and is accredited by @academiccme for 0.75h CE/#CME credit for #physicians #physicianassistants #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇬🇧🇪🇺. FOLLOW US for #cardiometabolic education from expert authors!

3) @cardiomet_CE is supported by educational grants from AstraZeneca, Bayer, Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company, and Chiesi. See archived programs still available for credit at cardiometabolic-ce.com. Disclosures at cardiometabolic-ce.com/disclosures/

Read 43 tweets

Giuseppe Galati

@GiuseppeGalati_

🎖 #ACC_AHA_HFSA #HF Guidelines are out
Short Tweetorial
🍀 Congrats to the authors for the huge effort : 108 pgs covering multiple aspects including #CardiacAmyloid
@ShelleyZieroth @hvanspall @carlosguizars @ValleAlfonso @JavedButler1 @gcfmd @JJheart_doc
rb.gy/ocnlb7

1️⃣ #HFrEF tx
✅ Pros: Clear 4 pillar 1st line 1 day ( No wait)
❌ Cons: NYHA is not fixed very changeable : Better using Hypotension (SBP<100 mmHg) as choice criteria for ACE/ARB vs ARNI
❌ Cons: After 1 + 1/2 year from #GALACTIC_HF Omecamtiv Mecarbil still not in GD

2️⃣ #HFmrEF
✅ Pros: Concur with HFmrEF recom.
⭕️ Probably a 2a in this class for #ARNI is more EBM
@DrNasrien @dranulala @robmentz @MicheleSenni @DrDEliaEmilia @gbiondizoccai @torresviera @JavierdeJuan1 @global_meded @Filippatos @YuriLopatin1
#ACC22

Read 6 tweets

American College of Cardiology

@ACCinTouch

Check out Top 10🔑points from the 🆕ACC/@American_Heart/@HFSA Guideline for the Management of #HeartFailure #CardioTwitter #ClinicalGuidelines #ACC22

🧵Key Points👇

1⃣ Guideline-directed medical therapy for #HeartFailure w/ reduced ejection fraction #HFrEF now incorporates four medication classes that include #SGLT2i. #ClinicalGuidelines

2⃣ #SGLT2i have a Class of Recommendation 2a in #HFmrEF. Weaker recommendations (COR 2b) are made for ARNi, ACEi, ARB, MRA & beta blockers in this population. #ClinicalGuidelines

Read 11 tweets

Henry Han, MBBS, MD

@HanCardiomd

In patients with #HFpEF, treatment with #empagliflozin improves clinical outcomes regardless of background #MRA therapy

jacc.org/doi/10.1016/j.…
@JACCJournals #JACC @unic_cardiovasc @JavedButler1 @FaiezZANNAD #MiltonPacker @robmentz @BiykemB @HFpEF @ShelleyZieroth

#MRAs were used in 37% of EMPEROR-Preserved study participants. MRA use was higher in those with a more congested clinical picture, with more HF🏥 within the past 12 months, worse HF symptoms, mildly reduced EF, higher NT-proBNP levels, and more use of loop diuretic agents

The effect of empagliflozin to reduce HF 🏥 was more pronounced in MRA nonusers than in MRA users, particularly in the subgroup of patients with LVEFs ≥50% @HFpEF @DrRyanPDaly @AndrewJSauer @AnastasiaSMihai @DrMarthaGulati @ErinMichos @ShelleyZieroth @mvaduganathan

Read 8 tweets

Henry Han, MBBS, MD

@HanCardiomd

Very insightful discussion on Spectrum of SGLT2-Inhibitor Benefits: Clinical to Symptoms to Quality of Life by @JavedButler1 in #THT2022

@LindenfeldJoa @TheHeartBeat3 @LiviuKlein @HFpEF @RyanTedfordMD @GreggWStone @SKumar_UTHealth @gtsayer @SrihariNaiduMD @purviparwani

📌SGLT2i clinical benefits is seen irrespective of baseline health status

#SGLT2i improve health status and quality of life early and sustained in both patients with #HFrEF and #HFpEF
@JavedButler1
@ShelleyZieroth @SeguraCardio @docbhardwaj @docbhardwaj @KevinShahMD #THT2022

#Canagliflozin Improves Quality of Life in HF Patients in #CHIEF-HF

One of the strengths of CHIEF-HF is the diversity of participants, noting that 14% of patients were Black and 45% were female @JavedButler1 #THT2022 @JamalRanaMD @crfheart @SantosGallegoMD @ShelleyZieroth

Read 4 tweets

Mickey Brener MD

@BrenerMickey

Just e-pub'ed ahead of print in @CircHF

Super proud of this multicenter effort describing right ventricular pressure-volume analysis

Check it out to learn more about how to perform RV PV analysis, interpret the loops, and use them clinically

ahajournals.org/doi/abs/10.116…

1/n

2....We begin the review with breaking down the right ventricular pressure volume loop. Learn how the PV diagram depicts systolic and diastolic function, as well as ventricular-vascular interactions/coupling.

3....we then show you how to perform pressure volume analysis with a conductance catheter

Read 8 tweets

cardio-met

@cardiomet_CE

Don’t miss a new accredited #tweetorial launching TOMORROW here on @cardiomet_ce. #Emergencymedicine researcher and devotee of deep understanding of drug mechanism of action @md_pollack will be considering why being #nonsteroidal means better #MRA. Don't miss it! @GoggleDocs

@drkevinfernando @kidney_boy @KateIsabelle24 @SantosGallegoMD @aayshacader @VietHeartPA @Lross246 @SeguraCardio @ValleAlfonso @edgarvlermamd @nephondemand @DrRaniKhatib @HanCardiomd @SABOURETCardio @ChristosArgyrop @JavedButler1 @Steph_Achenbach @mvaduganathan #cardiotwitter

1) Welcome to a #tweetorial where we’ll explore the mechanism of action of mineralocorticoid receptor antagonists (#MRA) & consider why it's so #vogue to be #nonsteroidal. This program is accredited for 0.50 credits for #physicians #nurses #pharmacists. I am @md_pollack. #FOAMed

Read 51 tweets

Prof Chris P Gale

@cpgale3

‘Effects of #empagliflozin & #dapagliflozin on hospitalisations for #heartfailure were consistent in the two independent trials & suggest that these agents also improve renal outcomes & reduce all-cause & #cardiovascular death in patients with #HFrEF’. thelancet.com/journals/lance…

The pooled treatment effects showed consistent benefits for subgroups based on age, sex, #diabetes, treatment with an ARNI & baseline #eGFR.

However, pooled treatment effects suggested treatment-by-subgroup interactions for subgroups based on NYHA functional class & race. Meta-analysis @TheLancet.

Read 3 tweets

Frederik H. Verbrugge

@FH_Verbrugge

Always nice to write an editorial together with partner-in-crime @kevin_damman! We dig into the question: "Is spironolactone a disease-modifying drug or diuretic in #HFpEF?" @ESC_Journals
onlinelibrary.wiley.com/doi/epdf/10.10…

Comment on:
onlinelibrary.wiley.com/doi/abs/10.100…

Key points:
1. Spironolactone = most cost-effective drug in #HFrEF
2. Considering modest diuretic effects with 25-50mg, likely due to pleiotropic effects (Figure)
3. Natriuretic effects increase with dosing up to 600 mg (cirrhosis)
4. Average TOPCAT ~ RALES dose

5. Current study shows marginal (<1%) & short-term (first 8 months) effect on weight loss in TOPCAT Americas.
Spiro patients gradually had lower diuretic need and RAS blockers more frequently withdrawn.
6. Beneficial effects of spironolactone independent of these trends

Read 4 tweets

Peder Myhre

@pmyhre

After a lot of work, so proud to finally share this work on #troponin, LV function (#echofirst) and inc HF in the general pop (#ARIC)

1. ⬆️trop is assoc with LV hypertrophy and diastolic (but not systolic!) dysfx

@JAMA_current @JAMACardio @scottdsolomon
ja.ma/2MVFXns

👉🏻Subjects with ⬆️trop AND diast dysfx are at particularly high risk of HF

👉🏻 LV diastolic dysfunction accounts most of the association between troponin and #HFpEF
👉🏻LV Mass accounts for most of the association between troponin and #HFrEF

Read 5 tweets

Giuseppe Galati

@GiuseppeGalati_