Podcasts about Echocardiography

In our May episode, we marked Hypertension Awareness Month with Dr. Robert Ostfeld, a cardiologist at Montefiore Medical Center. Dr. Ostfeld shared how his patients naturally lowered their blood pressure by adopting a plant-based diet and offered tips for eating more plant-based foods. In this month's Key Note, he explains how getting proper sleep can reduce stress hormones that contribute to high blood pressure. The Takeaway We want to hear from you! Please complete our survey: org/member-feedback. Drop us a line at our social media channels: Facebook// Instagram // YouTube. Get started on your health journey by making an appointment with your primary care physician to know your numbers. Get to know your numbers at 1199SEIUBenefits.org/healthyhearts. Find healthy recipes and meal-prep tips at 1199SEIUBenefits.org/food-as-medicine. Visit the Healthy Living Resource Center for wellness tips, information and resources; 1199SEIUBenefits.org/healthyliving. Get inspired by fellow members through our Members' Voices series: 1199SEIUBenefits.org/healthyliving/membervoices. Stop by our Benefits Channel to join webinars on building healthy meals, managing stress and more: 1199SEIUBenefits.org/videos. Visit our YouTube channel to view a wide collection of healthy living videos: youtube.com/@1199SEIUBenefitFunds/playlists. Sample our wellness classes to exercise body and mind: 1199SEIUBenefits.org/wellnessevents. Robert Ostfeld, MD, MSc, FACC, is the Director of Preventive Cardiology at Montefiore Health System and a Professor of Medicine at the Albert Einstein College of Medicine. Dr. Ostfeld treats patients with adult cardiovascular disease, including coronary artery disease, hypertension, hyperlipidemia and erectile dysfunction with a focus on prevention and treatment through lifestyle change. He works closely with his patients to help them adopt a plant-based diet. Dr. Ostfeld received his Bachelor of Arts in the Biologic Basis of Behavior from the University of Pennsylvania, graduating Summa Cum Laude and Phi Beta Kappa and his Doctor of Medicine from Yale University School of Medicine. He then did his medical internship and residency at the Massachusetts General Hospital and his Cardiology Fellowship and Research Fellowship in Preventive Medicine at Brigham and Women's Hospital, both teaching hospitals of Harvard Medical School. During his Cardiology Fellowship, he earned a Master's of Science in Epidemiology from the Harvard School of Public Health. Dr. Ostfeld's research focus is on cardiovascular disease prevention and reversal through lifestyle modification. Ongoing topics he investigates include the impact of plant-based nutrition on erectile function, coronary artery disease, angina and heart failure. His work has been published in peer-reviewed journals, books, articles, and clinical statements and has been presented nationally. Dr. Ostfeld is board certified in Cardiovascular Disease and Echocardiography, and he is a member of numerous professional societies, including the Physician's Committee for Responsible Medicine and the American College of Cardiology.

Commentary by Dr. Jian'an Wang.

For Hypertension Awareness Month, we are fortunate to have Dr. Robert Ostfeld, a cardiologist at Montefiore Medical Center, join us to talk about lifestyle approaches for treating – and preventing – high blood pressure. In this episode, Dr. Ostfeld explains the numbers, the symptoms – or lack of symptoms – and the associated risks. A self-confessed “reformed cardiologist,” he talks about how he saw his patients who adopted a plant-based diet significantly lower their blood pressure. Not ready to go totally plant-based? Dr. Ostfeld says simply adding more fruits, vegetables and whole grains to your diet can help lower not only your blood pressure but also your risk for heart disease, stroke and dozens of other conditions.   The Takeaway We want to hear from you! Please complete our survey: org/member-feedback. Drop us a line at our social media channels: Facebook// Instagram // YouTube. Get started on your health journey by making an appointment with your primary care physician to know your numbers. Get to know your numbers at 1199SEIUBenefits.org/healthyhearts. Find healthy recipes and meal-prep tips at 1199SEIUBenefits.org/food-as-medicine. Visit the Healthy Living Resource Center for wellness tips, information and resources; 1199SEIUBenefits.org/healthyliving. Get inspired by fellow members through our Members' Voices series: 1199SEIUBenefits.org/healthyliving/membervoices. Stop by our Benefits Channel to join webinars on building healthy meals, managing stress and more: 1199SEIUBenefits.org/videos. Visit our YouTube channel to view a wide collection of healthy living videos: youtube.com/@1199SEIUBenefitFunds/playlists. Sample our wellness classes to exercise body and mind: 1199SEIUBenefits.org/wellnessevents. Robert Ostfeld, MD, MSc, FACC, is the Director of Preventive Cardiology at Montefiore Health System and a Professor of Medicine at the Albert Einstein College of Medicine. Dr. Ostfeld treats patients with adult cardiovascular disease, including coronary artery disease, hypertension, hyperlipidemia and erectile dysfunction with a focus on prevention and treatment through lifestyle change. He works closely with his patients to help them adopt a plant-based diet. Dr. Ostfeld received his Bachelor of Arts in the Biologic Basis of Behavior from the University of Pennsylvania, graduating Summa Cum Laude and Phi Beta Kappa and his Doctor of Medicine from Yale University School of Medicine. He then did his medical internship and residency at the Massachusetts General Hospital and his Cardiology Fellowship and Research Fellowship in Preventive Medicine at Brigham and Women's Hospital, both teaching hospitals of Harvard Medical School. During his Cardiology Fellowship, he earned a Master's of Science in Epidemiology from the Harvard School of Public Health. Dr. Ostfeld's research focus is on cardiovascular disease prevention and reversal through lifestyle modification. Ongoing topics he investigates include the impact of plant-based nutrition on erectile function, coronary artery disease, angina and heart failure. His work has been published in peer-reviewed journals, books, articles, and clinical statements and has been presented nationally. Dr. Ostfeld is board certified in Cardiovascular Disease and Echocardiography, and he is a member of numerous professional societies, including the Physician's Committee for Responsible Medicine and the American College of Cardiology.

In this podcast, Dr. Valentin Fuster discusses a groundbreaking study from the Orbiter 2 trial, which explores how dobutamine stress echocardiography (DSE) can predict the efficacy of percutaneous coronary intervention (PCI) in relieving angina in patients with stable coronary artery disease. The study reveals that the degree of ischemia, as measured by DSE, is strongly correlated with improvement in symptoms, offering new insights into patient selection for PCI treatment.

In this episode, Dr Bleri CELMETA takes us on a powerful journey through the history of open-heart surgery — from the pioneering work of John Gibbon and C. Walton Lillehei to the evolution of minimally invasive and robotic approaches. Discover how cardiac surgery progressed from experimental beginnings to life-saving daily procedures, and how innovation continues to shape the operating room. Dr. Bleri Celmeta is a cardiac surgeon operating on the Minimally Invasive Cardiac Surgery Unit in Galeazzi-Sant'Ambrogio Hospital (Milan, Italy). He graduated in Medicine and Surgery at the University of Padova-Italy in 2014, then completed his residency program in Cardiac Surgery in the same university in 2020. His professional background included also a fellowship in Cardiac and Thoracic Surgery in the University Hospital of Nantes-France (2019-2020).   He is the author of numerous publications and conference presentations with particular interest in minimally invasive cardiac surgery, and review editor of various international Journals (Frontiers in Cardiovascular Medicine, Frontiers in Surgery, Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Journal of Cardiothoracic Surgery, among others). Dr. Celmeta is a member of the Working Group on Cardiovascular Surgery - European Society of Cardiology (ESC), Italian Cardiac Surgery Society (SICCH) and Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI).  LinkedIn profile: Bleri Celmeta | LinkedIn     About Behind the OR Behind the OR is the official podcast channel by Peters Surgical. Here, we invite you to step into the world of surgery, where we uncover what happens behind the closed doors of the operating room and beyond. Each episode features in-depth conversations with expert surgeons, providing insights into the latest surgical techniques, innovations, and the daily lives of those who dedicate themselves to saving lives. Founded in 1926, Peters Surgical is a French company with a global presence in over 90 countries. As a reference group for surgical practices worldwide, we are dedicated to improving surgical outcomes through innovative medical devices, including surgical sutures, hemostatic clips, and surgical glue. Our expertise lies in designing, manufacturing, and distributing these devices.  Visit our website here : https://peters-surgical.com/

This week we review a recent work from the team at Seattle Children's Hospital about obstetrical sonography and referral of fetuses with 'suboptimal imaging' for fetal echocardiography. Should all 'suboptimal imaging' cases be referred? How can fetal cardiologists parse out who needs a fetal cardiac scan and when? How does the fetal team in Seattle practically serve a geographic region exceeding 2,000 miles and properly triage the referrals, particularly when 'suboptimal imaging' is the rationale for referral? Associate Professor of Pediatrics at The University of Washington, Dr. Bhawna Arya provides deep insights into her recent work on how to think about fetuses referred for 'suboptimal imaging' as a rationale for fetal consultation. https://doi.org/10.1007/s00246-024-03495-9

In this episode, Dr. Sergio Zanotti explores one of medicine's fastest-evolving frontiers: artificial intelligence (AI). From predictive analytics to decision-support tools, AI is beginning to influence how we deliver critical care — but what does that actually mean for frontline clinicians? Dr. Zanotti is joined by Dr. Sharad Patel, a critical care physician with additional board certification in nephrology and Echocardiography. He is a Critical Care Intensivist at Cooper University Health Care, the assistant program Director for the Internal Medicine Residency Program, and an Assistant Professor of Medicine at Cooper Medical School of Rowan University. Dr. Patel is deeply interested in applying artificial intelligence and technology at the bedside. Additional resources: Landing page for New England Journal of Medicine – AI in Medicine section. A multitude of articles and resources on the topic: https://www.nejm.org/ai-in-medicine Attention Is All You Need. A Vaswani et al. NIPS 2017: https://proceedings.neurips.cc/paper_files/paper/2017/file/3f5ee243547dee91fbd053c1c4a845aa-Paper.pdf Artificial Intelligence Courses Online: https://www.coursera.org/courses?query=artificial%20intelligence UDEMY landing page for AI courses. https://www.udemy.com/AI Books mentioned in this episode: Meditations. By Marcus Aurelius (Author), Gregory Hayes (Translator): https://amzn.to/4iLvfLA Thinking Fast and Slow. By Daniel Kahneman: https://bit.ly/4c6pANu

Andrea Scotti, MD, JACC: Case Reports Deputy Editor, is joined by authors Richard Carrick, MD, PhD and Drew Bidmead, BS discussing this study from Carrick et al presented at ACC.25 and published in JACC: Case Reports. Left atrial dissection is a rare, but potentially serious, complication that most commonly arises following mitral valve surgeries. In this report, we describe an unusual case of left atrial dissection that occurred after multi-valve surgical replacement in a patient with hypertrophic cardiomyopathy. While permanent pacemaker placement was required due to recurrent episodes of complete heart block, the patient was otherwise managed safely using a conservative approach without surgical re-intervention.

POCUS Basic Echocardiography

CardioNerds (Dr. Rick Ferraro and Dr. Dan Ambinder) join Dr. Sri Mandava, Dr. David Meister, and Dr. Marissa Donatelle from the Columbia University Division of Cardiology at Mount Sinai Medical Center in Miami. Expert commentary is provided by Dr. Pranav Venkataraman.   They discuss the following case involving a patient with cardiac sarcoidosis presenting as STEMI:  A 57-year-old man with a history of hyperlipidemia presented with sudden onset chest pain. On admission, he was vitally stable with a normal cardiorespiratory exam but appeared in acute distress and was diffusely diaphoretic. His ECG revealed sinus rhythm, a right bundle branch block (RBBB), and ST elevation in the inferior-posterior leads. He was promptly taken for emergent cardiac catheterization, which identified a complete thrombotic occlusion of the mid-left circumflex artery (LCX) and large obtuse marginal (OM) branch, with no underlying coronary atherosclerotic disease. Aspiration thrombectomy and percutaneous coronary intervention (PCI) were performed, with one drug-eluting stent placed. An echocardiogram showed a left ventricular ejection fraction (EF) of 31%, hypokinesis of the inferior, lateral, and apical regions, and an apical left ventricular thrombus. The patient was started on triple therapy. A hypercoagulable workup was negative. A cardiac MRI was obtained to further evaluate non-ischemic cardiomyopathy. In conjunction with a subsequent CT chest, the results raised suspicion for cardiac sarcoidosis with systemic involvement. In view of a reduced EF and significant late-gadolinium enhancement, electrophysiology was consulted to evaluate for ICD candidacy. A decision was made to delay ICD implantation until a definitive diagnosis of cardiac sarcoidosis could be established by tissue biopsy. The patient was started on HF-GDMT and discharged with a LifeVest. Close outpatient follow-up with cardiology and electrophysiology was arranged.  US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Cardiac Sarcoidosis Presenting as STEMI Cardiac sarcoidosis can present with a variety of symptoms, including arrhythmias, heart block, heart failure, or sudden cardiac death. Symptoms can be subtle or mimic other cardiac conditions.  Conduction abnormalities, particularly AV block or ventricular arrhythmias, are common and may be the initial indication of cardiac involvement with sarcoidosis.  The additive value of Echocardiography, FDG-PET, and cardiac MR is indispensable in the diagnostic workup of suspected cardiac sarcoidosis.  Specific role of MRI/PET: Both cardiac MRI and FDG-PET provide a complementary role in the diagnosis of cardiac sarcoidosis. Cardiac MRI is an effective diagnostic screening tool with fairly high sensitivity but is limited by its inability to decipher inflammatory (“active” disease) versus fibrotic myocardium. FDG-PT helps to make this discrimination, refine the diagnosis, and guide clinical management. Ultimately, these studies are most useful when interpreted in the context of other clinical information.  Primary prevention of sudden cardiac death in cardiac sarcoidosis focuses on risk stratification, with ICD placement for high-risk patients. For patients awaiting definitive diagnosis, a LifeVest may be used as a temporary measure to protect from sudden arrhythmic events until an ICD is placed.  Notes - Cardiac Sarcoidosis Presenting as STEMI 1. Is STEMI always a result of coronary artery disease?  By definition, a STEMI is an acute S-T segment elevation myocardial infarction. This occurs when there is occlusion of a major coronary artery, which results in transmural ischemia and damage,

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Safety and Feasibility of 3D Intracardiac Echocardiography in Guiding Left Atrial Appendage Occlusion With WATCHMAN FLX

Read the article here: https://journals.sagepub.com/doi/full/10.1177/30494826241296671

Recent randomized trials, including EARLY TAVR, AVATAR, RECOVERY, and EVOLVED, suggest benefits of early aortic valve replacement (AVR) in asymptomatic severe aortic stenosis (AS). Early AVR reduces stroke, heart failure hospitalizations, and cardiovascular events, with a trend toward improved survival. The data support shifting from clinical surveillance to early intervention?

The Tri.Fr Randomized Clinical Trial evaluated the efficacy of Transcatheter Edge-to-Edge Repair (T-TEER) + Optimized Medical Therapy (OMT) versus OMT alone in 300 patients with severe, symptomatic tricuspid regurgitation (TR) across 24 centers in France and Belgium. At 1-year follow-up, 74.1% of patients in the T-TEER group improved, compared to 40.6% in the OMT-alone group (P < .001). T-TEER significantly reduced TR severity, improved NYHA class, patient global assessment (PGA), and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, and had a high procedural success rate (97.3%) with a low 30-day major adverse event rate (0.7%). The findings support T-TEER as an effective intervention for symptomatic severe TR, warranting long-term follow-up to assess mortality and hospitalization impact.

CardioNerds (Dr. Colin Blumenthal and Dr. Saahil Jumkhawala) join Dr. Rohan Ganti, Dr. Nikita Mishra, and Dr. Jorge Naranjo from the Rutgers – Robert Wood Johnson program for a college basketball game, as the buzz around campus is high. They discuss the following case involving a patient with ventricular tachycardia:  The case involves a 61-year-old man with a medical history of hypothyroidism, hypertension, hyperlipidemia, seizure disorder on anti-epileptic medications, and major depressive disorder, who presented to the ER following an out-of-hospital cardiac arrest. During hospitalization, he experienced refractory polymorphic ventricular tachycardia (VT), requiring 18 defibrillation shocks. Further evaluation revealed non-obstructive hypertrophic cardiomyopathy (HCM). We review the initial management of electrical storm, special ECG considerations, diagnostic approaches once ischemia has been excluded, medications implicated in polymorphic VT, the role of multi-modality imaging in diagnosing hypertrophic cardiomyopathy, and risk stratification for implantable cardioverter-defibrillator (ICD) placement in patients with HCM.  Expert commentary is provided by Dr. Sabahat Bokhari.   Episode audio was edited by CardioNerds Intern and student Dr. Pacey Wetstein.   US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - A Curious Case of Refractory Ventricular Tachycardia - Rutgers-Robert Wood Johnson Diagnostic Uncertainty in VT Storm: In VT storm, ischemia is a primary consideration; when coronary angiography excludes significant epicardial disease, alternative causes such as cardiomyopathies, channelopathies, myocarditis, electrolyte disturbances, or drug-induced arrhythmias must be explored.  ST elevations in ECG lead aVR:  ST elevations in lead aVR and diffuse ST depressions can sometimes represent post-arrest oxygen demand and myocardial mismatch rather than an acute coronary syndrome. This pattern may occur in the context of polymorphic VT (PMVT), where myocardial oxygen demands outstrip supply, especially after an arrest. While these ECG changes could suggest myocardial ischemia, caution is needed, as they might not always indicate coronary pathology. However, PMVT generally should raise suspicion for underlying coronary disease and may warrant a coronary angiogram for further evaluation.  Medication Implications in PMVT and HCM: Certain medications, including psychotropic drugs (e.g., antidepressants, antipsychotics) and anti-epileptic drugs, can prolong the QT interval or interact with other drugs, thereby increasing the risk of polymorphic VT in patients with underlying conditions like HCM. Careful management of these medications is critical to avoid arrhythmic events in predisposed individuals.  Multi-Modality Imaging in HCM: Cardiac MRI with late gadolinium enhancement (LGE) is invaluable in assessing myocardial fibrosis, a key predictor of arrhythmic risk, and can guide decisions regarding ICD implantation. Echocardiography and contrast-enhanced CT can provide additional insights into structural abnormalities and risk assessment.  Polymorphic VT in Nonobstructive HCM: Polymorphic ventricular tachycardia (PMVT) can occur in nonobstructive hypertrophic cardiomyopathy due to myocardial fibrosis and disarray, even in the absence of significant late gadolinium enhancement and left ventricular outflow tract obstruction.  ICD Risk Stratification in HCM: Risk stratification for ICD placement in HCM includes assessment of clinical features such as family history of sudden cardiac death, history of unexplained syncope, presence of nonsustained VT on ambulatory monitoring,

This week we review a work from the department of cardiology and department of cardiac surgery at Boston Children's Hospital on late hypertension in patients following coarctation repair. Late hypertension has been associated previously with late transverse aortic arch Z score but can this be predicted by the immediate postoperative transverse aortic arch Z score also? What factors account for late hypertension in the coarctation patient? Should more patients have their aorta repaired from a sternotomy? Dr. Sanam Safi-Rasmussen, who is a PhD candidate at Copenhagen University, shares her insights from a work she performed while a research fellow at Boston Children's Hospital. DOI: 10.1016/j.jtcvs.2024.08.049

N Engl J Med 2006;355:2395-407Am Heart J 2011;161:611-21Background: Registry data suggests that 10-20% of patients with a STEMI present more than 12 hours after the onset of symptoms. The optimal treatment for such patients is unknown. In some cases, the inciting event may have occurred weeks prior and been mistaken for indigestion or another non-life threatening condition. Such patients may present to the hospital with a new diagnosis of congestive heart failure or atrial fibrillation. Echocardiography often reveals a a large wall motion abnormality, perfusion testing demonstrates an infarct with peri-infarct ischemia and an occluded vessel is seen on angiography. Should we try to open it? On the one hand, the damage has been done. Attempting to open an occluded vessel is associated with higher procedural risks and the patient's themselves are more often than not sub-optimal candidates for intervention; often having some combination of heart failure, LV dysfunction, older age, multimorbidity and hemodynamic instability. But on the other hand, revascularization restores blood flow and that has to count for something, right?The Occluded Artery Trial (OAT) tested the hypothesis that a strategy of routine PCI for total occlusion of the infarct-related artery 3 to 28 days after AMI would improve cardiac outcomes compared to medical therapy alone.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients: Patients were eligible if coronary angiography, performed 3 to 28 days after MI, showed a total occlusion of the infarct-related artery with poor antegrade flow and either an EF less than 50% or the occlusion was in the proximal portion of a major coronary vessel with a large risk region, or both. The qualifying period of 3 to 28 days was based on calendar days with day 1 being the onset of symptoms and thus, the minimal time from the AMI to angiography was just over 24 hours. [This is important, readers should not take the inclusion criteria of 3 to 28 days to mean that patients were not eligible if angiography was performed 2.5 mg/dl, left main or 3 vessel disease, angina at rest, and severe ischemia on stress testing (stress testing was required if the infarct zone was not akinetic or dyskinetic).Baseline characteristics: The trial included 2,166 patients - 1,082 randomized to PCI and 1,084 to medical therapy. The average age of patients was 59 years and 78% were men. Over 80% were white. The median time between AMI and randomization was 8 days. Patients had normal kidney function with an average GFR of 81 ml/min. The mean EF was 48% with 20% of patients having an EF

"POCUS Spotlight: Assessment of Right Ventricle with Echocardiography" From ASRA Pain Medicine News, November 2024. See the original article at www.asra.com/november24news for figures and references. This material is copyrighted. Support the show

Show notes: (2:21) Dr. Kedan's journey to becoming a leader in cardiology innovation (6:12) The broader applications of handheld ultrasound in patient care (15:15) The cholesterol debate: Is inflammation the bigger issue? (21:37) The role of ultrasound in preventive cardiology (27:31) The importance of balancing lifestyle changes with medical interventions (31:17) Factors predicting adverse events in cardiovascular health (36:49) How to find the right cardiologist and leveraging new technologies (38:56) The cholesterol vs. inflammation debate (43:18) Ultrasound vs. other imaging technologies (46:54) Key lifestyle tips for maintaining heart health (52:09) Where to find Dr. Kedan (54:57) Outro Who is Dr. Ilan Kedan?   Dr. Ilan Kedan is a distinguished cardiologist with a career marked by an unwavering commitment to patient care, academic excellence, and technological innovation. He embarked on his journey in medicine at Tulane University School of Medicine, where he honed his skills in cardiovascular health and patient-centered care.   Dr. Kedan's professional journey led him to Cedars Sinai Medical Group, where he cared for over 10,000 patients, fostering a culture of excellence and growth. During this time, he became a leader in the adoption of handheld ultrasonic cardiology technology, performing over 40,000 point-of-care ultrasound exams (POCUS).   Dr. Kedan's dedication to advancing patient care through technology earned him recognition as a Fellow of the American Society of Echocardiography and membership in esteemed organizations such as the National Lipid Association and the American College of Cardiology.   Beyond clinical practice, Dr. Kedan is deeply engaged in research, focusing on clinical cardiology, handheld ultrasound, and cardiometabolic disease. He has authored numerous publications on topics ranging from cardiac imaging to COVID-19, contributing to the advancement of cardiovascular medicine. Committed to shaping the next generation of medical professionals, Dr. Kedan mentors trainees and students, sharing his expertise and drive for excellence. Connect with Dr. Kedan: Website: https://www.cardiolucent.com/ Links and Resources: Peak Performance Life Peak Performance on Facebook Peak Performance on Instagram  

Sivatharshini Ramalingam, MD, and Charlotte Manisty, MBBS, PhD, discuss JACC: CardioOncology Expert Panel Recommendations for cardiovascular risk evaluation prior to cancer treatment, cardiac nuances of therapy and highlight evidence gaps for future direction of research.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on cardiovascular adaptation in normal pregnancy with 2D and 3D-echocardiography, speckle tracking and radial Artery tonometry.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on technique and outcomes of intracardiac echocardiography to assist anatomical isthmus ablation in repaired Tetralogy of Fallot patients with ventricular tachycardia.

JACC: Case Reports Associate Editor Maurizio Taramasso, MD, PhD, joins author Brinder S Kanda, MD, FACC to discuss their case presented at AHA and published in JACC: Case Reports. In this case, an 83-year-old female with decompensated heart failure was found to have HOCM with SAM of the mitral valve and a large P2 flail segment with ruptured cords. TEER was performed resulting in mild MR and resolution of the prior LVOT gradient. The case supports TEER for patients with medication-refractory HOCM.

Nicholas Wilcox, MD, MHS, Darryl Leong, MBBS, MPH, M.Biostat, PhD discuss

JACC: Case Reports Associate Editor Maurizio Taramasso, MD, PhD, joins author Brinder S Kanda, MD, FACC to discuss their case presented at AHA and published in JACC: Case Reports. In this case, an 83-year-old female with decompensated heart failure was found to have HOCM with SAM of the mitral valve and a large P2 flail segment with ruptured cords. TEER was performed resulting in mild MR and resolution of the prior LVOT gradient. The case supports TEER for patients with medication-refractory HOCM.

Many significant medical discoveries were accidents, such as Fleming's discovery of penicillin in 1929. Similarly, in 1958, Dr. Mason Sones from the Cleveland Clinic accidentally injected contrast into a patient's right coronary artery, leading to a cardiac arrest. However, this incident allowed the first detailed visualization of the coronary artery, eventually leading to the development of coronary angiography, which remains the gold standard today. Dr Bleri CELMETA highlight these advancements, and explains the evolutions from open procedures to minimally invasive and robotic techniques.   Dr. Bleri Celmeta is a cardiac surgeon operating on the Minimally Invasive Cardiac Surgery Unit in Galeazzi-Sant'Ambrogio Hospital (Milan, Italy). He graduated in Medicine and Surgery at the University of Padova-Italy in 2014, then completed his residency program in Cardiac Surgery in the same university in 2020. His professional background included also a fellowship in Cardiac and Thoracic Surgery in the University Hospital of Nantes-France (2019-2020).   He is the author of numerous publications and conference presentations with particular interest in minimally invasive cardiac surgery, and review editor of various international Journals (Frontiers in Cardiovascular Medicine, Frontiers in Surgery, Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Journal of Cardiothoracic Surgery, among others). Dr. Celmeta is a member of the Working Group on Cardiovascular Surgery - European Society of Cardiology (ESC), Italian Cardiac Surgery Society (SICCH) and Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI).  LinkedIn profile: Bleri Celmeta | LinkedIn     About Behind the OR Behind the OR is the official podcast channel by Peters Surgical. Here, we invite you to step into the world of surgery, where we uncover what happens behind the closed doors of the operating room and beyond. Each episode features in-depth conversations with expert surgeons, providing insights into the latest surgical techniques, innovations, and the daily lives of those who dedicate themselves to saving lives. Founded in 1926, Peters Surgical is a French company with a global presence in over 90 countries. As a reference group for surgical practices worldwide, we are dedicated to improving surgical outcomes through innovative medical devices, including surgical sutures, hemostatic clips, and surgical glue. Our expertise lies in designing, manufacturing, and distributing these devices.  Visit our website here : https://peters-surgical.com/

An AI-ECG Algorithm for Left Ventricular Diastolic Dysfunction   Guest: Jae Oh, M.D.  Host: Anthony H. Kashou, M.D.    Diastolic function assessment is crucial in diagnosing, managing, and predicting outcomes in various cardiac conditions. It provides insight into heart health, particularly in diagnosing heart failure. Shortness of breath, a common patient complaint, often indicates elevated diastolic filling pressure if linked to a cardiac condition. Echocardiography is the primary method for assessing diastolic function, but it is operator-dependent and not always available. In contrast, ECGs are standardized and widely accessible. Although subtle changes in ECGs are not easily detectable by the human eye, artificial intelligence can identify specific conditions reflected in the ECG. By training an AI model with labeled ECGs based on diastolic function determined through echocardiography, researchers achieved high accuracy in detecting diastolic dysfunction. AI-enhanced ECGs can significantly impact the identification of both asymptomatic and symptomatic cardiac conditions, potentially streamlining diagnostic strategies and reducing costs. Future developments may enable patients to monitor their heart health using simple wearable devices, enhancing the management of heart failure and other conditions.   Topics Discussed: Your special clinical academic interest is echocardiography. Why are you interested in ECG AI in diastolic function? What is diastolic function and why is it important to assess diastolic function in clinical practice? Why did you decide to create AI-ECG for diastolic function assessment? What did you find and how do you envision AI ECG for diastolic function be used in clinical practice? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

In this episode, Efstratios Koutroumpakis discusses a critical study on autonomic dysfunction among adult survivors of childhood cancer, highlighting its prevalence and functional significance compared to community controls. The research underscores the complex etiologies of autonomic dysfunction linked to cancer treatments and stresses the importance of early detection and standardized testing to improve cardiovascular health and quality of life in this growing survivor population.

In this episode of the JACC: CardioOncology Podcast, Antonio Cannata discusses the PROACT clinical trial, which investigated the effectiveness of enalapril in preventing cardiac damage in breast cancer and lymphoma patients undergoing anthracycline therapy. Despite neutral results, the conversation delves into the challenges of defining myocardial injury and emphasizes the need for improved risk stratification and innovative trial designs in future research.

This week we listen in on a wonderful review lecture on fetal arrhythmias by noted fetal cardiologist Professor Bettina Cuneo. In this lecture Dr. Cuneo reviews the basics of fetal tachycardias and bradycardias and how these arrhythmias are diagnosed and sometimes treated. This is a lecture that was delivered on 9/20/24 by Dr. Cuneo at the Pedirhythm XI meeting in Rome, Italy. Thanks go to Dr. Fabrizio Drago and the organizers of Pedirhythm for allowing us to listen in on this wonderful lecture by a world-wide authority. 

ESC TV Today brings you concise analysis from the world's leading experts, so you can stay on top of what's happening in your field quickly. This episode covers: Cardiology this Week: A concise summary of recent studies Strategic decisions in atrial fibrillation Critical evaluation of clinical trials Snapshots Host: Perry Elliott Guests: Stephan Achenbach, Carlos Aguiar, Jane Armitage, Isabel Deisenhofer Want to watch that episode? Go to: https://esc365.escardio.org/event/1720 Disclaimer ESC TV Today is supported by Bristol Myers Squibb. This scientific content and opinions expressed in the programme have not been influenced in any way by its sponsor. This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. Declarations of interests Stephan Achenbach, Jane Armitage and Nicolle Kraenkel have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, BiAL, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, GSK, Lilly, Novartis, Pfizer, Sanofi, Servier, Takeda, Tecnimede. Davide Capodanno has declared to have potential conflicts of interest to report: Sanofi Aventis, Novo Nordisk, Terumo. Isabel Deisenhofer has declared to have potential conflicts of interest to report: speaker honoraria and travel grants from Abbott Medical, Biosense-Webster, Boston Scientific, BMS, Volta Medical, and research grant (for the institution) from Abbott Medical and Daiichi Sankyo. Perry Elliott has declared to have potential conflicts of interest to report: consultancies for Pfizer, BMS, Cytokinetics, AstraZeneca, Forbion. Steffen Petersen has declared to have potential conflicts of interest to report: consultancy for Circle Cardiovascular Imaging, Inc., Calgary, Alberta, Canada. Emma Svennberg has declared to have potential conflicts of interest to report: Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Johnson & Johnson.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on echocardiogram vector embeddings via R3D transformer for the advancement of automated echocardiography.

N Engl J Med 2020;382:1395-407 - ISCHEMIAN Engl J Med 2020;382:1608-16 - ISCHEMIA-CKDBackground: The COURAGE trial, published in 2007, represented a major reversal in cardiovascular medicine. In patients with stable CAD an initial strategy of revascularization plus medical therapy did not reduce the chance of dying or having a heart attack compared to an initial strategy of medical therapy alone. Prior to these results, patients with stable CAD were routinely managed with an initial invasive approach and the field of cardiology was intensely focused on finding coronary blockages and “fixing” them in symptomatic and asymptomatic patients alike. Thus, it's not surprising that following results from COURAGE, the practice continued to be vigorously defended and applied routinely in the management of patients with stable CAD.The first major attempt to reverse the results of COURAGE came from the FAME 2 trial, published in 2012, which tested the hypothesis that patients with stable CAD and an abnormal fractional flow reserve (FFR) in the cath lab would do better with an initial invasive strategy compared to medical therapy alone. The trial was stopped early for efficacy but the positive results were driven entirely by revascularization during follow up - not death or heart attack. The trial was criticized for being stopped inappropriately without providing an answer to whether an early invasive strategy improved hard endpoints compared to initial medical therapy alone. The concepts of “faith healing” and “subtraction anxiety” are useful for understanding the results and limitations of the FAME 2 trial.The ISCHEMIA trial which began enrolling patients in 2012 sought to overcome limitations of COURAGE and FAME. The investigative aim of the study was to test the hypothesis that in patients with stable CAD and moderate to severe ischemia on provocative testing, an initial invasive strategy reduced a composite of major cardiac events compared to initial medical therapy alone. The ISCHEMIA-CKD trial was performed in conjunction with the ISCHEMIA Research Group to address an important knowledge gap in managing patients with CAD. Patients with advanced chronic kidney disease (CKD) experience a higher rate of cardiac events than their counterparts without CKD; however, they are also at a higher risk of procedural complications. The standard of care at the time was generally to manage a patient with stable CAD and CKD like any other patient with CAD despite the fact that such patients were historically excluded from participation in clinical trials and thus, there was really no data from clinical trials to guide decision making.The ISCHEMIA-CKD investigators sought to test the hypothesis that in patients with advanced CKD and stable CAD and moderate to severe ischemia on stress testing, an initial invasive strategy reduced death or MI compared to initial medical therapy alone.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients: For the ISCHEMIA trial, eligible patients had to be at least 21 years of age or older with at least moderate ischemia on a qualifying stress test based on the following criteria:* Nuclear perfusion with SPECT or PET with >/= 10% ischemic myocardium* Echocardiography with >/= 3/16 segments with stress-induced severe hypokinesis or akinesis* Cardiac MRI with >/= 10% ischemic myocardium on perfusion imaging and/or >/= 3/16 segments with stress-induced severe hypokinesis or akinesis on wall motion assessment* Exercise treadmill test without imaging that met all 4 following criteria* clinical history of typical angina or typical angina during the stress test* absence of resting ST depression > 1.0 mm or confounders that render exercise EKG non-interpretable (LBBB, LVH with repolarization, pacemaker, etc.)* exercise-induced horizontal or downsloping ST depression >/= 1.5 mm in 2 leads or >/= 2.0 mm in any lead or ST elevation >/= 1.0 mm in a non-infarct territory* either of the following:* workload at which ST segment criteria are met is NOT to exceed completion of stage 2 of a standard Bruce protocol or 7 METS if a non-Bruce protocol is used* ST segment criteria are met at

In this podcast, Dr. Tim Markmann discusses a groundbreaking method for treating cardiac tumors using echocardiography-guided transapical radiofrequency ablation. This innovative approach from Dr. Liwen Liu and his team, which involves delivering thermal energy to the tumor via a percutaneous needle, shows promising results in reducing tumor size and alleviating heart failure symptoms, though it requires further study to address potential risks such as ventricular arrhythmias.

Send us a Text Message.Impact of early screening echocardiography and targeted PDA treatment on neonatal outcomes in "22-23" week and "24-26" infants.Giesinger RE, Hobson AA, Bischoff AR, Klein JM, McNamara PJ.Semin Perinatol. 2023 Mar;47(2):151721. doi: 10.1016/j.semperi.2023.151721. Epub 2023 Mar 5.PMID: 36882362As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Today, we're thrilled to have Board Certified Cardiologist and Director of Echocardiography and Cardiac Rehabilitation at Holy Name Hospital, Dr. David Wild with us. We'll be discussing the best practices for screening for heart disease, the role of doctors on social media, and debunking common heart myths. Stay tuned for an enlightening conversation that will help you take better care of your heart!

In this podcast, Dr Bleri CELMETA explore the history and evolution of cardiac surgery. The series covers early challenges, such as : The belief that Heart Surgery was impossible and fatal The invention of the heart-lung machine Significant milestones like Alexis Carrel's vascular techniques and the first successful heart surgery in 1896 The podcast highlights the advancements that made modern cardiac surgery possible, emphasizing the evolution of medical practices and technologies.  Dr. Bleri Celmeta is a cardiac surgeon operating on the Minimally Invasive Cardiac Surgery Unit in Galeazzi-Sant'Ambrogio Hospital (Milan, Italy). He graduated in Medicine and Surgery at the University of Padova-Italy in 2014, then completed his residency program in Cardiac Surgery in the same university in 2020. His professional background included also a fellowship in Cardiac and Thoracic Surgery in the University Hospital of Nantes-France (2019-2020).   He is the author of numerous publications and conference presentations with particular interest in minimally invasive cardiac surgery, and review editor of various international Journals (Frontiers in Cardiovascular Medicine, Frontiers in Surgery, Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Journal of Cardiothoracic Surgery, among others). Dr. Celmeta is a member of the Working Group on Cardiovascular Surgery - European Society of Cardiology (ESC), Italian Cardiac Surgery Society (SICCH) and Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI).  LinkedIn profile: Bleri Celmeta | LinkedIn     About Behind the OR Behind the OR is the official podcast channel by Peters Surgical. Here, we invite you to step into the world of surgery, where we uncover what happens behind the closed doors of the operating room and beyond. Each episode features in-depth conversations with expert surgeons, providing insights into the latest surgical techniques, innovations, and the daily lives of those who dedicate themselves to saving lives. Founded in 1926, Peters Surgical is a French company with a global presence in over 90 countries. As a reference group for surgical practices worldwide, we are dedicated to improving surgical outcomes through innovative medical devices, including surgical sutures, hemostatic clips, and surgical glue. Our expertise lies in designing, manufacturing, and distributing these devices.  Visit our website here : https://peters-surgical.com/

LATE BREAKING CLINICAL TRIAL: Three-Dimension Intracardiac (3D-ICE) vs Transesophageal (TEE) Echocardiography to Guide Transcatheter Edge-to-Edge Repair (TEER) With MitraClip: Interim Results of the 3 Dice-Clip Trial

On King's Birthday, the Governor-General announced Honours and Awards for 737 Australians in recognition for conspicuous service. Professor Konstantin Yastrebov has been awarded Member of Order of Australia for significant service to intensive and critical care medicine. - В честь Дня Рождения Короля генерал-губернатор объявил о награждении более 700 австралийцев, включая Орден Австралии за выдающиеся заслуги. Среди них — профессор Константин Ястребов, специалист в области интенсивной терапии и реанимации.

Three-Dimension Intracardiac (3D-ICE) vs Transesophageal (TEE) Echocardiography to Guide Transcatheter Edge-to-Edge Repair (TEER) With MitraClip

Thomas Conlon, MD is a pediatric intensivist at the Children's Hospital of Philadelphia, where he also serves as the Director of Pediatric Critical Care Ultrasound. His professional/research interests include clinical and educational outcomes in diagnostic and procedural ultrasound as well as programmatic ultrasound implementation.Sarah Ginsburg, MD is an Assistant Professor of Pediatrics at the University of Texas Southwestern and pediatric intensivist at Children's Medical Center Dallas. Her professional & research interests include clinical applications of POCUS in the PICU. She is very active both locally and nationally in improving POCUS skills for pediatric intensivists, including participating in Pediatric Research Collaborative on Critical Ultrasound, a subgroup of PALISI.Learning Objectives:By the end of this podcast, listeners should be able to:Identify the limitations of the physical exam and lab-based data in evaluating shock at the bedside of critically ill children.Describe how point-of-care ultrasound might provide greater accuracy in our evaluation of complex shock physiology.Discuss limitations to our ability as critical care physicians to use point-of-care ultrasound in our clinical practice and suggest solutions to overcome commonly encountered barriers.References:Lu et al. Recommendations for Cardiac Point-of-Care Ultrasound in Children: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2023 Mar;36(3):265-277. doi: 10.1016/j.echo.2022.11.010. Epub 2023 Jan 23. PMID: 36697294.Walker et al. Clinical Signs to Categorize Shock and Target Vasoactive Medications in Warm Versus Cold Pediatric Septic Shock. Pediatr Crit Care Med. 2020 Dec;21(12):1051-1058. Conlon et al. Diagnostic Bedside Ultrasound Program Development in Pediatric Critical Care Medicine: Results of a National Survey. Pediatr Crit Care Med. 2018 Nov;19(11):e561-e568.Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med. 2023 Sep;82(3):e115-e155. Conlon et al. Establishing a risk assessment framework for point-of-care ultrasound. Eur J Pediatr. 2022 Apr;181(4):1449-1457. https://coreultrasound.com/ https://coreultrasound.com/5ms/ https://www.youtube.com/@perccus How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

Thomas Conlon, MD is a pediatric intensivist at the Children's Hospital of Philadelphia, where he also serves as the Director of Pediatric Critical Care Ultrasound. His professional/research interests include clinical and educational outcomes in diagnostic and procedural ultrasound as well as programmatic ultrasound implementation.Sarah Ginsburg, MD is an Assistant Professor of Pediatrics at the University of Texas Southwestern and pediatric intensivist at Children's Medical Center Dallas. Her professional & research interests include clinical applications of POCUS in the PICU. She is very active both locally and nationally in improving POCUS skills for pediatric intensivists, including participating in Pediatric Research Collaborative on Critical Ultrasound, a subgroup of PALISI.Learning Objectives:By the end of this podcast, listeners should be able to:Identify the limitations of the physical exam and lab-based data in evaluating shock at the bedside of critically ill children.Describe how point-of-care ultrasound might provide greater accuracy in our evaluation of complex shock physiology.Discuss limitations to our ability as critical care physicians to use point-of-care ultrasound in our clinical practice and suggest solutions to overcome commonly encountered barriers.References:Lu et al. Recommendations for Cardiac Point-of-Care Ultrasound in Children: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2023 Mar;36(3):265-277. doi: 10.1016/j.echo.2022.11.010. Epub 2023 Jan 23. PMID: 36697294.Walker et al. Clinical Signs to Categorize Shock and Target Vasoactive Medications in Warm Versus Cold Pediatric Septic Shock. Pediatr Crit Care Med. 2020 Dec;21(12):1051-1058. Conlon et al. Diagnostic Bedside Ultrasound Program Development in Pediatric Critical Care Medicine: Results of a National Survey. Pediatr Crit Care Med. 2018 Nov;19(11):e561-e568.Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med. 2023 Sep;82(3):e115-e155. Conlon et al. Establishing a risk assessment framework for point-of-care ultrasound. Eur J Pediatr. 2022 Apr;181(4):1449-1457. https://coreultrasound.com/ https://coreultrasound.com/5ms/ https://www.youtube.com/@perccus How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

The Role of Multimodality Imaging for Pericarditis Guest: Prajwal (Praj) Reddy, MD Hosts: Malcolm R. Bell, M.D. Imaging can play a crucial role in diagnosis and management of pericarditis, particularly if recurrent. Echocardiography, cardiac computed tomography (CCT), and cardiac magnetic resonance imaging (CMR) offer complimentary evaluation of pericardial disease in its various presentations. In this podcast, we review the characteristic signs and features on multi-modality imaging in patients with acute and recurrent pericardial inflammation and its utility in tailoring therapy.   Topics Discussed: What is the role of imaging in the initial diagnosis of pericarditis? How is multi-modality cardiac imaging utilized in recurrent pericarditis? Follow up question to the above: Is serial imaging with cardiac MRI helpful in treatment of recurrent pericarditis? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

NEJM 1995;333:1670-6.Background Up to this point in history, a series of trials had been conducted using ACEi's in post-MI patients. A small to moderate short-term benefit had been shown when the drugs were started immediately (GISSI-3 and ISIS-4) and much greater long-term benefits were demonstrated when the drugs were started 5-11 days, on average, following AMI in patients with LV dysfunction and congestive heart failure (SAVE and AIRE).The SAVE and AIRE trials, however, were more selective and it was not clear how representative they were among all potentially eligible patients. Thus, TRACE authors sought to re-test the hypotheses tested in SAVE and AIRE with a focus on generalizability of trial procedures and results. Specifically, the Trandolapril Cardiac Evaluation Study (TRACE) sought to test the hypothesis that trandolapril would reduce all-cause mortality in post-MI patients with LV dysfunction when used in the majority of consecutively screened, potentially eligible patients.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients Consecutive patients ≥18 years of age who were hospitalized with a confirmed AMI were screened between day 2 and 6 after the onset of symptoms. All screen eligible patients underwent echocardiography and those with a wall motion index of ≤1.2, which corresponds to an EF ≤35%, were considered for enrollment. The key exclusion criteria included an absolute or relative contraindication to an ACEi or a definite need for an ACEi, severe uncontrolled diabetes, a serum sodium 2.3 mg/dl.Baseline characteristics The average age of patients was 68 years and 72% were men. Approximately one third of patients had a prior MI, 13% had diabetes, 23% had hypertension and smoking status was not listed. The average wall motion index was 1.0. Two thirds of patients had a Q wave MI (anterior 47% and inferior 19%). The mean time to randomization was 4.5 days. Forty-five percent of patients received thrombolysis. The average blood pressure and heart rate were 120/70 mmHg and 76 beats per minute, respectively. At the time of randomization 16% of patients were receiving a beta blocker and 28% digoxin. Before randomization, 60% of patients had been classified as Killip class ≥2 and at the time of randomization it was 21%.A total of 6,676 consecutive patients experienced an AMI of whom 2,606 had a wall motion index of ≤1.2. There was an inverse relationship between wall motion index and mortality. In patients with scores ≥1.3, 40% had signs of CHF and the 1-year mortality rate was 12%. Among patients with scores ≤1.2, 74% had signs of CHF and the 1-year mortality was 34%.Of the 2,606 eligible patients, 859 (33%) were excluded. The most common reasons for exclusion included need for mandatory ACE inhibition [6%], cardiogenic shock [4%], death during screening [3%], renal failure or a single kidney [2%], intolerance of the test dose of trandolapril [1%], lack of consent [8%], or other reasons [8%].Altogether, 1,749 (67%) of patients with a wall motion index score ≤1.2 were enrolled.Procedures Eligible patients were given a test dose of 0.5 mg of trandolapril, which led to the exclusion of 1% of patients. These patients were not included in the ITT analysis. Double-blind medication was started between day 3 and day 7 after AMI. Patients were randomly assigned to receive 1 mg of trandolapril once daily or matching placebo. After two days, the dose was increased to 2 mg once daily. After four weeks, the dose was again increased, to 4 mg once daily. If the highest dose was not tolerated, patients could continue with a dose of 2 mg or 1 mg once daily, but the drug was withdrawn if a dose of 1 mg once daily was not tolerated.Outpatient visits were scheduled one and three months after the infarction, with subsequent visits every three months. Echocardiography was repeated after 3, 6, and 12 months.The original protocol specified that treatment would continue for at least 12 months. When the results of the SAVE study were published in 1992, showing no survival benefit until after almost one year of treatment with ACE inhibitors, the steering committee decided (without any knowledge of the results of the study) to extend the closing date to 24 months after the last random assignment.Endpoints The primary study endpoint was all-cause mortality. Secondary endpoints were death from a cardiovascular cause, sudden death, progression to severe heart failure, recurrent MI, and change in wall motion index.The investigators estimated they would need a sample size of 1,500 patients to detect a 25% relative reduction in the risk of death with 80% power and 1-sided alpha of 2.5%. This was based on an estimated death rate of 30% at 12 months in the placebo group; however, the steering committee increased the sample size to 1,860 patients to allow for the possibility of a lower-than-expected placebo mortality rate.In the spring of 1992 the overall mortality of randomized patients followed for 1 year was 24%. Inclusion of patients was therefore terminated at the end of June 1992 at the point where 1,749 patients had been randomized.Results The final analysis included 1,749 patients; 876 in the trandolapril group and 873 in the placebo group.Information on the percentage of patients discharged on various doses of the study drug are not provided.Compared to placebo, trandolapril significantly reduced all cause death by 22% [(35% vs 42%; 95 percent confidence interval, 0.67 to 0.91 p = 0.001)}. The mortality curves diverged early (Kaplan–Meier estimate of mortality at one month 9% vs 11%) and continued to diverge throughout the follow-up period. Trandolapril also significantly reduced secondary endpoints, including death from CV causes, sudden death, and progression to severe heart failure but it did not significantly reduce reinfarction.Examination of subgroups showed no evidence of treatment effect heterogeneity for all cause mortality, but again, similar to the SAVE and AIRE trials, the size of TRACE limits subgroup testing.Premature withdrawals from study drug, not including death, occurred in 37% of patients in the trandolapril group compared to 36% in the placebo group. The most common reason for withdrawal was need for treatment with an open-label ACEi and this occurred more in the placebo group. Withdrawal due to cough, hypotension and reduction in kidney function were rare in both groups but slightly more common in patients on trandolapril compared to placebo.Conclusions In the majority (67%) of consecutively screened patients with AMI complicated by left ventricular dysfunction, trandolapril significantly reduced death over at least 2 years of follow-up with a number needed to treat of approximately 14 patients. Results from TRACE strengthen support for ACEi in post-MI patients, and the trial has high external validity. It not only tested the intervention in two-thirds of potentially eligible patients but was highly transparent about why patients were excluded. A clinician looking to apply the procedures used in TRACE to the management of patients in clinical practice would not have to guess whether or not their patient would have been included. This is rare in clinical research and the investigators should be applauded for their efforts.Investigators studying ACEi in post-MI patients have triangulated the population of patients who benefit from this therapy. In our opinion, TRACE provides the final piece to the puzzle. There is no doubt about the clinical efficacy of these drugs in the overwhelming majority of post-MI patients and higher risk patients stand to benefit the most.Thank you for reading Cardiology Trial's Substack. This post is public so feel free to share it. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

CardioNerds cofounder Dr. Amit Goyal and cardiology fellows from the Cleveland Clinic (Drs. Alejandro Duran Crane, Gary Parizher, and Simrat Kaur) discuss the following case: A 61-year-old man presented with symptoms of heart failure and left ventricular hypertrophy. He was given a diagnosis of obstructive hypertrophic cardiomyopathy. He eventually underwent septal myectomy, mitral valve replacement, aortic aneurysm repair, and aortic valve replacement with findings of Fabry's disease on surgical pathology. The case discussion focuses on the differential diagnosis for LVH and covers Fabry disease as an HCM mimic. Expert commentary was provided by Dr. Angelika Ewrin. The episode audio was edited by student Dr. Diane Masket. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - An Unusual Cause of Hypertrophic Cardiomyopathy – Cleveland Clinic Pearls - An Unusual Cause of Hypertrophic Cardiomyopathy – Cleveland Clinic Left ventricular hypertrophy is a cardiac manifestation of several different systemic and cardiac processes, and its etiology should be clarified to avoid missed diagnosis and treatment opportunities. Fabry disease is a rare, X-linked inherited disease that can present cardiac and extra-cardiac manifestations, the former of which include hypertrophic cardiomyopathy, conduction defects, coronary artery disease, conduction abnormalities, arrhythmias, and heart failure.  The diagnosis of Fabry disease includes measurement of alpha-galactosidase enzyme activity as well as genetic testing to evaluate for pathogenic variants or variants of unknown significance in the GLA gene. Family members of patients diagnosed with Fabry disease should be screened based on the inheritance pattern.   Multimodality imaging can be helpful in the diagnosis of Fabry disease. Echocardiography can show left ventricular hypertrophy (LVH), reduced global strain, aortic and mitral valve thickening, and aortic root dilation with associated mild to moderate aortic regurgitation. Cardiac MRI can show hypertrophy of papillary muscles, mid-wall late gadolinium enhancement and low-native T1 signal.   The treatment of Fabry disease involves a multi-disciplinary approach with geneticists, nephrologists, cardiologists, nephrologists, and primary care doctors. Enzyme replacement therapy can delay the progression of cardiac disease.    Show Notes - An Unusual Cause of Hypertrophic Cardiomyopathy – Cleveland Clinic What are the causes of left ventricular hypertrophy? LVH is extremely common. It is present in 15-20% of the general population, and is more common in Black individuals, the elderly, obese or hypertensive individuals, with most cases being secondary to hypertension and aortic valve stenosis. In general terms, it is helpful to divide the causes of LVH into three main groups: high afterload states, obstruction to LV ejection, and intrinsic myocardial problems. Increased afterload states include both primary and secondary hypertension and renal artery stenosis. Mechanical obstruction includes aortic stenosis, subaortic stenosis, and coarctation of the aorta. Lastly, several intrinsic problems of the myocardium can cause LV hypertrophy, such as athletic heart with physiological LVH, hypertrophic cardiomyopathy with or without outflow obstruction, and infiltrative or storage diseases such as cardiac amyloidosis, Fabry's disease, or Danon disease, among others.  How does Fabry disease present? Fabry disease is present in all races and is an X-linked lysosomal storage disorder caused by pathogenic variants in the GLA gene that result in reduced alpha-galactosidase enzyme activity,

This week we delve into the world of fetal cardiology when review a recent report from Nationwide Children's Hospital on the utility of fetal echocardiography in the setting of a negative obstetrical ultrasound and Down syndrome. Down syndrome is associated with congenital heart disease but can the obstetrical ultrasound effectively rule out 'critical' newborn heart disease, obviating the need for a fetal echo, particularly if a postnatal transthoracic scan is planned? Associate Professor of Pediatrics, Dr. Clifford Cua shares his thoughts on this provocative question and work. doi: 10.1007/s00246-023-03183-0.Epub 2023 Jun 23.

The following question refers to Section 4.3 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by Texas Tech University medical student and CardioNerds Academy Intern Dr. Adriana Mares, answered first by Rochester General Hospital cardiology fellow and Director of CardioNerds Journal Club Dr. Devesh Rai, and then by expert faculty Dr. Eldrin Lewis.Dr. Lewis is an Advanced Heart Failure and Transplant Cardiologist, Professor of Medicine and Chief of the Division of Cardiovascular Medicine at Stanford University. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #26 A 45-year-old man presents to cardiology clinic to establish care. He has had several months of progressive dyspnea on exertion while playing basketball. He also reports intermittent palpitations for the last month. Two weeks ago, he passed out while playing and attributed this to exertion and dehydration. He denies smoking and alcohol intake.   Family history is significant for sudden cardiac death in his father at the age of 50 years. Autopsy has shown a thick heart, but he is unaware of the exact diagnosis. He has two children, ages 12 and 15 years old, who are healthy.   Vitals signs are blood pressure of 124/84 mmHg, heart rate of 70 bpm, and normal respiratory rate. On auscultation, a systolic murmur is present at the left lower sternal border. A 12-lead ECG showed normal sinus rhythm with signs of LVH and associated repolarization abnormalities. Echocardiography reveals normal LV chamber volume, preserved LVEF, asymmetric septal hypertrophy with wall thickness up to 16mm, systolic anterior motion of the anterior mitral valve leaflet with 2+ eccentric posteriorly directed MR, and resting LVOT gradient of 30mmHg which increases to 60mmHg on Valsalva.   You discuss your concern for an inherited cardiomyopathy, namely hypertrophic cardiomyopathy. In addition to medical management of his symptoms and referral to electrophysiology for ICD evaluation, which of the following is appropriate at this time? A  Order blood work for genetic testing B  Referral for genetic counseling C  Cardiac MRI D  Coronary angiogram E  All of the above Answer #26 Explanation   The correct answer is B – referral for genetic counseling.  Several factors on clinical evaluation may indicate a possible underlying genetic cardiomyopathy. Clues may be found in: ·       Cardiac morphology – marked LV hypertrophy, LV noncompaction, RV thinning or fatty replacement on imaging or biopsy ·       12-lead ECG – abnormal high or low voltage or conduction, and repolarization, altered RV forces ·       Presence of arrhythmias – frequent NSVT or very frequent PVCs, sustained VT or VF, early onset AF, early onset conduction disease ·       Extracardiac features – skeletal myopathy, neuropathy, cutaneous stigmata, and other possible manifestations of specific syndromes In select patients with nonischemic cardiomyopathy, referral for genetic counseling and testing is reasonable to identify conditions that could guide treatment for patients and family members (Class 2a, LOE B-NR). In first-degree relatives of selected patients with genetic or inherited cardiomyopathies, genetic screening and counseling are recommended to ...