MONDAY | NOV. 18, 2024 Daily News #AHA24 Today’s Late-Breaking Science and Featured Science 2 Environmental crises call for more CV research 3 Inside LBS.02 | Redefining Arrhythmia Treatment 5 Wake-up call: Heeding global risk factors The past 100 years have seen incredible progress in cardiovascular medicine. Heart care protocols and guidelines have advanced patient care, new therapies have improved outcomes for acute cardiovascular events and age-standardized mortality rates from cardiovascular disease have declined almost 35% globally since 1999. Yet the burden from cardiovascular disease has continued to grow, said AHA President Keith Churchwell during yesterday’s Presidential Session. Churchwell, who delivered the Lewis A. Conner Lecture, outlined a century of improvements in health care but was quick to point out that an incredible amount of work stands to be done. “As a physician, my life’s work has been a part of the dramatic change in how we care for patients,” he said, “but we are at an inflection point on what we can and need to do to achieve the best care for everyone.” When Churchwell began his career, most U.S. cardiologists were in private practice and, as recently as 2007, still were. However, by 2023, with the pandemic playing a central role as a reason for practice acquisition, almost 80% of cardiologists were employed by hospitals and other corporate entities, he said. This profound change has contributed to the expansion of care and growth of health systems, including the creation of service lines in hospitals. “You can find ‘heart centers’ from Mumbai to Stockholm to Indianapolis, with hospitals and institutes that treat and evaluate cardiovascular disorders, conduct research and strive to continually innovate,” Churchwell said. “This shift has been fascinating to witness and to be a part of,” he said. However, there is no time to linger on past accomplishments when so much potential for progress lies ahead. “A presidential advisory published this year in Circulation shows that if we continue on our present path, then many key clinical disease metrics will surge in the wrong direction by 2050,” Churchwell warned, citing a 2023 World Obesity Atlas report that estimates by 2035, the number of people who will be clinically defined as overweight will top four billion. The associated economic annual financial cost for that — if unchecked by 2050 — will top $1.8 trillion in the U.S. alone. “These statistics on global risk factors and recent advisories should be a wake-up call for all of us,” he said. “First, we must find more ways to aggressively treat hypertension, See PRESIDENTIAL SESSION, page 10 Improving patient outcomes for sudden cardiac arrest Technology-enhanced prediction tools, public awareness and training are key. Sudden cardiac arrest (SCA) continues to be a major public health problem. Each year, approximately 400,000 people in the U.S. experience SCA, with a survival rate of only about 10%. Despite decades of research, patient outcomes remain dismal. Those staggering statistics drove a robust discussion during Friday’s session, “Tackling the Challenge to Improve Outcomes After Sudden Cardiac Arrest: Paradigms to Accelerate Detection and Deployment Earlier in the Chain of Survival (AHA Joint Sessions with Heart Rhythm Society).” Speakers addressed the “why” as well as strategies for moving toward improved patient outcomes. Sana Al-Khatib, MD, FAHA, professor of medicine at Duke University School of Medicine in Durham, North Carolina, co-moderated the session to break it down. According to Al-Khatib, there are several factors responsible for the very low survival rates, starting with the paradox in the epidemiology of sudden cardiac death (SCD). “The highest incidence of SCD is in high-risk groups, such as patients with heart failure and a prior myocardial infarction (MI). But the absolute number of SCD is highest in the general population (people who do not appear to be at an increased risk of SCD),” AlKhatib said. “It has been shown that for some people who end up with SCD, there were symptoms that they ignored. So, we need to intensify efforts to raise awareness See CARDIAC ARREST, page 11 Chugh Al-Khatib LBS.03 | Harnessing AI for better heart health 6 Dissecting the complex relationship between atrial cardiomyopathy and stroke 10 LBS.04 | Coronary and valvular heart disease 12 Managing patients with symptomatic mitral or tricuspid regurgitation 14 AHA President Keith Churchwell challenges health care professionals to work toward a better world for everyone, everywhere, during the AHA’s next century.
2 SCIENTIFIC SESSIONS DAILY NEWS | Day 3 Monday, Nov. 18, 2024 Today at Sessions Late-Breaking Science LBS.06: Building on the Four Pillars: Novel Trials of Medical Therapy for Heart Failure 8-9:15 a.m. | Main Event I • Myeloperoxidase Inhibition With Mitiperstat in Heart Failure With Preserved and Mildly Reduced Ejection Fraction: Primary Results From the ENDEAVOR Randomized Clinical Trial • Effects of Sacubitril-Valsartan on Prevention of Cardiotoxicity in High-Risk Patients Undergoing Anthracycline Chemotherapy: A Double-Blind Randomized Placebo-Controlled Clinical Trial: The SARAH Trial • Novel Bumetanide Nasal Spray (BNS) Demonstrates Safety, Tolerability and Equivalent Efficacy Compared to Intravenous and Oral Bumetanide (RSQ-777-02) • Sodium Zirconium Cyclosilicate and MRA Optimization in Heart Failure With Reduced Ejection Fraction and Hyperkalemia: Main Results From REALIZE-K Randomized Controlled Trial LBS.07: Revolutionizing AF Management: Cutting-Edge Approaches 9:45-11 a.m. | Main Event I • Comparison of Linear Ablation Plus Pulmonary Vein Isolation vs. Pulmonary Vein Isolation Alone for Persistent Atrial Fibrillation: Results From the PROMPT-AF Randomized Trial • Cryoballoon Ablation vs. Radiofrequency Ablation in Patients With Persistent Atrial Fibrillation (CRRF-PeAF): A Prospective, Multicenter, Randomized, Noninferiority Clinical Trial • Randomized Controlled Trial of Metformin and Lifestyle/ Risk Factor Modification for Upstream Prevention of Atrial Fibrillation Progression: The Targeting Risk Interventions and Metformin for Atrial Fibrillation (TRIM-AF) Trial • Aggressive Risk Factor Reduction Study for Atrial Fibrillation (ARREST-AF) Implications for Ablation Outcomes: A Randomized Clinical Trial LBS.08: New Targets and New Treatments: Advances in Lipid Therapeutics 1:30-2:45 p.m. | Main Event I • ALPACAR Phase 2 Trial of Zerlasiran: Multiple Doses of a Short-Interfering RNA Targeting Lipoprotein(a) Over 60 weeks. • A Randomized Phase 2 Trial of Muvalaplin: An Oral Disrupter of the Assembly of Lipoprotein(a) Particles (KRAKEN) • Safety and Efficacy of Obicetrapib in Patients With Heterozygous Familial Hypercholesterolemia (BROOKLYN) Featured Science FS.04: Vascular Outcomes in the Spotlight 8-9:15 a.m. | S100A • Geographical Variations of Treatment Disparities Between Black and White Patients With Peripheral Artery Disease Across the United States • Anatomically Directed Lower Extremity Gene Therapy for Ulcer Healing: A Double Blind, Randomized, Placebo Controlled Study (Legend 1 Trial) • Bempedoic Acid and Limb Outcomes in Statin-Intolerant Patients With Peripheral Artery Disease: New Insights From the CLEAR OUTCOMES Trial • Rivaroxaban for 18 Months vs. 6 Months in Cancer Patients With Low-Risk Pulmonary Embolism: ONCO PE Trial FS.05: Amyloid, Hypertrophic and Danon Cardiomyopathies: Targeted Therapies and Specific Populations 9:45-11 a.m. | S103BC • Danon Disease Phase 1 RP-A501 Results: The First Single-Dose Intravenous Gene Therapy With Recombinant Adeno-Associated Virus (AAV9:LAMP2B) for a Monogenic Cardiomyopathy (accepted, not confirmed at time of publication) • Mavacamten Treatment in Patients With Obstructive HCM Referred for Septal Reduction Therapy: 128-Week Results From VALOR-HCM Trial • Acoramidis Reduces AllCause Mortality (ACM) and Cardiovascular-Related Hospitalization (CVH): Initial Outcomes From the ATTRibuteCM Open-Label Extension (OLE) Study • Impact of Vutrisiran on Markers of Disease Progression in Patients With Transthyretin Amyloidosis With Cardiomyopathy in the HELIOS-B Trial • The Prevalence of Transthyretin Cardiac Amyloidosis in Older Black and Hispanic Individuals With Heart Failure: The Screening for Cardiac Amyloidosis With Nuclear Imaging in Minority Populations Study (SCAN-MP) • ATTR-Specific Medication in Dual Pathology Aortic Stenosis and Transthyretin Cardiac Amyloidosis FS.06: Novel Insights in Cardiovascular Interventional Outcomes 1:30-2:45 p.m. | S100A • Semaglutide Improves Cardiovascular Outcomes in Patients With a History of Coronary Artery Bypass Surgery and Overweight or Obesity: The SELECT Trial • Five-Year Results From the AMPLATZER Amulet Left Atrial Appendage Occluder Randomized Controlled Trial (Amulet IDE) • The Impact of Carbon Monoxide to Determine the In-Hospital Prognosis After Acute Coronary Syndrome (ADDICT-ICCU) • Quantitative Assessment of Mitral Annular Calcification Severity Predicts Outcomes in Severe Aortic Stenosis Patients Undergoing Transcatheter Aortic Valve Replacement FS.07: Incretion Modulation Is the Time Now for Standard of Care 1:30-2:45 p.m. | S103BC • Effect of Tirzepatide on Cardiac Structure and Function in Obese HFpEF: the SUMMIT CMR Substudy • Effects of Tirzepatide on the Clinical and Symptom Burden of Patients With Heart Failure and a Preserved Ejection Fraction: Results From the SUMMIT Trial • Benefits of Semaglutide on Chronic Kidney Disease Outcomes by Cardiovascular Status or Risk in the FLOW Trial Main Events Making Great Strides: Our Journey in the Treatment of Acute Myocardial Infarction 9:45-11 a.m. | Main Event II Henning Lecture Session: Non-Traditional Risk Factors & Biomarkers of Peripheral Arterial Disease 9:45-11 a.m. | S100A Gene Therapy in the Cardiology Clinic: Ready for Prime Time? 1:30-2:45 p.m. | Main Event II Additional resource available: Gene Therapy in Cardiovascular Disease: Recent Advances and Future Directions in Science a recently released AHA Science Advisory
3 #AHA24 ScientificSessions.org Scan the QR code to view the Industry Programming Guide. Check the Mobile Meeting Guide app for updates. Environmental crises call for more CV research Pollution, rising temperatures can have a big impact on health. Air pollution and rising heat levels in some regions of the world will impact areas beyond just the environment, including the health of people struggling with cardiovascular disease, according to speakers at the Sunday session “Environmental Crisis Exposome: Reshaping the Landscape of CV Basic Research and Health Care.” Sanjay Rajagopalan, MD, MBA, FACC, said environmental crises are one of the leading causes of global morbidity and mortality and are collectively responsible for a large increase in noncommunicable diseases. Those account for more than 41 million deaths each year around the world, according to the World Health Organization. “Cardiovascular disease constitutes a majority of these fatalities,” said Rajagopalan, chief of cardiovascular medicine at Harrington Heart and Vascular Institute in Cleveland. “While traditional risk factors for CVD — such as diabetes, hypertension, smoking and hypercholesterolemia — have long been recognized as independent entities, there is growing evidence that environmental stressors play an increasingly significant role in the genesis of these factors.” Annette Peters, PhD, chair of epidemiology at Ludwig-Maximilians University in Munich, said cardiologists need to be aware of how these changes can impact patients. “The environmental crisis and specifically climate change are leading to increased levels of air pollution and heat,” she said. “Air pollution has both shortterm and long-term impacts on cardiovascular disease, while heat triggers cardiovascular disease exacerbation. On a molecular level, we observe, for example, an increase in biological aging both in association with air pollution and heat exposure.” One cardiovascular area delving into climate-related issues has been ischemic heart disease, Peters said. But research is beginning to expand far beyond that. “Nowadays, all cardiovascular diseases and cardiovascular function are under investigation,” she said. “Broad-ranged approaches from basic to clinical research and population-based health care research are badly needed.” Novel areas to investigate include underlying molecular mechanisms and pathomechanisms, integrating cutting-edge approaches in cardiovascular research, Peters said. Research is also needed to address the impact of interventions mitigating the environmental crisis on CV risk. “Finally,” she said, “we need research geared to improve patient treatment during extreme environmental events.” Rajagopalan noted emerging opportunities for interdisciplinary research between cardiovascular medicine and other fields. “The emerging areas of research are clearly in bridging disparate fields or transdisciplinary research, including medicine and engineering and, in particular, artificial intelligence that has an incredible capacity to process large amounts of data and synthesize it,” he said. “Systems science approaches and ways to connect disparate datasets are the needs of the hour.” In rapidly urbanizing societies at risk for climate hazards, systems science can inform resilience and mitigation measures, Rajagopalan said. “Central to this is the idea that health needs to be an essential consideration in urban engineering to combat risk factors like obesity because of poorly structured environments.” Session organizer Konstantinos Drosatos, MSc, PHD, FAHA, professor of pharmacology, physiology and neurobiology at the University of Cincinnati College of Medicine, said a particularly important aspect of research is an ongoing effort to create a consensus on standard experimental models to study the effects of environmental crisis on cardiovascular biology. “This initiative is expected to resonate strongly within the cardiovascular research community,” he said, noting that the American Heart Association will play a pivotal role in creation of this consensus. “As more research groups begin to incorporate the effects of environmental crisis into their cardiovascular biology programs, the AHA’s involvement will be crucial in setting the standards that will foster standardization and collaboration across the field,” he said. Rajagopalan Peters Drosatos See more #AHA24 highlights online at Scientific Sessions Conference Coverage sessions.hub.heart.org Meet the Trialist MTT.04 | MHYH-RCT 8–8:30 a.m. | Overflow Theater 2, North Building, Level 2 MTT.05 | ZODIAC 8:45–9:15 a.m. | Overflow Theater 2, North Building, Level 2 Don’t miss … Hot Debates in Heart Failure 9:45-11 a.m. | S401D Cardiogenic Shock: A TeamBased Approach to Discovery and Clinical Management 9:45-11 a.m. | N227AB Pearls to Improve Periprocedural Care 1:30-2:45 p.m. | N139 Simulation Zone Located in the Heart Hub For those interested in taking a deep dive into aspects of diagnosis and management. Sign up for the 9:15-11:15 a.m. Masterclass. Each class runs for 60 minutes.
4 SCIENTIFIC SESSIONS DAILY NEWS | Day 3 Monday, Nov. 18, 2024 Scientific Sessions Daily News is produced for the American Heart Association for Scientific Sessions by Ascend Media, LLC (ascendmedia.com). After you have read this issue of Scientific Sessions Daily News, please share with colleagues or deposit it in an approved paper recycling bin. ©2024 by the American Heart Association 7272 Greenville Ave. Dallas, TX 75231 214-570-5935 ScientificSessions.org Visit us at BOOTH #1112 NewAmsterdam Pharma is dedicated to Defusing the LDL-C Threat © NewAmsterdam Pharma B.V. 2024. 09/24 UM---0004 NewAmsterdam Pharma recognizes the need for alternative pharmacologic approaches to LDL-C management and is committed to developing novel, nonstatin, oral therapies that will potentially reduce patients’ ASCVD risk. Paid Advertisement ASCVD, atherosclerotic cardiovascular disease; CV, cardiovascular; LDL-C, low-density lipoprotein cholesterol. Reference: 1. Family Heart Foundation. Prioritizing LDL-cholesterol control. Accessed August 21, 2024. https://familyheart.org/prioritizing-ldl-cholesterol-control Failure to attain LDL-C goals results in a 44% increase in CV events1 IT’S TIME TO EXPECT MORE Scan to learn more The American Heart Association (AHA) marks an historic landmark this year: its 100th anniversary! A wide range of celebratory events is planned to commemorate this important anniversary, to catalog, celebrate and honor the AHA’s 100 year-long journey. This is a time to recognize and honor the AHA’s numerous successes and enormous influence. Beyond that, many are working to envision and sculpt the next 100 years of the AHA’s influence and impact. As part of this exciting yearlong celebration, the AHA’s journals are launching a series of short articles termed Centennial Collection. Visit www.ahajournals.org/ centennial for a full listing of Centennial Collection articles and more. New: 100 Years of Lifesaving Work and Counting: Happy Birthday to the American Heart Association Highlights from the Centennial Collection The American Heart Association Journals Centennial Collection • Joseph A. Hill, MD, PhD, FAHA, and on behalf of the editorsin-chief of the American Heart Association Journals CEO Foreword: The Centennial Presidential Advisory • Nancy Brown, AHA CEO Cardiology: A Century of Progress • Eugene Braunwald, MD, MACC, FAHA The Feminine Face of Heart Disease 2024 • Nanette K. Wenger, MD, MACC, MACP, FAHA Centennial Collection The AHA marks its 100 years with journal articles highlighting its 100 years of lifesaving work.
5 #AHA24 ScientificSessions.org Redefining Arrhythmia Treatment Saturday’s Late-Breaking Science session “Redefining Arrhythmia Treatment: Pushing Boundaries” found that: • Catheter ablation tops antiarrhythmic drug therapy to block VT in ischemic cardiomyopathy. • OPTION showed left atrial appendage device beats oral anticoagulation for bleeding after AF ablation. • No cognitive impairment or stroke benefit from oral anticoagulation seen in BRAIN-AF. The first large head-to-head trial of catheter ablation versus antiarrhythmic drug therapy to suppress ventricular tachycardia (VT) following myocardial infarction (MI) suggested ablation is the preferred first-line therapy for patients who have persistent VT with an implantable cardioverter-defibrillator (ICD). The VANISH2 trial showed a 25% benefit for ablation (HR 0.75, 95% CI 0.580.97, p=0.03) without major differences in safety compared to antiarrhythmic drug therapy. Patients were followed for a median of 4.3 years. Sapp “In terms of serious adverse events, there was no statistically significant difference, although the trend was toward better survival following catheter ablation” said John Sapp, MD, professor of cardiology at Dalhousie University in Halifax, Canada. “We observed the anticipated drug side effects and procedural complications.” Cardiac arrhythmia that stems from electrical dysfunction across ischemic scars is one of the most common causes of sudden death in individuals who have had one or more prior MI’s, Sapp said. VT is the most common arrhythmia leading to sudden death in the days to weeks and years following MI. The VANISH1 trial established the superiority of catheter ablation versus escalation of drug therapy in patients with VT despite antiarrhythmic drug therapy but did not address first-line treatment. VANISH2 randomized 416 patients in North America and Europe with prior MI and clinically significant VT, defined as VT storm, appropriate ICD shock, recurrent anti-tachycardia pacing, or sustained VT presenting for emergent treatment. Patients received either catheter ablation (203 patients) or drug therapy (213 patients) with sotalol or amiodarone as initial therapy. Ablation was performed within 14 days of randomization. The primary endpoint was a composite of death or, ≥ 14 days after treatment, VT storm, appropriate ICD shock or sustained VT that presented for emergent treatment emergently. The primary endpoint was seen in 50.7% of patients who received ablation and 60.6% of those who received drug treatment, a 9.9% absolute reduction and 25% relative reduction for ablation. Among patients randomized to ablation, death was observed in 1.0% of patients, nonfatal stroke in 1.0%, cardiac perforation in 0.5% and vascular injury in 1.9%. Among patients randomized to drug treatment, one died due to pulmonary toxicity and 21.6% experienced nonfatal drug-related adverse events. While VANISH2 clearly demonstrated a benefit for ablation versus antiarrhythmic drug therapy as first-line treatment for ischemic cardiomyopathy, the trial did not address other, nonischemic causes of VT. Sapp noted that VT resulting from cardiac scarring other than MI can be more difficult to treat with ablation than VT associated with MI scarring. “We still need to understand how best to treat patients with VT who have nonischemic cardiomyopathy,” Sapp said. “The outcomes for ablation may be different in that population and the relative benefits and risks could therefore be different as well.” VANISH2 was published simultaneously in the New England Journal of Medicine. Left atrial appendage closure beats oral anticoagulation for bleeding after catheter ablation The first direct comparison between oral anticoagulation and left atrial appendage closure (LAAC) using the WATCHMAN implant after catheter ablation for atrial fibrillation (AFib) found significantly less major or clinically relevant nonmajor bleeding, 8.5% for LAAC versus 18.1% for oral anticoagulation. The closure device was statistically non-inferior to oral anticoagulation for a composite endpoint of all-cause death, stroke or systemic embolism at 36 months (5.3% vs. 5.8%, respectively, p for noninferiority <0.0001) with a numerical trend for superiority. Wazni “This has the possibility of changing clinical practice,” said Oussama Wazni, MD, MBA, head of electrophysiology at the Cleveland Clinic. “I think people are going to want to close the left atrial appendage and not have to worry about anticoagulation, especially because the difference in bleeding rates was so high.” See ARRHYTHMIA, page 15 Streamlining the pathway to publish cardiovascular research The American Heart Association (AHA) is thrilled to announce a new collaboration between the New England Journal of Medicine (NEJM) and the AHA’s flagship journal Circulation. In January 2025, research authors will have the option to select a seamless transfer of their manuscript between NEJM and Circulation. This pilot program leverages the expertise of the journals’ worldclass editors and peer reviewers to streamline the publication of novel cardiovascular research. NEJM is the most widely read and cited general medicine journal in the world, and coupled with Circulation’s stature in cardiology this arrangement helps to expedite the submission process for authors, simplifying the publication pathway for high-impact cardiovascular articles. This collaboration aims to strengthen, diversify and improve the quality of research published in both journals, providing greater benefits to authors and readers. Together, the journals are set to amplify the sharing of innovative cardiovascular research, speed the publication of practicechanging science and address pressing health challenges, while underscoring each organization’s commitment to improving global health outcomes for the benefit of patients everywhere. Post-conference survey We want to hear from you! Don’t miss out on an opportunity to be randomly selected to receive complimentary registration to Scientific Sessions 2025.
6 SCIENTIFIC SESSIONS DAILY NEWS | Day 3 Monday, Nov. 18, 2024 Harnessing AI for better heart health Saturday’s Late-Breaking Science session “Smart Cardiology: Harnessing AI and Innovation for Better Heart Health” found that: • Pharmacy management can improve guideline-directed medical therapy for heart failure. • Wearable sensor matches implanted sensor for pulmonary capillary wedge pressure in heart failure. • Artificial intelligence can boost echocardiogram performance with less sonographer fatigue. • PanEcho can automate echocardiographic interpretation Initial results from a randomized trial found that empowering pharmacists to titrate guidelinedirected medical therapy (GDMT) for heart failure can significantly increase pharmacist engagement in heart failure care. Pharmacists embedded in primary care practices received an audit and feedback intervention in addition to heart failure education compared with usual care pharmacists that received heart failure education alone. Pharmacists in the audit and feedback arm completed more monthly heart failure encounters and more encounters with heart failure medication adjustment compared with usual care pharmacists. Heart failure patients managed by pharmacists that received audit and feedback were more likely to receive new mineralocorticoid receptor antagonist prescriptions, 11.6% versus 9.2% for usual care (p<0.01), which have historically been the most under-prescribed components of heart failure GDMT. Sandhu “We are fortunate to have a variety of incredibly effective medication therapies that dramatically reduce morbidity and mortality of heart failure,” said Alexander Sandhu, MD, assistant professor of cardiovascular medicine at Stanford University School of Medicine. “Unfortunately, these therapies remain under-utilized. There is an urgent need to find and implement care strategies that improve our utilization of guideline-directed medical therapy for this incredibly high-risk group. “Audit and feedback” is an effective approach to increasing guideline-directed heart failure medication management by pharmacists.” The PHARM-HF A&F Study randomized 120 primary care pharmacists in Veterans Administration facilities across Northern and Central California, Nevada and the Pacific Islands to usual care, audit and feedback, or A&F+. VA pharmacists have independent prescribing authority, Sandhu said, and are actively involved in GDMT management of hypertension, diabetes and other chronic conditions. However, pharmacists often lack the experience or comfort with managing heart failure medications. All pharmacists in the study had access to heart failure-specific education, including a monthly webinar, to learn more about heart failure management. Pharmacists in the audit and feedback arm received emailed audit and feedback information on their heart failure medication activities compared to peers in their local VA facility and region. Pharmacists in the A&F+ arm also received lists of patients eligible for heart failure medication titration. The primary outcome was the difference in rates of heart failure medication adjustment encounters between usual care and the combined A&F/A&F+ arms. Pharmacists’ heart failure management activities were followed for six months. An additional six months of follow-up will be reported at a later date. “We hope that increased audit and feedback and heart failure education will empower pharmacists to confidently improve heart failure medication therapy. We hope we will see the effect of this intervention grow over time as pharmacist experience increases,” Sandhu said. “We would like to improve and adapt these practices and then scale them to other VA regions to further improve heart failure care.” External sensor results match implanted sensor for intracardiac hemodynamics in heart failure A novel wearable sensor that sits on the chest of patients with heart failure shows similar pulmonary capillary wedge pressure (PCWP) and other data as implanted sensors. The noninvasive CardioTag uses accelerometers to measure chest movement with each heartbeat and a novel algorithm to translate chest movement into intracardiac pressures. The SEISMIC-HF I trial showed a mean error for PCWP of 1.04 mmHg compared to gold standard right heart catheterization (RHC) measurements. Klein “A sensor on the chest is able to capture the heart’s movement in tridimensional space,” said Liviu Klein, MD, MS, professor of cardiology and director of the Advanced Heart Failure Comprehensive Care Center at the University of California, San Francisco. “These movements are related to heart contractions, which are related to pressures in the heart. We can get results that are very similar to an implantable device such as a CardioMEMS or Cordella PAP sensor using a wearable sensor.” Hemodynamic-guided management of heart failure using an implantable sensor to measure pulmonary artery pressures can improve the quality of life and decrease the risk of heart failure hospitalization, Klein said. But clinical adoption has been limited due to the invasive procedure and reimbursement challenges. The prospective observational SEISMIC-HF I study followed 943 heart failure patients at 15 U.S. centers scheduled for routine RHC. The mean age was 63, 58% were male, 55% White and 27% African American. Most, 88% had a heart failure diagnosis, 39% with LVEF ≤ 40%, and 90% had NYHA class II-IV symptoms. In addition to the RHC, participants used a CardioTag to collect electrocardiography, seismocardiography and photoplethysmography data. The CardioTag device and algorithm received a Food and Drug Administration Breakthrough Device Designation in 2022. The mean RHC measured pulmonary artery pressures were 42.6 mmHg systolic and 18.4 mmHg diastolic, while the mean RHC measured PCWP was 15.9 mmHg. Klein reported the validation set results showed a mean error of just over 1 mmHg for PCWP compared to gold standard RHC. “In heart failure, we know that people feel poorly and end up in the
7 #AHA24 ScientificSessions.org hospital when pressures in the heart start to increase,” he said. “These pressures don’t just increase two or three days prior to hospitalization, it takes four, five, six weeks. If you have an implantable sensor, we can track pressures and adjust medications, but maybe 1% of the heart failure population has a sensor implanted. This noninvasive device can provide similar information that can prevent patients from ending up in the hospital, prevent them from having symptoms and help them lead a more normal daily life at home.” Artificial intelligence can improve echocardiographic workflow A single-center randomized crossover study found that a novel artificial intelligence (AI)-based analysis tool can streamline the daily workflow in echocardiology with improved measurements and more patients examined compared to conventional manual echocardiography for cardiovascular risk assessment. AI assistance reduced the time per exam, 13.0 minutes versus 14.3 minutes for manual exams (p<0.001) and increased the number of daily exams from 14.1 to 16.7 (p=0.003) with less sonographer fatigue (p=0.039), 3.4-fold more echocardiographic parameters analyzed per exam (85 versus 25, p<0.001) and improved cardiographic image quality (p<0.001). Kagiyama “Over 90% of the AI’s initial values were clinically acceptable and used in clinical practice,” said Nobuyuki Kagiyama, MD, PhD, associate professor of cardiology at Juntendo University School of Medicine in Tokyo, Japan. “AI can enhance efficiency in the echo lab, easing a boring, repetitive task like screening echocardiograms, so sonographers and cardiologists can spend more time on the detailed evaluation of more severe patients who really need more intensive care and attention.” Improving echocardiography workflow is a particular interest in Japan, which has about onethird the U.S. population but performs about 1.3 times more echocardiograms, commonly for routine cardiovascular risk screening. AI-ECHO randomized four experienced sonographers performing screening echocardiography over 38 days on a daily basis to use AI for automatic echocardiography analysis (19 AI days) or conventional procedures (19 non-AI days). Both AI and nonAI echocardiograms were reviewed by expert cardiologists, who finalized all reports for clinical use. The primary endpoint was examination efficiency, defined as the time per examination and the number of exams performed per day. Secondary endpoints included the number of parameters analyzed and image quality. AI days allowed sonographers to focus on image acquisition and quality, Kagiyama said, resulting in an overall improvement in image quality compared to non-AI days. Because AI was handling image analysis, sonographers could, and did, concentrate more on acquiring higher quality images knowing that they would not have to spend time later evaluating imaging themselves. “This software is already approved by the FDA and the Pharmaceuticals and Medical Devices Agency in Japan for some uses, but AI-ECHO pushed it beyond what is approved today,” Kagiyama said. “This realworld randomized trial demonstrates how AI-based automatic analysis can significantly improve the efficiency of screening echocardiography by reducing exam time while maintaining image quality and reducing sonographer fatigue.” AI interpretation can accurately interpret echocardiogram findings across multiple metrics Transthoracic echocardiography (TTE) is a key tool for cardiovascular evaluation, but manual reporting can be slow, and interpretation is subject to intra-reviewer variability. A novel AI tool, PanEcho, is the first view-agnostic, multitask AI model that automates TTE interpretation across views and acquisitions for all key echocardiographic metrics and findings. An initial validation study showed a median area under the receiver operating characteristic curve (AUC) of 0.91 across 18 classifications. Key findings include an AUC of 0.99 to detect severe aortic stenosis, 0.98 for moderatesevere left ventricular (LV) systolic dysfunction and 0.95 for moderatesevere LV dilation. Holste “To our knowledge, this is the first AI model to provide comprehensive echocardiogram interpretation from multiview echocardiography,” said Gregory Holste, MSE, graduate student at the Yale School of Medicine Cardiovascular Data Science (CorDS) Lab. “Current AI applications in echocardiography have been limited to single views and single pathologies for outcomes. And intrepetation is nearly real time. PanEcho was developed using 1.23 million echocardiographic videos from 33,927 TTE studies performed at a New England health system between January 2016 and June 2022. The model can perform 39 TTE reporting tasks spanning the full spectrum of myocardial and valvular structure and function from parasternal, apical and subcostal views, including B-mode and color Doppler videos. The model was evaluated on a distinct New England health system cohort and two cohorts in California. Researchers assessed off-the-shelf diagnostic performance and PanEcho’s ability to function as a foundational model that can be fine-tuned for specific domains. Khera The model estimated continuous metrics with a median normalized mean absolute error (MAE) of 0.13 across 21 routine echocardiographic tasks. LV ejection fraction (EF) can be estimated with 4.4% MAE and LV internal diameter with 3.8 mm MAE. PanEcho can identify which views are most informative for each task. The model has transferred LVEF estimation to novel pediatric populations with superior performance compared to existing approaches, 3.9% MAE versus 4.5% MAE for the next-best approach. “We see strong predictive performance even in very simplified acquisition of just five videos from key views,” said principal investigator Rohan Khera, MD, MS, CorDS Director. “Such applications to simpler acquisitions could broaden the efficient, expert-level interpretation of PanEcho even to point-of-care ultrasound, especially suited to low-resource settings. The next step is prospective validation in a real-world clinical workflow.” Customized agendas for Sessions 2024 Pick up your copy near the Science & Technology Hall entrance, or scan the QR codes to view online. Take a through
2502 2512 Posters Zone 2 Moderated Digital Posters 6-11 201 Public Service 1 2 12 320 Puppy Snuggles Supported by Sanofi 323 324 326 327 328 331 423 424 426 427 521 Bayer 526 Bridgebio 531 Eli Lilly and Company 702 Duke Clinical Research Institute 706 708 710 712 BMS/ Pfizer 716 Mayo Clinic 902 Bristol Myers Squibb 909 Intermountain Health 914 917 Merck & Co., Inc. 921 1109 Boehringer Ingelheim/Lilly Commercial 1112 New Amsterdam Pharma 1115 Pfizer, Inc. 1119 ZOLL Medical Corporation 1123 Medtronic 1302 Novartis Pharmaceuticals Corporation 1308 Novartis Pharmaceuticals Corporation 1312 Cytokinetics 1316 AstraZeneca 1322 Merck & Co., Inc. 1702 Esperion Therapeutics 1705 Idorsia Pharmaceuticals US Inc. 1708 1710 1714 1717 Arrowhead Pharmaceuticals 1720 1721 1808 1809 1820 1821 1902 Johnson & Johnson 1912 Amgen 1920 1921 1924 Amarin Pharma, Inc. 2020 2021 2022 2109 Silence Therapeutics 2120 2122 2220 2224 Kiniksa Pharmaceuticals 2302 Novo Nordisk, Inc. 2308 2309 2310 2312 2313 2315 2316 2318 Amgen 2321 Alnylam Pharmaceuticals 2408 2409 2410 2412 2413 2415 AtriCure 2514 BMS/J&J Alliance 2517 American College of Cardiology 2520 Viatris 2526 2527 2528 2531 2532 2533 2534 2712 2713 2714 2715 2717 2718 2719 2720 2721 2812 2813 2814 2815 2817 2818 2819 2820 2821 2222 806 808 809 Posters Zone 1 Moderated Digital Posters 1-5 CardioTalk Theater I Eli Lilly and Company DOWN UP UP Best of Specialty Conferences Posters Down to Level 2.5 ENTRANCE Information Counter/ Concierge Mobile App Desk Poster Attendant Booth GRAND CONCOURSE rd reet afe Global Quality Showcase HeartQuarters Heart Theater I FIRST AID FedEx Kinkos Business Center TO MAIN EVENT I Exhibit Hall Concierge Desk B39 B40 B41 B42 1909 2009 2010 Take center stage at #AHA24 with our 360-degree photo booth! Located at HeartQuarters in the Heart Hub Scan the QR code to view more exhibit hall highlights in Experience Scientific Sessions
Posters Zone 4 Moderated Digital Posters 17-23 3468 Posters Zone 3 Moderated Digital Posters 12-16 3 4 5 6 Simulation Zone 8 9 10 11 13 14 3072 AHA Scholars’ Posters Supporting Undergraduate Research Experiences (S.U.R.E.) Program 15 16 537 Daiichi Sankyo, Inc. 541 Getting to the Heart of Stroke 2542 Novo Nordisk, Inc. 2550 CardioTalk Theater II 2739 Lexicon Pharmaceuticals, Inc. 2754 Lp(a) Testing Supported by Novartis Pharmaceuticals Corporation HEART HUB HIPods 1-3 HIPods 4-6 Health Innovation Pavilion STAGE UP UP UP NCY EXIT EMERGENCY EX Charging Lounge Supported by Eli Lilly and Company Member Lounge Learning Studio I Learning Studio II FAHA Lounge Heart Theater II Abstracts on USB Supported by Lexicon 7 B1 B2 B3 B4 B5 B6 B7 B8 B9 B10 B11 B12 B13 B14 B15 B16 B17 B18 B19 B20 B21 B22 B23 B24 B25 B27 B28 B31 B34 Exhibitor Lounge/ Sales Office B35 Business Suites B26 B30 B36 B48 B45 B41 B42 B47 B46 Publisher's Row 2939 2942 2943 2945 Wolters Kluwer 2951 2952 3042 3043 3051 3052 3139 3140 3141 3142 3143 3145 3151 3152 3239 3240 3241 3242 3243 3251 3252 2654 2557 Rocket Pharmaceuticals, Inc. Dedicated IT 2554 Explore these useful learning and networking opportunities. Science & Technology Hall South Hall, Level 3 Hours: Monday, Nov. 18 9 a.m.-3 p.m. Coffee and Tea Breaks: Stop by for a complimentary coffee or tea at one of the stations located within the Science & Technology Hall. Take #AHA24 science home Pick up your complimentary copy of Abstracts on USB in Booth 2739. Scan the QR code for a list of First-Time Exhibitors at #AHA24
10 SCIENTIFIC SESSIONS DAILY NEWS | Day 3 Monday, Nov. 18, 2024 Dissecting the complex relationship between atrial cardiomyopathy and stroke Paul Dudley White Lecture lays groundwork for promising patient outcomes. Atrial cardiomyopathy is one of the most diagnosed cardiovascular diseases in the United States, surpassing even coronary artery disease in developed countries. As a risk factor for ischemic stroke, heart failure and premature death, it is debilitating — particularly for older people — and is a considerable health system burden. Despite the challenges, Barbara Casadei, MD, DPhil, FRCP, FMedSci, FESC, maintains that much of atrial cardiomyopathy’s role in ischemic stroke is up for debate. Casadei is a professor of cardiovascular medicine and head of Imperial College’s National Heart and Lung Institute in London. She delivered Sunday’s Paul Dudley White International Lecture and Session, “Atrial Cardiomyopathy and Ischemic Stroke: The Jury Is Out.” “This is an area of intensive research. Several investigators have reported metabolic changes in atrial tissue. Others have highlighted the importance of interstitial fibrosis. But because the atrial wall is so thin, it is difficult to assess these changes in vivo and in patients reliably,” Casadei said. “For this reason, the research community has focused on risk factors and on plasma, imaging or EKG-derived biomarkers of atrial cardiomyopathy and cardioembolic stroke risk,” she said. “Much research is ongoing, but to date it remains unclear whether this effort will translate into practical solutions that will improve risk assessment and prevention of cardioembolic stroke.” Casadei’s work represents advances in the understanding of the relationship between atrial cardiomyopathy, atrial fibrillation and stroke. By expanding the focus from AFib to now include atrial cardiomyopathy, her work may pave the way for improved stroke prevention and care. “Better understanding of this complex relationship may help us reduce the burden of stroke, identify patients at risk of developing heart failure and enhance the quality of life of millions of patients around the globe,” Casadei said. Current treatments for AFib, such as pulmonary vein isolation or antiarrhythmic drugs, improve symptoms and quality of life, but AFib recurs and the benefit of these approaches in reducing stroke risk remains uncertain. “AFib is a combination of a trigger and a substrate that facilitates the initiation and maintenance of the arrhythmia,” Casadei said. “Although it is unlikely that all ectopic beats from the pulmonary veins result in AFib, the combination of a trigger and an atrial cardiomyopathy substrate will provide a ‘fertile terrain’ for AFib to take root. Whether we will be able to prevent or reverse the atrial cardiomyopathy substrate is an ongoing challenge.” Traditional thinking is insufficient to explain all clinical observation. Casadei’s research has shown that molecular, structural and electrical changes that precede or accompany the onset of AFib may contribute to stroke risk independent of AFib. Her research emphasizes a need for a new model of stroke risk prediction that accounts for both AFib and atrial cardiomyopathy. This model could lead to more personalized and effective AFib and stroke prevention strategies, she said. But, to date, efforts to test the use of anticoagulation in patients with cryptogenic stroke with or without evidence of atrial cardiomyopathy have not produced positive results. “Whether this is because the biomarkers that have been used to identify atrial cardiomyopathy lack specificity or direct mechanistic links with atrial thrombogenesis remains to be explored. Investigators that define atrial cardiomyopathy based on local inflammation or left atrial flow characteristics may reach different conclusions,” she said. Casadei’s research also underscores the importance of imaging methods to identify patients at high risk of stroke. Techniques such as advanced cardiac magnetic resonance imaging and computed tomography aided by artificial intelligence applications will be crucial for identifying and subclassifying atrial cardiomyopathy and the associated stroke risk. New tools and the availability of larger and larger datasets may open the possibility of teasing apart different types of AFib that may require different treatment and carry different risks. “Our priority now is to find a way to bridge the gap between understanding the mechanisms of atrial cardiomyopathy and applying this knowledge to improve patient outcomes through prevention and treatment,” she said. Casadei Driving breakthroughs Nancy Brown, AHA CEO, welcomed everyone to yesterday’s Presidential Session with a message 100 years in the making. “Since our founding in 1924, deaths from cardiovascular diseases have been cut in half. And yet, there are still so many lives to be saved,” she said. “By driving breakthroughs in science, policy and care, together, we can continue to deliver on this mission in powerful new ways during our second century.” Brown underscored last year’s AHA success in defining cardiovascular-kidney-metabolic syndrome, saying that, over the next four years, the association will engage an initial 150 hospitals and sites to advance guidelines for CKM care, with plans to expand to the nearly 2,900 Get With The Guidelines hospitals nationwide, which will impact 89 million patients in the U.S. who are at risk for, or living with, CKM syndrome. Brown also pointed to the game-changing impact of GLP-1 agonists for diabetes, cardiovascular outcomes and weight management, pointing to the AHA’s Healthy Living BEYOND Weight Study that will examine individuals living with overweight or obesity, to improve understanding of the causes and treatments of the conditions. control diabetes, battle obesity and treat hyperlipidemia with therapies that we know work and continue pursuing new and innovative treatments. Next, with our partners in government, industry and communities, we must find ways to improve the social drivers of health. Access to care is a universal problem.” Finally, Churchwell said the working environment for clinicians, scientists and nurses must be enhanced to increase efficiency so that these health care workers can feel that their work is fulfilling. “We are facing a crisis,” he said. “While a sense of urgency always looms over medical care, it feels as if the clock is ticking a bit faster — and louder. “None of us is expected to have all the solutions. But I’ve learned that each of us can do something — and together, we can play parts large and small to make a difference. And not only can we, we must.” PRESIDENTIAL SESSION continued from page 1 Brown
11 #AHA24 ScientificSessions.org without creating anxiety, and then of course, efforts should focus on rapid detection of SCA and increased access to automated external defibrillators (AEDs), including making sure people know how to use AEDs and are not afraid to use them.” Detection and quick response are key in addressing SCA, Al-Khatib said, particularly because prediction tools have been studied for decades and little progress has been made. Most existing tests designed to predict SCA are either not sensitive enough or not specific enough to gather the information clinicians need, she said. Currently, a low, left ventricular ejection fraction (LVEF) of 35% or less remains one of the most powerful predictors. She said she also sees promise in some of the work that is being done with wearables that could quickly identify patients in a life-threatening rhythm, potentially leading to quick dispatch of EMS and ultimately a significant improvement in patients’ survival. As for awareness, Al-Khatib said the American Heart Association (AHA) has done a great job in that area through training the masses in basic life support (BLS) as well as health care practitioners in advanced cardiovascular life support (ACLS). “I am hopeful that with wearables, artificial intelligence (AI), heightened awareness, etc., we will be able to detect SCA and intervene promptly to save people’s lives,” AlKhatib said. In his presentation, “Prevention of Sudden Cardiac Death Beyond AEDs and ICDs,” fellow speaker Sumeet S. Chugh, MD, FAHA, discussed a new approach to prevent SCD that goes beyond AEDs and implantable cardioverter defibrillators (ICDs). Chugh is a professor of cardiology and medicine at the Cedars-Sinai Smidt Heart Institute in Los Angeles. Chugh has proposed a novel strategy known as “near-term prevention” for preventing SCD. The strategy is designed to bridge the gap between ICDs and AEDs. This approach leverages warning symptoms that precede imminent SCA. Research from the Oregon Sudden Unexpected Death Study revealed that individuals who responded to warning symptoms by calling 911 had a significantly higher survival rate. However, the challenge lies in distinguishing SCA-related symptoms from those of other conditions to avoid overwhelming emergency services with false alarms. In his research on the topic, Chugh’s team compared symptoms reported before SCA with those from non-SCA emergency calls. “We identified that symptoms such as dyspnea, chest pain, diaphoresis and seizure-like activity were more likely to be associated with SCA,” Chugh said. “These findings were sex-specific, with chest pain, dyspnea and diaphoresis being significant predictors in men, while only dyspnea was significant in women.” Like Al-Khatib, Chugh said the future of near-term prevention lies in the integration of smart devices and AI. Smart devices, equipped with AI algorithms, have the potential to perform rapid triage based on an individual’s symptoms and prompt them to seek urgent care. Additionally, other devices such as smart speakers have shown promise in detecting agonal breathing, a sign of SCA, and distinguishing it from normal sleep sounds. This remote, non-contact detection could enable rapid emergency response and improve survival rates. Near-term prevention could also be deployed in emergency departments to better triage symptomatic individuals, Chugh said. This approach would help distinguish those who need immediate observation and further investigation from those who can be safely discharged with follow-up care. “Although AEDs and ICDs remain crucial in SCD prevention, their effectiveness may have reached a plateau,” Chugh said. “Further research and clinical trials are needed to refine novel AI-powered approaches that predict imminent SCA and ensure their successful deployment in both community and clinical settings.” CARDIAC ARREST continued from page 1
12 SCIENTIFIC SESSIONS DAILY NEWS | Day 3 Monday, Nov. 18, 2024 Coronary and valvular heart disease late-breaking science Research from four abstracts highlight oxygenation strategies, DOACs and novel agents to optimize cardiac surgery and outcomes post-myocardial infarction. They found that: • Liberal or restrictive oxygenation may be safe for patients undergoing cardiopulmonary bypass-assisted coronary artery bypass grafting or aortic valve replacement. • Perioperative novel exenatide, a GLP-1 agonist therapy, did not benefit cardiac surgery patients. • Edoxaban shows clinical benefit in patients after bioprosthetic valve replacement. • Spironolactone may reduce heart failure but did not reduce primary outcomes in patients after acute myocardial infarction. Liberal or conservative oxygenation strategy during cardiac surgery may be considered Adequate oxygenation is essential for preserving organ function during coronary artery bypass grafting or aortic valve replacement surgery. Traditionally, high levels of oxygenation have been applied during extracorporeal circulation. Still, a conservative or liberal oxygenation strategy could be considered for patients undergoing these surgical interventions, according to the Efficacy of Restrictive versus Liberal Oxygenation in Patients undergoing Coronary Artery Bypass Grafting or Aortic Valve Replacement, results of one of two co-primary interventions independently investigated in the GLORIOUS trial. The 2-by-2, single-center clinical trial randomized 1,400 patients undergoing elective or subacute coronary artery bypass grafting and/ or surgical aortic valve replacement from 2016 to 2021 to a conservative oxygenation strategy of 50% fraction of inspired oxygen (FiO2) versus a liberal oxygenation strategy of 100% FiO2 during cardiopulmonary bypass surgery and for the first hour after weaning. The primary outcome was time to the first occurring composite endpoint during follow-up, including death, renal failure requiring renal replacement therapy, stroke, new onset heart failure or any readmission for heart failure. The trial was designed as event driven, and accordingly, the follow-up period was a priori defined to continue until a total of 323 events had occurred. Secondary endpoints included predefined safety endpoints during the index admission, such as surgical site infection, acute kidney injury, hypoglycemia, pancreatitis, a relative reduction of ejection fraction of 50% compared to baseline, reoperation for bleeding and any cause and post-surgical myocardial infarction. Additionally, re-admission for cardiovascular causes within 12 months was monitored. Wiberg Overall, oxygenation at 50% versus 100% did not affect the composite endpoint of organ injury in adults undergoing cardiopulmonary bypass-assisted cardiac surgery after a median follow-up of 5.9 years. “The neutral results of our trial suggest that it’s safe to only administer 50% oxygen during cardiopulmonary bypass and that if you are worried about endorgan perfusion, it’s also safe to administer 100% oxygen,” said Sebastian Wiberg, MD, PhD, clinical associate professor at Copenhagen University Hospital Rigshospitalet in Denmark. “Our results show that you should feel free to administer the oxygenation strategy best suited for the patient.” GLP-1 analog exenatide did not show benefit during cardiac surgery Infusion with the GLP-1 analog exenatide initiated before cardiopulmonary bypass-assisted coronary artery bypass grafting and/ or surgical aortic valve replacement did not improve outcomes, according to a second independent co-primary endpoint investigated in the GLORIOUS trial. The 2-by-2 single-center, eventdriven trial randomized 1,400 patients undergoing elective or subacute coronary artery bypass grafting and/or surgical aortic valve replacement from 2016 to 2021 to a six-hour and 15-minute infusion of 17.4 micrograms of the GLP-1 analog exenatide or placebo initiated after anesthesia prior to surgery in a double-blind fashion. “Based on a number of preclinical studies from 2010 to 2015 in stroke and myocardial infarction, which showed that treatment with exenatide could reduce final cerebral and myocardial infarction size, we had hypothesized that initiating a novel treatment of exenatide could prevent some of the organ damage that occurs during cardiopulmonary bypass-assisted heart surgery,” Wiberg said. The composite primary endpoint assessed throughout follow-up was death, renal failure requiring renal replacement therapy, stroke, new onset heart failure or any readmission for heart failure until 323 events. Secondary endpoints included predefined safety endpoints during the index admission, such as surgical site infection, acute kidney injury, hypoglycemia, pancreatitis, a relative reduction of ejection fraction of 50% compared to baseline, reoperation for bleeding and any cause, and post-surgery myocardial infarction. Additionally, re-admission for cardiovascular causes within 12 months was monitored. Results showed that perioperative exenatide treatment did not reduce mortality or morbidity from renal failure, stroke or heart failure, compared to placebo, after a median follow-up of 5.9 years. Still, the study adds to the body of evidence for cardiac surgery approaches to consider, or not. “During cardiac surgery, we have many different strategies to choose from, many of which are based on a very low level of evidence,” Wiberg said. “It’s important to evaluate some of them in a clinical setting.”
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