Twitter Beğeni Hilesi

Note that RALES included patients with severe symptoms only (NYHA Class III and IV). Also see EPHESUS and EMPHASIS-HF Trials, which broadened the role of MRAs such as spironolactone to include class II symptoms as well👇 apps.apple.com/us/app/cardiac…

Mattman26 Steve Greene Circulation Duke Clinical Research Institute Javed Butler Harriette Van Spall, MD MPH Shelley Zieroth Muthu Vaduganathan Adrian “WE NEED RCTS!” Hernandez Alexandre Mebazaa Andrew J Sauer MD Alfonso Valle Henry Han HFrEF In DAPA-HF all-cause ☠️ ⬇️ was HR 0.83 (0.71-0.93) Incremental to background GDMT Rx + extended median survival 1-2 years In EMPEROR-R ☠️: was 0.92 (0.77-1.10) Meta-analysis ☠️: HR 0.87 (0.77-0.98) doi.org/10.1016/S0140-…

Routinely dialyzing patients with cardiorenal syndrome? This trial showed increased adverse effects and worsening renal function, rendering ultrafiltration a last resort in our arsenal against decompensated heart failure. CARRESS-HF Trial, NEJM 2012 ♥️

Localization and timing of STEMI on ECG #BacktoBasics

Aspirin for acute coronary syndrome? A well-established treatment today, with mortality benefit demonstrated first by this historic trial in unstable angina. Note that this trial predates ISIS-2 (1988) which evaluated aspirin specifically in MI. VA Cooperative Study, NEJM 1983 ♥️

SGLT2 Inhibition for heart failure? A landmark trial showing mortality reduction in HFrEF regardless of diabetes status. Originally a diabetes drug — with later proven cardiovascular and renal protective effects. EMPEROR-Reduced Trial, NEJM 2020 ♥️

Bringing together 🔑 cardiology principles 📚 E/e’ > 15 suggests elevated LA pressure In absence of MS, LA pressure = LVEDP Elevated LVEDP at rest or exertion is what defines heart failure Heart failure with: EF >50% = HFpEF, <40% = HFrEF, 40-49% = HFmrEF #fundamentals

PCI for non-flow limiting coronary lesions? This trial showed PCI in non-flow limiting but “vulnerable” coronary plaques prevents ischemic events — setting the stage for further research in this arena to expand the role of PCI in chronic CAD. PREVENT Trial, Lancet 2024 ♥️

Cardiac CT to detect plaque regression? This trial by Matthew Budoff MD used coronary CTA to show the mechanism of icosapent ethyl’s mortality benefit — via regression of unstable plaque — and set the stage for future trials to use cardiac CT in this arena. EVAPORATE Trial, EHJ 2020 ♥️

ECG Skills: Can you tell the difference between pericarditis and benign early repol on ECG? V6 ST/T height > 1/4 with pericarditis, < 1/4 with early repol Some other key features 📚👇 #meded

Thanks to X, I’m “attending” ESC24 without actually attending #ESC24

How does end organ damage from chronic hypertension manifest? … and how can we detect it? #ESC2024

Low dose dopamine to improve renal function in acute decompensated heart failure? Because clinical trials are equally important in showing us what does NOT work. ROSE Trial, JAMA 2013 ♥️

MRA in HFrEF RALES 1999 ⬇️ ☠️ HR 0.70 (0.60-0.83) p<0.001 EMPHASIS-HF 2010 ⬇️ ☠️ HR 0.76 (0.62-0.93) p=0.008 Class 1 in guidelines for HFrEF Cost of Rx ~$40 per year Use in routine US clinical practice in eligible patients without CI/intolerance in 2024? <40% 🚨🚨🚨🚨🚨

~~New trials added to Cardiac Trials~~ Nonsteroidal MRA for HFpEF? This trial showed finerenone to improve outcomes — a trial building upon a positive secondary outcome alone years prior in TOPCAT, and adding to our now growing arsenal for HFpEF. FINEARTS-HF Trial, NEJM 2024 ♥️

We’ve added four new practice-changing trials to the Cardiac Trials app, now totaling 8 new additions all published in 2024. Here’s to spreading evidence-based medicine worldwide 🌎

SGLT2 Inhibition in heart failure? This landmark study showed mortality reduction in HFrEF, mirrored by the EMPEROR-Reduced trial a year later. SGLT2 inhibition now carries class I indication as a part of HFrEF quadruple therapy. DAPA-HF Trial, NEJM 2019 ♥️