Friday, 20 July 2018

Next-generation of MitraClip approved for use in the USA

Abbott has received approval from the US FDA for a next-generation version of its MitraClip heart valve repair device used to reduce mitral regurgitation. A press release reports that the transcatheter clip-based therapy, now on a third-generation of product innovations, has been used to treat more than 65,000 patients worldwide over the last 10 years.

The next-generation MitraClip system is designed to provide cardiologists with advanced steering, navigation, and positioning capabilities for the clip, making it easier to use in difficult anatomies. The enhanced system is aims to allow for more precise placement during deployment, resulting in more predictable procedures, and additionally offers a second clip size with longer arms that expands the reach of the clip-based device. The additional clip size is designed to help doctors treat patients who have more complex anatomies when repairing the mitral valve.

Abbott received CE Mark for the next-generation device earlier this year, allowing for sale of the devices in the European Union and other countries that recognize this regulatory designation. Francesco Maisano (UniversitätsSpital Zürich, Switzerland), who was an early implanter of MitraClip, comments: “Physicians rely on MitraClip as an alternative to surgery for patients who aren’t surgical candidates and may need treatment to relieve their symptoms or to survive. The enhanced MitraClip design allows for even more precise navigation, accuracy, and stability during valve repairs, which may be important when treating people with more complex or advanced valve disease.”

Prior to the availability of MitraClip, people who were not eligible for the standard-of-care surgery to treat their mitral regurgitation could only manage their symptoms with medications that don’t stop the progression of the disease. Left untreated, the condition leads to a variety of life-altering symptoms and severe complications, and may ultimately lead to heart failure and death.

Michael Dale, vice president for Abbott’s structural heart business, comments: “Abbott engineers designed these enhancements based on feedback from doctors to improve device delivery and to treat more types of cases and anatomies. We are committed to helping people with mitral regurgitation return to living their best lives, and these advances will enable doctors to treat even more patients without surgery.”

Abbott recently began enrolment in the MitraClip EXPAND clinical study, a prospective study evaluating the safety and performance of the new MitraClip system in a contemporary real-world setting. Saibal Kar (Smidt Heart Institute, Cedars-Sinai, Los Angeles, USA) treated the first patient enrolled, and is the lead investigator of the study. EXPAND will enrol approximately 1,000 patients in more than 50 centres across the USA and Europe; interim results from the study are expected later this year.

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Thursday, 19 July 2018

Four ways innovation can help to beat heart disease

A scientist using a petri dish
The statistics are staggering: non-communicable diseases (NCDs) account for 63% of deaths annually worldwide, and 80% of them occur in low- and middle-income countries, according to the World Health Organization.
 
NCDs are characterized by their long duration and slow progression, and impose substantial clinical and economic burdens on society. Saving lives and lifting financial strains requires an acceleration in the pace of drug discovery, then making those drugs affordable and accessible to patients everywhere. It takes approximately 10 years for a new medicine to make it to market, and each drug costs nearly $2.6 billion to develop. A sustainable approach to addressing cost and access must include fostering innovation to meet the evolving needs of patients globally. Some strategies to consider include:

• Laying out a consumer-centric, sustainable system that promotes value, affordability and innovation to create the most appropriate healthcare for all;

• Harnessing the collective impact of participant commitments by connecting like-minded stakeholders to pilot new disruptive models of care delivery and payment;

• Leveraging the collective data platforms and analytics of participant organizations to allow for evaluation of the models and their impact on patients across the health continuum; and

• Bringing together researchers, regulators and innovators to develop clinical trial designs that are more efficient and less costly, and capable of accelerating the introduction of medicines to market.



The traditional “one-drug, one-target” paradigm for drug discovery oversimplifies the underpinnings of disease. The capacity of high-performance computing to analyze multiple aspects of drug-target interactions is likely to be game-changing by reducing the time needed for drug development. Precision medicine could ultimately reduce the overall cost to the system by developing targeted and affordable medicines for patients.

As an evidence-based patient advocacy organization committed to health equity, the American Heart Association aims to ensure treatments are available, affordable and targeted.

To that end, the Association established the AHA Center for Accelerated Drug Discovery and partnered with Lawrence Livermore National Laboratory. Together, we are removing the guesswork from drug effectiveness by designing simulated environments for testing how drugs bind to their target proteins. Our aim is to reduce drug development time by up to 50%, as together we overcome the burden of drug discovery, cost and access.

Additionally, The AHA Institute for Precision Cardiovascular Medicine TM and Duke Clinical Research Institute’s data science team are working together to advance artificial intelligence and machine learning methods on its Precision Medicine Platform, powered by Amazon Web Services. Top scientists funded by DCRI grants are also developing state-of-the-art tools and data-harmonization methods to improve our ability to extract discoveries from data.

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Wednesday, 18 July 2018

Cardiac hybrid imaging is an effective tool for predicting myocardial infarction

According to a study published in Radiology, cardiac hybrid imaging with computed tomography (CT) and nuclear stress testing is an excellent long-term predictor of adverse cardiac events such as myocardial infarction in patients being evaluated for coronary artery disease.

Philipp A Kaufmann (University Hospital Zurich, Zurich, Switzerland) and colleagues looked at 428 patients who underwent hybrid imaging. During a median follow-up of 6.8 years, a total of 160 major adverse cardiac events—including 45 deaths—were observed in the final study population. Patients with matched findings (stenosis of 50% or more on CT angiogram with evidence of ischaemia on single photon emission tomography [SPECT] in the area of the heart to which the blocked vessel was supplying blood) had more than five times the risk of adverse events than those with normal findings. Patients with unmatched findings, or evidence of ischaemia but not in the area of the heart being fed by the stenotic artery, had three times the risk. Major adverse cardiac event rates were 21.8% for matched findings and 9% for unmatched—considerably higher than the 2.4% rate for normal findings.

The results show that cardiac hybrid imaging is an excellent long-term predictor of adverse cardiac events in patients evaluated for coronary artery disease. Kaufmann says that hybrid imaging findings could help guide treatment decisions, such as whether or not a patient should have a revascularisation procedure such as bypass or angioplasty. He comments: “In patients with multiple lesions or complex coronary anatomy, it is, in many cases, very difficult to correctly identify the culprit lesion. In a previous multicentre trial with hybrid imaging we were able to see that about one in five patients should be revascularised in another coronary artery than originally planned. The present study now documents the prognostic importance of the comprehensive assessment provided by hybrid imaging.”

The study supports CT angiography use for an initial, non-invasive evaluation of patients with known or suspected stable coronary artery disease. No additional imaging would be necessary if the results were normal. If a lesion was evident, then clinicians could employ a nuclear scan to assess ischaemia and take advantage of both modalities by fusing the results together to make a hybrid image.

“The strategy of direct referral to invasive coronary angiography without non-invasive imaging is obsolete. Even after documenting coronary artery disease with CT angiography, we need further non-invasive evaluation before deciding upon revascularization versus medication,” Kaufmann notes.

Kaufmann et al hope to run a trial to show that hybrid imaging can have a positive impact on patient outcomes. They are also looking at what they call “triple hybrid” imaging, which combines the CT angiography/SPECT hybrid with information on coronary artery shear stress. The shear stress information could help identify lesions that do not yet have an impact on ischaemia but will in the future.

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Friday, 13 July 2018

Did You Know About The Journey after Heart Transplantation

                          Did You Know About The Journey after Heart Transplantation

Taking a healthy heart from a deceased donor and replacing it with a diseased heart of a patient is known as a heart transplant surgery. Patients who have end-stage heart failure usually go through heart transplant surgery.

A damaged or weak heart results in a heart failure. Heart Transplant is required when the heart is no more able to pump the required blood through the body and all the medication is no more effective.

Overview

Heart transplant is a life-saving measure for end-stage heart failure.

Patients go through a selection process to get the heart from donors since the supply is very less. To receive a new heart patient’s heart must be in end-stage and patient should be in a healthy condition to receive it.

Over the past decade the survival rates have increased to 88 percent for the first year after heart transplant and 75 percent survive for 5 years.

It is seen that most of the patients who have gone through Heart Transplant, have returned to their normal day to day activities.

Process : Heart Transplant

First the patient is referred to the Heart Transplant Center where the doctors confirm that the patient’s heart is at end stage.

When the center confirms that the patient is healthy enough to receive the heart or undergo a heart transplant surgery then the patient is added to the transplant waiting list.

When a suitable donor is found then the patient undergoes Heart Transplant surgery. It is after the surgery that the patient needs to be taken care for life long. Doctors suggest a lifelong medical care plan and frequent health check-ups.

Heart Transplant : Who Needs It

Mostly patients who are referred to heart transplant centres are the one have end-stage heart failure. Their heart failure might have been caused by:
  • Hereditary conditions.
  • Coronary heart disease.
  • Viral infections of the heart.
  • Damaged heart valves and muscles.

Heart Transplant : Risks Involved

Heart transplant is a lifesaving method which revives a patient with new hopes and life. But it comes with many side effects and life risks. Patients are supposed to undergo lifelong medical check-up plans proposed by the doctors. Many associated risks can be eliminated by having frequent health check-ups.

The risks of having a heart transplant include:
  • Complications from medicines
  • Infection
  • Failure of the donor heart
  • Cancer
  • Problems that arise from not following a lifelong care plan after surgery
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Thursday, 12 July 2018

Did You Know These Facts About Heart Bypass Surgery !!

coronary artery bypass grafting cosmicseries





What is coronary artery bypass surgery?

Coronary artery bypass surgery or Heart bypass surgery, is a process of replacing the blocked arteries that supplies blood to a human heart muscle. The operating surgeon on the patient uses blood vessels taken from another part of the human body to fix the blocked arteries. 213,700 coronary bypass surgeries were performed by the doctors in the United States in 2011.

When the coronary arteries gets blocked or damaged, then this surgery is performed. The oxygenated blood is supplied to the heart muscle through these coronary arteries. Heart failure risks are there if the blood flow to the heart is blocked and heart muscle is not able to work properly.

Heart Bypass Surgery: Different Types
Depending on how many of the arteries are blocked the doctor will recommend a certain type of bypass surgery
  • Single bypass          :        Blockage of One Artery
  • Double bypass        :        Blockage of Two Arteries
  • Triple bypass          :        Blockage of Three Arteries
  • Quadruple bypass :        Blockage of Four  Arteries
Heart Bypass Surgery: When is it required?

When the cholesterol level increases in our body, it starts depositing on the walls of the arteries which results in the flow of less blood to the human heart. The heart’s primary pump, the left ventricle is the most affected one in such cases.
If the coronary artery gets much narrowed and there is a risk of heart attack then your doctor can advise bypass surgery for that.

Heart Bypass Surgery: How is it determined?

Whether a person is ready for open-heart surgery or not is determined by a group of doctors and a cardiologist. Medical conditions like diabetes, emphysema, kidney disease and peripheral arterial disease (PAD) which can complicate surgery where doctors may not go for open-heart surgery.

Heart Bypass Surgery: Alternatives

Nowadays there are many alternatives to Heart Bypass Surgery. More methods are available today as below:
  • Balloon angioplasty
  • Enhanced external counterpulsation (EECP)
  • Medications
  • Diet and lifestyle changes
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Wednesday, 11 July 2018

Your Heart May Be Suffering From CHD !

                                    coronary-heart-disease-cosmicseries-2018HCC

Narrowing of the coronary arteries refers to as Coronary heart disease in which blood vessels that supply oxygen and blood to the heart gets narrowed. It is one of the major cause of deaths globally.
When cholesterol starts accumulating on the artery walls, it results in Coronary Heart Disease (CHD). In such cases, the arteries get narrowed, which results in the reduction of blood flow to the heart. Many times a clot gets formed which obstructs the flow of blood to the heart muscle.

                                         coronary-heart-disease-2018HCC-cosmicseries

CHD results in chest pain, myocardial infarction, shortness of breath, or heart attack. One of the most common types of heart disease in the United States is CHD, almost 3-4 lakhs death occurs every year due to CHD.

Some Facts and Figures :
  • In 2008, 23.5 % of deaths were accounted for CHD in The US.
  • About 7.35 Lakhs Americans have a heart attack each year as reported by the Centres for Disease Control and Prevention (CDC),.
  • The initial symptoms or warnings include discomfort in breathing and chest pain.
  • Angina and Heart attack are examples of coronary heart disease.
Coronary Heart Disease :

The human fist and the human heart muscle are of the same size.  A human heart pumps the blood to the lungs, where it collects oxygen. The oxygen-rich blood is then pumped back to the heart and which is then pumped to organs throughout the body through arteries.
The de-oxygenated blood is then sucked back into the heart via veins to send it to lungs to oxygenate it.

Heart’s network of blood vessels are the coronary arteries. The coronary arteries cover the surface of the heart, and Coronary arteries are the one which supplies the heart muscle with oxygen. Once this gets narrowed, the heart muscle gets low oxygen-rich blood.

Initially, this may not lead to any symptoms but after sometime when the fat keeps depositing and the arteries path keeps getting narrowed, symptoms like chest pain starts arising.

Symptoms :
  1. Angina
The following are symptoms of angina:
  • Chest pain
  • Related symptoms
  • Stable angina
  • Unstable angina
  • Variant angina
  1. Shortness of breath (dyspnea)
  2. Heart attack
Prevention
  1. Dieting: Having fresh foods, vitamins rich foods and avoiding cholesterol-rich food helps a lot to avoid CHD.
  2. Workout: Have some physical activity in your daily activity at least of one hour daily. It increases the blood circulation which in result burns the body fats.
  3. People with CHD or diabetes should be in doctors regular touch and follow every instruction given by the doctor.
Sometimes Stay Hungry and Stay Healthy!

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Thursday, 5 July 2018

Look what Virtual Reality is to Offer for the Future o Cardiovascular Medicine

Virtual Reality Begins to Make Its Mark on Cardiovascular Medicine_0

Virtual-reality (VR) tools are on the verge of becoming more commonplace in cardiovascular medicine, according to a state-of-the-art review. Once hindered by bulky technology, recent advances in computing mean that physicians are having a chance to explore new approaches to education, procedural planning and visualization, and patient care.

“Importantly, head-mounted displays have become untethered and are light enough to be worn for extended periods of time, see-through displays allow the user to remain in his or her environment while interacting with digital content, and processing power has allowed displays to keep up with human perception to prevent motion sickness,” lead author Jennifer N.A. Silva, MD (Washington University School of Medicine, St. Louis, MO)

Silva told TCTMD that while “the equipment itself has evolved so quickly,” even now “some of these headsets are clunky, and they’re big. They’re even heavy.” But much like car phones evolved into the array of mobile devices we carry with us today she also added, “what we’re already starting to see is that the hardware pieces are undergoing rapid improvement. It’s really exciting to push the boundaries [with the new devices], again keeping the patient in mind as the focus of everything we do” that makes for a more user-friendly experience.

VR, which is fully immersive, exists on the continuum of “extended reality” that’s currently being developed and applied. On the other end of the spectrum is so-called augmented reality, where virtual objects appear against a true background on a see-through display but can’t be altered. In between are merged and mixed reality, where it’s possible to interact with virtual objects on the backdrop of the real world, either through an immersive display or a see-through display, respectively.

All of these have their pros and cons, Silva said. “What’s exciting for me is to find the technology matching the need. And when you see those two things match and match well, there is a way to see patients’ anatomies and interact with those anatomies that we’ve just never been able to do before. The clinician in me has to believe that that improvement is going to end up in some way leading to some improvement for my patient. The scientist in me believes that that’s going to lead to [better understanding of heart] abnormalities in a deeper, fuller way.”

The Stanford Virtual Heart Project, among other things, is using an immersive VR headset to help pediatric patients and their families better understand cardiac anatomy as well as to teach medical students.

For preprocedural planning, the EchoPixel system (EchoPixel) enables a user wearing specialized glasses to visualize and manipulate cardiovascular anatomy. It employs True 3-D, a US Food and Drug Administration (FDA)-approved display, that works much like 3-D movie theaters and televisions.

Getting VR into procedures, though, is what excites Silva more. “That’s probably where it’s going to be most impactful to patients, and at the end of the day, that’s the Holy Grail,” she said. “That’s what we’re all chasing: how do we improve the way we take care of people?”

Silva herself has been working on Project ĒLVIS, a VR approach to imaging in electrophysiology. The system “not only empowers the interventional electrophysiologist to visualize patient-specific 3-D cardiac geometry with real-time catheter locations, but also allows direct control of the display without breaking sterility, which is a key advance,”

Another system, known as Realview (Realview Medical Imaging), has been used in the cardiac cath lab to generate real-time 3-D holograms using rotational angiography and transesophageal echocardiography.

To TCTMD, Silva said that over the next year she expects more and more of these technologies to become commercially available, gradually trickling into the “communal wisdom” of cardiovascular medicine.

Know time to share your views after reading this article, Let me know whether VR will play a crucial part in Cardiovascular medicine in the furture ? Shoot me your Thoughts.

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