Future Pulse Cardiology

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Prof. Stefan Neubauer and Dr. Thomas Nero discuss two recent papers on the utility of coronary inflammation imaging on CT coronary angiography with Fat Attenuation Index (FAI)FAI score.  The ORFAN study demonstrated a 20 fold increased risk in CV event rates with low vs high FAI score and a 10 fold increased event rate in patients with elevated FAI score who have no coronary plaque. FAI score re-categorized 40% of patients in their follow-up studies.

Prof. Neubauer is the head of the Division of Cardiovascular Medicine and Director of the Oxford Centre for Clinical Magnetic Resonance Research (OCMR) at the University of Oxford and Past President of the Society for Cardiovascular Magnetic Resonance (SCMR).  We discussed two recently published landmark papers from his division:

Kenneth Chan, Elizabeth Wahome , et al. Inflammatory risk and cardiovascular events in patients without obstructive coronary artery disease: the ORFAN multicentre, longitudinal cohort study. Lancet. 2024;403(10392):1823-1835. doi:10.1016/S0140-6736(24)00596-8

Christopher J. Farina, Michael H. Davidson, Prediman K. Shah, Charles Stark, Wenqi Lu, Cheerag Shirodaria, Timothy Wright, Charalambos A. Antoniades, Jan Nilsson and Nehal N. Mehta (2024). Inhibition of oxidized low-density lipoprotein with orticumab inhibits coronary inflammation and reduces residual inflammatory risk in psoriasis: a pilot randomized, double-blind placebo-controlled trial. Cardiovascular Research, European Society of Cardiology, March 25, 2024.

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Dr Gibson and Dr Nero discuss the oft maligned issue of medical statistics.  Their discussion covers the pros and cons of traditional Cox proportional hazards regression models and Kaplan-Meier curves and newer techniques including win ratios.  They then dip their toes into AI.  A great overview by one of our leading clinical trialists.

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This episode is a deep dive into Lipoprotein a with Dr Steven Nissen from the Cleveland Clinic.  He and Dr Nero discuss the genetics of Lp(a), its pathophysiology, current treatment strategies and research into lowering Lp(a) levels.  This is a fascinating conversation that also discusses the role of coronary inflammation in the work of Dr. Paul Ridker as well as the role of CT angiography in future clinical trials.

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Dr Steven Nissen from the Cleveland Clinic discuses with Dr. Thomas Nero the basic clinical approach to Lp(a) with need for routine testing and a few simple case studies.  In the second (longer podcast) they take a deep deep dive into Lp(a) genetic, pathophysiology and the current research trials.  

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Dr Thomas Nero speaks with Dr Aaron Baggish about coronary artery disease in the endurance athlete (and non-athlete as well!)  They discuss cardiovascular testing in Masters athletes including ETT, coronary calcium scoring and CT angiography as well as risk factor identification, inflammation, physical & emotional stress and ongoing research. Dr Baggish is  a Professor of Sports Cardiology at Université de Lausanne and founder of the  Cardiovascular Performance Program, Massachusetts General Hospital, Harvard Medical School.  He has been team cardiologist for USA rowing, US Soccer, and the New England Patriots.  He was the medical director for the Boston Marathon and is a consultant to the IADA, IOC and FIFA.  

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Dr Mandrola discusses recent trail data with Dr. Thomas Nero including the results from Artesia, NOAH Afnet 6, Frail AF, Azalea and Oceanic-AF.  They also discuss Left Atrial Appendage Occlusion and utility of wearable devices.  Finally, a shout out to Dr. Andre Foy and his work on multi-morbidity and its role in clinical trial interpretation.

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Dr. Thomas Nero speaks with Dr. Mathew Budoff about Coronary Calcium Scoring, CT Coronary Angiography and cardiovascular outcomes.  The discussion goes beyond basic risk factor enhancement, highlighting its role to help evaluate disease progression, power future clinical trials and determine efficacy of therapy.  Along the way, they discuss coronary inflammation, perivascular adipose tissue imaging and fat attenuation index (FAI) as well as diving into the plaque stabilizing effects of EPA.   

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Dr. Elizabeth Ofili discusses the African American Heart Study with Dr. Thomas Nero.  They also discuss her work at the NIH and the African American Heart Failure Trial and the role of community based pragmatic clinical trials.

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Dr. Thomas Nero discusses current therapy with Factor X inhibitors, the new research with Factor XI inhibition and specifically the enrolling Milvexian clinical trials with Dr. C Micahel Gibson.  In addition they discuss, the addition of these medications along wiht anti-platelet therapy, Lp(a) and other interesting current and future research in cardiovascular disease.

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Dr. Thomas Nero speaks with Dr Peter Toth about the dramatic change occuring in diabtetes management and its effect on cardiovascular disease.  Starting with the biochemestry of diabetes and its effects at the cellular level, the discussion goes on to speak about the role SGLT2 inhibitors and GLP1 receptor agonists play in DM management as well as the future of diabetes care.  (If you want to skip the excelllent, but quite deep dive into biochemistry, jump to 11:22 - but honestly Dr. Toth's description is breathtaking)