Category: Cardiovascular

Cardiovascular disease (CVD) claimed about 18 million lives in 2019. While obesity is traditionally associated with CVD, the extent to which this association is mediated by other health conditions linked to obesity remains unknown. A new study recently published in the International Journal of Obesity explores how obesity contributes to CVD by investigating this association in low-risk people. Study: Association of obesity with cardiovascular disease in the absence of traditional risk factors. Image Credit: BELLA KA PANG / Shutterstock.com Risk factors for CVD Traditional risk factors for CVD include an abnormal lipid profile, hypertension, diabetes, and smoking; however, people without any of these risk factors may still develop CVD at a higher rate than expected. Body mass index (BMI) and waist-height ratio (WHtR) are measures of obesity, both of which are associated with a higher risk of CVD. WHtR is a reliable measure of abdominal obesity and correlates better with CVD risk than waist circumference or waist-hip ratio. Despite this, conflicting findings from earlier studies have made it difficult to identify definitive associations between these measurements and CVD. Earlier research has also largely focused on obesity with traditional CVD risk factors, thus providing little clarity on whether obesity by itself is a predictor of CVD. Such clarity is required to shape prevention strategies at the population level for low-risk obese individuals. What did the study show? In the current study, researchers used both BMI and WHtR to evaluate how overall and abdominal obesity correlate with CVD risk in the absence of other risk factors Related Stories The study was based on a population-based cohort from the Kailuan study. This study included about 32,000 people, about two-thirds of whom were male, with a mean age of 48 years. All study participants were followed up for a median of 13 years. The mean BMI was 24 and mean WHtR 0.51. Older people, especially males, were more likely to be overweight or obese, have less education, and more risk factors. During this period, there were about 1,300 CVD cases. When classified by BMI into obese and normal-weight groups, the risk of CVD, particularly for stroke and myocardial infarction (MI), increased by 30%, 20%, and 60%, respectively, in the obese group. There were about 2.2 CVD events for every 1,000 person-years in the low-BMI group as compared to about four in the obese group. After compensating for confounding factors, the risk of CVD increased by 30% in the obese group as compared to the normal BMI group. For stroke, the risk was 20% higher in obese individuals. Comparatively, for MI, the risk increased by over 60% in obese individuals as compared to those with a normal BMI. In all cases, the risk increased linearly with the BMI. When categorized into obese and non-obese individuals by WHtR, a similar increase in risk was observed for CVD, stroke, and MI by 25%, 20%, and 60%, respectively in obese individuals as compared to non-obese groups. With about 2.3 CVD events for every 1,000 person-years in the non-obese group, there was a linear increase to 4.1 in the obese group, with the risk being 25% higher in obese individuals. WHtR increased with age. The strongest correlation of WHtR with CVD was observed in people under 60 years of age, who were at a 44% higher CVD risk and 37% higher risk for stroke. What are the implications? Our study suggests that BMI and WHtR are important influencing factors of CVD even in individuals without traditional risk factors.” These findings corroborate earlier studies, in which BMI was found to be an independent predictor of CVD risk. Some discrepancies such as a non-linear relationship between WHtR and CVD risk, with a steep rise in risk after a WHtR threshold of 0.5, might be due to the small sample sizes in many prior studies. It has been suggested that cardiac failure with preserved ejection fraction (CFPEF) may be caused by obesity, with a risk of myocardial fibrosis. The chronic inflammation in abdominal fat deposits associated with obesity causes changes in the secretion of multiple adipokines and cytokines. This may contribute to cardiovascular stiffness, vasodilation, and cardiac diastolic dysfunction. Another mechanism of heightened CVD risk in obesity is the activation of the renin-angiotensin-aldosterone system (RAAS). RAAS is pro-inflammatory under disease conditions and may lead to structural remodeling and, as a result, cardiovascular injury. The study findings emphasize the importance of controlling BMI and WHtR to prevent the development of CVD, even in individuals without traditional CVD risk factors. Given that the participants were from a coal-mining industry, which increases their risk of exposure to air pollution and stress, further research into the impact of these factors, as well as the role of dietary and physical activity patterns, is needed to ensure the generalizability of these findings. Journal reference: Luo, H., Liu, Y., Tian, X., et al. (2023). Association of obesity with cardiovascular disease in the absence of traditional risk factors. International Journal of Obesity. doi:10.1038/s41366-023-01408-z.

Share on PinterestResearchers say sitting for prolonged periods is detrimental to heart health. DZ FILM/Stocksy Researchers report that any activity is more beneficial to heart health than sitting, including sleeping. Experts say daily activity can help with blood pressure, glucose levels, and muscle strength. They say that even taking 5-minute walking breaks during the workday can be beneficial. Baseball great Satchel Paige famously said “Don’t look back. Something might be gaining on you.” In other words: keep moving. That’s the theme of a new study that states any activity — even sleeping — is better for the heart than sitting. Supported by the British Heart Foundation and published today in the European Heart Journal, the study’s authors say their research is the first to assess how different movement patterns throughout the 24-hour day are linked to heart health. The researchers say it’s the first evidence to emerge from the international Prospective Physical Activity, Sitting and Sleep (ProPASS) consortium. Cardiovascular disease — all diseases of the heart and circulation — is the number one cause of mortality globally, the researchers point out. In 2021, it was responsible for one in three deaths (18 million) worldwide, with coronary heart disease the single biggest killer. In their study, University College London scientists analyzed data from six studies, encompassing 15,246 people from five countries, to see how movement across the day is associated with heart health. Each participant wore a device on their thigh measuring their activity throughout the 24-hour day and had their heart health measured. Heart health was measured using six outcomes: body-mass index (BMI), waist circumference, HDL cholesterol, HDL-to-total cholesterol ratio, triglycerides, and HbA1c. The study identified behaviors making up a typical 24-hour day, with time spent doing moderate-vigorous activity providing the most benefit to heart health, followed by light activity, standing, and sleeping. All were compared with the adverse impact of sedentary behavior. The team modeled what would happen if an individual changed various amounts of one behavior for another each day for a week to estimate the effect on heart health for each scenario. They reported that when replacing sedentary behavior, as little as 5 minutes of moderate-vigorous activity had a noticeable effect on heart health. The researchers said for a 54-year-old woman with an average body mass index of 26.5, a 30-minute change translated into a 0.64 decrease in BMI, which is a difference of 2.4%. Replacing 30 minutes of daily sitting or lying time with moderate or vigorous exercise could also translate into a 2.5 cm (2.7%) decrease in waist circumference or a 1.33 mmol/mol (3.6%) decrease in glycated haemoglobin. “The big takeaway from our research is that while small changes to how you move can have a positive effect on heart health, intensity of movement matters,” Jo Blodgett, PhD, the study’s lead author and a researchers at the UCL Surgery & Interventional Science and the Institute of Sport, Exercise & Health, said in a statement. Blodgett added that the most beneficial change the team observed was replacing sitting with moderate to vigorous activity, which could be a run, a brisk walk, or stair climbing. “Basically any activity that raises your heart rate and makes you breathe faster, even for a minute or two,” she said. Although the authors said the findings can’t infer causality between movement behaviors and cardiovascular outcomes, this research does contribute to a growing body of evidence linking moderate to vigorous physical activity over 24 hours with improved body fat metrics. They also said more long-term studies will be crucial to better understanding the associations between movement and cardiovascular outcomes. Researchers said that although time spent doing vigorous activity was the quickest way to improve heart health, there are ways for people of all abilities to benefit. It’s just that the lower the intensity of the activity, the longer the time is required to start having a tangible benefit. They said using a standing desk for a few hours a day instead of a sitting desk, for example, is a change over a relatively large amount of time but is also one that could be integrated into a working routine fairly easily. The least active subjects were also found to gain the greatest benefit from becoming more active. “A key novelty of the ProPASS consortium is the use of wearable devices that better differentiate between types of physical activity and posture, allowing us to estimate the health effects of even subtle variations with greater precision,” Emmanuel Stamatakis, PhD, the joint senior author of the study and a professor the Charles Perkins Centre and Faculty of Medicine and Health at the University of Sydney, said in a statement. Dr. Cheng-Han Chen, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California, told Medical News Today there are many simple ways to add more steps to one’s day. “Take scheduled breaks throughout the day to take a short five-minute walk, either around the house or around the office; taking the stairs instead of the elevator, parking farther from the store and walking, and walking more briskly when shopping,” he advised. Chen said using stairs has multiple positive effects. “Walking upstairs is harder exercise than walking on level ground. That’s because not only are you moving your body, you’re moving it against gravity, and you’re essentially pushing yourself up and out,” he said. “You are also building your muscles in your lower body, strengthening your core, and your lower back.” “Climbing stairs is more difficult, you’re doing more exercise, and more exercise is better for you and your heart. We think that climbing stairs actually gives you three times as much exercise as the same amount of time walking on the ground,” Chen noted. Dr. Yu-Ming Ni, a cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in California, told Medical News Today that more activity leads to better blood pressure control. That, in turn, puts less strain on the heart over

Are you one of those who wake up early daily, get your kids ready for school, and rush to catch the train to work? And then, do you stay up late at night to finish your chores or pay your bills? The sleeping disorders If you answered yes, you are not alone. About one-third of Americans are in the same boat and get only five to six hours of sleep every night instead of the recommended seven to eight hours. But what you may not know is that even a slight and chronic lack of sleep can increase your risk of developing heart disease in the future: Surveys of thousands of people have shown that people who report mild but chronic sleep deficits have more heart disease later in life than people who get enough sleep.

Abstract There are reports of link of osteoprotegerin (OPG) gene polymorphism to type-2 diabetes (T2D) and hypertension (HTN). The objective of the study was to assess the allele frequency of OPG (rs2073618) gene polymorphism and its association with heart rate variability (HRV) and blood pressure variability profile as CVD risks in diabetes mellitus patients with hypertension undergoing treatment. T2D patients on treatment without hypertension (n = 172), with hypertension (n = 177) and 191 healthy volunteers were recruited for the study. Their blood pressure variability including baroreflex sensitivity (BRS), heart rate variability (HRV), OPG, insulin, lipid profile, receptor-activator for NFkB (RANK), receptor-activator for NFkB-Ligand (RANKL), and tumor necrosis factor-α (TNF-α) were estimated. Allele frequency of OPG (rs2073618) gene polymorphism was assessed from the DNA samples. BRS and HRV indices were decreased, and RANKL/OPG and TNF-α were increased in T2D and T2D + HTN groups, respectively compared to healthy control group. The reduction in BRS was contributed by increased inflammation and reduced SDNN of HRV in GG genotype in T2D + HTN. In GG + GC subgroup, it was additionally contributed by rise in RANKL/OPG level (β − 0.219; p 0.008). Presence of mutant GG genotype contributed to the risk of hypertension among T2D patients (OR 3.004) as well as in general population (OR 2.79). It was concluded that CV risks are more in T2D patients with HTN expressing OPG rs2073618 gene polymorphism. Introduction According to World Health Report 2002, cardiovascular diseases (CVD) will be the largest cause of death and disability by 2020 in India. Nearly half of these deaths are likely to occur in young and middle-aged individuals (30–69 years) especially who have diabetes and or hypertension or are genetically susceptible to develop diabetes and or hypertension1,2. Diabetes mellitus and hypertension are two major established risk factors for CVD3. Further, coexistence of hypertension with insulin resistance increases the risk of target organ damage and clinical cardiovascular accidents4. Nevertheless, not all patients with diabetes mellitus develop hypertension at least in the first 5 years5. However, a quite significant number of patients with diabetes develop hypertension quite early after acquiring the disease6. Genetic susceptibility for hypertension has been proposed to play important role in nearly 50% of insulin resistant individuals to develop hypertension, in the early phase of the disease even after receiving standard antidiabetic treatment7. Till date, no study has been conducted to assess the pathophysiological difference in the CVD risk profile of diabetes patients with or without having hypertension. Vascular calcification, a factor common to both CVD and hypertension is no longer considered as age related phenomenon8. Irrespective of the site and degree of involvement, the vascular calcification is a strong independent predictor of cardiovascular mortality9. The intimal calcification is associated with atherosclerosis while medial calcification seen in ageing is associated with arterial stiffening leading to reduced vascular compliance8. Arterial stiffening due to atherosclerosis accelerated by calcification is a known pathophysiological mechanism of hypertension10. Osteoprotegerin (OPG) is a biomarker of vascular calcification and associated with CVD. OPG is a decoy receptor for receptor-activator for NFkB-ligand (RANKL), which has been implicated in pathophysiology of CVD. OPG has also been linked to myocardial stiffness11, hypertension and diabetes12. Recently we have reported the link of OPG to CVD risk in diabetes13. The TNFRSF11B gene at 8q24.12 of chromosome 8 encodes OPG in humans. There are several reports of single nucleotide polymorphisms (SNP) for OPG gene, linked to DM and CVD14. Among these, the 1181 G > C SNP polymorphism has been particularly associated with CVD, left ventricular hypertrophy in essential hypertension15 and abnormal coronary arteries16. The rs2073618 of OPG is an exon variant with G > C transversion at exon 1. This leads to change in the third amino acid of the signal peptide from lysine (AAG), into asparagine (AAC). Polymorphism at exon region can influence splicing by affecting the binding sites of enhancers and silencers thus affecting protein level in circulation. However, studies relating RANK/RANKL/OPG level or associated gene polymorphisms in this pathway, in relation to blood pressure alteration, are scarce in Indian population. We hypothesize that any alteration in the levels of receptors such as RANK and OPG; their major ligands such as RANKL and TNF-alpha; or the corresponding allele polymorphism of OPG could play a pivotal role in insulin resistance associated hypertension and subsequent increase in CV risks in the Southern Indian (Tamil) population. Sympathetic nervous system (SNS) activation and retrograde inflammation are two major mechanisms in the genesis of hypertension17,18,19, insulin resistance20,21 as well as CVD22,23. Blood pressure variability (BPV) and heart rate variability (HRV) are two sensitive methods of measurements of CV risks in health and disease24,25,26. Decreased baroreflex sensitivity (BRS) an important parameter of BPV and decreased HRV as the marker of reduced cardiovagal modulation are the recently established indices of CVD risks in diabetes and hypertension. As BRS is influenced by mechanical properties of vascular wall, high vascular transmural pressure could alter the BRS and influences the autonomic regulation of blood pressure in diabetes with hypertension. Recently we have reported the plausible role of OPG in decreased cardiovagal modulation in diabetes13. Also, we have reported the link OPG with decreased BRS in patients with diabetes receiving oral anti-diabetic drugs27. However, the CVD risks has not been assessed in patients with diabetes with or without hypertension expressing SNP of OPG gene. Therefore, the primary objective of the study was to assess the allele frequency of OPG (rs2073618) gene polymorphism in diabetes mellitus patients under treatment with hypertension compared with similar age, gender and ethnicity matched diabetes patients without hypertension. Also, we have assessed the HRV and BPV profile as CVD risks and their association with gene polymorphism of OPG in these patients. Materials and methods Study design This was a single center cross sectional comparative study in the Southern Indian (Tamil) population consisting of three groups. The study was first approved by an institution research review board and the Ethics Committee (Human studies: JIP/IEC/2018/305) prior to commencement. Verbal approval followed by written informed consent was obtained from the participants before recruitment. Participants Participants were divided into three groups: control group, test

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The Food and Drug Administration (FDA) has granted 510(k) clearance for the SpotLight and SpotLight Duo computed tomography (CT) scanners that are specifically geared to cardiovascular assessments. In addition to a 25 cm field of view for dedicated cardiovascular CT scans, key benefits of the SpotLight system include best-in-class specifications for one beat whole heart coverage (14 cm), spatial resolution (0.5 mm detector) and temporal resolution (120 msec), according to Arineta, the developer of the SpotLight and SpotLight Duo scanners. “… The new SpotLight systems continue Arineta’s history of clinical innovation,” said Scott Schubert, the CEO of Arineta. “Our vision is to grow cardiac CT as the front-line non-invasive test for diagnosing, therapy planning and monitoring of cardiovascular disease, the number one cause of death and costs for healthcare worldwide.” Arineta said the SpotLight Duo offers whole organ acquisition with 4D imaging for enhanced visualization of vascular flow and organ motion. The SpotLight Duo also features 45 cm high resolution scans to facilitate full cardiothoracic CT assessments for conditions such as lung cancer, COVID-19 and other pulmonary diseases, according to Arineta.

Fewer patients with CLL experienced cardiac toxicity with Calquence than Imbruvica. Calquence (acalabrutinib) led to fewer treatment-related heart toxicities and an otherwise similar safety profile compared with Imbruvica (ibrutinib) when used to treat patients with chronic lymphocytic leukemia (CLL). These results were seen regardless if patients had cardiovascular disorders at the start of treatment, according to recent research. Data presented at the 2023 International Workshop on CLL demonstrated that the exposure-adjusted incidence rates of cardiac disorder events observed were consistently lower in the Calquence group compared with the comparator arms across the three individual trials regardless of grade. Although no distinct trend was noted among patients who presented with one or more baseline cardiovascular disorders, the number of events in this subgroup was limited. In the pooled comparator group (585 patients), incidence of any grade of cardiac disorder events were approximately twice as high to the pooled Calquence group (599 patients). Analysis of cardiac disorder events in patients who switched from other treatments to Calquence in the phase 3 ELEVATE-TN trial (72 patients) demonstrated a lower incidence of any-grade cardiac disorder events during the post-crossover period with Calquence compared with the pre-crossover period with comparator treatment. “This analysis does not suggest an increased risk of cardiac treatment-emergent adverse effects and outcomes in (Calquence)-treated patients, regardless of the presence of baseline cardiovascular disorders,” Dr. Rupal O’Quinn, of Perelman School of Medicine, and colleagues wrote in a poster presentation on the data. Although the first-generation BTK inhibitor Imbruvica has shown significant efficacy in the treatment of patients with CLL, it is associated with notable cardiac toxicity, including cardiac arrhythmias, cardiac failure and sudden death. In contrast, the next-generation BTK inhibitor Calquence offers a more favorable cardiovascular safety profile with fewer atrial fibrillation events compared with Imbruvica due to its selectivity. Given that the CLL patient population is inherently at higher risk for cardiac events due to factors like advanced age, polypharmacy, substantial comorbidities and pre-existing cardiac conditions, a comprehensive evaluation of cardiac toxicities associated with CLL therapies is imperative. In this longitudinal review, investigators conducted a comprehensive assessment of cardiac outcomes with Calquence compared to active comparator drugs, such as Imbruvica in patients with and without cardiovascular disorders at baseline. The analysis evaluated how CLL therapies affect cardiac health. Safety data were gathered from 3 randomized phase 3 studies: ELEVATE-RR, ELEVATE-TN, and ASCEND. Regarding patients’ treatment regimen, those on ELEVATE-RR received Calquence or Imbruvica, those on ELEVATE-TN were treated with Calquence with or without Gazyva (obinutuzumab) vs Gazyva plus chlorambucil, and patients in ASCEND received Calquence vs Zydelig (idelalisib) plus Rituxan (rituximab) or bendamustine plus Rituxan. A total of 1,362 patients who experienced 3,672 treatment-related side effects were identified from the clinical trial database. Demographic and baseline characteristics were similar between the Calquence and comparator arms in all three trials. Across all trials, 404 patients (29.7%) presented with at least one baseline cardiovascular disorder. The distribution of these baseline cardiovascular disorders was also comparable between the Calquence and comparator arms across the various studies. Specifically, 599 patients received Calquence monotherapy, 178 were treated with Calquence plus Gazyva, and 585 were treated with various comparators, including Imbruvica and other anticancer agents. Within the ELEVATE-TN and ASCEND trials, 72 patients who initially received Gazyva plus chlorambucil and 80 patients who were treated with Zydelig plus Rituxan or bendamustine plus Rituxan later transitioned to Calquence monotherapy. Notably, the median duration of exposure to BTK inhibitors administered continuously exceeded that of the comparator treatments across all studies. Regarding the incidence for baseline cardiac disorder events in patients without any baseline cardiovascular disorders, the results varied by trial. In ELEVATE-RR, the incidence associated with Imbruvica was two-times higher than that observed with Calquence (0.67 vs. 0.34). Meanwhile, the EAIR in ELEVATE-TN was numerically lower for both Calquence plus Gazyva (0.28) and Calquence monotherapy (0.25) vs chlorambucil plus Gazyva (0.59). In the ASCEND trial, Calquence demonstrated a numerically lower incidence (0.28) vs Zydelig plus Rituxan (0.44) and bendamustine plus Rituxan (0.54). These findings suggest a potentially favorable cardiovascular safety profile associated with Calquence. Pooled analysis revealed that the incidence of any-grade cardiac disorder events among patients without any baseline cardiovascular disorders was numerically lower in the pooled Calquence group (0.29) vs the comparator group (0.62). Patients in the pooled Calquence group with a baseline number of one, two or three or more cardiovascular disorders experienced any-grade incidence of 0.16, 0.05 and 0.05, respectively. Corresponding any-grade incidence in the pooled comparator arm were 0.22, 0.07 and 0.04. The most frequently occurring any-grade cardiac disorder in both groups was atrial fibrillation (Calquence group, 0.20; comparator group, 0.41). Other common any-grade PTs included palpitations (0.08; 0.12), cardiac failure (0.04; 0.08), tachycardia (0.04; 0.08), angina pectoris (0.06; 0.05), sinus tachycardia (0.01; 0.05), chronic cardiac failure (0.01; 0.04), myocardial ischemia (0.01; 0.04), acute myocardial infarction (0.01; 0.03), arrythmia (0.02; 0.03) atrial flutter (0.01; 0.03), cardiac arrest (0.00; 0.03), coronary artery disease (0.00; 0.03), mitral valve incompetence (0.00; 0.03), myocardial infarction (0.01; 0.03), pericarditis (0.00; 0.03) and sinus bradycardia (0.03; 0.03) Notably, the incidence of fatal events within the cardiac disorder category was three- to four-times higher in the pooled comparator group vs the pooled Calquence group. However, the incidence of fatal events did significantly increase in patients with one or more baseline cardiovascular disorder compared with those without baseline cardiovascular disorders (0.01 vs 0.06). Within the subgroup of patients without baseline cardiovascular disorders, the incidence of fatal events was three-times higher in the pooled comparator group compared with the pooled Calquence group. The overall incidence of fatal events remained low. In the ELEVATE-TN trial (72 patients), the incidence of grade 3 or greater (moderate to severe) events remained similar pre- and post-crossover, and only one fatal event occurred during the post-crossover period. However, among patients with no cardiovascular disorders at baseline, the incidence were similar pre- and post-crossover (0.44 vs 0.40). Conversely, the incidence among those who had one or more any-grade cardiovascular disorder at baseline was higher pre- vs post-crossover. Those

The changing business landscape of nuclear cardiology Discussions at the ASNC meeting examined several key business-related considerations for nuclear cardiology practices. Topics included how to grow your new nuclear cardiology lab; diversity, equity and inclusion session; and how to get start a positron emission tomography (PET) imaging program. Hendel said PET is the way of the future for nuclear cardiology because it offers better imaging and additional information on microvascular blood flow while it enables imaging for new types of cardiac conditions. He said PET offers advantages well beyond what is possible from single photon emission computed tomography (SPECT), the current workhorse nuclear cardiology technology. “The business aspects included an update on coding and reimbursement issues and how to develop a pro forma and recognize new expenses,” Hendel said. “I think the average nuclear cardiologist, especially those just maybe starting out and growing their laboratory, really haven’t been exposed to that. So this was sort of an introduction to at least give them some background.” While cardiologists are trained to diagnose, treat and care for patients, he said the transformation of the American healthcare system in recent years requires managers of cardiology departments to better understand the business side of operations. This is something most clinicians are not taught at universities. Addressing the squeeze on margins in cardiology One of the key drivers behind the focus on business aspects in nuclear cardiology is the evolving healthcare landscape in the United States. Reimbursements for cardiovascular imaging have been steadily declining, placing a financial squeeze on practices. There also have been major shifts in ownership of cardiology practices in recent years. “We’ve watched it transform from private practice to hospital based and hospital owned. And now we have a lot of private equity firms and venture capital dollars going in, which really transforms the landscape in terms of nuclear cardiology business profiles,” he explained. The pressure to maintain quality patient care while navigating these financial challenges has led to a growing interest in understanding how to maximize resources, optimize laboratory operations and reduce costs. “I think there’s a big squeeze. The margins, especially for cardiovascular imaging, have been drastically reduced. Some would say it’s not really worthwhile anymore. And also the transition from the reimbursement levels that let’s say a private practice got versus a hospital owned practice that’s different. And now with private equity, it’s a whole new ballgame,” Handel said. While patient care is paramount, he said cardiology is also a business, so resources cannot be wasted and departments cannot spend unnecessarily. There are also concerns in nuclear cardiology, where surveys of ASNC members have shown some practices are still using imaging systems and technology from the 1990s. New technology has greatly improved computed tomography (CT), echocardiography and cardiac MRI, but nuclear cardiology is being left behind with poorer imaging quality, less valuable clinical information and high radiation doses. Handel said one standout presentation at ASNC was on the venture capital infusion of dollars and private equity firms because they are willing to make the initial investments to modernize nuclear cardiology departments to keep them competitive. He said these changes taking place in ownership may offer opportunities to improve the imaging technology. “That’s really been a tough point for a lot of small practices and even small hospitals to go out and spend another half a million or a million or more for new equipment. But in terms of being able to afford a capital investments, it certainly does provide opportunities,” Hendel said. Coding and reimbursement challenges in nuclear cardiology One of the areas of concern discussed at the ASNC meeting was coding and reimbursement. While coding in nuclear cardiology has not seen significant changes in recent years, the reimbursement landscape has evolved, where it is expected that the levels of reimbursement between office-based imaging and hospitals will see more equalization. The session also stressed the importance of accurately completing American Medical Association (AMA) Specialty Society Relative Value Scale Update Committee (RUC) surveys they are sent. Hendel said these surveys tend to have very low participation, but are the tool used to determine reimbursement levels for physician relative value units (RVUs). “If people just throw the surveys out and don’t pay attention to them, we’re going to get what you expect, which is very little or it’s going to be negative. So you can’t whine about something if you don’t participate. So if you get a RUC survey, even though it seems pretty straightforward, please go ahead and do it, and do it fairly, so that we can maximize what we think is fair reimbursement,” Handel explained. He said this can include explaining the time to teach techs on how to do a better scan, reviewing the image processing, and watching the quality of your lab by performing cath correlations with nuclear cardiology studies. He said that should all be accounted. Prior authorizations and appropriate use criteria The challenges posed by prior authorizations have been another significant concern for nuclear cardiology practices. While prior authorizations aim to ensure the appropriate use of studies, they also can create administrative burdens. In response to these concerns, some states have implemented “gold carding” programs to exempt high-performing practices from the burdensome prior authorization process. At the federal level, the Prior Authorization and Accountability Act (PAMA) is currently on hold, with uncertainty about its future. This hold is because the Centers of Medicare and Medicaid Services (CMS) found requiring pre-authorization for all imaging exams created more work for doctors and was adding cost and frustration for hospitals. “A number of states have already moved forward with gold carding where if a practice or an individual is doing well and they’re performing at a high level with appropriate use of the studies and the technologies, then they don’t have to go through prior authorization every single time. And that’s what we’ve been advocating for a long time, and we’re seeing that now has traction,” Handel said. When prior authorization requests are denied, there is

Specialists at Cleveland Clinic have treated a hypertrophic cardiomyopathy (HCM) patient with a new gene therapy designed to reverse disease progression. This represents the first patient to receive treatment as part of the MyPeak-1 Phase Ib clinical trial, a first-in-human study sponsored by Tenaya Therapeutics. The trial intends to recruit at least six adult patients diagnosed with MYBPC3-associated nonobstructive HCM. Myosin binding protein C3 (MYBPC3) gene mutations are a common cause of HCM. The group hopes this new-look gene therapy, known as TN-201, can restore the patient’s MYBPC3 levels and eventually lead to disease reversal. The only other HCM treatments at this time are mavacamten, which the U.S. Food and Drug Administration (FDA) approved in 2022, and more invasive procedures such as septal myectomy and alcohol ablation. Cardiologist and cardiac imaging specialist Milind Desai, MD, director of Cleveland Clinic’s Hypertrophic Cardiomyopathy Center and vice chair of its Heart, Vascular and Thoracic Institute, is one of the trial’s primary investigators. Desai has years of experience studying potential HCM treatments and even presented data at ACC.22 on mavacamten’s safety and effectiveness before it had received FDA approval. He is also a paid consultant of Tenaya Therapeutics.

The gold markers, visible on X-ray imaging, have been perhaps the most publicized of the Evolut FX valve’s new features since the device first launched. In one recent study published in Circulation: Cardiovascular Interventions, for instance, researchers wrote that the radiopaque markers were able to help TAVR operators confirm commissural alignment during TAVR.[1] “This exciting milestone helps us continually enhance a trusted platform to better respond to clinicians’ needs making TAVR procedures easier to visualize and more predictable for heart teams,” Jeffrey Popma, MD, vice president and chief medical officer of Medtronic’s structural heart and aortic business, said in a prepared statement. “Receiving CE Mark for the Evolut FX system highlights our commitment to providing minimally invasive treatment options globally for patients experiencing severe aortic stenosis.” “With the latest Evolut FX system, we are elevating the precision, control and predictability of transcatheter aortic valve replacement procedures for patients with severe aortic stenosis,” added Danny Dvir, MD, director of interventional cardiology and cath labs at Shaare Zedek Hospital Canter in Jerusalem, Israel. “The system provides physicians with an innovative solution to meet the needs of a patient population desiring to get back to their active lifestyles sooner.” Now that Medtronic has gained this key approval, the company expects the Evolut FX valve to be commercially available throughout Europe in “the coming weeks.”