This week’s Parallax episode is focusing on the latest science and questions surrounding one of the conundrums of cardiovascular science: Lipoprotein(a).
Dr. Ankur Kalra invites Dr Salim S Virani to help simplify the concept of Lp(a) with answering key questions about its measurement and its place in practice and prevention.

Dr Virani is a Professor at Baylor College of Medicine, Director of the Cardiovascular Disease Fellowship Program and Vice Provost of Research at Aga Khan University from early next year.

Lp(a) was first described in 1963. Since then, many epidemiologic studies have noted association of high Lp(a) levels with elevated risk of cardiovascular disease, however, the role of this particle remained a conundrum (Kamstrup, 2017). New data from the development of novel drugs are offering strong evidence on the causality between Lp(a) and ASCVD and AVS (Kronenber et al. 2022).
Dr Virani, one of the authors of the new European Atherosclerosis Society consensus statement on Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis, summarises the key concepts, shares his advice on clinical practice and talks about emerging therapies.

What is Lp(a) and what are the main associations? In what patient population should we lower LP(a)? What do you tell patients about Lp(a) testing and how easy it is to get it tested?

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

EP 78: Your Guide to Lipoprotein(a) with Dr. Salim S Virani

This week’s episode is dedicated to one of the biggest cardiovascular meetings, AHA’s Scientific Sessions. Dr Ankur Kalra’s guest is Dr Manesh Patel, chair of the AHA Committee on Scientific Sessions and Chief of the Division of Cardiology and Co-Director of the Heart Center at Duke University.

Year on year, the organisers of the Scientific Sessions aim to give platform to cardiovascular science at its best: innovative, impactful, and collaborative.
In this information-packed episode, Dr Patel takes us behind the scenes and talks about the work that goes into the curation of the programme and the considerations that shape the event. Dr Kalra asks Dr Patel about his highlights over the years and the movement and changes that he observed as vice chair and chair of the event. Dr Patel elaborates on the key late-breaking science trials in 2022. Dr Kalra and Dr Patel discuss the grading system of the award applications and share some useful information with our listeners.

What does Dr Patel think about the function of the Scientific Sessions? What happens after you submit your application to an award? How do the organisers concert a balance between the scientific and the social need of a global community?

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

EP 80: AHA’s Scientific Sessions: Science, Innovation and Community With Dr Manesh Patel

Although rare, the occurrence of a pacemaker or a defibrillator infection is an important complication which can and must be treated fast and effectively. On a weekly basis the story unfolds: how to best manage CIED patients when their device becomes infected and gather insights from physicians with different specialties in an interactive setting.

This series is supported by Philips.

What is a CIED? - Archie Rao and Angelo Auricchio

Although rare, infection of a pacemaker or a defibrillator is an important complication which must and can be treated effectively. Cardiac electronic implantable device (CIED) infection is a Class I indication for extraction but recent data have demonstrated that less than 2 in 10 patients receive appropriate treatment. Prof Carina Blomström-Lundqvist, Swedish Professor of Cardiology, and Dr Archie Rao, British consultant cardiologist, are both passionate about this topic. Carina Blomström-Lundqvist is the lead author of the European CIED infection guidelines and Archie Rao has led a gap analysis into the knowledge of CIED infection and treatment. They explain how to recognise a patient at risk and what to do to provide best outcomes for your patient.

This series is supported by Philips.

How to Recognise and Treat CIED Infection - Carina Blomström-Lundqvist and Archie Rao

Although rare, cardiac implantable electronic device (CIED) infections may occur at any timepoint in the lifecycle. It is important to remain alert and recognise signs early. Traditionally, antibiotics alone are used to treat infection. But for CIED infections, when treated with antibiotics only, the relapse rate varies between 50 and 100 percent. But why is that? Dan Atar, Editor-in-Chief of the scientific journal ‘Cardiology’, and infectiologist Stefan Hagel, not only challenge the traditional point of view but tear down the decades of belief which surround it. Why are antibiotics not doing the job? What are the consequences? What is the solution? Why are infections sometimes overlooked and what is the action to change that in your practice?

This series is supported by Philips.

Why Do Antibiotics Fail With CIED Infection? - Dan Atar and Stefan Hagel

Infection of a cardiac electronic implantable device (CIED) is a rare, but serious complication. We now know that, because of the appearance of biofilm on implants, these infections cannot be treated by antibiotics alone. As such, Worldwide Cardiac Society guidelines recommend complete system removal of all hardware, including the leads, when an infection is present. Although the guidelines are clear, too many patients continue to not get the appropriate treatment. Why is that? Mauro Biffi and Carina Blomström-Lundqvist, both experts in the field of lead extraction, see a lot of patients fall through the cracks. They discuss why and what the consequences are of not extracting in time but also: what is the recommended care pathway to improve the outcomes.

This series is supported by Philips.

Lead Extraction is the Solution to Treat CIED Infection - Mauro Biffi & Carina Blomström-Lundqvist

Infection of a cardiac electronic implantable device (CIED) is a rare, but serious, complication. When this happens, the removal of the entire system, generator and leads, is the only correct way to treat the infection. What happens during a procedure with lead extraction? Brigitte Osswald, an expert in the field who has performed more than 3,500 lead extraction procedures, talks to Nicola Montano, a physician in internal medicine, about the fundamentals of the procedure and explains why and how this is lifesaving for her patients.

This series is supported by Philips.

Procedure of Lead Extraction - Brigitte Osswald and Nicola Montano

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

What are the top late-breaking trials from #TCT2023?

TCT 2023 — Join interventional cardiologists, Prof Nicolas Van Mieghem and Dr Joost Daemen from the Thoraxcenter as they unpack the most impactful late-breaking clinical trials and science data from this year's Transcatheter Cardiovascular Therapeutics Conference.

Dive into this practical and engaging discussion and learn more about the latest data for practice and for research.

We value your opinion! Share your feedback by commenting on this page or sending us an email at info@radcliffe-group.com.

Trials covered:
00:20 - PARTNER 3 Low-Risk: Five-Year Clinical and Echocardiographic Outcomes
01:47 - EVOLUT Low-Risk: Four-Year Outcomes From the EVOLUT Low Risk Trial
04:02 - ALIGN-AR: Initial Outcomes of the JenaValve Trilogy Transcatheter Aortic Valve Replacement
06:18 - VIVA: Transcatheter versus Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Small Aortic Annuli
08:19 - AGENT IDE: Primary Outcomes of a Pivotal Multicenter Randomized Trial Comparing the AGENT
11:56 - DCB-ACS: Drug-Coated Balloon for Acute Coronary Syndromes
14:06 - T-PASS: Less Than 1-month Dual Antiplatelet Therapy Followed by Ticagrelor Monotherapy after Coronary Drug-Eluting Stent Implantation for Acute Coronary Syndrome
16:40 - WATCH TAVR: Safety and Efficacy of Left Atrial Appendage Occlusion at the Time of Transcatheter Aortic Valve
19:20 - TRILUMINATE: Quality of Life After Transcatheter Tricuspid-Valve Repair vs. Medical Therapy in Patients with Severe Tricuspid Regurgitation
21:13 - TRISCEND II: A Randomized Trial of Transcatheter Tricuspid Valve Replacement in Patients With Severe Tricuspid Regurgitation
23:23 - PICSO-AMI-I: Pressure-Controlled Intermittent Coronary Sinus Occlusion (PiCSO) in Acute Myocardial Infarction
26:07 - RADIANCE: Individual Patient-data Pooled Analysis of Endovascular Ultrasound Renal Denervation or a Sham Procedure at 6 Months

View from the Thoraxcenter: TCT 23 Late-breaking Science Wrap Up

The Radcliffe Cardiology Podcast brings you the latest advancements, research and best practices in the field of cardiology. Each episode features expert insights and engaging discussions with leading healthcare professionals, covering a breadth of topics in cardiovascular science. 

Our podcast aims to build on the best science, with key takeaways from the top cardiology conferences and recent publications from our journals.

‘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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