Pulmonary Hypertension Knowledge Sharing Platform ’s Post

🫀 Pulmonary Hypertension - key lessons 💜 Huge shoutout to our 4th year medical student, Lisa Depledge (and soon to be rock-star Cardiologist) for giving an excellent talk recently on diagnosis and management of PH and the different subtypes! 🔸Pulmonary hypertension (PH) is a complex condition - early and accurate diagnosis is crucial for effective management and for best chances for living a good quality life. ❓What is pulmonary hypertension (PH)? PH is the cardiovascular disease resulting from increase in the pressures inside the pulmonary arteries and/or veins. 🔹Here's a breakdown of key take-home points on diagnosis and treatment of PH ✅ Prevalence: Group 3 PH, secondary to left heart disease, is the most common type. ✅ Prognosis: Reported 1-year survival rates range from 67% to 99%, depending on the subtype and severity. While PH is a progressive disease, early diagnosis and treatment can significantly improve prognosis. ✅ Diagnosis: 1️⃣ Clinical suspicion: Unexplained dyspnea, fatigue, edema, and syncope are red flags. 2️⃣ Risk factors: Left-sided heart disease, different types of connective tissue disease, liver disease, HIV, and lung conditions. 3️⃣ Echocardiogram: Initial test showing increase in pulmonary pressures plus evaluation of the left and right heart. ✅ Workup: 🔗 Right heart catheterization: The gold standard for confirming PH and assessing hemodynamics. 🔗 Ventilation/perfusion scan (VQ scan): Helps rule out chronic thromboembolic pulmonary hypertension (CTEPH), a potentially curable form. 🔗 High resolution chest CT scan: to assess for interstitial lung disease 🔗 Pulmonary Function Tests: to evaluate for underlying COPD or emphysema 🔗 Blood tests to look for possible connective tissue disease/rheumatologic/autoimmune/hematological abnormalities 🔗 Genetic testing 🔗 Vasoreactivity testing: to assess group 1 PH (pulmonary arterial hypertension) ✅ Management: ➖ General measures: Oxygen therapy, diuretics, and lifestyle changes are crucial across all 5 groups/subtypes. ➖ Group 1 (PAH): vasodilators, which can be different classes, e.g. PDE5 inhibitors, prostacyclins, endothelin receptor antagonists, atrial septostomy ➖ Group 2: management of left sided heart disease ➖ Group 3: treatment of lung disease ➖ Group 4: Surgical intervention (pulmonary endarterectomy), balloon angioplasty or riociguat (a stimulator of soluble guanylate cyclase) ➖ Group 5: treatment of underlying disease ❗️Early diagnosis and tailored treatment are key to improving quality of life for PH patients. Let's keep the conversation going! Share your experiences or insights in the comments. #healthcare #pulmonarymedicine #cardiology #patientcare #medicine

Beyond clinical medicine toward subclinical medicine From early sign to Earlier sign From sign of disease to sign of health condition Prevention before cure This simple tendinitis or plantar fasciitis what does this tell about your body ?! Here’s what it could indicate: Possible Health Conditions Associated with Chronic Subclinical Inflammation: 1. Cardiovascular Disease: • Chronic low-grade inflammation is a known risk factor for the development of atherosclerosis (plaque buildup in arteries), which can lead to heart attacks or strokes. • Inflammatory markers like C-reactive protein (CRP) are often elevated in people at risk for cardiovascular diseases. 2. Metabolic Syndrome and Type 2 Diabetes: • Inflammation is implicated in insulin resistance, a key feature of metabolic syndrome and type 2 diabetes. Chronic low-level inflammation can contribute to impaired glucose metabolism 3. Obesity: • Fat cells, particularly visceral fat (fat around organs), release pro-inflammatory cytokines, contributing to chronic inflammation. 4. Autoimmune Diseases: • In some autoimmune conditions (such as rheumatoid arthritis or lupus), subclinical inflammation 5. Chronic Pain Syndromes: • Conditions like fibromyalgia or chronic fatigue syndrome may involve a subclinical inflammatory response. 6. Neurodegenerative Diseases: • Chronic, low-grade inflammation has been linked to conditions like Alzheimer’s disease and other neurodegenerative disorders. Inflammatory responses in the brain may contribute to neuronal damage over time. 7. Cancer: • Chronic inflammation is thought to play a role in cancer development by promoting a microenvironment that supports tumor growth and metastasis. 8. Chronic Kidney Disease (CKD): • Subclinical inflammation is often seen in individuals with CKD. It can accelerate the progression of kidney damage and impair the kidney’s ability to filter waste effectively. 9. Chronic Respiratory Conditions: • Conditions like asthma or chronic obstructive pulmonary disease (COPD) may also involve subclinical inflammation in the lungs, which can lead to worsening symptoms over time, even if no acute flare-ups are present. 10. Mental Health Disorders: • Subclinical inflammation has been linked to mood disorders like depression and anxiety. Inflammation in the brain can affect neurotransmitter systems and stress responses, contributing to mental health issues. Signs and Indicators: • Interleukin-6 (IL-6) These can be elevated even if you don’t feel sick. Physicians may use these markers to assess chronic low-grade inflammation and identify potential health risks. Management of Chronic Subclinical Inflammation: • Anti-inflammatory Diet: Eating foods rich in antioxidants (e.g., fruits, vegetables, whole grains) and omega-3 fatty acids (e.g., fish, nuts) • Exercise: Regular physical activity helps reduce chronic inflammation. • Weight Management • Stress Management:

Cardiac Troponin Market Opportunities, Segmentation, Assessment and Competitive Strategies by 2033 https://lnkd.in/gskPpguM The Cardiac Troponin Market revolves around the diagnostic products and tools used to measure cardiac troponin levels in the blood, which are essential biomarkers for detecting heart damage, particularly myocardial infarction (heart attack). Cardiac troponins, including troponin I (cTnI) and troponin T (cTnT), are proteins released into the bloodstream when the heart muscle is injured. As the most sensitive and specific markers for heart attacks, cardiac troponin testing is widely used in emergency departments, hospitals, and clinical labs, playing a critical role in the early diagnosis and management of acute coronary syndromes (ACS). Key Components and Market Drivers: Types of Cardiac Troponin Assays: High-Sensitivity Cardiac Troponin (hs-cTn) Assays: High-sensitivity troponin tests have revolutionized the detection of heart attacks, enabling earlier and more accurate diagnosis of even minor cardiac damage. These assays are now the gold standard in emergency care for diagnosing ACS. Conventional Troponin Assays: While still in use in some healthcare settings, conventional troponin tests are being gradually replaced by high-sensitivity assays due to the latter’s superior ability to detect low levels of troponin in the blood. Point-of-Care (POC) Troponin Testing: POC testing devices offer rapid results at the bedside, in ambulances, or in outpatient settings, providing immediate information to guide treatment decisions. These devices are crucial for quickly diagnosing heart attacks in settings where immediate lab access may be limited. Market Drivers: Rising Prevalence of Cardiovascular Diseases (CVDs): Cardiovascular diseases, including heart attacks, remain the leading cause of death globally. As the incidence of CVDs continues to rise due to aging populations, poor lifestyle choices, and increasing rates of diabetes and hypertension, the demand for accurate diagnostic tools like troponin assays is growing. Advancements in Diagnostic Technologies: The development of high-sensitivity troponin assays has dramatically improved the ability to detect even the slightest heart damage, allowing for earlier and more effective intervention. Continuous innovation in assay sensitivity and accuracy is driving market growth. Adoption of POC Testing: As healthcare moves toward more decentralized and patient-centric models, the adoption of point-of-care troponin testing is on the rise. These portable devices allow for quicker diagnosis in settings such as ambulances, primary care clinics, and rural hospitals, where rapid access to diagnostic labs is limited. Guidelines and Recommendations: Clinical guidelines from organizations such as the American Heart Association (AHA) and the European Society of Cardiology (ESC) strongly recommend using high-sen

🔬❤️ Improved heart failure outcomes with Mounjaro - SUMMIT Trial❤️🔬 Early data from Eli Lilly and Company’s phase 3 SUMMIT trial, has shown Mounjaro (tirzepatide) causes a reduction in heart failure events and improved patient symptoms in patients with HFpEF and obesity. This follows hot on the heels of Novo Nordisk's impressive results in the STEP-HFpEF with semaglutide. ❓Why is this important Patients with heart failure have worse symptoms and poorer outcomes when overweight/obese and it is reported that 60% of HFpEF patients in the U.S. also live with obesity. Therefore tirzepatide’s potential to improve outcomes in patients with both HFpEF and obesity is another positive in the cardiology world. 🔬 Study Design - A multi-centre, randomised, double-blind, placebo-controlled study with varying doses of tirzepatide - gradually increasing from an initial 2.5 mg to a maximum tolerated dose of either 5 mg, 10 mg, or 15 mg, depending on individual tolerance levels 🌍 Demographic - 731 patients with HFpEF and a BMI ≥ 30 (with or without diabetes) from various countries  U.S., Argentina, Brazil, China, India, Israel, Mexico, Puerto Rico, Russia, and Taiwan. 📆 Duration: 52-week treatment period with follow-up at 104 weeks to assess long-term effects. 🥇 Primary Endpoints 1) Reduce risk of composite endpoint of time to first occurrence of urgent heart failure visit, heart failure hospitalisation, oral diuretic intensification and cardiovascular death to study completion (median 104 week follow up) 2) Change in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) from baseline to week 52. 🥈 Secondary Endpoints - Longer 6-minute walk-test distance, lower CRP levels, and reduced body weight through 1 year. 🚀 Promising Outcomes - Reduced risk of heart failure outcomes by 38% compared to placebo - KCCQ-CSS improved by 24.8 points for those randomised to tirzepatide (30% higher than placebo) - Weight loss of 15.7% in those treated with tirzepatide (2.2% placebo) - Improvements in ALL secondary endpoints 🤔 Considerations - Further longitudinal studies on longer term effects on heart failure outcomes are needed, including the impact of side effects and potential complications - Further research is needed to evaluate the drug’s impact across a wider HFpEF phenotype, particularly in those with severe heart failure. - A head to head trial of tirzepatide and semaglutide looking at efficacy and complications. Eli Lilly and Company's SUMMIT trial is encouraging and is a significant step forward in managing HFpEF with obesity, which for years had limited treatment options. Final research will likely be published later in the year and I imagine licence for use in these patients. #SUMMITtrial #mounjaro #tirzepatide #obesitymanagement #HFpEF #heartfailure #cardiology #healthoutcomes #elililly

29th September, World Heart Day. The biomarker based cardiac care model in clinical decision making involves strategies for harmonising, communicating and integrating with all stakeholders; like, clinicians and diagnosticians, in order to formulate guidelines for assisting in correct measurement, diagnosis and management of cardiovascular diseases. Laboratories must take on the responsibility of being the evidence based decision makers in healthcare ecosystem managing the essential diagnostics like cardiac care and chronic conditions affecting population health or acute care. We must drive the care-models on measurable outcome and risk stratification/ risk assessment. Risk stratification in apparently healthy adults for developing future cardiovascular diseases would be paramount. Directing these individuals with appropriate preventive interventions along with closer follow-up could prevent their progression to a higher risk group. NT-proBNP is indicated for the diagnosis of individuals suspected of having congestive heart failure and detection of mild forms of cardiac dysfunction. It also aids in the assessment of heart failure severity in patients diagnosed with congestive heart failure. It is further indicated for the risk stratification of patients with acute coronary syndrome and congestive heart failure, and it can also be used for monitoring the treatment in patients with left ventricular dysfunction. It can help in the cardiovascular risk assessment of patients with type 2 diabetes mellitus. It can be used to identify elderly individuals at high-risk for atrial fibrillation. For patients at risk of developing HF, natriuretic peptide biomarker-based screening followed by team-based care, including a cardiovascular specialist optimising GDMT, can be useful to prevent the development of left ventricular dysfunction (systolic or diastolic) or new-onset HF. ADA Consensus 2022 on Heart Failure in Diabetes provides clear guidance to practitioners on the best approaches for screening and diagnosing HF in individuals with diabetes or prediabetes. In patients of type 2 diabetes mellitus without signs and symptoms of cardiac disease, values of ≥ 125 pg/mL are predictive of the occurrence of subsequent cardiovascular events. The addition of a high sensitive troponin (hsTn) assay to current risk-stratification tools like hsCRP, lipid -profile can enhance risk prediction in case of CVD and over-all cardiovascular deaths in asymptomatic individual thereby alerting clinicians in order to prevent future CVDs. The evaluation of high sensitive Troponin assay in comparison to existing risk stratification algorithms and biomarkers also show promising results wherein there is improvement in the prognostic accuracy. High sensitive troponin I assay can function as predictive biomarkers for cardiovascular risk stratification (high/ moderate/ low risk) in the general population.

The Clinical Utility of Laboratory Markers in Cardiac Diseases: Current State of Knowledge. *Troponins* **Diagnostic Utility:** Troponins are highly specific to cardiac muscle.High-sensitivity assays for troponins (hs-cTn) have further enhanced their diagnostic accuracy, allowing for the detection of even minor myocardial injuries. The sensitivity of high-sensitivity troponin assays can reach up to 95-99%, while their specificity ranges from 80-90% (White, 2011). **Prognostic Value:**The positive predictive value (PPV) of troponins for myocardial infarction can be as high as 85-90%, while the negative predictive value (NPV) can exceed 95% (Thygesen et al., 2012). *Natriuretic Peptides* **Diagnostic Utility:** Elevated levels of BNP and NT-proBNP are indicative of heart failure. They are particularly useful in differentiating cardiac from non-cardiac causes of dyspnea. The sensitivity of BNP and NT-proBNP for diagnosing heart failure is approximately 90-95%, with specificity around 80-85% (Maisel et al., 2002). **Prognostic Value:** The PPV for adverse outcomes in heart failure patients can reach 75-80%, while the NPV is around 90-95% (McMurray et al., 2012). *High-Sensitivity C-Reactive Protein (hs-CRP)* **Diagnostic Utility:** Although hs-CRP is not specific to cardiac tissue, it provides valuable information about systemic inflammation and atherosclerotic activity. Elevated hs-CRP levels are associated with an increased risk of coronary artery disease (CAD) and other cardiovascular events. The sensitivity and specificity of hs-CRP for predicting cardiovascular events are approximately 70-80% (Ridker, 2016). **Prognostic Value:** The PPV of hs-CRP for cardiovascular events is around 60-70%, while the NPV is about 80-85% (Ridker et al., 2008). *Galectin-3* **Diagnostic Utility:** Elevated galectin-3 levels are seen in patients with heart failure and are associated with disease severity.The sensitivity of galectin-3 for heart failure is approximately 70-80%, with specificity around 75-85% (de Boer et al., 2013). **Prognostic Value:** The PPV of galectin-3 for adverse outcomes in heart failure is around 65-70%, while the NPV is about 80-85% (Lok et al., 2010). *Other Emerging Biomarkers* **ST2:** Soluble ST2 is another marker of myocardial stress and fibrosis. The sensitivity and specificity of ST2 for heart failure outcomes are approximately 70-80% (Weinberg et al., 2003). **Growth Differentiation Factor-15 (GDF-15):** GDF-15 is linked to inflammation and oxidative stress. The sensitivity and specificity of GDF-15 for cardiovascular outcomes are around 65-75% (Kempf et al., 2006). **MicroRNAs:** These small non-coding RNAs regulate gene expression and are involved in various pathophysiological processes in CVD. They hold promise for early diagnosis, risk stratification, and monitoring of therapeutic responses, though clinical utility metrics are still under active research (Condorelli et al., 2014).

Cardiac Troponin Market Opportunities, Segmentation, Assessment and Competitive Strategies by 2033 https://lnkd.in/gskPpguM The Cardiac Troponin Market revolves around the diagnostic products and tools used to measure cardiac troponin levels in the blood, which are essential biomarkers for detecting heart damage, particularly myocardial infarction (heart attack). Cardiac troponins, including troponin I (cTnI) and troponin T (cTnT), are proteins released into the bloodstream when the heart muscle is injured. As the most sensitive and specific markers for heart attacks, cardiac troponin testing is widely used in emergency departments, hospitals, and clinical labs, playing a critical role in the early diagnosis and management of acute coronary syndromes (ACS). Key Components and Market Drivers: Types of Cardiac Troponin Assays: High-Sensitivity Cardiac Troponin (hs-cTn) Assays: High-sensitivity troponin tests have revolutionized the detection of heart attacks, enabling earlier and more accurate diagnosis of even minor cardiac damage. These assays are now the gold standard in emergency care for diagnosing ACS. Conventional Troponin Assays: While still in use in some healthcare settings, conventional troponin tests are being gradually replaced by high-sensitivity assays due to the latter’s superior ability to detect low levels of troponin in the blood. Point-of-Care (POC) Troponin Testing: POC testing devices offer rapid results at the bedside, in ambulances, or in outpatient settings, providing immediate information to guide treatment decisions. These devices are crucial for quickly diagnosing heart attacks in settings where immediate lab access may be limited. Market Drivers: Rising Prevalence of Cardiovascular Diseases (CVDs): Cardiovascular diseases, including heart attacks, remain the leading cause of death globally. As the incidence of CVDs continues to rise due to aging populations, poor lifestyle choices, and increasing rates of diabetes and hypertension, the demand for accurate diagnostic tools like troponin assays is growing. Advancements in Diagnostic Technologies: The development of high-sensitivity troponin assays has dramatically improved the ability to detect even the slightest heart damage, allowing for earlier and more effective intervention. Continuous innovation in assay sensitivity and accuracy is driving market growth. Adoption of POC Testing: As healthcare moves toward more decentralized and patient-centric models, the adoption of point-of-care troponin testing is on the rise. These portable devices allow for quicker diagnosis in settings such as ambulances, primary care clinics, and rural hospitals, where rapid access to diagnostic labs is limited. Guidelines and Recommendations: Clinical guidelines from organizations such as the American Heart Association (AHA) and the European Society of Cardiology (ESC) strongly recommend using high-sen

Janssen-Cilag therapy becomes the first single tablet combination therapy for PAH in europe The European Commission has approved Yuvanci (macitentan 10 mg and tadalafil 40 mg), a single tablet combination therapy (STCT) for the long-term treatment of pulmonary arterial hypertension (PAH) in adult patients. This approval marks a significant milestone as Yuvanci becomes the only single tablet option available for PAH patients in Europe. Janssen-Cilag International NV, a Johnson & Johnson company, announcement has highlighted the comprehensive PAH portfolio that now covers all three guideline-recommended foundational treatment pathways. “In the Phase 3 A DUE study, the macitentan and tadalafil single tablet combination therapy demonstrated a reduction of 29 percent in pulmonary vascular resistance as compared to macitentan, and 28 percent reduction as compared to tadalafil,” said Professor Ekkehard Grunig, MD, Professor of Internal Medicine at Heidelberg University.  He added: “These results, along with the consistent efficacy across different patient subgroups, are encouraging. This single tablet combination therapy represents an important new treatment option for many people living with PAH, who, until now, had no single tablet option available.” PAH is a rare, progressive, and life-threatening disease characterized by the constriction of small pulmonary arteries and elevated blood pressure in the pulmonary circulation, eventually leading to right heart failure and death.  Initial double combination therapy with macitentan and tadalafil for PAH patients without cardiopulmonary comorbidities has the highest class of recommendation in the 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) pulmonary hypertension guidelines. “People living with PAH face complex treatment regimens, with many having to take multiple pills per day. This can deeply impact their daily lives as they might struggle to maintain adherence to their treatment regimen,” said Tamara Werner-Kiechle, EMEA Therapeutic Area Lead Neuroscience and Cardiopulmonary, Johnson & Johnson Innovative Medicine. “This approval addresses a significant unmet need for the PAH community, and we are delighted to bring a new and innovative treatment option to adults living with PAH that follows the ESC/ERS guidelines.” Read more: https://lnkd.in/eszbQWF6 Stay in touch with all the leading stories, events and opportunities by subscribing to my weekly LinkedIn Newsletter here:  https://bit.ly/3KQs0mD

Defending Statins: A Key Tool in Cardiovascular Care Statins have been at the forefront of cardiovascular treatment for decades, with strong evidence supporting their ability to lower cholesterol and reduce heart attack and stroke risks. These medications are especially effective for individuals with a history of cardiovascular disease or genetic predispositions like familial hypercholesterolemia. Statins not only lower cholesterol but also stabilize plaques and reduce inflammation, providing comprehensive cardiovascular protection. With the rise of precision medicine, including whole genome sequencing, we can now tailor statin use to maximize benefits and minimize risks. The Criticism Despite the benefits, critics argue statins are overprescribed, particularly for people at low risk of heart disease. Side effects like muscle pain, cognitive changes, and liver damage are cited as reasons for caution. Additionally, some challenge the focus on cholesterol as the main driver of cardiovascular disease, suggesting lifestyle changes should take precedence over medication. Addressing the Criticism While these concerns are valid for some, they do not outweigh the benefits statins provide to high-risk patients. Side effects, though possible, are rare and generally manageable. For patients with significant cardiovascular risk, the benefits far outweigh the risks. Moreover, precision medicine now allows us to identify patients more likely to experience side effects through genetic testing and adjust their treatments accordingly. Whole genome sequencing enables personalized care, ensuring that the right patients benefit from statins while minimizing adverse reactions. This tailored approach enhances both safety and efficacy. A Balanced Approach The statin debate highlights the importance of precision in medical care. While lifestyle changes like diet and exercise remain essential for heart health, statins play a vital role, especially for those at higher risk. Whole genome sequencing refines how we use statins, ensuring that those who need them most receive the greatest benefit with fewer side effects. Personalized medicine is the future, and statins are a key tool in this evolving landscape. Conclusion In an era of personalized care, statins continue to provide significant benefits in reducing cardiovascular risk. Genomic tools help us ensure statin use is precise, safe, and effective. For high-risk individuals, statins are still a cornerstone of care, offering life-saving benefits when used appropriately. The integration of precision medicine into clinical practice reaffirms that statins, combined with tailored care, should remain a key part of cardiovascular treatment strategies.

New study finds high-dose inhaled nitric oxide decreases the risk of death among critically ill Black patients with COVID-19. University of Alabama at Birmingham. February 09, 2024. Link to study enclosed. Excerpt: Acute respiratory distress syndrome (ARDS) is a condition that most commonly occurs in a lung infection such as COVID-19. “In ARDS, the barrier between blood vessels and air sacs in the lungs is disrupted leading to accumulation of fluid from the blood vessels in the air sacs, restricting air exchange in the lungs,” said Naman S. Shetty, M.D., a research fellow in UAB Division of Cardiovascular Disease and first author of this manuscript. “Poor air exchange in ARDS leads to organ damage and increases risk of death. Increasing oxygenation in ARDS may improve survival and decrease organ damage. However, it may not be possible to maintain oxygenation in patients with ARDS when providing external support for breathing using a mechanical ventilator.” During the peak of COVID-19 pandemic, ever-increasing mortality of COVID-19 patients led Pankaj Arora, M.D., senior author and an associate professor in UAB Division of Cardiovascular Disease, to collaborate with Lorenzo Berra, M.D., to initiate NOSARSCOVID trial, an international multicenter trial to examine effects of high-dose inhaled nitric oxide on improving oxygenation in COVID-19 patients requiring support from a mechanical ventilator. Trials are rare in critically ill patients due to enrollment difficulties; this effort provided a boost in critical care research during the pandemic. The primary trial revealed high-dose inhaled nitric oxide therapy improved oxygenation. As an extension of the NOSARSCOVID trial, Shetty and his team assessed whether racial differences to inhaled nitric oxide were present. The trial recruited a diverse patient population, allowing them to effectively examine this research question. “In the study, we evaluated whether improvement in oxygenation and risk reduction in mortality differed among white and Black patients recruited in the trial,” Shetty said. “Inhaled nitric oxide therapy was associated with a larger improvement in oxygenation among Black patients compared with white patients. Most notably, inhaled nitric oxide therapy reduced risk of death at 28 and 90 days in Black patients. This benefit was not observed among white patients.” Note: “Our study highlights treatment effect of an intervention may vary by race,” Arora said. “There is a need for adequate representation of minority populations in large clinical trials. Furthermore, our study draws attention to individualization of treatment based on the patient. Precision phenotyping techniques incorporating clinical, physiological, imaging and molecular markers may help guide physicians to individualize therapy in ARDS.” https://lnkd.in/eMP-7RMv