A new ground-breaking technology was recently used at the University of Ottawa Heart Institute (UOHI) where two cardiologists, Dr. David Birnie and Dr. Pablo Nery, implanted anew innovative leadless defibrillator, the subcutaneous implantable cardioverter defibrillator (S-ICD), to a 18year-old patient. Under Health Canada
Surgeons at Boston Children’s Hospital have successfully implanted a modified version of a expandable prosthetic heart valve in several children with mitral valve disease. Unlike traditional prosthetic valves that have a fixed diameter, the expandable valve can be enlarged as a child grows, thus potentially avoiding the repeat valve replacement surgeries that are commonly required in a growing child. The new paradigm of expandable mitral valve replacement has potential to revolutionise care for infants and children with complex mitral valve disease.
The surgical team, led by Sitaram M. Emani, MD, and Pedro J. del Nido, MD, of the Department of Cardiac Surgery at Boston Children’s, have summarised their outcomes with two patients.
The care of patients with disease of the mitral valve
Using an endoscope to guide the removal of leg veins used in heart surgery is as safe as using large, ankle-to-groin incisions, according to a study by Duke University Medical Center researchers.
The data shows the two procedures have similar mortality rates after three years. The endoscopic method has lower rates of infection and wound complications. Today
On 14 February 2012, the German Institute for Quality and Efficiency in Health Care (IQWiG) published the results of a literature search for evidence-based clinical practice guidelines on the treatment of people with heart failure. The aim of the report is to identify those recommendations from current guidelines of high methodological quality that may be relevant for the planned revision of the module ‘heart failure’ in the disease management programme (DMP) for coronary heart disease (CHD). According to the results of the report, there is no compelling need for revision of any part of the DMP module. However, IQWiG identified several aspects that could be supplemented and specified.
Evidence was documented in detail
One of the responsibilities of IQWiG specified by law (Social Code Book V, SGB V) is to develop and issue recommendations for DMPs. It is first of all the Institute’s aim to identify differences between guideline recommendations and the DMP. The Federal Joint Committee (G-BA) then examines these differences and decides on whether they should actually lead to a revision of the DMP.
In the commission now completed, which was awarded by the G-BA, IQWiG systematically searched for new guidelines, assessed their methodological quality, and extracted relevant recommendations on the diagnosis and treatment of heart failure. In addition, the Institute documented how highly the guideline authors graded the robustness of the recommendations. However, the sources of the recommendations were not examined again; this is where IQWiG’s guideline appraisals and benefit assessments differ.
A total of 27 German and international guidelines containing recommendations on the treatment of people with heart failure were included. As the analysis showed, the recommendations are, by and large, consistent with the specifications of the DMP. No contradictions in content concerning the DMP requirements were found. The Director of IQWiG, Professor Dr med. J
Cardiologists at Washington University School of Medicine in St. Louis have developed a non-invasive imaging technique that may help determine whether children who have had heart transplants are showing early signs of rejection. The technique could reduce the need for these patients to undergo invasive imaging tests every one to two years.
The invasive imaging test, a coronary angiogram, involves inserting a catheter into a blood vessel and injecting a dye to look for dangerous plaque on the walls of arteries feeding blood to the heart. This plaque build-up indicates coronary artery disease and is a sign that the body may be rejecting the new heart. Since pediatric heart transplant patients are at high risk of developing coronary artery disease, doctors monitor their arteries on a regular basis. But recurring angiograms become problematic.
‘Many of these children have undergone so many operations, we have lost access to their big blood vessels,’ says Charles E. Canter, MD, professor of pediatrics. ‘Sometimes it
Transplant patients are among those at highest risk of adverse outcomes when receiving a stent to address a blockage in an artery. Compared with the general public, these patients have a much higher rate of restenosis, a side effect of stenting in which the artery becomes re-blocked because of an exaggerated scarring process at the stenting site.
New research by UCLA researchers and colleagues has found that heart transplant patients who develop restenosis after receiving a stent have poor long-term survival.
‘The findings point to the need for improvements in prevention and treatment of transplant coronary artery disease that may help reduce restenosis for patients who require later cardiac procedures like stenting,’ said Dr. Michael Lee, an assistant professor of cardiology at the David Geffen School of Medicine at UCLA.
A stenting procedure begins with an angioplasty, in which a catheter is placed in an artery of the groin and a tiny wire is snaked up through the artery to the blocked area of the heart. The clogged artery is cleaned out, and then a stent
In a world-first, researchers from Charite – Universitatsmedizin Berlin and the Max Delbruck Centre for Molecular Medicine (MDC) have performed cardiac MRI imaging using a 7T MRI scanner in a patient-based study. 7T MRI imaging is a powerful new technology that allows high resolution images of the beating heart, and has the capability to provide valuable information of the myocardial (heart muscle) tissue structures. Results of the study show that the technology allows the visualizing of very subtle changes of the myocardial tissue structure in patients with abnormal thickening of the heart muscle.
Cardiovascular magnetic resonance imaging (CMR) is turning into a key technology in the diagnosis of myocardial disorders. The method is constantly evolving, and is becoming capable of visualizing both healthy and diseased tissue in increasingly minute detail, even in a heart with normal function. It gives new insights in the heart muscle and assess myocardial damage, including in patients with hypertrophic cardiomyopathy (HCM), a genetically determined abnormal thickening of the heart muscle. 7T MRI imaging is expected to be powerful at visualizing tissue structure at the microscopic scale, including pathological changes and minute depressions. The full capabilities are under evaluation.
In clinical practice, cardiac imaging is performed using 1.5T and 3T MRI scanners. 7T MRI scanners, which constitute a further refinement of the technology, operate at a higher field strength, offering significantly improved resolution as a result. Most of these new scanners remain to be certified for routine clinical use, meaning that their use is limited to research applications; there are currently only five centres in the world capable of visualizing the beating heart using the 7T MRI technology. The biggest challenge of CMR imaging is the heart’s constant movement.
The research group led by Prof. Dr. Jeanette Schulz-Menger, Head of the Experimental and Clinical Research Centre’s (ECRC) Cardiac Outpatient Department. ‘Our aim was to test the potential of 7T MRI scanning in patients with hypertrophic cardiomyopathy, and to test whether the technology is capable of visualizing even the smallest morphological changes,’ explains the cardiologist who specializes in CMR. The researchers succeeded in detecting myocardial crypts’ – minute clefts or fissures which have so far been impossible to visualize in clinical practice in this location.
Their success was made possible as a result of close cooperation with a research group at the MDC’s Berlin Ultrahigh Field Facility (B.U.F.F.), which was led by Prof. Thoralf Niendorf. Together, the researchers compared data obtained from patients with abnormal thickening of the heart muscle who had undergone scanning using both a 7T MRI scanner with 2D CINE imaging and a 3T MRI scanner. The researchers also studied images obtained from healthy volunteers, and using the new generation of MRI scanners.
Following analysis, the researchers concluded that the use of 7T MRI gives new information in patients with hypertrophic cardiomyopathy. ‘In seven out of 13 patients, we were able to adequately visualize minute depressions in the myocardial tissue of the left ventricle,’ says the study’s first author, Dr. Marcel Prothmann. ‘The technology’s high spatial resolution constitutes a massive leap forwards in terms of imaging quality. It allows the precise visualization of structural changes within areas of extensive thickening,’ says Dr. Prothmann. High-resolution imaging may allow us to make more informed diagnoses when faced with a case of heart failure or another type of heart disease.
Charite – Universitatsmedizin Berlin
http://tinyurl.com/hr4b2rj
Even a single dose of a specific ribonucleic acid molecule, known as a small interfering RNA (siRNA), offers patients at high risk of cardiovascular disease long-lasting protection against high LDL cholesterol – one of the main risk factors for heart attack and stroke. This is the result of a clinical study by researchers from Charite and Imperial College London
As a component of cell walls and a building block of numerous hormones, cholesterol plays an important role in the cell’s lipid metabolism. However, too much LDL cholesterol in the blood results in an increased risk of atherosclerosis (hardening of the arteries) and problems such as heart attack and stroke. Patients suffering from a genetic disorder which causes very high levels of LDL cholesterol are at a particularly high risk. In these patients, a protein known as PCSK9 (proprotein convertase subtilisin/kexin type 9) prevents the liver from removing LDL cholesterol from the blood.
In their study, Prof. Ulf Landmesser, Head of Charite’s Department of Cardiology (Campus Benjamin Franklin), and Prof. Kausik Ray from Imperial College London, used the principle of RNA interference. The process, which was discovered a few years ago, uses RNA molecules (small interfering RNA) to inhibit the synthesis of harmful proteins. When double-stranded siRNA is introduced into a cell, it will bind to a molecule known as the RNA-induced silencing complex (RISC complex). This allows the process to be used in a targeted manner to silence specific genes.
In their study, the researchers investigated how effective and efficient a specific siRNA was at targeting the PCSK9 protein. A total of 501 high-risk patients with high LDL cholesterol levels received varying subcutaneous doses of either inclisiran or placebo. Results showed that inclisiran led to a significant reduction in levels of both the protein and LDL cholesterol, with LDL cholesterol levels being reduced by up to 41.9 percent after a single dose, and up to 52.6 percent after two doses.
‘It was particularly interesting to see just how sustained the effect of treatment was, with the effect of a single dose remaining apparent for a duration of over nine months,’ explains Prof. Ulf Landmesser. He adds: ‘The next step will be to further develop this treatment by conducting a large clinical outcome trial. We are hoping to test what might become a new type of therapy for the prevention.
Charite
www.charite.de/en/service/press_reports/artikel/detail/molecular_therapy_set_to_protect_at_risk_patients_against_heart_attack_and_stroke/
Researchers have discovered the molecular basis for the increased incidence of cardiovascular diseases in older women. The study found that older women had mitochondrial dysfunction, reduced antioxidant proteins, and increased inflammation.
Previous studies have shown sex differences in the age at which cardiovascular diseases occur. Ischemic heart disease, for example, develops on average seven to ten years later in women compared with men. It occurs three to four times more often in men than in women below the age of 60 years, but after the age of 75, most patients are women.
It is not clear why many women are protected from cardiovascular disease at a young age but are more susceptible after menopause. Estrogen levels may play a role but the mechanism is unknown. This study looked at molecular changes in the cells of the heart that happen with ageing, and how they differ between men and women.
Specifically, the researchers looked at healthy hearts to see if there are sex differences in mitochondrial function and inflammation during ageing. Heart tissue was obtained from seven women and seven men aged 17 to 40 years, and from eight women and nine men aged 50 to 68 years. The researchers measured levels of proteins involved in inflammation and in the function of the mitochondria.
The researchers found that the levels of Sirt1, a protein that is important for the function of the mitochondria, are higher in young women compared to young men. In the older hearts, Sirt1 levels had decreased in women but not in men. Expression of superoxide dismutase 2, an antioxidant protein in the mitochondria, was higher in young females than males but the difference was no longer present with age.
In addition, the expression of catalase, an enzyme that protects cells from oxidative damage, was higher in young females than males but again the difference was lost with age.
With age, female hearts shifted from an anti-inflammatory to a pro-inflammatory environment. Compared to young men, young women had higher levels of anti-inflammatory cytokines such as interleukin 10 – but this difference was lost with age. Levels of macrophages, which promote inflammation, increased with age in women but not in men.
Dr Maria Luisa Barcena De Arellano, scientific researcher, Institute of Gender Medicine, Charité University Medicine Berlin, Germany, said: “Our study provides a molecular explanation for the increased incidence of cardiovascular diseases in older women.”
European Society of Cardiology
https://tinyurl.com/y8zah7gn
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