📌Outstanding academic session yesterday at the Clinical Cardiology Council discussing Ischemic Cardiomyopathy 💔 (Coronary Artery Disease with LVEF <35%). Here I´m sharing my conclusions on the topic. #CardioTwitter #MedTwitter #CVD #HFrEF Sociedad Argentina de Cardiología

Some key ADHF terminology:

- HFrEF - EF <40%
- HFpEF - EF 50%+
- HFimpEF - 'improved' EF >40% with GDMT
- HFmrEF - EF 40-49% 'midrange' or 'mildly reduced'

#MedTwitter #MedEd

Point of Care Medicine

Adult male admitted for ADHF. He has a hx of HFrEF with EF 15% and he present for dyspnea, found severely volume up with JVD up the ears. Labs noticeable for LFTs elevation and bili of 4 with INR of 2.8. Lactic acid 1.5, BP stable at 95/65.

This is the RHC

What #MRA do you use in care of #HFrEF pts and what target dose? Poll below👇

52AAM w/T2DM, HTN, HFrEF, obesity, chronic myositis who presented after a fall and found to have nephrotic syndrome. #UrineMicroscopy #UrinarySediment #Lipiduria #NephroticSyndrome

it's SGLT2's week!➡️bit.ly/3NjpHZV Here's #JCTR contribution on the topic by Mustapic et al.: 3-months therapy improves LV systolic function in #HFrEF patients! 👉👉👉link.springer.com/article/10.100… #ISCTR Enrique Lara-Pezzi Marat Fudim, MD MHS Paul JR Barton Joost Sluijter Jozine ter Maaten
Anzhela Soloveva

SGLT2i dari DM, HFrEF, HFpEF, weight loss sampai CKD; keren memang ini pleiotrophic effect

The Leading Edge Is the limited use of sglt2 a limitation? Remember that the landmark trials on sglt2 use in hfref were outpatients. 😊

Sacubitril-valsartan (an angiotensin-neprilysin inhibitor) for HFrEF? Neprilysin inhibition is thought to work in part by reducing BNP breakdown –thus improving natriuresis and preload reduction – beyond its reverse remodeling effect. PARADIGM-HF Trial, NEJM 2014 ♥️ #MedEd

These results were corroborated further by this trial in hospitalized decompensated HFrEF, which showed quicker resolution of myocardial stress (via NT-proBNP) with ARNI. PIONEER-HF Trial, NEJM 2019 ♥️ #CardioEd

In this 🇩🇰 cohort of pts w/ new-onset #HF rEF who initiated mineralocorticoid receptor antagonists - the authors Johan Larsson Søren Lund Kristensen et al. found:
 
❕No differences in clincical outcomes – ☠️ and #HF - associated w/ eplerenone vs. spironolactone❕
 
📣 European Society of Cardiology Journals

Some key terminology:

- HFrEF - EF <40%
- HFpEF - EF 50%+
- HFimpEF - 'improved' EF >40% with GDMT
- HFmrEF - EF 40-49% 'midrange' or 'mildly reduced'

4/20

Ivabradine can be used for chronic stable angina and chronic HFreF who cannot tolerate B blocker ( with NSR on ecg)

There's no way to unsee these 🤩

Segun Olusanya (He/Him) [email protected] Ashley Miller If we keep using VExUS for volume, we will break it, and then Philippe Rola will armbar all of us 😂

Just today VExed this pt- sepsis, anuric atn 15L+ oedema in flanks. Collapsible ivc, normal PV. And pt has a hx of HFrEF! Likely getting hepatic artery with PV.

🎨 #Art and #Architecture 🕌

youtu.be/ZOm7hAaMaY4

Stroke in patients with #HFpEF or #HFrEF

📌Meta-analysis of 7 trials shows #stroke history in #HeartFailure patients (8.3% HFrEF, 9.7% HFpEF) leads to more vascular comorbidity & worse HF.

📌Future stroke risk doubles, yet 30% with #AFib aren't on anticoagulants, 29% with…

Just published! Eplerenone provides significant benefits shortly after treatment initiation in HFrEF patients, even in those subgroups with a low probability of receiving MRAs in clinical practice!
CIC-Plurithématique Nancy Faiez ZANNAD Nicolas Girerd Université Lorraine
onlinelibrary.wiley.com/doi/10.1002/ej…

Don't be that guy 😅

HFrEFはヘフレフ、HFpEFはヘフペフって呼ぶと思うけど、HFmrEFはなんて呼んでるの？

左室収縮の落ちた心不全(HFrEF)においてβ遮断薬、ARNI、MRA、SGLT-2阻害薬は予後を改善する重要な薬剤です。しかし心不全を見つけたら、いきなり全部を突っ込むわけではありません。うっ血の治療に重要なループ利尿剤とともに、導入のタイミングの私見をまとめました。

In patients with worsening #HFrEF , vericiguat significantly decreased NT-proBNP levels compared with placebo.

Learn more about this study & other research highlights in our annual report: thecvc.ca/patient-center…

Justin Ezekowitz Cindy Westerhout, PhD Yinggan(Gray) Zheng UAlberta Med & Dent

The ketone body 3-hydroxybutyrate increases CO in #HFrEF patients, but Nigopan Gopalasingam et al show that surprisingly HCA2 activation or prostaglandin release wasn't involved. Niacin had no impact on cardiac output. #AHAJournals Department of Cardiology Research AUH ahajrnls.org/3Nq1JMP

Very happy 👇finally published - hard work done by skilled PhD student Johan Larsson - eager to hear any comments re. findings, while we wait for the results of the ongoing 🇩🇰 cluster-RCT comp spiro and eplererenone classic.clinicaltrials.gov/ct2/show/NCT03… RigsHeart 🫀🚨

Update baru 2023
- Untuk dokter -

Pada penyakit ginjal kronis GFR >20 non diabetes dengan gagal jantung direkomendasikan untuk diberikan SGLT-2 Inhibitor

Bila diatas 20-45 dengan pemeriksaan urine ACR <200 dianjurkan untuk diberikan SGLT-2 Inhibitor.

Obat ini pada umumnya…