For #doctors and #pharmacists in #Canada. A short news story I wrote for Pharmacy Practice/Canadian #Healthcare Network.

Rounder hearts predict future heart failure, a-fib
Greater left ventricular sphericity showed 47% greater incidence of cardiomyopathy.

"A study in CellPress, where researchersanalysed cardiac MRIs of over 30,000 people, found that variations in left ventricle sphericity in normal hearts predicted risk for cardiomyopathy and related outcomes.

Researchers hypothesized that beyond size and function, the shape of hearts might carry extra details about heart health. To study this, they used data from a large biobank with #cardiac imaging data to help analyze variation in cardiac morphology in normal populations.

They noted “Cardiomyopathies of different etiologies often result in a similar end-stage phenotype of a more round, spherical ventricle. Among individuals with known cardiac disease, increased sphericity of the left ventricle (LV) has been associated with adverse outcomes, including ventricular arrhythmias and death.”

It also stated that “within the spectrum of normal LV chamber size and systolic function, there exists variation in LV sphericity, and this variation may be a marker of #cardiac risk with genetic underpinnings.”

The researchers turned to artificial intelligence to help analyze 38,897 cardiac MRIs from the U.K. Biobank database. The cohort had undergone cardiac MRIs and had normal LV end-diastolic volume, normal LV end-systolic volume, and normal LV ejection fraction...."

The rest of the story is on the site. Sorry, password protected for people in Canadian healthcare.

#heart #cardiology #CardioMastodon #MedMastodon #physiology

https://www.canadianhealthcarenetwork.ca/rounder-hearts-predict-future-heart-failure-fib

Wow! Significant difference in not just MACE but composite kidney outcomes with up titration of dose? Another med class to maximize the dose, to max the gains, I guess. Cost and formulary availability are still a barrier to even initiate.
@hswapnil @Kidney_boy @mike_johansen #MedMastodon #cardiomastodon
#NephMastodon
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.063716

This supplemental fig from EMPA-KIDNEY is particularly useful to all of us in the US who have to deal with insurance companies : #flozin (SGLT2i) may work even if not on RAS therapy. Caveat emptor applies (85% of participants were on RASi subgroup analysis etc)
#CKD #nephmastodon #cardiomastodon #endomastodon
@Kidney_boy @hswapnil @edgarvlermamd @mike_johansen

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7614055/

Finding a way around mastodon, where is #cardiology around here? #CardioDon ? #CardioMast #cardiomastodon #MastoHeart #mastomedics ?
Would be great to reach the critical mass working so well at #cardiotwitter
@GordFogg @load_dependent @TheCanuck

Not all escape rhythms require immediate treatment. The focus of an accelerated escape rhythm is treatment of the underlying cause. Bradycardic rhythms, however, may need meds or pacing to maintain a rate that is compatible with life. #CVBoardPearl #CardioMastodon #MedMastodon

Ok #nephmastodon, #endomastodon , #cardiomastodon and all fellow travelers in #medmastodon.
Get your manuscripts ready!
The Journal of Clinical Medicine's invitation for articles about #CKD in #Diabetes is out. Deadline to send us your killer paper is September 15th 2023. Will you miss out on the fun?

Treatment of focal junctional tachycardia is beta-blockade, diltiazem, or verapamil. If first-line therapy fails, consider flecainide or propafenone as long as the patient doesn't have structural or ischemic heart disease. #CVBoardPearl #CardioMastodon #MedMastodon

Junctional tachycardia occurs due to either enhanced automaticity or triggered activity. It may be associated with episodic AV dissociation and should be differentiated from SVT or AVNRT with block. #CVBoardPearl #CardioMastodon #MedMastodon

In the assessment of arrhythmia vs. artifact, try to march out QRS complexes. Use as many leads as are available to track the underlying rhythm. If the R-R interval is < 110 msec, it's like artifact since the ventricle should be refractory within this interval. #CVBoardPearl #CardioMastodon #MedMastodon

Fun Fact: CAD was noted in the coronary arteries of ancient populations in Egypt, the Roman Empire, Peru, and the Southwestern Americas (~1500 BCE to 1500 CE). This group CT-scanned mummies looking for coronary calcifications to discover this. https://pubmed.ncbi.nlm.nih.gov/23489753/ #CardioMastodon #MedMastodon

Anticoagulation is typically continued through an AFib/AFlutter ablation, and patients should be on AC for ≥3 weeks. Continue AC uninterrupted for ≥2 months post-ablation with longer-duration AC based on individual risk factors. #CVBoardPearl #CardioMastodon #MedMastodon

Patients in AFib/AFlutter for >48 hours who are undergoing a cardioversion must be on uninterrupted anticoagulation for ≥3 weeks to avoid a TEE. The AC should be continued uninterrupted for ≥4 weeks post-cardioversion. #CVBoardPearl #CardioMastodon #MedMastodon

HAS-BLED should be used to determine how to correct the underlying risk factors for bleeding--not how to avoid AC. Those with a HAS-BLED ≥3 may need closer follow-up and earlier review of AC. #CVBoardPearl #MedMastodon #CardioMastodon

Population studied in the finerenone trials #FIGARODKD and #FIDELIODKD in a snapshot.
(Share with everyone who questions how widely applicable these trials are in #DKD #diabetes #CKD #NephMastodon #EndoMastodon #cardiomastodon

In CHA2DS2-VASc, the V refers to complex vascular disease--history of MI, significant angiographically-demonstrated CAD, PAD, or complex aortic plaque noted on imaging. It doesn't refer to just any degree of CAD. #CVBoardPearl #MedMastodon #CardioMastodon

Will we see a South American clash in the NephroWorldCup.com Tournament?

#ARG : CKD after nephrectomy: https://sites.google.com/view/nephroworldcup/scouting-reports/group-c/argentina

#BRA : 0.9% saline or balanced solutions: https://sites.google.com/view/nephroworldcup/scouting-reports/group-g/brasil

Both did well in the Group stage.

Vote your favorite @ https://docs.google.com/forms/d/e/1FAIpQLSeyt8gTI0GAtZW97uHEbGao0oO2WO4QbvY_8GBY6TeXayGZcg/viewform

A "Rarely Appropriate" indication MPI exposes patients to higher cancer-risk & lower benefit-to-risk ratio, with disproportionately higher risk in women. Appropriate/May Be Appropriate use has no excess cancer-risk or gender predilection. PMID 27103019 #MedMastodon #CardioMastodon #CVBoardPearl

So much information in the supplement of the #Fidelity meta-analysis
https://academic.oup.com/eurheartj/article/43/6/474/6433104?login=false#supplementary-data
This the risk profile of the participants I treat.
It does not matter what their characteristics are, or whether they take other drugs #flozins #GLP1RA.
#Finerenone works the same!
#nephmastodon #endomastodon #cardiomastodon
#ckd #diabetes #cvd

When I read this paper, I had nightmares that I joined a practice which uses only 5 mg of #lisinopril.
https://www.mayoclinicproceedings.org/article/S0025-6196(22)00447-5/pdf
#ckd #diabetes #nephmastodon #endomastodon #ARB #ACEi #cardiomastodon
1/3 of pts were on appropriate dose!!
(Nephrologists didn't do better than the other specialties)

We should talk about eGFR triggered Nephrology referrals in the elderly.

#CKD #nephmastodon #EndoMastodon #cardiomastodon
Is the solution to look beyond eGFR, i.e. risk stratify with albuminuria+eGFR / KFRE + screening labs as suggested by NIDDK ?
@hswapnil @edgarvlermamd @mike_johansen @jsussman