Year : 2020 | Volume
: 21 | Issue : 2 | Page : 57--59
Consultant Cardiologist, Department of Cardiology Heart Hospital, Hamad Medical Corporation Doha, Qatar
Dr. Uma Velupandian
Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha
|How to cite this article:|
Velupandian U. Cardiovascular News.Heart Views 2020;21:57-59
|How to cite this URL:|
Velupandian U. Cardiovascular News. Heart Views [serial online] 2020 [cited 2022 Dec 5 ];21:57-59
Available from: https://www.heartviews.org/text.asp?2020/21/2/57/288323
New Hope for Advanced Heart Failure Patients
On February 5, 2020, the US Food and Drug Administration made an announcement to grant the “breakthrough device designation” to Abbott for “fast tracking” the development of the new system of a fully implantable left ventricular assist system (FILVAS).
Mr. Robert L Kormos (medical director for mechanical circulatory support at Abbott) announced that this device allows the patients short periods of time (4–6 h) when they are not tethered to any external battery unit and is completely free. This is achieved by implanting both the battery and its controller units within the body. The battery can then be charged across the skin in a manner similar to the wireless charging for smartphones. Currently, the patients have to carry quite bulky battery and external controllers, wearing them on their body all the time.
Therefore, the new left ventricular assist device (LVAD; FILVAS) will give heart failure patients almost complete freedom from external paraphernalia, but at the same time ensure that there are safe methods of battery recharging and backups. The patients are, therefore, more likely to be able to lead near-normal lives with increased mobility and better quality of life.
The momentum is definitely picking up for advanced heart failure patients from the success of the MOMENTUM 3 trial which showed that heartmate-3 LVAD implant had 2-year survival of 79% comparable to heart transplant (82%).
With this new ray of hope, the future certainly looks bright for advanced heart failure patients.
Cath Lab Digest News 2020;28:2.
N Engl J Med 2019;380:1618-1627.
Acc Alert: Coronavirus Has Cardiac Implications, Especially in Existing Cardiovascular Disease
The American College of Cardiology released a bulletin on the cardiac implications of the coronavirus emphasizing the importance of advising patients with cardiovascular disease (CVD) on their potential increased risk for the virus. “2019-nCoV is a fast-moving epidemic with an uncertain clinical profile,” Madjid et al. wrote “Providers should be prepared for guidance to shift as more information becomes available.”
The coronavirus COVID-19 was first reported in late December 2019 and originated in Wuhan, China. Compared to SARS and MERS, coronavirus had higher infectivity and lower case fatality rate.
Several cardiac implications have been determined from case reports, including elevated risk for mortality, or complications from the coronavirus in patients with underlying conditions.
CVD or cerebrovascular disease, have been observed in 40% of patients hospitalized with a confirmed diagnosis of the coronavirus.
Nearly 20% of patients developed acute respiratory distress syndrome. In addition, 7.2% developed acute cardiac injury, 8.7% developed shock, 3.6% developed acute kidney injury, and 16.7% developed arrhythmias. Several unpublished first-hand reports also suggested that some patients who were diagnosed with the coronavirus developed myocarditis. As always, the cardiovascular patients must keep up-to-date with their pneumococcal and influenza vaccines.
ACC Clinical Bulletin. Feb 13, 2020.
The Noble and Excellent Choice for Patients With Left Main Disease? (Abstract from the Noble [The Nordic-Baltic-British Left Main Revascularization Study] Trial)
Percutaneous coronary intervention (PCI) is increasingly used in revascularization of patients with left main coronary artery disease in place of the standard treatment, coronary artery bypass grafting (CABG). The NOBLE trial aimed to evaluate whether PCI was noninferior to CABG in the treatment of left main coronary artery disease now report updated 5-year outcomes of the trial.
This was a large prospective, randomized, open-label, noninferiority trial, conducted at 36 hospitals in nine northern European countries. Patients with left main coronary artery disease requiring revascularization were enrolled and randomly assigned (1:1) to receive PCI or CABG.
One thousand two hundred and one patients were enrolled and allocated to PCI; 592 patients in each group were included in this analysis. Kaplan–Meier 5-year estimates of major adverse cardiac or cerebrovascular event (MACCE) were 28% (165 events) for PCI and 19% (110 events) for CABG (heart rate [HR] 1.58 [95% confidence interval (CI) 1.24–2.01]); the HR exceeded the limit for noninferiority of PCI compared to CABG. CABG was found to be superior to PCI for the primary composite endpoint MACCEs (P = 0.0002). All-cause mortality was estimated in 9% after PCI versus 9% after CABG (HR 1.08 [95% CI 0.74–1.59]; P = 0.68); nonprocedural myocardial infarction was estimated in 8% after PCI versus 3% after CABG (HR 2.99 [95% CI 1.66–5.39]; P = 0.0002); and repeat revascularization was estimated in 17% after PCI versus 10% after CABG (HR 1.73 [95% CI 1.25–2.40]; P = 0.0009).
In revascularization of left main coronary artery disease, PCI was associated with an inferior clinical outcome at 5 years compared with CABG. Mortality was similar after the two procedures, but patients treated with PCI had higher rates of nonprocedural myocardial infarction and repeat revascularization.
One cannot be fully swayed over toward the CABG side, though this study certainly leans toward it. The noble study emphasizes the need for a thorough heart team evaluation with the assessment of suitability for stenting or grafting and the overall surgical risk, and an individualized discussion with the patient on the benefits and risks associated with the two treatments to ensure that they are able to provide sufficiently informed consent.”
Gastrointestinai Bleeding on Oral Anticoagulants in Atrial Fibrillation May Be a Red Flag Sign for Cancer
An interesting study published in the European Heart Journal by Rasmussen et al. on February 7, 2020, raises a very important question about gastrointestinal (GI) bleeding in patients with atrial fibrillation (AF) treated with oral anticoagulation (OAC) therapy. Their aim was to investigate to what extent lower GI bleeding represents the unmasking of occult colorectal cancer.
A total of 125,418 Danish AF patients initiating OAC therapy were identified using Danish administrative registers. During a maximum of 3 years of follow-up, they identified 2576 patients with lower GI bleeding, of whom 140 patients were subsequently diagnosed with colorectal cancer within the 1st year of lower GI bleeding.
In all age groups, they observed high risks of colorectal cancer after lower GI bleeding. The absolute 1-year risk ranged from 3.7% (95% CI 2.2–6.2) to 8.1% (95% CI 6.1–10.6) in the age group of ≤65 and 76–80 years, respectively. When comparing patients with and without lower GI bleeding, they found increased risk ratios of colorectal cancer across all age groups, with a risk ratio of 24.2 (95% CI 14.5–40.4) and 12.3 (95% CI 7.9–19.0) for the youngest and oldest age group of ≤65 and >85 years, respectively.
They concluded that, in anticoagulated AF patients, lower GI bleeding conferred high absolute risks of incident colorectal cancer. Lower GI bleeding should not be dismissed as a benign consequence of OAC therapy but always examined for a potential underlying malignant cause.
Eur Heart Journal (2020) 0;1 – 7.
A Novel Contrast Agent for Magnetic Resonance Imaging
Researchers at the University of Texas at Dallas University are developing a new magnetic resonance imaging (MRI) contrast agent, a completely organic and biodegradable compound that would eliminate the need for heavy metals such as gadolinium in contrast agents.
The only class of contrast agents approved for use with MRI currently is based on the heavy metal gadolinium, which is typically excreted through a patient's urine after an MRI is completed. For patients with compromised kidneys (estimated glomerular filtration rate <30) who have difficulty excreting these contrast agents, gadolinium can accumulate in tissues and increase the risk of developing nephrogenic fibrosing sclerosis, a fatal condition.
Gassensmith et al. revisited a type of organic radical contrast agent (or ORCA), which is metal-free, less toxic to the body, and is highly biodegradable. Unfortunately, it is so biodegradable that it is impractical to use. Gassensmith et al. overcame this by attaching the thousands of ORCA molecules to thousands of docking sites on a tobacco mosaic virus. Since this is a plant virus, it cannot infect people or animals and is easily broken down by the liver because the virus is so large.
To protect the agent so that it would last long enough in the body, they wrapped each ORCA molecule in a cage of fabricated hollow chemical structures called cucurbiturils.
The cage and the contrast agent have no chemical bond, but the molecules stick together; nonetheless, this approach is called “supramolecular” chemistry, which makes the agent they created a smORCA – supramolecular macromolecular ORCA.”
The cage is constructed like a sieve so that water can reach the ORCA as MRIs use the water in the body to create an image. At the same time, the cage blocks larger molecules, such as ascorbate, that can inactivate the ORCA. In mice, the unprotected ORCA broke down within about 30 min, whereas the protected version provided more than 2 h of visible contrast.
How soon this ingenious innovative technology is introduced into clinical practice remains to be seen, but certainly, the new contrast on the horizon is bright for MRI.
Chem Sci 2020;11, 2045-2050.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.