In the second episode of our series "Conversations about Hypertrophic Cardiomyopathy", Dr Ankur Kalra sat down with Dr Ahmad Masri to have a deep-dive into the management paradigms of hypertrophic cardiomyopathy (HCM), considering the evolution of medical therapy in recent years. Dr Ahmad Masri is a Cardiologist and the Director of OHSU Hypertrophic Cardiomyopathy Center.

This series is supported by an unrestricted educational grant from Bristol Myers Squibb. Please see www.camzyosrems.com for important safety information.

Dr Kalra invites Dr Masri to guide us through his decision-making process in evaluating medical and surgical options in patients with obstructive hypertrophic cardiomyopathy. Dr Masri delves into first and second-line treatment strategies while exploring the significance of FDA-approved cardiac myosin inhibitors in the management of hypertrophic cardiomyopathy. Dr Kalra asks Dr Masri about the practical office-based clinical course for patients deemed suitable candidates to receive mavacamten. Dr Masri provides a clear and practical outline of what it entails to opt for this second-line medical therapy including the REMS programme required for therapy (www.camzyosrems.com). Dr Masri highlights the importance of looking at HCM patients holistically to find the treatment which best fits their circumstances and preferences in choosing surgical and medical therapy options.

What are the available management options for patients with HCM? How does Dr Masri approach shared decision-making in the management of HCM? What are some of the practical considerations regarding the cardiac myosin inhibitor, mavacamten?

This content is intended for US-based physicians.

EP 96: Conversations about Hypertrophic Cardiomyopathy: Navigating HCM Management Paradigms

In the finale of our series "Conversations about Hypertrophic Cardiomyopathy", Dr Ankur Kalra welcomes, Dr Anjali Tiku Owens, for a dynamic and practical discussion.

Dr Owens is Medical Director of the Center for Inherited Cardiac Disease and Associate Professor of Medicine at the Hospital of the University of Pennsylvania.

This series is supported by an unrestricted educational grant from Bristol Myers Squibb. Please see www.camzyosrems.com for important safety information.

In this week’s episode, Dr Kalra and Dr Owens take us on a journey through the complexities of hypertrophic cardiomyopathy (HCM), with focus on the diagnostic challenges and breakthroughs in this field.
Emphasising with the critical importance of making accurate diagnoses, Dr Owens shares her insights into identifying the common mimickers of HCM through a structured approach starting with taking the patients history.
As the conversation delves deeper, Dr Owens discusses the various diagnostic tools and tests used to rule out other conditions and uncover the underlying aetiology. She navigates us through the algorithm for interpreting genetic test results, differentiating pathogenic variants, benign variants and variants of uncertain significance (VUS). Dr Owens talks about the wider implications for family members and the cases in which she recommends screening.
Dr Kalra asks Dr Owens about her approach to exercise in HCM patients. Additionally, they cover the debated topic of defibrillator therapy and the use of HCM Risk-SCD risk calculator.
Dr Owens provides an overview of the treatment paradigms for HCM, touching on haemodynamic classifications, symptomatology and the evaluation of sudden death risk.

What are the most common mimickers of HCM? What is Dr Owens and her heart team approach to decision making? What is the role of genetic testing in patients with HCM?

This content is intended for US-based physicians.

EP 97: Conversations about HCM: Differential Diagnosis, Genetic Testing & Patient-centric Therapy

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In this week's episode of Parallax, Dr Ankur Kalra's guest is Dr Craig R Smith, Cardiac Surgeon and Chairman of the Department of Surgery at Columbia Presbyterian Hospital.

In 2020, The Wall Street Journal called Dr Smith the pandemic's most powerful writer. Each day throughout the COVID-19 crisis, Dr Smith provided the faculty and staff with updates on pandemic response and priorities, offering both vital information and unwavering support. This month, Dr Smith released his book, 'Nobility in Small Things: A Surgeon's Path’.

In this inspiring episode, Dr Smith delves into the story behind his book and the motivating circumstances that led him to become an author. Dr Kalra asks Dr Smith about his experience as a leader during the pandemic as a surgeon. Dr Smith shares the story of his unconventional journey into medicine, emphasizing how hard physical labor built his resilience and prepared him for his residency. Dr Kalra also asks about Dr Smith's experience as a surgeon for President Bill Clinton in 2004. We learn more about some of the highlights of Dr Smith's book and his advice for listeners aspiring to become writers.

Nobility in Small Things is available for purchase here: https://us.macmillan.com/books/9781250278531/nobilityinsmallthings

Questions and comments can be sent to “podcast@radcliffe-group.com” and may be answered by Ankur in the next episode.
Guest: Dr Craig R SmithHost: @AnkurKalraMD and produced by: @RadcliffeCARDIO.

EP 102: Nobility in Small Things with Cardiac Surgeon, Dr Craig R Smith

On October 28th, 2023, the Canadian Cardiovascular Society (CCS) released a new classification system for acute atherothrombotic myocardial infarction (MI) based on stages of tissue injury severity (CCS-AMI). This expert consensus is the result of decades of data on acute MI with reperfusion therapy.

Dr Ankur Kalra is joined this week on Parallax by Dr Andreas Kumar, Chairperson of the Writing Group of the Expert Consensus Statement, Associate Professor of Medicine at the Northern Ontario School of Medicine, Cardiologist at Health Sciences North, and President of the Canadian Society of Cardiovascular MRI.

In this informative episode, Dr Kumar shares what led his team and the CCS to introduce a new classification scheme for acute MI. He discusses how research from the past 15 years highlighted the need to incorporate tissue changes resulting from acute myocardial infarction (MI) into clinical practice. Dr Kumar outlines the four stages of CCS-AMI, and we gain insight into how this novel classification scheme could impact bedside medicine.

Dr Kalra asks about treatment optimization based on stages of tissue injury severity. Dr Kumar delves into the risks associated with the four stages, with a particular focus on CCS Stage 4, MI with reperfusion haemorrhage. Finally, Dr Kumar highlights how the use of the classification system can lay the foundation for future research studies and bring us closer to finding answers and identifying agents suitable for different stages of acute MI.

What are the key messages from CCS-AMI? What are the data behind the new scheme? How might the new classification scheme impact the development of new treatment options?

Resources:

Kumar A, et al. The Canadian Cardiovascular Society Classification of Acute Atherothrombotic Myocardial Infarction Based on Stages of Tissue Injury Severity: An Expert Consensus Statement. CJC 2023. https://doi.org/10.1016/j.cjca.2023.09.020 

Gaba P & Bhatt DL. Promise of a Novel Classification System for Acute Myocardial Infarction. CJC 202. https://doi.org/10.1016/j.cjca.2023.10.011

Questions and comments can be sent to “podcast@radcliffe-group.com” and may be answered by Ankur in the next episode.
Guest: @AndreasKumarMD Host: @AnkurKalraMD and produced by: @RadcliffeCARDIO.

EP 103: CCS-AMI: New Classification for Acute Myocardial Infarction with Dr Kumar

In this week's Parallax, Dr Ankur Kalra welcomes back Dr Sukhjinder Nijjer for their much-anticipated annual review of advancements in cardiovascular medicine that defined the year 2023.

Dr Nijjer, a Consultant Cardiologist in the UK, serves as the President of the Royal Society of Medicine and is an Honorary Senior Clinical Lecturer at Imperial College London.

Drs Kalra and Nijjer share their perspectives and experiences, offering valuable insights, practical tips and considerations when interpreting this year’s most impactful trials:

•    ORBITA-2 (AHA Scientific Sessions): PCI for stable angina
•    FIRE (ESC Congress): Functional versus culprit-only revascularization in elderly patients with myocardial infarction and multivessel disease
•    DAPA-MI (AHA Scientific Sessions): SGLT2i in MI without diabetes or heart failure
•    ILUMIEN IV (ESC Congress): OCT vs angiography-guided PCI
•    OCTOBER (ESC Congress): OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions
•    ARTESIA (ESC Congress): Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation
•    SELECT (AHA Scientific Sessions): Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes

What are the most impactful cardiovascular trials of 2023? How do Dr Kalra and Dr Nijjer integrate the latest information into their daily practices?

EP 105: The Year 2023 in Review with Dr Sukh Nijjer

In the season 6 premiere of Parallax, Dr Ankur Kalra welcomes Dr Alex Carter, a Senior Lecturer at the London School of Economics and Political Science (LSE) Department of Health Policy. As the course director for the executive MSc in Health Economics, Policy & Management, Dr Carter delves into the origins and evolution of LSE's health economics program, showcasing its transformation in response to the challenges facing health systems in 2024.

The podcast embarks on an exploration of the program's three fundamental pillars: health economics, outcomes measurement, and management. Dr. Carter underscores the importance of efficiently allocating scarce resources, evaluating health system performance through population outcomes, and translating theoretical knowledge into practical application through leadership.

Dr Kalra asks Dr Carter about his work with the HyperMarker project, an EU-funded initiative that leverages big data analytics to optimize the prescription of antihypertensives and generate personalized treatment recommendations for patients with hypertension.

What do we gain by understanding health economics? How was one of the first health economics programs created? What is Dr Carter’s message to our listeners?

EP 106: Transforming Health Systems Through Economics with Dr Alex Carter

Join Dr Ankur Kalra on Parallax this week as he welcomes Dr Candice K Silversides, the first Editor-in-Chief of JACC: Advances.

Dr Silversides, a cardiologist and professor at the University of Toronto, wears many hats. She leads the Obstetric Medicine program and directs the Cardio-Obstetric clinic at Mount Sinai Hospital, while simultaneously steering JACC: Advances in its exciting early stages.

Dive into the unique synergy between her clinical practice and editorial leadership as Dr Silversides shares her vision for the journal. Learn how she navigates diverse responsibilities, manages peer reviews, and ensures fair evaluation of the submitted manuscripts. Get insights into launching a journal, from adapting to the needs of the readership and editorial board selection to time management. Dr Silversides joins Dr Kalra in exploring the evolving landscape of academic publishing, discussing the challenges and opportunities presented by AI and other advancements.

What does the future of academic publishing look like? What is the role of AI? What are the day-to-day tasks of an Editor-in-chief?

EP 107: JACC: Advances - Leadership & the Future of Publishing with Dr Silversides

In this week's Parallax episode, Dr Ankur Kalra welcomes Dr Haider Warraich, a cardiologist at Brigham and Women's Hospital. Dr Warraich is not only a Senior Advisor for Chronic Disease to the FDA Commissioner but also a prolific author, having written three books, including "Song of Our Scars: The Untold Story of Pain." He is a regular contributor to publications like the New York Times and the Washington Post.

During the conversation, we learn more about Dr Warraich's journey into medicine and his current role at the FDA, along with his passion for writing. Dr Kalra asks about how Dr Warraich manages his busy schedule and what it takes to write a book.

Dr Warraich openly shares his personal experience grappling with chronic pain, a pivotal event that not only influenced his career trajectory but also inspired his book "Song of Our Scars." Moreover, he discusses his role as a Senior Advisor to Dr Robert M Califf, offering insights into his day-to-day responsibilities within the FDA. The conversation also touches upon the agency's perspective on emerging technologies like artificial intelligence (AI).

How does writing complement Dr Warraich’s work as a physician? How did he become a senior advisor to Dr Robert M Califf at the FDA? What is his message to our listeners?

EP 108: Song of Our Scars: Authorship & Medicine with Senior Advisor for FDA, Dr Warraich

In this informative episode of Parallax, Dr Ankur Kalra is joined by Dr Andrew Darlington, an Advanced Heart Failure Cardiologist at Piedmont Heart Institute in Georgia.

Together, Dr Kalra and Dr Darlington delve into the significance of assessing volume status in patients with heart failure, highlighting its continued relevance in 2024, including the availability of new diagnostic tools, including the Heart Failure Management System (HFMS).

Dr Darlington shares his approach to taking a patient’s medical history and some of the cues he looks for during a physical exam and the art of assessing neck veins. Together, they explore diagnostic tools and technologies available to measure fluid volume, including HFMS and strategies for effectively communicating about the utility of this technology to patients with worsening heart failure.

Dr Darlington gives a comprehensive overview of the recent clinical data presented at ACC 2023 on the BMAD trial and how he uses HFMS in his own clinical practice.

This series is supported by ZOLL and is intended for Health Care Professionals.

EP 109: Navigating Volume Status in Heart Failure Patients with Dr Andrew Darlington

Dr Ankur Kalra’s guest this week is Dr Saraschandra Vallabhajosyula, Interventional and Critical Care Cardiologist, Assistant Professor of Medicine at the Warren Alpert Medical School of Brown University and the Director of the Cardiac Intensive Care Unit at Rhode Island Hospital, the Miriam Hospital and Lifespan Cardiovascular Institute. In this episode of Parallax, they delve into the latest insights from ACC.24 through the lens of five pivotal late-breaking trials.

Dr Vallabhajosyula offers a deep dive into the nuances of each study. Together, Dr Kalra and Dr Vallabhajosyula distil the complexities of these trials into key messages for practice, grounded in their own clinical experiences.

In the spotlight are five key trials:
1. DanGer Shock: Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock
2. RELIEVE-HF: Safety and effectiveness of the V-Wave® Ventura® Interatrial Shunt for the treatment of heart failure (HF)
3. PREVENT: Preventive PCI or medical therapy alone for vulnerable atherosclerotic coronary plaque
4. REDUCE AMI: Decreased usage of beta-blockers after acute myocardial infarction
5. ORBITA-COSMIC: Coronary sinus reducer for the treatment of refractory angina

Dr Kalra and Dr Vallabhajosyula dissect the practical implications of these trials, answering pressing questions and addressing emerging dilemmas. What are the key takeaways from ACC.24? How do these findings shape contemporary clinical practice?

EP 111: ACC 24 in Review With Dr Vallabhajosyula: 5 Trials That Will Change Your Practice

In this week’s Parallax, host Dr Ankur Kalra welcomes back Dr Jonathan Fisher, a cardiologist, organizational well-being leader, and bestselling author of Just One Heart: A Cardiologist’s Guide to Healing, Health, and Happiness.

In this compelling conversation, Dr Fisher shares his personal experience with burnout within the US healthcare system. He provides a concise overview of the roots of Western medicine's culture and the current epidemic of physician burnout and depression. Dr Kalra then invites him to explore solutions for reversing these negative trends and enhancing patient care. Dr Fisher discusses the workshops he leads, emphasizing core principles like positive attitude, compassion, connection, and teamwork. He also offers a sneak peek into his new book that extends the discussion to a wider audience.

Tune in for a rich discussion on the future of healthcare, well-being, and rediscovering the human connection at the heart of medicine.

Just One Heart: A Cardiologist’s Guide to Healing, Health, and Happiness is available to order here: https://www.amazon.com/Just-One-Heart-Cardiologists-Happiness-ebook/dp/B0D1526W7D

EP 112: Just One Heart: Burnout, Positive Mindset & Leadership with Dr Fisher

This week on Parallax, Dr Ankur Kalra welcomes Eric Radtke, Vice President at Worldwide Innovations & Technologies, Inc, and Barbara Breininger, a cardiovascular radiologic technologist and clinical manager with 26 years of experience.

This special episode dives deep into the crucial topic of radiation hygiene, exploring it from the perspectives of both manufacturers and users of radiation safety products.
Barbara Breininger shares her experiences traveling nationwide to educate healthcare professionals on radiation safety, emphasizing the need for collective awareness and best practices in cath labs.
Eric Radtke discusses the company's evolving focus on radiation safety, the origins of their initiatives, and the concerning impacts of radiation exposure as revealed by recent studies. We'll also explore practical steps to enhance safety and delve into the RADPAD tools that can shield interventional cardiologists and allied professionals from exposure.

How can we protect ourselves from radiation in the Cath lab? How can we raise awareness of radiation hygiene?

Trials mentioned in the episode:

Aizer A, Qiu JK, Cheng AV, et al. Utilization of a Radiation Safety Time-Out Reduces Radiation Exposure During Electrophysiology Procedures. JACC EP 2019; 5:5:626-634. https://doi.org/10.1016/j.jacep.2018.12.002

Ahmad IM, Abdalla YM, Moore TA, et al. Healthcare Workers Occupationally Exposed to Ionizing Radiation Exhibit Altered Levels of Inflammatory Cytokines and Redox Parameters. Antioxidants 2019; 8:1. https://doi.org/10.3390/antiox8010012

Support: This episode is supported by Radcliffe Cardiology; it received no funding from Worldwide Innovations & Technologies.

EP 113: Your Guide to Radiation Hygiene: Insights from Manufacturer and Users

‘Parallax’ (/ˈparəlaks/)-noun: the effect whereby the position or direction of an object appears to differ when viewed from different positions. Join Ankur Kalra, MD as he shows you a different side to cardiovascular care, management and science. Listen to Ankur’s conversations with legendary cardiologists, critical reviews of key congresses and late-breaking trials, and concise summaries. Published every second Monday of the month, this is your fix of reliable updates on all things cardiology by someone from a non-traditional background, who is always trying to look at it from new angles! Dear cardiologists, we want to make this podcast about you, and for you! Please email us critical thoughts, comments and questions for Ankur at podcast@radcliffe-group.com.

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