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Cardio NewsWire

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FDA approves first ARNi for heart failure on 7 July 2015

Action to tackle non-communicable diseases globally

Testing endurance athletes

Cardiac devices and smartphones in cardiology

NOAC treatment during AF ablation

ESC Grants available

ESC toolkit for cardiovascular nurses

2015 Arrigo Recordati Prize for Prevention

Tribute to Guido Tarone MD

Heartfailurematters.org now in Portuguese and Arabic

Hand grip strength predicts MI and CVA


Adolfo J de Bold’s 1981 pioneering discovery results in first ARNi drug approval for heart failure

The first drug in the class ARNi, a combination of an Angiotensin Receptor Blocker (valsartan) and a Neprilysin inhibitor (sacubitril) was approved by the U.S. Federal Drug Administration on 7 July 2015, after it had been demonstrated to reduce rehospitalisation rates and prolong life in patients with heart failure and reduced ejection fraction.

Adolfo J. de Bold discovered atrial natriuretic protein (ANP) in 1981 which he originally called atrial natriuretic factor whilst at Queen’s University, Kingston, Ontario, Canada. He found that an extract from the atrial muscle of rat hearts caused a rapid and profound increase in sodium and chloride excretion. This led to the PARADIGM-HF (Prospective comparison of ARNi with ACEi to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial which was closed early based on the strength of interim results.

Dr Eugene Braunwald, TIMI Study Group, Boston, USA, has stated, “the unambiguous superiority of clinical outcomes in patients with HFrEF by the first ARNi over enalapril in the PARADIGM HF trial represents a significant achievement with important clinical implications. Adolfo J. de Bold’s discovery places him among the most important cardiovascular scientists of the last 100 years”.



Policy statement from AHA, ESC, EACPR and ACPM

Experts call for ‘all hands on deck’ to tackle global burden of non-communicable disease. A policy statement from the American Heart Association, the European Society of Cardiology, the European Association for Cardiovascular Prevention and Rehabilitation and the American College of Preventive Medicine on the action needed to tackle non-communicable diseases (NCDs) on a global basis, has just been published, simultaneously in EHJ and Mayo Clinic Proceedings [1].

The authors propose that organisations at every level of society, from the family unit, to companies, to industry, to government and non-governmental organisations worldwide should collaborate to create, implement and sustain healthy lifestyle initiatives that will reverse the current upward trajectory of NCDs.

They say that identifying the enormous burden caused by NCDs is not enough and it is time to pursue strategies both within and outside traditional healthcare systems that will succeed in promoting healthier lifestyles in order to prevent or delay health conditions that cause the deaths of over 36 million people worldwide each year at a cost of at least US $6.3 trillion – that is projected to rise to $13 trillion by 2030.

Professor Ross Arena, of the University of Illinois at Chicago (USA), who was chair of the policy statement authors stated “The challenge is how to initiate global change, not towards continuing documentation of the scale of the problem, but towards true action that will result in positive and measurable improvements in people’s lifestyles.”

The experts call for a paradigm shift in the prevention and treatment of NCDs. “The importance of promoting and leading a healthy lifestyle must take a significantly more prominent role, from the individual/family to global population level, capitalising on all forms of preventive strategies. They propose that the treatment of NCDs should move outside of the traditional, often reactionary, healthcare model. Prevention is the key and preventive strategies at earlier stages in the community are best, for instance at the very beginning of life.

The paper identifies a number of barriers or challenges to implementing healthy lifestyles, and it suggests possible solutions. The authors conclude that they hope their paper will motivate organisations at all levels of society to: “1) Embrace their defined roles with respect to HL [healthy lifestyles] promotion and take action that will result in meaningful and positive change; 2) officially designate one or more healthy lifestyle ambassadors that have the organisational support needed to develop and implement HL initiatives; and 3) commit to ongoing communication amongst stakeholders that will result in collaborative HL initiatives.”

[1] “Healthy lifestyle interventions to combat non-communicable disease: a novel non-hierarchical connectivity model for key stakeholders. A policy statement from the AHA, ESC, EACPR and ACPM”, by Ross Arena et al.
Published simultaneously in:
Mayo Clinic Proceedings, doi: 10.1016/j.mayocp.2015.05.001
European Heart Journal. doi:10.1093/eurheartj/ehv207


Endurance athletes should have cardiac testing while exercising rather than at rest

New evidence published in the European Heart Journal [1] 3 June, has shown that important signs of right ventricular dysfunction which are potentially fatal can only be detected during exercise.

In this new study, Prof André La Gerche and his colleagues in Australia and Belgium have found that problems in the way the right ventricle works become apparent only during exercise and cannot be detected when an athlete is resting. La Gerche said: “You do not test a racing car while it is sitting in the garage. Similarly, you can’t assess an athlete’s heart until you assess it under the stress of exercise.”

The researchers tested cardiac performance in 17 athletes with right ventricular arrhythmias, 8 of whom had an ICD in place, 10 healthy endurance athletes and 7 non-athletes, using  invasive procedures such as cardiac MRI with intravascular catheters, and non-invasive methods e.g. echocardiography. They found that cardiac function at rest was similar in all three groups, as was left ventricular function during exercise. However, measurements during exercise showed changes in right ventricular function in the athletes who were known to have arrhythmias compared to the other two groups.
La Gerche said: “These results should stimulate cardiologists who manage athletes to pay greater attention to the right side of the heart. The tests that we describe are ready for clinical use now and are not too challenging. It is simply a case of ‘you will not find unless you look’.”

In an accompanying editorial [2], Prof Sanjay Sharma, of St George’s University of London (UK), who is medical director of the London Marathon and chair of the European Society of Cardiology’s sports cardiology nucleus, and Dr Abbas Zaidi, a research fellow at St George’s University of London, and a marathon runner, describe the study as “novel and important in several regards”. They write: “Importantly, assessment of the right ventricle should form an integral component of risk assessment in athletes presenting with potentially lethal rhythm disturbances. Until only recently considered to be a Pandora’s Box of spurious and detrimental public messages, the right ventricle and its potential for adverse remodelling is increasingly acknowledged to represent the true Achilles’ heel of the endurance athlete.”
[1] “Exercise-induced right ventricular dysfunction is associated with ventricular arrhythmias in endurance athletes”, by André La Gerche et al. European Heart Journal. doi:10.1093/eurheartj/ehv202
[2] “Arrhythmogenic right ventricular remodelling in endurance athletes: Pandora’s Box or Achilles’ heel?” by Abbas Zaidi and Sanjay Sharma. European Heart Journal. doi:10.1093/eurheartj/ehv199


Cardiac device wearers should keep distance from smartphones

Cardiac device wearers should keep a safe distance from smartphones to avoid unwanted painful shocks or pauses in function, according to research presented at EHRA EUROPACE – CARDIOSTIM 2015 by Dr Carsten Lennerz.

Pacemakers can mistakenly detect electromagnetic interference (EMI) from smartphones as a cardiac signal, causing them to briefly stop working. In implantable cardioverter defibrillators (ICDs) the external signal mimics a life threatening ventricular tachyarrhythmia, leading the ICD to deliver a painful shock.

Device manufacturers and regulatory institutions including the US Food and Drug Administration (FDA) recommend a safety distance of 15 to 20 cm between pacemakers or ICDs and mobile phones. The advice is based on studies performed primarily in pacemakers 10 years ago. Since then smartphones have been introduced, mobile network standards have changed and new cardiac devices are in use.

The study evaluated whether the recommended safety distance was still relevant with the new smartphones, networks and cardiac devices. A total of 308 patients (147 pacemakers and 161 ICDs, including 65 CRTs) were exposed to the electromagnetic field of three common smartphones (Samsung Galaxy 3, Nokia Lumia, HTC One XL) which were placed on the skin directly above the cardiac device.

The smartphones were connected to a radio communication tester, which works like a mobile network station. The investigators put the smartphones through a standardised protocol of the calling process which included connecting, ringing, talking and disconnecting. The actions were performed in GSM, LTE and UMTS at the maximum transmission power and at 50 Hz, a frequency known to influence cardiac implantable electronic devices. Electrocardiograms (ECGs) were recorded continuously and checked for interference.

More than 3,400 tests on EMI were performed. One out of 308 patients (0.3%) was affected by EMI caused by smartphones. This patient’s MRI compatible ICD misdetected electromagnetic waves from the Nokia and HTC smartphones operating on GSM or UMTS as intracardiac signals.

Lennerz said: ‘Interference between smartphones and cardiac devices is uncommon but can occur so the current recommendations on keeping a safe distance should be upheld. Interestingly, the device influenced by EMI in our study was MRI compatible which shows that these devices are also susceptible.’


Uninterrupted NOAC therapy during AF ablation is safe

Uninterrupted treatment with novel oral anticoagulants (NOACs) during catheter ablation of atrial fibrillation (AF) is safe, according to research presented at EHRA EUROPACE – CARDIOSTIM 2015 by Dr Carsten Wunderlich.

The observational study included 549 consecutive patients with drug refractory AF who were scheduled for catheter ablation with pulmonary vein isolation at the Heart Centre Dresden. A total of 233 patients were taking a vitamin K antagonist and 316 patients were taking a NOAC. Patients continued to take their prescribed anticoagulation medication without missing any doses. After the procedure echocardiography was performed to exclude pericardial effusion and patients were followed up for six months.

No patients in either group experienced a stroke or systemic embolism. There was one pericardial effusion in the vitamin K antagonist group and two in the NOAC group. Three NOAC patients had an arteriovenous fistula compared to one on vitamin K antagonists. Pseudoaneurysms were experienced by seven patients on vitamin K antagonists and two on NOACs, while three NOAC patients had groin hematoma compared to four on vitamin K antagonists.

‘Our study suggests that NOACs can be continued during catheter ablation of AF without an increased risk of periprocedural bleeding or thromboembolism,’ said Wunderlich. ‘Importantly, pericardial effusions in the NOAC group did not require specialised treatment.’

He added: ‘The results of our observational study suggest that continuous NOACs are as good as continuous vitamin K antagonists during ablation of atrial fibrillation. Our study was conducted in a high volume centre with heart surgery on site and experienced physicians doing about 1,200 ablations a year. In clinical practice we do not stop NOACs before an ablation and this is a good approach for experienced centres but I would not recommend it for all hospitals. This is a single centre experience and a randomised trial is needed before firm conclusions can be drawn.’


ESC Grants available summer 2015

1. Young basic scientist wanting to get connections abroad?

The Council on Basic Cardiovascular Science encourages young scientists within Europe to establish research links by visiting institutions abroad. Apply for the ESC First Contact Initiative Grant by 15 July 2015

2. EACVI Training & Research Grants

The EACVI offers research & training grants to help young candidates in obtaining experience in a high standard academic centre in an ESC member country, other than their own
Don't miss the opportunity to get specialised training or research in a non-invasive cardiovascular imaging technique!

Application deadline: 30 September 2015


New ESC toolkit for cardiovascular nurses and allied professionals

The ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP) launched its online toolkit during its Annual Congress EuroHeartCare 2015 weekend in Dubrovnik, on 14-15 June. Composed of videos, webcasts, presentations and educational tools, this toolkit aims to help Nurses in implementation of ESC Guidelines. This new initiative is an educational and motivational aid to nurses and allied professionals working in clinical practice.

The toolkit is part of the CCNAP Guidelines Implementation Programme which also includes a survey to evaluate knowledge of Nurses and Allied Professionals in Guidelines Implementation.


Salim Yusuf and John McMurray share renowned Prize

John McMurray and Salim Yusuf

Salim Yusuf MD and John J V McMurray MD shared the 2015 Recordarti Prize of €100,000.00 at an award ceremony during the European Society of Hypertension Annual Meeting 13 June 2015, in Milan, Italy.

The eighth edition of the Arrigo Recordati International Prize for Scientific Research recognized a clinical or basic science investigator who had achieved distinction in the study of secondary prevention and risk reduction strategies for patients with cardiovascular diseases.

In his acceptance speech Salim Yusuf spoke of his early career at Oxford, UK, which brought about the groundbreaking knowledge, that simple aspirin and beta blockers had a profound effect on reducing the mortality of acute myocardial infarction.

The Arrigo Recordati International Prize for Scientific Research was established in 2000 and is a legacy in memory of the Italian pharmaceutical entrepreneur Arrigo Recordati. It is awarded every two years to a scientist who has demonstrated dedication to the advancement of scientific knowledge in cardiology. 


Guido Tarone MD tribute

Guido Tarone

Guido Tarone, the current chair of the WG Myocardial Function, passed away on May 17 2015 at age 63. A bicycle accident took him away too soon from his beloved family, his students and his colleagues.

Guido was an integral member of the small European community of true basic scientists that entered the field of translational science in cardiology. He was associated with EU networks and together with his group in Turin, Italy, was one of the key partners to enthusiastically promote interactions and cooperation between the European groups.

Guido contributed substantially to ESC and HFA activities. He initiated and contributed to position papers, summer schools, workshops. He was as Chair of the WG on Myocardial Function appointed to the office at the ESC meeting in 2014. Guido organized the 2015 annual meeting of the WG on myocardial function together with HFA and the WG on Cell biology in Varenna, Italy, early in May. It was a great meeting, with a new format giving a lot of room to young scientists. It is a great tragedy that now we have to announce his unexpected demise which was an incredible shock.

His inspiring attitude towards science assures that his thoughts will be pursued. During his career he inspired, formed and influenced countless researchers. His personality left a strong imprint as well: Guido was not only a talented scientist, he was also a person with exquisite gentle manners and great humanity. He will be remembered for his warmth and for his kind, open mood. He showed how science requires inspiration and excitement but also independence of thought.

With his scientific work he pioneered our understanding how the heart sensitizes mechanical strain. His work focused on how interaction of cardiac muscle cells with the extracellular matrix could become novel therapeutic targets.
We will never forget Guido, he lives on in our hearts.

Johann Bauersachs, FESC, FHFA, Past Chair WG Myocardial Function
Stephane Heymans, Vice Chair WG Myocardial Function


Heartfailurematters.org now in Portuguese and Arabic

Heartfailurematters.org is a website created by the Heart Failure Association of the ESC and designed to provide easily understood and practical information about living with heart failure for patients, their families and carers. The site was developed by heart failure specialists, nurses and primary care physicians with input from patients and caregivers from across Europe. It is presented in 6 sections:

  • Understanding Heart Failure,
  • What can your doctor do?
  • What can you do?
  • Living with Heart Failure,
  • For caregivers,
  • Warning Signs

And also provides useful downloadable tools.  Tailored information is delivered not only in the text, but also by real-life videos of patients discussing the common issues faced by these patients. In addition, the site includes a number of original and captivating animations of the heart showing how the heart works, what goes wrong in heart failure and how treatments can improve symptoms and quality of life.

The site, based on a platform at the IT dept. at the European Heart House, receives over 140 000 visits per month. It is accessed from all over the world, due to the fact that the entire site is translated into 9 languages: English, Spanish, German, French, Dutch, Greek, Russian, Portuguese/Brazilian and Arabic. The site is also currently being translated into Swedish.
An animated guide helps visitors navigate through the site in all languages. Feedback from patients and healthcare professionals on the comprehensive but patient-friendly information is extremely positive and the site is regularly updated and reviewed by an active core group with representatives from each language.

Emphasis is placed on helping patients understand their condition and on providing practical advice for living with heart failure. The value of the site as an educational tool is currently being evaluated by a large randomised trial in the Netherlands. This attractive, web-based tool is an indispensable information resource as part of a treatment programme.

It is also employed by cardiologists, nurses and primary care physicians to provide information and educate patients living with heart failure.

Visit Heartfailurematters.org

Hand grip strength predicts MI and stroke

Weak hand grip strength is linked with shorter survival and a greater risk of myocardial infarction or stroke, according to the PURE study.

Reduced muscular strength, which can be measured by grip strength, has been consistently linked with early death, disability, and illness. But until now, information on the prognostic value of grip strength was limited, and mainly obtained from select high income countries.

The Prospective Urban-Rural Epidemiology (PURE) study included nearly 140,000 adults and was conducted in 17 countries of varying incomes and sociocultural settings. Grip strength was assessed using a handgrip dynamometer and subjects were followed for a median of four years.

The researchers found that every 5kg decline in grip strength was associated with a 16% increased risk of death from any cause, a 17% greater risk of cardiovascular death, a 17% higher risk of non-cardiovascular mortality, a 7% increased risk of heart attack and a 9% higher risk of stroke.

The associations persisted even after adjusting for age, education level, employment status, physical activity level, and tobacco and alcohol use.

Grip strength was a stronger predictor of all cause and cardiovascular mortality than systolic blood pressure.

Read the paper in The Lancet


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