Thursday, 21 November 2024



     Transcatheter tricuspid valve replacement effective                            treatment for severe regurgitation

In patients with severe tricuspid regurgitation, transcatheter tricuspid valve replacement plus medical therapy improved outcomes compared with medical therapy alone, researchers reported at TCT 2024.

For the TRISCEND II trial, whose main findings were simultaneously published in The New England Journal of Medicine and whose quality of life findings were simultaneously published in the Journal of the American College of Cardiology, the researchers randomly assigned 400 patients (mean age, 79 years; 76% women; eight were not treated after randomization) with severe symptomatic tricuspid regurgitation 2:1 to transcatheter tricuspid valve replacement (TTVR; Evoque, Edwards Lifesciences) plus medical therapy or medical therapy alone.

“Evoque is a bovine pericardial valve in a nitinol frame,” Susheel Kodali, MD, director of the Structural Heart and Valve Center at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and director of the interventional cardiology fellowship program and associate professor in medicine at Columbia University Irving Medical Center, said at a press conference. “This is a different therapy from the one in the TRILUMINATE study (TriClip G4, Abbott), a repair system in which you are clipping the leaflets trying to reduce [tricuspid regurgitation]. With replacement, the goal is to eliminate the tricuspid regurgitation.”

The results were evaluated on a hierarchical composite outcome at 1 year and expressed as a win ratio. The hierarchy was as follows: all-cause death, heart transplant or implant of a right ventricular assist device, tricuspid valve intervention after the index period, hospitalization for HF, improvement in Kansas City Cardiomyopathy Questionnaire–Overall Summary (KCCQ-OS) score of at least 10 points, improvement in NYHA functional class by at least one class and improvement of at least 30 m in 6-minute walk distance.

After the TTVR procedure, 99% of patients had moderate or less tricuspid regurgitation and 95% had mild or less tricuspid regurgitation, Kodali said at the press conference.

The win ratio was 2.02 (95% CI, 1.56-2.62; P < .001) in favor of the TTVR group, Kodali said at the press conference, noting that it was driven by improvement in KCCQ-OS score (23.1% vs. 6%) and improvement in NYHA class (10.2% vs. 0.8%).

Severe bleeding was more common in the TTVR group than in the control group (15.4% vs. 5.3%; P = .003), as was new permanent pacemaker implantation (17.4% vs. 2.3%; P < .001), according to the researchers.

In an analysis of the KCCQ-OS score over time, the difference in the score favored the TTVR group at 30 days (difference, 11.8 points; 95% CI, 7.4-16.3), 6 months (difference, 20.8 points; 95% CI, 16.1-25.5) and 1 year (difference, 17.8 points; 95% CI, 13-22.5), the researchers found.

At 1 year, 58% of the TTVR group had a large or moderate improvement in KCCQ-OS score compared with 31% of the control group, whereas 24% of the TTVR group had worse health status or died compared with 45% of the control group (P < .001), Kodali said at the press conference.

TTVR improved health status as measured by the KCCQ-OS score to a greater degree in those with torrential tricuspid regurgitation (treatment effect, 23.3) and massive tricuspid regurgitation (treatment effect, 22.6) compared with those with severe tricuspid regurgitation (treatment effect, 11.3; P for interaction = .049), according to the researchers.

At 1 year, 64.6% of the patients in the TTVR group were alive and well, defined as KCCQ-OS score of 60 points or more and no decline of 10 points or more from baseline, compared with 31% of the control group, the researchers found.

“We’ve done a lot of work to understand how much of this is biologically mediated and how much of this may be placebo effect,” Suzanne Arnold, MD, MHA, professor of medicine at University of Missouri-Kansas City School of Medicine and clinical scholar for Saint Luke’s Mid America Heart Institute, said at the press conference. “One important thing is the magnitude of improvement. An 18-point improvement in the KCCQ is really big. That helps, and that it’s stable through 1 year also helps. The other thing interesting here is there is continued improvement between 1 month and 6 months. If it were all placebo, you would expect to see it all up front. The fact that it continues to grow is reassuring. We also found that if you had an improvement in KCCQ, you had a reduction in the risk of heart failure hospitalization and mortality, though the trial was not powered appropriately for mortality and heart failure hospitalization.”

#TranscatheterValveReplacement #TricuspidValve #HeartHealth #Cardiology #MedicalInnovation #HeartSurgery #ValvularDisease #TricuspidRegurgitation #MinimallyInvasive #HeartCare #MedicalResearch #InterventionalCardiology #HeartDiseaseTreatment #ValveTherapy

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Wednesday, 20 November 2024


Transforming cardiac care: Innovation and collaboration for a healthier future

Cardiovascular diseases (CVDs) are a growing global concern, and India is at the forefront of this battle. With South Asians experiencing heart disease at nearly twice the rate of their Western counterparts, the need for advanced solutions and collaboration in cardiac care is more urgent than ever.

The Role of Innovation in Cardiac Care

Recent technological advancements are reshaping how cardiovascular diseases are diagnosed, treated, and managed. Artificial intelligence (AI) and telemedicine, for instance, are enabling healthcare providers to offer personalized and efficient cardiac care. AI-driven tools analyze patient data with exceptional accuracy, often identifying early signs of heart disease before symptoms appear. Early detection significantly boosts treatment success and reduces complications, allowing healthcare providers to act proactively.

In a forward-thinking approach, Meril has taken a lead in bringing innovation closer to communities in India. Recently, they launched the second edition of their Treatment Zaroori Hai (TZH) campaign, themed “Aapki Takleef Sirf Aapki Nahin Hoti.” This initiative uses AI and a multi-channel media strategy to engage patients in the importance of early intervention. Originally focused on Transcatheter Aortic Valve Implantation (TAVI) and Bioresorbable Scaffolds (BRS), the campaign has now expanded to include timely treatments for hernia, bariatric surgery, peripheral artery disease, and sinus surgery. By integrating technology into patient education, Meril underscores the importance of timely intervention, reflecting the dynamic progress India is making in MedTech.

Additionally, wearable devices equipped with ECG monitoring are proving transformative in cardiac care. These smart devices allow for real-time tracking, giving physicians early insights into heart health trends. As Dr. Kumar Kenchappa, Consultant Interventional Cardiologist, explains, “AI and wearables are revolutionizing cardiac management, allowing us to prevent severe complications through timely intervention.”

Collaboration: Expanding Access to Cardiac Care

While technological advancements drive innovation, collaboration across healthcare providers, tech developers, and policymakers is essential to make advanced cardiac care accessible to all. In India, public-private partnerships are crucial to reaching underserved populations, ensuring that life-saving innovations are available to those in remote areas as well as urban centers. Through partnerships, the healthcare sector and technology companies are developing scalable solutions to bridge the gap between urban and rural healthcare.

Telemedicine exemplifies this collaborative approach by providing specialized consultations to patients in rural regions, where healthcare access is limited. This virtual extension of care allows cardiologists to remotely evaluate patients, thereby reducing travel barriers and wait times. According to Dr. Sunita Maheshwari, a pioneer in pediatric cardiac care, “Telemedicine is a game-changer. It enables us to reach patients who would otherwise face long delays in receiving care.”

Data-Driven Personalized Care

Data analytics is playing a vital role in personalizing cardiac treatment. By analyzing data from wearables and patient histories, healthcare providers can tailor treatment plans to each patient’s unique health profile, leading to more accurate diagnoses, better treatment decisions, and improved outcomes. One such innovation is Transcatheter Aortic Valve Implantation (TAVI), a minimally invasive option for patients with severe aortic stenosis. By using patient data to refine candidate selection, TAVI offers optimized outcomes, reducing recovery times and enhancing patient experiences.

The Future of Cardiac Care in India

Looking forward, India’s future in cardiac care will be defined by continued technology integration and collaborative initiatives. Innovations such as AI, telemedicine, wearable devices, and data analytics are setting the stage for a more efficient and effective healthcare system. However, to drive widespread change, collaboration between healthcare providers, technology companies, and government bodies will be essential.

Empowering patients to take control of their heart health through awareness campaigns, regular screenings, and access to advanced treatments is another critical factor. With stakeholders working together, India is poised to make significant strides in cardiac care. Meril’s “Treatment Zaroori Hai”, for example, is partnering with doctors and hospitals nationwide to promote timely treatment and advanced solutions for critical health issues like Aortic Stenosis. This reflects India’s broader narrative of MedTech progress and commitment to patient-centered care.

Conclusion: A Collaborative Path to a Healthier Future

The future of cardiac care in India looks promising, thanks to the combined efforts of innovation and collaboration. By embracing new technologies and uniting resources. Early intervention, patient-centered treatments, and a collaborative commitment to healthcare equity are essential in reducing the burden of cardiovascular diseases and ensuring a healthier future for all.

#CardiacCare #HeartHealth #MedicalInnovation #HealthcareCollaboration #FutureOfMedicine #CardiologyAdvances #HealthyHeart #HeartDiseasePrevention #CardiovascularInnovation #TransformingHealthcare

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Tuesday, 19 November 2024


 

Revolutionising Cardiac Care: An In-Depth Examination Of                                TAVI For Aortic Stenosis


As technology develops, TAVI is set to play an even more significant role in treating heart valve disease.

Cardiovascular diseases continue to represent a global health crisis affecting millions of people worldwide. These conditions necessitate urgent medical intervention, as cardiovascular diseases account for several premature deaths worldwide. These life-threatening coronary problems include coronary artery disease, heart failure, hypertension, stroke and many more. With the growing number of cardiac cases around the world, there is an urgent need for new and more effective treatment options. The field of cardiac care has transformed, introducing minimally invasive procedures, personalised medicine and a well-planned approach to patient management. Innovations and minimally invasive procedures like Transcatheter Aortic Valve Implantation (TAVI) are reshaping the cardiac landscape for better and more effective results.

Aortic Stenosis

Aortic stenosis is a critical heart condition often caused by age-related cardiac issues or inherent heart problems. It results in restricted blood flow from the heart to the body's other organs, leading to dizziness, fatigue, and chest pain. These conditions are often brought on by stenosis, which narrows and malfunctions the aortic valve. The usual course of treatment for this condition was SAVR, which involved the traditional treatment method. Due to drastic transformations and technological advancements in medicine, transcatheter aortic valve implantation (TAVI) has been introduced to treat aortic stenosis.

TAVI

Transcatheter Aortic Valve Implantation (TAVI) heart procedure performed on patients diagnosed with aortic stenosis. This treatment aims to implant a replacement aortic valve instead of the old, damaged one. This approach is used for patients who are at high risk for traditional treatment methods and have significant aortic stenosis. TAVI's shortened recovery period and lower risk have been of great help to many patients. This procedure aims to enhance the patient's quality of life and lengthen their life expectancy.

The Procedure

TAVI is a minimally invasive technique. It is typically performed with a catheter, a thin, flexible tube introduced through a small incision, usually in the groin area. The guided catheter delivers the bioprosthetic valve to the location of the defective valve, where it expands and takes over the functions of the original valve.

TAVI: Advantages And Outcomes

Like any other cardiovascular treatment, TAVI has its advantages and outcomes. Compared to the traditional treatment method, TAVI offers many benefits. This procedure only involves a small incision, which reduces the risk of injury, discomfort, and recovery time. Depending on how quickly they heal, patients can resume regular activities at home in a few days. This shorter recovery period and limited days in the hospital make this whole process a lot easier for the patients. Additionally, TAVI also comes with a lower risk of post-procedural complications like infection.

TAVI represents a significant advancement in treating aortic stenosis surgical aortic valve replacement and improves patients' quality of life and results.


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#AorticStenosis
#TAVI
#HeartHealth
#MinimallyInvasive
#CardiologyInnovation
#ValveReplacement
#MedicalAdvancements
#HeartSurgery
#InterventionalCardiology
#HealthyHeart
#HeartDiseaseAwareness
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#HeartCareRevolution
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Monday, 18 November 2024



         Aortic stenosis: benefits of early intervention

Until now, patients with aortic stenosis – a narrowing of one of the heart’s main valves – have had to wait until symptoms become severe before undergoing valve replacement. Findings from the EVOLVED study, however, indicate that patients can avoid symptoms such as chest pain, dizziness and fainting if surgery is performed at an earlier stage of the condition. Researchers from the University of Edinburgh and the University of East Anglia (UEA) say this new approach could also lead to fewer unplanned hospital visits, easing the pressure on an already overstretched healthcare system. 

The findings were published in JAMA. 

Aortic stenosis is the most common heart valve disease in developed countries. It is estimated that up to 10% of people over 65 have the condition – often caused by a buildup of calcium on the aortic valve over time – with that number increasing with age. Narrowing of the aortic valve – the heart’s main outlet valve – limits blood flow from the heart to the rest of the body. Over time, it can lead to serious complications, including weakness of the heart muscle which can cause heart failure. Replacing the aortic valve remains the only treatment option, and a new keyhole approach is now available for many patients who are unable to undergo major surgery.

Experts set out to explore what difference earlier intervention would have on patients. The EVOLVED study took place across 24 cardiac centres in the UK and Australia and involved 224 patients with severe aortic stenosis but only mild symptoms. The average age of the participants was 73. They were randomly assigned to either a group that received early intervention in the form of aortic valve replacement or one that received standard monitoring of their condition. In the early intervention group, 94% underwent aortic valve replacement, with the average time from signing up to surgery around five months. In the monitoring group, the average time before surgery was 20 months. About 77% eventually had surgery, often due to their symptoms getting worse. 

Researchers found that just 6% of patients in the early intervention group experienced an unplanned aortic stenosis-related hospitalisation, compared to 17% in the management group. After one year, 20% of participants allocated to early intervention had experienced symptoms related to their condition. That figure was almost double – 38% – in the group who underwent management. The study team reported a similar number of deaths in both groups, with most deemed unrelated to their aortic stenosis. 

The findings suggest that aortic valve intervention should be offered to patients earlier, to prevent the development of symptoms and emergency hospital admissions. These findings should lead to updates in guidelines for doctors, the experts say. Dr Neil Craig, Clinical Research Fellow at the University of Edinburgh and a cardiology doctor, said: “Our study, alongside a similar one carried out in America, suggests that early intervention for severe aortic stenosis can lead to fewer symptoms and hospitalisations. These findings emphasise the importance of timely treatment for patients with this condition, potentially reshaping how doctors approach management strategies in the future.” 

Professor Vassilios Vassiliou, a co-author of the study from UEA’s Norwich Medical School, said: “The current evidence supports the consideration of earlier intervention to alleviate symptoms and minimise unplanned hospitalisations. This data challengwill likely require intervention regardless, these findings provide a compeles the existing treatment plan of delaying intervention until symptom onset. Given that this cohort of patients ling basis for advancing treatment timelines in asymptomatic severe aortic stenosis – an approach that will be well received by patients.” 

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Thursday, 14 November 2024


 

               Why mental stress can take a toll on the heart

Insufficient cardiovascular response to mental stress linked to reduced blood flow in the heart among people with heart disease

Imagine walking through a park and suddenly spotting a bear. Normally your heart starts beating faster and your blood vessels constrict. That’s the sympathetic nervous system preparing your body for a “flight or fight” response. Then, once you reach safety, your parasympathetic nervous system helps calm you down. Eventually, your blood pressure and heart rate return to normal.

For some people with heart disease, however, this experience can be concerning because stressful events can further negatively impact the heart. In 2021, NIH-supported researchers found that one in six people with heart disease were twice as likely to experience myocardial ischemia — a reduction in blood flow to the heart —  when they experienced mental stress and that, in turn, was linked to increased risks for having a heart attack or a heart-related death years later. 

Now, the same researchers have identified a key mechanism involved. Their findings, published in Circulation: Cardiovascular Imagingexternal link, homed in on the parasympathetic and sympathetic nervous systems, which help the brain communicate with the heart, and found that a dysregulated response, measured by reductions in heart rate variability (the variation in time between two heartbeats) appears to influence this increased risk for ischemia.  

The findings are helping researchers understand what’s happening beneath the surface for people with coronary artery disease who experience mental stress-induced ischemia, said Rebecca Campo, Ph.D., a program officer in the Clinical Applications and Prevention branch in the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute (NHLBI). “Generally, a healthy response to stress is when the sympathetic and parasympathetic nervous systems work in harmony,” she explained.

Campo noted that like a teeter-totter during mental stress, the sympathetic nervous system kicks in, while the parasympathetic nervous system withdraws. This flops when the parasympathetic response is activated and soothes physiological responses to stress. Lower heart rate variability may reflect dysfunction in these two systems and a state where the sympathetic nervous system is more dominant.

The researchers suspected that an imbalance between the two systems, also called autonomic dysregulation, is what may lead to mental stress-induced ischemia. To evaluate this, they measured heart rate variability to see if they could pinpoint the connection. When the time between heart beats fluctuates a lot, they knew, it often translates to a person’s ability to quickly sense and respond to stress. In other words, this signals that their autonomic nervous system is adaptive. If the time between beats doesn’t change much, this suggests there could be problems.

To test this in the lab, the researchers evaluated cardiovascular outcomes from more than 700 adults who participated in the Myocardial Infarction and Mental Stress Study 2 and the Mental Stress Ischemia Mechanisms and Prognosis Study. Participants fasted overnight and were asked to rest 30 minutes before the start of the exercise. They were then assigned a standard laboratory mental stress-inducing task: to prepare a speech envisioning how they would respond to learning about the mistreatment of a loved one in a senior living facility. They had two minutes to prepare the speech and three minutes to deliver it in front of at least three people.

The participants wore portable heart monitors to measure their heart rate variability in five-minute increments before, during, and after the task. They also had cardiac imaging track their heart’s activity and blood flow during rest and the mental stress task.

The findings confirmed the research team’s hypothesis. During the mental stress test, 119 participants, 16% of the study sample, experienced myocardial ischemia. Those with the lowest heart rate variability, which signaled a poor cardiovascular response to stress, accounted for about one-fourth of study participants. The researchers found these participants were twice as likely to experience ischemia during the mental stress challenge compared to those with higher heart rate variability.  

Amit J. Shah, M.D., a cardiologist at the Atlanta VA Medical Center, an associate professor of epidemiology at Emory University’s Rollins School of Public Health, and the lead study author, said many reasons could explain responses to mental stress. A weak heart — which could have resulted from a major heart attack — is one of them. That’s because the heart plays as much of a role as the brain in the functioning of the autonomic system, he said. “Both are voting members in terms of what happens with heart rate variability.”

Participants also completed a conventional stress test, which included walking on a treadmill until they reached their maximum heart rate. This type of physical stress did not elicit the same response as the speech exercise — reinforcing that mental stress activates distinct physiological responses in the body.  

Shah and his colleagues, including first study author Jeffery Osei, M.D., M.P.H., noted that more research is needed to pinpoint the specific pathways involved in how autonomic dysregulation causes mental stress-induced myocardial ischemia. However, findings from this study and future studies could help advance research focused on ways to minimize these effects and also support cardiovascular function.

For example, the researchers suggested that future studies could assess if wearable heart rate monitors may help people with heart disease recognize early signs of stress and take steps to offset risks for heart problems. Others may study the effectiveness of pairing early detection with interventions, such as aerobic exercise, yoga, deep-breathing exercises, or even medications for people with significant risks, to help the body better sense and respond to stress. 

“The more we can do after stressful events to help replenish and restore our body’s normal functions, such as through activating the parasympathetic nervous system, the better - and the more we’ll be doing to help our hearts,” said Campo.

This research was supported by grants from the National Institutes of Health, including NHLBI, the National Institutes of Mental Health, the National Institute of Minority Health and Health Disparities, and the National Center for Advancing Translational Sciences.

  • #MentalHealthAndHeart
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  • #MindBodyConnection
  • #HeartAndMind
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  • #MentalWellness
  • #ReduceStress
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  • #MindfulnessMatters

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