Years ago, Dr Bhatt, an early adopter of telemedicine, had difficult news for her patient that she wanted share with him in person. Her patient was resistant and they scheduled a video meeting. The patient asked Dr Bhatt to let him hear the news surrounded by his family in the safety of his home. Dr Bhatt learnt that she needed to listen to patients about how they want to be told things and how these interactions might effect them.

This week’s guest on Parallax is Dr Ami Bhatt, Chief Innovation Officer of ACC, Associate Professor at Harvard Medical School and Director of the ACHD program at Massachusetts.

In this engaging and in-depth episode, Dr Kalra and Dr Bhatt talk about the state of digital transformation today: They discuss the challenges and opportunities of telemedicine, artificial ‘collaborative’ intelligence and novel technologies that could enhance medical training. Dr Kalra asks Dr Bhatt about how she balances her responsibilities and her tips for approaching complex problems. Dr Bhatt also shares insights on the practicalities of her role as Chief Innovation Officer of ACC.

What is the next frontier in cardiovascular medicine? How can we best utilise available technology in medicine? What is Dr Bhatt’s advice to our audience?

Questions and comments can be sent to “podcast@radciffe-group.com” and may be answered by Ankur in the next episode. Guest, Dr @AmiBhattMD hosted by @AnkurKalraMD. Produced by @RadcliffeCARDIO.

EP 70: Technological Ecosystem, Innovation & Personalised Medicine with Dr Ami Bhatt

Back by popular demand, Dr Ankur Kalra's guest is Dr Purvi Parwani, Director of Women’s Cardiovascular Disease Clinic and Assistant Professor at Loma Linda University Medical Center, US.

In this ESC 2022 edition of Parallax, Ankur asks Purvi to review her highlights of the congress. Purvi details the study design and key findings of each trial and provides her insights after attending the event in Barcelona. Ankur and Purvi discuss how each trial will inform their practice.

Trials covered in detail include:

- REVIVED: Study of Efficacy and Safety of Percutaneous Coronary Intervention to Improve Survival in Heart Failure (NCT01920048)
- DANCAVAS: Danish Cardiovascular Screening Trial II (NCT03946410)
- DELIVER: Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure (NCT03619213)
- SECURE: Secondary Prevention of Cardiovascular Disease in the Elderly Trial (NCT02596126)
- INVICTUS: INVestIgation of rheumatiC AF Treatment Using Vitamin K Antagonists, Rivaroxaban or Aspirin Studies, Non-Inferiority (NCT02832544)


What are the key take-home messages of ESC 22? How can we implement these findings into daily practice? Where are the opportunities for further research?

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

EP 77: ESC 22 in Review With Dr P Parwani: 5 Trials That Will Change Your Practice

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

“Sham peer review or malicious peer review is defined as the abuse of a medical peer review process to attack a doctor for personal or other non-medical reasons.”

“Most doctors — warns Dr Kaki — do not understand that ultimately your privileges are not dictated by your colleagues through a fair process, but hospital administration controls our destiny”. In 2018, Dr Kaki was subject to a campaign of retaliation that set out to revoke the well-respected cardiologist’s privileges. Today, Dr Kaki is Director of Mechanical Circulatory Support at Ascension and Clinical Associate Professor at Wayne State University School of Medicine.

In this week’s Parallax Dr Kalra’s guests are the team that fought for justice in Dr Kaki’s case: Dr Lawrence R Huntoon, Editor-in-Chief of the Journal of the Association of American Physicians and Surgeons and Deborah Gordon, employment attorney.

Dr Kaki walks us through his Kafkaesque experience and the knowledge he acquired during his battle with his former hospital. We get insight into the stages of a peer review process and the role of key stakeholders. Dr Huntoon, expert in this field, helps us put Dr Kaki’s experience in context and talks about the prevalence of sham peer reviews through shocking cases. Ms Gordon supports the discussions with practical tips and insights on the role of an attorney. Join Ankur and his guests for a must listen show on your rights as a physician.

What do you need to know about the hospital peer review process and your rights? What can you do if targeted? What is Dr Kaki’s advice to physicians?

Stay tuned for Part 2 of Parallax’s Medico-Legal series with Dr Kalra and Dr Huntoon.

Resource: https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.12903

Questions and comments can be sent to “podcast@radcliffe-group.com” and may be answered by Ankur in the next episode.
Guests: @DrAmirKaki, Dr Lawrence R Huntoon and Deborah Gordon host: @AnkurKalraMD and produced by: @RadcliffeCARDIO.

EP 82:   Hospital Peer Review Process: What You Need to Know as a Physician

“The hospitals like things just the way they are. It gives them almost complete immunity for any peer reviews, good faith, or bad faith, that they conduct against a physician.”
 
The Health Care Quality Improvement Act of 1986 considers accused physicians to be guilty of the charges unless and until they can prove their innocence. Over the years many hospitals abused the peer review system to extort and silence competent physicians.
 
Dr Lawrence Huntoon, Editor-in-Chief of the Journal of the Association of American Physicians and Surgeons, returns for a deep dive into the topic of the hospital peer review system.
 
In this second episode of our medico-legal series, Dr Kalra invites Dr Huntoon for an overview of the key terminologies and processes of the hospital peer review system.
Dr Huntoon summarises some of key actions you can take as a physician to prepare and defend yourself. We learn more about different sham peer review tactics through recent cases. Dr Huntoon shares his thoughts on what we can do to create a just system and better future for practicing physicians.
 
What do you need to know about hospital investigations? What is the difference between OPPE and FPPE? How can you get educated on hospital bylaws and processes?
 
Get involved with the work of AAPS and access more free-to-access resources on this topic: https://aapsonline.org
 
Questions and comments can be sent to “podcast@radcliffe-group.com” and may be answered by Ankur in the next episode.
Guest: Dr Lawrence R Huntoon Host: @AnkurKalraMD Produced by: @RadcliffeCARDIO.

EP 83: Sham Peer Reviews: A Deep Dive with Dr Lawrence Huntoon

“Medical school cannot, and should not, feel easy—but it should feel worthwhile” – these are the opening words of Dr Kittleson’s book, Mastering the Art of Patient Care. Dr Kittleson’s book is not only a great resource for patient care, but a heartful companion to early career faculty as well.

Dr Kalra’s guest on Parallax this week is Dr Michelle Kittleson, Professor of Medicine at Cedars-Sinai, Director of Education in Heart Failure and Transplantation and Director of Heart Failure Research at the Smidt Heart Institute.

Coming from generations of doctors, Dr Kittleson describes herself first and foremost a dedicated clinician. With her new book, Dr Kittleson offers her mentorship and shares her advice on how to make patient care fulfilling for both clinicians and patients.
In this rich and insightful discussion, Dr Kittleson talks about the origins of famous #kittlesonrules, a collection of tips for doctors shared on Twitter, and her thoughts on mentorship. We learn more about Mastering the Art of Patient Care. Dr Kalra and Dr Kittleson discuss strategies for managing difficult situations in patient care.

You can find out more about Mastering the Art of Patient Care here: https://t.co/zdJT2MWl6J

How do you pick a medical programme? How can you define your medical style? What can you learn from Mastering the Art of Patient Care?

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

EP 84: Mastering the Art of Patient Care with Dr Michelle Kittleson

Parallax features a guest episode from the new podcast Neurophilia by Nupur Goel.

Do you think and act with your mind or heart? How about both?

Neurocardiology refers to the intersection between the fields of neurology and cardiology. The mind and heart are deeply interconnected in terms of anatomy, physiology, and various pathologic states.

This episode features a vascular neurologist and an interventional cardiologist who will discuss the relationship between their two fields of medicine.

Dr. Blake Buletko is a vascular neurologist at the Cleveland Clinic. He completed his residency and fellowship training at the Cleveland Clinic and was the former medical director of their mobile stroke program. In addition to his clinical responsibilities, Dr. Buletko serves as an Assistant Professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and is the current Program Director of the Adult Neurology Residency program for the Cleveland Clinic.

Dr. Ankur Kalra is an interventional cardiologist, and founder of the non-profit startup, makeadent.org. He is director of Barry J. Maron Hypertrophic Cardiomyopathy Center in New Delhi, India. He is also the host of the cardiology podcast show, Parallax. He has presented late-breaking science at national and international scientific cardiovascular meetings, and has published over 250 scientific manuscripts in various peer-reviewed journals. His past appointments include interventional cardiologist, associate professor, and medical director of clinical research for regional cardiovascular medicine at the Cleveland Clinic.

Check out the Neurophilia podcast by Dr Nupur Goel: https://podcasts.apple.com/gb/podcast/neurophilia/id1654775116

Neurophilia Guest Episode: A Talk Between the Mind and Heart

In this week’s Parallax Dr Kalra welcomes back Dr Nijjer for their annual review of the most impactful and controversial cardiovascular trials of 2022.

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

The coronary physiology trial FLAVOUR was presented at ACC.22 by Dr Bon Kwon Koo. This South-Korean study compared the safety and efficacy of FFR and IVUS-guided stenting. Dr Nijjer interprets the findings and outlines the take-home messages by describing his practice.
Following this, Dr Kalra and Dr Nijjer look at REVIVED-BCIS2 presented at ESC 2022 by Dr Divaka Perera. Dr Nijjer talks about the complexity of running this study that evaluated whether revascularization by PCI can improve outcomes in patients with ischemic left ventricular systolic dysfunction compared with optimal medical therapy. They distill some of the nuances for practice.
Dr Nijjer summarises the all-comers PROTECTED TAVR trial that assessed the use of Sentinel® Cerebral Protection System in patients undergoing TAVR. We learn more about the secondary outcomes and the reception of the results. Dr Kalra shares how the new data impacted his approach.
Last, they discuss the implications of Chinese CTS-AMI trial presented at AHA 22 by Dr Yuejin Yang. The trial showed that a traditional remedy, Tongxinluo improved the clinical outcomes of patients with STEMI. Dr Nijjer and Dr Kalra consider the meaning and impact of these trials such as CTS-AMI on Western medicine.

How can we interpret some of the controversies from REVIVED? What can we learn from traditional medicinal remedies? What are the key takeaways for clinical practice from the reviewed trials?

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

EP 86: The Year 2022 in Review with Dr Sukh Nijjer

“We're providing about 20,000 different ingredients in our diet to a gut microbiome that has 4 million genes. And they're processing these 20,000 ingredients at a flood of chemicals.”

In this episode of Parallax, Dr Ankur Kalra speaks with Dr. Momchilo Vuyisich, co-founder and chief science officer of Viome Life Sciences.

Dr Vuyisich shares his personal journey with rheumatoid arthritis and how it led him to explore the intersection of nutrition and the gut microbiome function.
He explains how the complexity of nutrition and the compounds generated by the gut microbiome can impact our health. We learn more about three compounds produced by our gut microbiome that have a strong connection with heart disease.
Through this conversation, Dr Vuyisich invites us to reframe our approach to nutrition and prevention as a question of food education and data-driven science.

What is the effect of red meat and processed food on our gut biome? What can we learn about prevention through understanding gut biome function? How can data-driven science help us make informed choices about nutrition and health?

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

EP 87: Gut Microbiome and Heart Health: The 3 Compounds You Need to Know About with Dr Vuyisich

Bullying is a phenomenon that most of us are familiar with, whether through personal experience or through the stories of friends and colleagues. But what exactly is the impact of bullying on an individual and, in turn, on their community or field of work? In the context of medical science, the consequences can be particularly dire.

In the latest episode of Parallax, Dr Ankur Kalra's guests are Dr Susanne Täuber and Dr Morteza Mahmoudi. Dr Täuber, an expert in organisational behaviour, was recently terminated for speaking out against discrimination at her institution. Dr Mahmoudi is a radiologist at Michigan State University and co-founder of @AcademicParity movement.

Dr Mahmoudi and Dr Täuber teamed up to explore bullying in academic settings. Together with Dr Kalra they discuss why bullies thrive in such environments and the ways institutions enable such behaviour. Dr Täuber offers solutions and a critical overview of institutional narratives, while Dr Mahmoudi highlights the long-term effects on academic work and medicine. They call for action against toxic behaviour and for stakeholders to eliminate incentives for universities to support perpetrators.

What prompted Dr Mahmoudi to write about academic bullying? How do we disrupt toxic behaviours? What is Dr Täuber’s and Dr Mahmoud’s message to individuals who have been targeted by perpetrators?

Join the petition to reinstate Dr Susanne Täuber: https://openletter.earth/reinstate-susanne-tauber-protect-social-safety-and-academic-freedom-at-the-rug-ed83c085

Support Dr Susanne Täuber: https://www.gofundme.com/f/crowdfunding-campaign-to-support-susanne-tauber

Resources:
Täuber S & Mahmoudi M. Disrupting targets’ dependency on bullies. Science 2022.
https://doi.org/10.1126/science.abo3412

Mahmoudi M. Academic bullying slows the evolution of science. Nat Rev Mater 2023.
https://doi.org/10.1038/s41578-023-00549-x

Mahmoudi M. Academic bullying: How to be an ally. Science 2021.
DOI: 10.1126/science.abl7492

Mahmoudi M. A survivor’s guide to academic bullying. Nat Hum Behave 2020.
https://doi.org/10.1038/s41562-020

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

EP 90: Academic Bullying Unmasked: Enablers, Effects & Solutions with Dr Täuber & Dr Mahmoudi

In this final episode of our mini-series on value in academic medicine, Dr Ankur Kalra welcomes back Dr Nandan Anavekar, a Professor of Medicine at Mayo Clinic College of Medicine and consultant for both the Cardiovascular and Radiology Departments at Mayo Clinic, who also serves as the Program Director for the Adult Cardiovascular Diseases Fellowship program.

In this inspiring conversation, Dr Anavekar and Dr Kalra discuss the education of postgraduate medical students and reflect on Dr Anavekar’s role as a Program Director. Dr Anavekar shares his motivations and the moral framework he uses to approach his responsibility towards his students.

The conversation then shifts towards the learning environment provided for medical students. Dr Anavekar contrasts the prevalent competitive culture and draws on Vedic philosophies to outline how we can strive for a student-centric culture that fosters a more collaborative environment and supports autonomous decision-making. Dr Anavekar asks listeners to look at medical education with fresh eyes by reframing what value means within this context.

Finally, Dr Anavekar talks about the Global Cardiology University Project and his work on democratizing medicine on a global scale.

How can we create a safe learning environment for medical students? What is Dr Anavekar's thoughts on the role of teachers and students in medical setting? What is Dr Anavekar's message to early-career faculty?

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

EP 92: Beyond Metrics: Redefining Success Through a Student-Centric Approach

In this week's Parallax, Dr Ankur Kalra is joined by guests, Dr Rama Ellauzi, Dr Nandan Anavekar and Dr Anthony Kashou, also known as The EKG Guy. Together, they delve into cardiovascular education and the Global Cardiology University (GCU).

The genesis of GCU traces back to Dr Kashou's time as an intern at Mayo Clinic. Recognizing the challenges of postgraduate education, Dr Kashou embarked on a journey to enhance early-level training. Drawing inspiration from his own struggle to comprehend electrocardiograms (EKGs), he set out to build a comprehensive database. This eventually led to the birth of GCU.

Dr Ellauzi, Dr Anavekar and Dr Kashou share their passion for education and the devotion that drew them to the GCU. They explore the vision of GCU, which revolves around creating a community space where knowledge is shared, aligning with educational trends, and empowering learners. Through scientific content evaluation and a commitment to providing premium yet affordable materials, GCU embraces community ownership. As the team has grown, teachers and students now find themselves in the same virtual room, fostering a collaborative and supportive environment.

The conversation moves to the platforms and interactions offered by GCU. Dr Ellauzi and Dr Kashou shed light on the diverse formats available. They discuss the process of content vetting, emphasizing the importance of explanations and foundations for learners at all levels. They stress that GCU, serves as a complementary resource, enhancing traditional education methods for learners at different stages of knowledge acquisition.

How can we empower learners in the digital age? How do we build global learning communities and cultures? When should new knowledge become part of a curriculum?

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

EP 93: Empowering Learners in Cardiovascular Education with Dr Kashou, Dr Anavekar & Dr Ellauzi

“You should neither take the outcome personally nor fall into the trap of thinking that doing nothing better.”

In this special episode of Parallax, we bring you Dr Ankur Kalra's thought-provoking lecture delivered at the IU School of Medicine Department of Anaesthesia Grand Rounds and introduced by Dr Nandan Anavekar.
In this episode, Dr. Kalra explores the intersection of spirituality and healthcare, encouraging us to reflect on its significance for both patients and providers.

Dr. Kalra begins by defining spirituality and highlighting its interconnectedness with patient care and the broader concept of life. He invites us to think about the various mechanisms behind spiritual experiences and practices, sharing his own personal journey with meditation. Examining studies on the impact of meditative practices like yoga and mindfulness on heart outcomes, he sheds light on their place in healthcare.

Delving into his experiences as a physician, Dr. Kalra presents two patient cases, illustrating how he navigates disparate outcomes. Drawing from Eastern perspectives, Dr. Kalra offers insights from the Bhagavad Gita to encourage a re-evaluation of medicine beyond metrics and focusing on the effort invested in care. He raises important questions about leading a mindful life and the challenge of remaining unattached to outcomes in a metric-driven healthcare system.

What does spirituality mean in the context of healthcare? How can physicians take control of their mindset? And what does the data reveal about the benefits of mindfulness in patient care?

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

EP 94: IU Anesthesia Grand Rounds: Religiosity/Spirituality in Medicine

Join Dr Ankur Kalra in this episode of our mini-series, "Conversations about Hypertrophic Cardiomyopathy", as he engages in an in-depth discussion with Dr Carolyn Yung Ho. Together, they explore the journey from symptoms to diagnosis and management options for hypertrophic cardiomyopathy (HCM).

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

Dr Ho is Medical Director of the Cardiovascular Genetics Center and an Associate Professor at Harvard Medical School.

Dr Ho offers a comprehensive examination of HCM, providing valuable insights on diagnosing the condition and distinguishing it from other conditions. The discussion addresses important questions, such as when to refer patients suspected of having HCM.

The episode explores the significance of cardiac MRI in diagnosing and distinguishing HCM, with a focus on the distinctive features that aid in assessment. The differentiation between sarcomeric and non-sarcomeric forms of HCM is examined for its clinical relevance, with an emphasis on identifying individuals at risk.

Dr Ho sheds light on the diagnostic tools used for risk stratification in both obstructive and non-obstructive cases of HCM. The conversation delves into management strategies for non-obstructive HCM patients, including additional approaches to alleviate symptoms such as exertional dyspnoea.

The episode concludes by discussing cardiac myosin inhibition as a potential therapy, covering important considerations and providing a comprehensive checklist for initiating treatment. Additionally, the latest evidence on exercise training in HCM patients is highlighted.

Tune in to gain insights into the diagnosis and management of HCM as Dr Ankur Kalra and Dr Carolyn Yung Ho illuminate this intricate cardiovascular condition.

This content is intended for US-based physicians.

EP 95: Conversations about Hypertrophic Cardiomyopathy: Symptoms, Diagnosis and Management

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

In this week's Parallax, Dr Ankur Kalra welcomes back Dr Jag Singh to discuss Dr Singh's recently published book, "Future Care," which delves into the exciting evolution of medicine over the next 5 to 10 years.

Dr Jagmeet Singh is a Cardiac Electrophysiologist and a Professor of Medicine at Harvard Medical School. He is also the Founding Director of the Resynchronization and Advanced Cardiac Therapeutics Program at Massachusetts General Hospital.

"Future Care" wasn't written overnight; it had been simmering in Dr Singh's mind for nearly a decade. The catalyst for this book was a convergence of factors, including the COVID-19 pandemic and Dr Singh’s personal health journey. Drawing from his experiences across three different countries, his role in patient care and leadership and his unique perspective as a patient himself, Dr Singh explores the crucial question of how medicine can and should evolve.
In this episode, Dr Kalra and Dr Singh delve deeply into the ideation, research, and writing process that brought "Future Care" to life. We learn more about Dr Singh's valuable tips for aspiring authors. Dr Singh unpacks the four key chapters of his book: Sensors, Virtual Care, AI, and the Establishment of a sustainable healthcare system. Looking into the future, Dr Singh paints a vivid picture of the hospital of tomorrow—a place where technology and human touch harmoniously converge. As we adapt to the changes brought about by the pandemic, Dr Singh outlines the necessary steps to foster a reality in which we can utilize these technologies to create more time for human connection.
What advice does Dr. Singh have for our listeners? What does the future of medicine look like? How can we scale high-tech solutions effectively?

Order Dr Singh's book today: https://mcpress.mayoclinic.org/product/future-care/

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

EP 98: Hospital of the Future: AI, Sensors & Sustainability with Dr Jag Singh

In this week's Parallax, Dr Ankur Kalra's guest is Dr Mirvat Alasnag. Dr Alasnag is an interventional cardiologist at King Fahad Armed Forces Hospital (KFAFH) in Saudi Arabia. Additionally, she serves as the Editor-in-Chief at Current Cardiovascular Imaging Reports and is a member of the Board of Trustees at SCAI.
Dr Alasnag and Dr Kalra provide a comprehensive review of the key highlights from ESC Congress 2023. Dr Alasnag distills the background and latest evidence from key interventional trials, emphasizing their significance for patient care.
Tune in to discover the strategies that Dr Kalra and Dr Alasnag are currently employing and gain insights into how these data will shape their future decision-making in the catheterization laboratory. Don't miss this informative discussion at the forefront of interventional cardiology.
 
Trials included:
FIRE: Physiology-Guided Complete PCI in Older MI Patients
MULTISTARS AMI: MULTivessel Immediate Versus STAged RevaScularization in Acute Myocardial Infarction
ILUMIEN IV: Optical coherence tomography-guided coronary stent implantation compared to angiography
OCTOBER:  European Trial on Optical Coherence Tomography Optimized Bifurcation Event Reduction
OCT Vs IVUS Vs Angiography Guidance
OCTIVUS: Optical coherence tomography non-inferior to intravascular ultrasound for stent guidance
 
What are the take-home messages from ESC 2023 for interventional cardiologists? How can we interpret the results for patient care? What new data have the power to change guidelines?

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

EP 99: ESC 23 Review: Interventional Trials with Dr Mirvat Alasnag

In the landmark centennial episode of Parallax, Dr Ankur Kalra welcomes a true luminary in the field of cardiology, Dr Valentin Fuster.

Dr Valentin Fuster, a renowned cardiologist, currently holds multiple roles. He serves as the Director of the Cardiovascular Institute and as the Physician-in-Chief at the Mount Sinai Medical Center in New York. Additionally, Dr Fuster is the General Director of the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) in Madrid. Notably, he also holds the position of Editor-in-Chief at the Journal of the American College of Cardiology (JACC).

In this candid and rich episode, Dr Fuster delves into his upbringing in Barcelona and reflects on the influential role his family played in providing him with role models and a sense of freedom during his formative years. Dr Fuster invites us to contemplate the concepts of mentorship and trust by recounting pivotal moments from his life, revealing how these principles propelled him towards a life of fulfilment.
Dr Kalra and Dr Fuster revisit one of the central questions explored in Dr Fuster's book, "The Circle of Motivation" – how can one maintain a positive outlook and prepare for life's inevitable fluctuations? Dr Fuster shares insights into his daily routine, which aids him in reflection, tuning into his intuition, and making choices that align with his true self.
While discussing his priorities, we gain insight into Dr Fuster's projects, driven by the concern that we do not intervene early enough in the treatment of individuals. Dr Kalra and Dr Fuster engage in a discussion about Dr Fuster's thoughts on JACC and Dr Fuster outlines the key principles of leadership in various contexts, accompanied by examples from his own life. Dr Kalra seeks Dr Fuster's perspective on augmentative intelligence and the future of medicine, shedding light on what Dr Fuster believes is essential for contemporary medical education in light of the transformative impact of AI.
Finally, Dr Fuster shares three influential books that have shaped his thinking, along with a message for our listeners.

Resources:
JACC Journals’ Pathway Forward With AI Tools: The Future Is Now
https://www.jacc.org/doi/10.1016/j.jacc.2023.02.030
The Circle of Motivation
https://www.amazon.com/Circle-Motivation-Valentin-Fuster-ebook/dp/B07YLVMSKH

EP 100: Conversation with Dr Valentin Fuster: Trust, Fulfilment & Leadership

In this week's episode of Parallax, Dr. Ankur Kalra welcomes Dr. John Mandrola, a cardiac electrophysiologist practicing in Louisville and the host of the popular podcast "This Week in Cardiology" and co-author of Sensible Medicine, among other forums.

In this insightful episode, we delve into Dr. Mandrola's career journey. He discusses how the beginnings of his career during a period of significant innovations and the reversal of expert opinions profoundly influenced his perspective on medicine, leading to a more conservative stance. Dr. Kalra then invites Dr. Mandrola to share the motivations that drive his work as a medical journalist and communicator, along with his methods of selecting studies to highlight in his writings and show.

Dr. Mandrola emphasizes the importance of bedside medicine and the critical role of translating and interpreting evidence in modern healthcare. Together, Dr. Kalra and Dr. Mandrola explore the complexities of practicing medicine today and ponder the value propositions associated with the latest innovations.

Dr. Mandrola sheds light on what he considers the most promising new advances in the field. He concludes the episode by offering valuable advice to our listeners, advocating for the implementation of innovations grounded in medical evidence and supported by sound policies.

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

EP 101: Translating Evidence, Innovations & Value for Patients with Dr John Mandrola

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 thought-provoking episode, Dr Ankur Kalra is joined by Dr Anuradha Lala, assistant professor of medicine at the Zena and Michael A Wiener Cardiovascular Institute and in the Department of Population Health Science and Statistics at Icahn School of Mount Sinai and Mount Sinai Hospital. Dr Lala is also the Deputy Editor of the Journal of Cardiac Failure.

Dr Kalra and Dr Lala delve into the critical topic of disparities in care within the healthcare system from a cardiologist's point of view and explore actionable steps towards a more inclusive and fair healthcare landscape.

Dr Lala advocates for an approach focused on the patient, valuing the unique needs and preferences of each individual as crucial elements in creating a personalised treatment strategy. In this podcast, she provides insight to her study on 'Acute Heart Failure Presentation to the Emergency Department: National Trends by Race and Ethnicity 2007-2019' and how it shows there are differences based on race and ethnicity in terms of wait time and the demographic of patients presenting.

The fundamental principle that healthcare is a basic human right is emphasised, setting the stage for a deeper exploration of the disparities prevalent within the system. Through candid discussions, the episode highlights the differences in healthcare access and quality and examines methods to prevent and mitigate these discrepancies.

Addressing the 'why' behind these disparities is a central theme, exploring the presence of subconscious biases within healthcare. The conversation isn’t just theoretical, Dr Kalra and Dr Lala present real-life scenarios and personal stories, offering a refreshingly honest and open perspective. 

Key questions are explored, such as identifying the top places where disparities in care exist and strategies to address these issues. 

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

EP 104: Caring for All Hearts: Disparities in Care with Dr Anuradha Lala

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

In this week’s episode of Parallax, Dr Ankur Kalra welcomes Dr Shashank Sinha. Dr Sinha is an Advanced Heart Failure, Mechanical Circulatory Support, and Transplant Cardiologist at Inova Fairfax Medical Campus, where he serves as Co-Medical Director of the Cardiac Intensive Care Unit and Director of the Cardiovascular Critical Care Research Program. Additionally, he holds the position of Assistant Professor of Medical Education at the University of Virginia School of Medicine.

In this episode, Dr Sinha shares his insights on leadership after participating in the prestigious Presidential Leadership Scholars Programme. This programme, designed for mid-career professionals with 10+ years of experience, aims to foster bipartisan, action-oriented leaders. Dr Sinha discusses what motivated him to apply for the programme and guides us through the practical details of the process. Ankur asks him about his modules and the lessons he derived from this multidisciplinary programme.
Dr Sinha and Dr Kalra discuss civic duty and the values that can be nurtured to make a difference on a larger scale. Dr Kalra also asks about Dr Sinha's approach to conflict management and combating inherent bias.

What is the Presidential Leadership Programme? What qualities constitute a good leader? How can individuals foster their leadership skills?

EP 110: Cultivating Leadership, Civic Duty & the Presidential Leadership Programme with Dr Sinha

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

‘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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