Year : 2021 | Volume
: 22 | Issue : 1 | Page : 1--2
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 2021;22:1-2
|How to cite this URL:|
Velupandian U. Cardiovascular News. Heart Views [serial online] 2021 [cited 2021 Jun 13 ];22:1-2
Available from: https://www.heartviews.org/text.asp?2021/22/1/1/314403
Alert: Face Masks can cause burns during Magnetic Resonance Imaging scans
Face masks can cause facial burns during magnetic resonance imaging (MRI) scans and this came to limelight after one reported case of a patient's face being burned in the outline of a mask that they wore during a 3-Tesla MRI neck scan. Following this, the US Food and Drug Administration (FDA) cautioned that face masks containing metal can heat to unsafe temperatures during scanning. This alert includes surgical masks, nonsurgical masks, and respirators. Metal parts, like nose pieces sometimes called nose clips or wires, nanoparticles (ultrafine particles), or antimicrobial coating that may contain metal (such as silver or copper), may become hot and burn the patient during an MRI. The FDA recommends patients wear face masks with no metal during MRIs.
The simplest way to prevent this problem perhaps would be for patients to be provided with a mask from the MRI unit which is definitely not known to contain any metal particles or nanoparticles. In the current COVID-19 era this may well become routine practice for most MRI centres.
FDA Safety Commission - US FDA Alert: Wear face masks with no metal during MRI Exams. Dec.7, 2020
First experience with completely leadless cardiac resynchronization therapy
A small, nonrandomized, retrospective investigational study opens up the possibility of performing cardiac resynchronization therapy (CRT) pacing (biventricular pacing) without any leads i.e. placing a leadless pacemaker in the right ventricle and another leadless pacemaker in the left ventricle (LV). This revolutionizes the future of cardiac pacing, Conventional CRT with a lead placed in the coronary sinus is the first-line choice for patients with symptomatic heart failure with persistent reduced LVEF and conduction disturbances, but 8% to 10% of CRT-eligible patients are unable to undergo the procedure because of anatomic constraints. Totally, leadless CRT can be delivered with a combination of Micra and WiSE-CRT systems. The authors described the technical feasibility and first insights into the safety and efficacy of this combination in European experience.
The authors concluded that, the Micra and the WiSE-CRT systems can successfully operate together to deliver total leadless CRT to a patient. Moreover, the WiSE-CRT system provides the only means to upgrade the large population of Micra patients to CRT capability without replacing the Micra.
EP Europace 2020 Published 13 Dec. 2020
Interventional Tricuspid Valve Repair – The Triluminate trial's first year outcomes are promising
There is growing awareness of tricuspid regurgitation (TR) as a relevant and increasing public health concern. Recent evidence suggests that TR is associated with increased morbidity and mortality, partly due to the development of right heart failure. It is an independent prognostic factor.
One-year outcomes of the TRILUMINATE trial of 85-patients, single-arm study, reported in the Journal of the American College of Cardiology show improved symptoms, function, and quality of life after clip-based transcatheter repair of the tricuspid valve.
At 1 year, tricuspid regurgitation was reduced to moderate or less in 71% of subjects compared with 8% at baseline (P < 0.0001). Patients experienced significant clinical improvements in New York Heart Association (NYHA) functional class I/II (31%–83%, P< 0.0001) and a 6-minute walk test (272.3 ± 15.6 to 303.2 ± 15.6 meters, P = 0.0023), and Kansas City Cardiomyopathy Questionnaire (KCCQ) score (improvement of 20 ± 2.61 points, P< 0.0001). Significant reverse right ventricular remodeling was observed in terms of size and function. The overall major adverse event rate and all-cause mortality were both 7.1% at 1 year.
The authors concluded that, transcatheter tricuspid valve repair using the TriClip device was found to be safe and effective in patients with moderate or greater TR. The repair itself was durable at reducing TR at 1 year and was associated with a sustained and marked clinical benefit with low mortality after 1 year in a fragile population that was at high surgical risk.
This trial will be followed by the ongoing 700-patient TRILUMINATE Pivotal Trial comparing the TriClip device with standard medical therapy in symptomatic patients who are at intermediate or higher risk for surgery and the open-label TRI-FR trial scheduled to start this month in Europe and will compare best medical therapy alone or on top of TriClip repair in 300 patients with severe tricuspid disease. Both trials scheduled to complete next year in 2022 and should give us useful insights to managing tricuspid regurgitation.
J Am Coll Cardiol.2021;77 (3):229-239
Increased incidence of Kawasaki's disease in children with COVID19 – Is there a beacon in site for demystifying the management of this SARS-CoV2 related disease?
Multisystem inflammatory syndrome in children, or MIS-C, is a complex syndrome associated with SARS-CoV-2, the virus that causes COVID-19. Children have presented with diarrhea, vomiting, and severe cardiovascular problems in addition to respiratory problems. Other symptoms include conjunctivitis, skin rash, swollen hands or feet, cracked lips and a red tongue – signs typically associated with classic Kawasaki disease, an inflammatory disease that can cause coronary artery aneurysms. Clinicians are significantly challenged when it comes to diagnosing and managing these patients, and predicting which children need hospitalization and who will become critically ill.
Johns Hopkins investigators, Prof. Shelby Kutty and Dr. Cedric Manlhiot, have been awarded a $4.8 million US dollar grant by the National Institutes of Health to design predictive models for multisystem inflammatory syndrome in children.
In partnership with the International Kawasaki Disease (IKDR), this study will pool data over two years from 40 other hospitals in the United States as well as hospitals in South America, France, Italy, the United Kingdom, Taiwan, and India, which will then be used to help create the algorithms employing artificial intelligence-based models for diagnosis, treatment, and outcome prediction. In the third and fourth years, the performance and clinical utility of these models will be validated in a predictive decision support system, adding real-time epidemiological surveillance data.
Johns Hopkins Medicine, News and Publication
Published on Jan. 14, 2021
Can ACEIs and ARBs be safely continued in COVID-19:– The Evidence is here at Last!
Since the start of the COVID-19 pandemic, this dilemma has always loomed in the minds of all clinicians especially cardiologists, i.e., how safe it is to continue angiotensin-converting enzyme inhibitor (ACEI) during acute SARS-CoV2 infection, and now we have some robust evidence to back up recommendations.
The BRACE-CORONA trial – the first randomized trial to address the question of whether patients with COVID-19 should continue to take ACEI or angiotensin receptor blockers (ARBs) – has now been published. This was a randomized clinical trial of 659 patients hospitalized in Brazil with mild to moderate COVID-19 who were taking ACEIs or ARBs prior to hospitalization. The primary outcome was the number of days alive and out of the hospital through 30 days. Secondary outcomes included death, cardiovascular death, and COVID-19 progression.
The median age of the patients was 55 years. Of these patients, 57.1% were considered to have mild cases at hospital admission, and 42.9% were considered to have moderate cases. Results showed no significant difference in the number of days alive and out of the hospital for patients in the discontinuation group (mean 21.9 days) in comparison with patients in the continuation group (mean 22.9 days) in comparison with patients in the continuation group (mean 22.9 days). The mean ratio was 0.95 (95% CI, 0.90 - 1.01).
There also was no statistically significant difference in deaths (2.7% of the discontinuation group vs. 2.8% for the continuation group); cardiovascular death (0.6% vs. 0.3%); or COVID-19 progression (38.3% vs. 32.3%). The most common adverse events were respiratory failure requiring invasive mechanical ventilation (9.6% in the discontinuation group vs. 7.7% in the continuation group), shock requiring vasopressors (8.4% vs. 7.1%, respectively), acute myocardial infarction (7.5% vs. 4.6%), new or worsening heart failure (4.2% vs. 4.9%), and acute kidney failure requiring hemodialysis (3.3% vs. 2.8%).
The authors concluded - these findings do not support routinely discontinuing ACEIs or ARBs among patients hospitalized with mild to moderate COVID-19 if there is an indication for treatment.
JAMA. 2021;325(3):254-264. doi:10.1001/jama.2020.25864
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